10.0 Risk Management and Regulatory Compliance Home Page

Solutions for business, industry and health care providers.

Risk Management is a serious concern for most companies.  The US tort liability system and governmental regulations pose a substantial compliance challenge for all companies in all industries.  

Health care providers have their own unique challenges.  Medicare and Medicaid coding and billing compliance and professional or malpractice liability are just a few of the risk management concerns that physicians, clinics, hospitals and other providers have.  

However, risk management is a challenge that is often overshadowed by the most vital challenge a company or health care provider has: remaining competitive and profitable in an ever more competitive world.  In fact, some companies and health care providers view risk management as only more paperwork and bureaucracy that gets in the way of making money.

It doesn’t have to be this way.  The same plans, systems and procedures that meet your risk management needs can also make your company more profitable!  No matter what industry you are in, your business success hinges primarily on only two things:  (1) Your employees doing what they are supposed to do; and, (2) Your employees not doing  what they are not supposed to do!  If they don’t do what they’re supposed to do and do what they’re not supposed to do, your productivity and profitability will decrease and your exposure to legal and regulatory liability will increase!

Some businesses rely heavily on individual training and discipline to address their risk management and regulatory compliance needs.  Health care relies on this approach to a great extent.  Under this approach, individual employees are expected to develop extensive knowledge of complex subjects and are disciplined if there are failures.  However, this approach has recently been called into question.  The fixing of blame for problems generally promotes sandbagging or cover ups of mistakes or events gone wrong for a variety of reasons.

We believe that although training and discipline are important components of any management program, they are best utilized in conjunction with comprehensive and documented systems and procedures.  The military and commercial aviation are good examples of organizations that rely on systems and procedures to achieve their performance and quality goals.   If this approach is taken, when regulations, legal standards or the state of the art in the industry changes as they inevitably do, it is much easier to change the system or procedure and train the employees to do their part of the new or revised system or procedure than it is to train the employees to become overall experts under whatever new standards have been imposed.     

10.0    Risk Management Techniques and Solutions.    This chart illustrates how good risk management is good profitability management for general business and industry and how documented systems and procedures can efficiently meet all of your business needs. 

10.1    Risk Management Techniques and Solutions for Health Care Providers.    This chart provides the same information in a format tailored to meet the needs of health care providers.   

10.2    Medicare-Medicaid Compliance Systems Summary.  This file illustrates how the Roster Network system of quality and procedure documentation used for general quality system facilitation and management and ISO 9000 facilitation can be used to meet one of the pressing compliance needs of health care providers.

10.2.1  Federal Fraud Enforcement Compliance

10.2.2  Development and Implementation of a Management and Compliance Plan

10.2.3  The Documentation Process and Team

Related Links

5.0      Employment Practices Risk Management, the Legal Background.   This file, written by Baker & Daniels, discusses the laws, regulations and other legal issues regarding employment practices, an area of exposure for every employer.