Enterprise Risk Management - Health Care Providers

An Opportunity to improve Profitability, Quality and Compliance/Legal Liability Risk Management

 

Profitability and Quality are the first concerns of all Health Care Providers.  Profit and Loss risk management is at the top of every executive's list.  Quality and compliance/legal liability risk management are also important concerns.  No longer is it necessary to have separate, often conflicting and expensive systems to meet these needs,

 

Enterprise Risk Management with Roster Network technologies and systems creates the opportunity to...

Our Enterprise Risk Management Assessment will identify all of your needs and provide the opportunity to meet them with our Performance Management technologies and systems.  Make your company a Performance Managed organization.  The results can be outstanding!  Malcolm Baldridge award winners have outperformed the S&P 500 by 4.4 to 1. Other award winning firms have 48% growth in operating income over similar firms.
(see: http://www.nist.gov/public_affairs/releases/S&P500.htm)

 

 

Additional information on Enterprise Risk Management           Request an Enterprise Risk Management Assessment

 

 

The following chart illustrates the opportunities
Roster Network Performance Management creates for your organization.

 

Note: The following are generally risks and exposures specifically applicable to health care providers.   In addition, most of the exposures found on the Enterprise Risk Management chart for general business and industry and not listed below are also applicable to health care providers.

 

 

Performance Management Techniques 

Below are essential Enterprise Risk Management Techniques.  Click to see how our Performance Management technologies and systems meet these needs. 

Business Risks - Exposures to Liability

Below are risks it is essential for any provider to manage.  Below each need is a number.  By clicking on the number, you will see a general explanation of the management need or risk. If an "X" appears in the cell of the chart where the column intersects with the Performance Management technique, that particular technique is applicable to that risk.  
Profit- Loss
Risk
 (1) 		Medicare- Medicaid
Compliance 
(2) 		Quality
System
Mgmt.
(3)		 Managed Care
Compliance  
(4)   		Licensing and Creden-
tialing
(5) 		Malpractice
 (6)

HIPAA Compliance
  (7)

Benefit

Plans
(8)

A. Objective job descriptions X X X X X X X X
B. Objective employee
recruiting procedures		 X X X X X X X X
C. Employment background checks X X X X X X X N/A
D. Objective and documented employment policies, procedures and handbooks X X X X N/A N/A X X
E. Business or strategic plan X X* X X X X X X
F. Documented emergency and disaster recovery procedures X X X X X X X N/A
G. Documented compliance plan X X* X X X X X N/A
H. Compliance officer/team X X* X X X X X N/A
I. Documented professional and general patient service procedures X X X X X X X N/A
J. Documented office, radiology and physical facilities procedures  X X* X X X X X N/A
K. Documented medical emergency, safety, infection control and pharmaceuticals procedures X X X X X X X N/A
L. Documented medical records, coding, billing, collection and business procedures X X* X X X X X N/A
M. Identification and tracking of individual and group licensing, credentialing and continuing education needs  X X* X X X X N/A N/A
N. Suspected violations and grievance hotline X X X X X X X X 
O. Internal and external investigations procedures X X* X X X X X X
P. Work assignments based on skills and experience X X X X X X X X
Q. Efficient and effective HR information system X X X X X X X X
R. Work activities classified by codes X X X X N/A N/A N/A N/A
S. Identification of individual training needs and training programs   X X X X X X X N/A
T. Identification of tools and processes requiring special or safety training X X X X X X X N/A
U. Effective policies on workplace theft, violence and moral problems X X X X X X X X
V. Employee grievance and ADR procedures X X X X X X X X
W. Objective performance reviews X X X X X X X X
X. Objective discipline and termination procedures X X X X X X X X
Y. Workplace injury reporting and management systems, return to work program X N/A X X N/A N/A N/A X
Z. Effective organizational communication X X* X X X X X X
AA. Access to competent legal counsel X X X X N/A X X X
BB. Temporary, contract, and leased workers management X X X X X X X N/A
CC. Off-site storage of data and knowledge X X X X X X X X
DD. Ability to search information in disparate sites and data bases X X X X X X N/A X
EE. Documented operational systems and procedures X X X X X X X X
FF. Physical plant and facilities documentation and procedures X N/A X N/A N/A N/A X N/A

 

Notes on Exposures to Liability:

1.  Includes creating the efficiencies, systems and procedures to assure maximum profitability for the Provider. The multi-faceted uses of Roster’s systems and procedures enhance profitability while promoting compliance with legal and contractual requirements on the Provider, including compliance with practice agreements, business plans, management of individual professional revenue production, service pricing analysis and receivables collection.

2.  Compliance with legal obligations imposed by law on providers as respects coding, billing and collection, including Medicare-Medicaid “anti-fraud” reporting and billing requirements, including those systems and procedures recommended by the American Medical Association, Office of the General Counsel, “Federal Fraud Enforcement Physician Compliance” memo(*).

3.  Exposure of loss of business and customers due to insufficient quality, not meeting customer, payor or patient needs or loss of quality system certification; e.g., ISO 9000.

4.  Compliance with all requirements imposed by insurers and managed care organizations.

5.  Includes verification, documentation and maintenance of all individual professional, technical and group licensing and credentialing standards imposed by law and various professional credentialing organizations.

6.  Documentation of procedures and services to prove applicable standard of care used in the delivery of professional services.

7.  Requirement under federal HIPAA statute that anyone who maintains or transmits health information shall maintain reasonable and appropriate administrative, technical and physical safeguards (A) to ensure the integrity and confidentiality of the information; and, (B) to protect against any reasonably anticipated (i)  threats or hazards to the security or integrity of the information; and, (ii) unauthorized uses or disclosures of the information; and, (C) otherwise to ensure compliance with this part by the officers and employees of such persons.

8.  Exposures in this category would include experience, administrative costs and compliance with applicable legal requirements. 

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Applicable Integrated Solutions:

 

A. Objective job descriptions

HR Review Questionnaire questions 53-63.

1. The Position Matrix Communication System creates the objective job descriptions.

2. PerformanceWare and HR Data Management manage the job descriptions.

3. The MeetingBusinessNeeds.com includes the Position Matrix Communication System. 

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B. Objective employee recruiting procedures

HR Review Questionnaire questions 70-83.

1. The Position Matrix Communication System creates the objective job descriptions needed for objective recruiting.

2. PerformanceWare and HR Data Management manage the job descriptions and the resumes and other data used in the recruiting process.

3. Employment Background Reports, available through your Roster Network Member, provide objective information on candidates and their work experience and backgrounds.

4. The MeetingBusinessNeeds.com includes forms and checklists for recruiting.

5.  Search and Recruiting Services provide recruiting services.

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C. Employment background checks 

HR Review Questionnaire questions 7, 77-79.

Employment background checks from a reputable national provider are available from your Roster Network member.                                                                                             

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D. Objective and documented employment policies, procedures and handbooks 

HR Review Questionnaire questions 14-45,99-115.

1. Your policies and procedures can be developed and managed with PerformanceWare. 

2. The MeetingBusinessNeeds.com provides templates and checklists for all of these items.

3. HR Data and Documentation Management can manage this information.

4. Systems and Procedures Documentation Plus, ISO 9000 Plus, HR Assistance Plus and Knowledge Management development services can develop and document this information.                   

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E. Business or strategic plan

HR Review Questionnaire questions 1-2.

1.  Business Planning services will help you develop a plan.   

2.  The Position Matrix Communication System, Systems and Procedures Documentation Plus, ISO 9000 Plus, HR Assistance Plus and Knowledge Management development services will develop and document the systems and procedures necessary to execute the plan.

3.  PerformanceWare and HR Data and Documentation Management manage the information necessary to the execution of the plan. 

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F. Documented emergency and disaster recovery procedures 

HR Review Questionnaire questions 178-180.

1. The Position Matrix Communication System, Systems and Procedures Documentation Plus, ISO 9000 Plus, HR Assistance Plus and Knowledge Management development services will develop and document the necessary systems and procedures.

2. PerformanceWare and HR Data and Documentation Management manage the information necessary to the execution of the necessary systems and procedures. 

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G. Documented compliance plan

1. Medicare-Medicaid Compliance Programs will develop and implement this plan.

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H. Compliance officer/team

1. Medicare-Medicaid Compliance Programs feature a compliance team composed of the provider's compliance officer, a representative of a Roster Network firm and a health care lawyer from a Roster Network Preferred Counsel firm.

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I. Documented professional and general patient service procedures

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for documentation.

2.  PerformanceWare can manage this information.

3.  HR Data and Documentation Management can manage this information.

4.  Systems and Procedures Documentation Plus, ISO 9000 Plus for Health Care, Medicare-Medicaid Compliance Programs,  and Knowledge Management development services can develop and document these systems and procedures.  

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J. Documented office, radiology and physical facilities procedures 

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for documentation.

2.  PerformanceWare can manage this information.

3.  HR Data and Documentation Management can manage this information.

4.  Systems and Procedures Documentation Plus, ISO 9000 Plus for Health Care, Medicare-Medicaid Compliance Programs,  and Knowledge Management development services can develop and document these systems and procedures.  

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K. Documented medical emergency, safety, infection control and pharmaceuticals procedures

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for documentation.

2.  PerformanceWare can manage this information.

3.  HR Data and Documentation Management can manage this information.

4.  Systems and Procedures Documentation Plus, ISO 9000 Plus for Health Care, Medicare-Medicaid Compliance Programs,  and Knowledge Management development services can develop and document these systems and procedures.  

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L. Documented medical records, coding, billing, collection and business procedures

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for documentation.

2.  PerformanceWare can manage this information.

3.  HR Data and Documentation Management can manage this information.

4.  Systems and Procedures Documentation Plus, ISO 9000 Plus for Health Care, Medicare-Medicaid Compliance Programs,  and Knowledge Management development services can develop and document these systems and procedures.  

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M. Identification and tracking of individual and group licensing, credentialing and continuing education needs 

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for identifying licensing, credentialing and continuing education needs..

2.  PerformanceWare can manage this information.

3.  HR Data and Documentation Management can manage this information.

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N. Suspected violations hotline

1. Your Roster Network Member will provide this service for Medicare-Medicaid Compliance Programs clients.

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O. Internal and external investigations procedures

1. Your Roster Network Member will provide this service for Medicare-Medicaid Compliance Programs clients.

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P. Work assignments based on skills and experience 

HR Review Questionnaire questions

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for work assignments based on skills and experience.

2.  The MeetingBusinessNeeds.com has templates and checklists for hiring procedures to evaluate applicants skills and experience.  

3. Employment Background Reports and Personality Evaluations will aid in identifying candidate skills, experience and aptitudes.

4. PerformanceWare and HR Data and Documentation Management manage the information regarding work assignments, skills, training, cross-training, etc.

5. HR Assistance Plus will help you with this process.

6. Search and Recruiting Services will identify individuals with the requisite skills and experience.                                     

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Q. Efficient and effective HR information system

HR Review Questionnaire questions 3-45.

1. PerformanceWare and HR Data and Documentation Management provide an effective and efficient HR information system that adds value beyond merely managing the information.

2. HR Assistance Plus will help you evaluate your needs and manage the information with either of these systems.

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R. Work activities classified by codes  

HR Review Questionnaire question 175.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for proper classification of activities.

2. PerformanceWare and HR Data and Documentation Management manage the necessary information.

3. The Position Matrix Communication System, Systems and Procedures Documentation Plus, ISO 9000 Plus, HR Assistance Plus and Knowledge Management development services will develop and document the systems and procedures involved in these work activities.

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S. Identification of individual training needs and training programs  

HR Review Questionnaire questions 84-98.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for identification of individual training needs and the documentation and management  of training.

2.  PerformanceWare and HR Data and Documentation Management manage the necessary information.

3.  HR Assistance Plus will help you meet your training and development needs.    

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T. Identification of tools and processes requiring special or safety training  

HR Review Questionnaire questions 164-172.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it, an essential starting point for identification of tools and processes requiring special or safety training and the documentation and management  of training.

2.  PerformanceWare and HR Data and Documentation Management manage the necessary information.

3.  HR Assistance Plus will help you meet your training and development needs.

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U. Effective policies on workplace theft, violence and moral problems

HR Review Questionnaire questions 36-37, 166.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This promotes fairness and objectivity in employment decisions, which will promote employee morale and reduce other employee problems.

2. The MeetingBusinessNeeds.com has templates and checklists for such policies and the procedures to implement them.

3. Employment Background Reports and Personality Evaluations will aid in identifying individuals who have a history of behavioral problems and promote employees being assigned to work to which they are suited, promoting morale and reducing other problems.

4. HR Assistance Plus will help you develop and administer such policies and document them in employee handbooks.

5. Your policies and procedures can be developed and managed with PerformanceWare or HR Data and Documentation Management.

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V. Employee grievance and Alternative Dispute Resolution procedures  

HR Review Questionnaire questions 115, 131-149.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This promotes fairness and objectivity in employment decisions, which will promote employee morale and reduce grievances.

2. The MeetingBusinessNeeds.com has templates and checklists for such policies and the procedures to implement them.

3. Employment Background Reports and Personality Evaluations will aid in identifying individuals who have a history of behavioral problems and promote employees being assigned to work to which they are suited, promoting morale and reducing other problems.

4. HR Assistance Plus will help you develop and administer such policies and document them in employee handbooks.

5. Your policies and procedures can be developed and managed with PerformanceWare or HR Data and Documentation Management.

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W. Objective performance reviews  

HR Review Questionnaire questions 64-69.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This promotes fairness and objectivity in performance reviews.

2. The MeetingBusinessNeeds.com has templates and checklists for performance reviews.

3. Employment Background Reports and Personality Evaluations will aid in identifying individuals who have a history of good performance and promote employees being assigned to work to which they are suited, promoting morale and improving performance.

4. HR Assistance Plus will help you administer performance reviews and document policies and procedures in employee handbooks.

5. Data from performance appraisals can be managed with PerformanceWare or HR Data and Documentation Management.

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X. Objective discipline and termination procedures  

HR Review Questionnaire questions 131-149.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This promotes fairness and objectivity and reduces the need for discipline and terminations for cause.

2. The MeetingBusinessNeeds.com has templates and checklists for discipline and terminations.

3. Employment Background Reports and Personality Evaluations will aid in identifying individuals who have a history of good performance and promote employees being assigned to work to which they are suited, promoting morale and reducing the need for discipline and terminations for cause.

4. HR Assistance Plus will help you administer discipline and terminations and document policies and procedures in employee handbooks.

5. Data regarding discipline and terminations can be managed with PerformanceWare or HR Data and Documentation Management.

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Y. Workplace injury reporting and management systems, return to work program

HR Review Questionnaire questions 173-176.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This allows developing an effective return to work program based on an individual's knowledge of, and experience with, specific work activities and tools and processes used.

2. Data regarding injury reporting and management and return to work programs can be managed with PerformanceWare or HR Data and Documentation Management.

3. HR Assistance Plus will help you administer injury reporting and management and return to work programs.

4. The MeetingBusinessNeeds.com has templates and checklists for injury reporting and management and return to work programs.

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Z. Effective organizational communication  

HR Review Questionnaire questions 101-117.

1. The Position Matrix Communication System defines, documents and communicates what people do and how they do it.  This forms the basis for objective and effective communication as to how work is to be accomplished.

2. Systems and Procedures Documentation Plus, ISO 9000 Plus, HR Assistance Plus and Knowledge Management development services will develop the systems and procedures for effective organizational communication.

3. HR Assistance Plus will help you develop effective organizational communication policies and procedures.

4. Organizational communication cam be managed with PerformanceWare or HR Data and Documentation Management.

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AA. Access to experienced legal counsel  

HR Review Questionnaire questions 10.

1. The Legal Hotline available to licensees of The Position Matrix Communication System provides free initial legal advice.

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BB. Temporary, contract, and leased workers management  

HR Review Questionnaire questions 45-52, 183-202.

All of the Roster Network Integrated Solutions apply equally well to the management of temporary, contract and leased workers!

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CC.  Off-site storage of data and knowledge

Your knowledge management documentation and business data can be stored off-site in a secure data center.

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DD.  Ability to search information in disparate sites and data bases