to reaching the acceptance stage. For this
reason, many organizations continue to make
do with ineffective processes and systems.
Within these organizations, provider directory accuracy is consistently considered to be a
one-time issue, a fire to be put out.
At times of grief, it is common to wish to isolate one’s self. A large managed care health
plan begins to request its medical groups and
management services organizations (MSOs)
complete quarterly provider directory accuracy data reconciliations by emailing a form
and a spreadsheet. Phones are not picked up.
Discussions are neglected. Medical groups
and MSOs find themselves receiving requests
from multiple health plans with varying
deadlines, formats, and directions. Yet these
new requirements would be more easily met
with collaboration between health plans and
their contracted provider groups and entities.
Acceptance is where you want your organization to be, as within acceptance is
opportunity. Getting to acceptance means
leadership can begin to not only embed
these regulatory requirements into everyday operations, but also become strategic
and proactive in their implementation and
improvement (see sidebar). How can leadership achieve acceptance?
Connect the dots
Yes, there are new regulatory requirements
for managed care provider directory accuracy. How do these new requirements align
with your existing mission, business objectives, strategic plan, and existing functions?
How can leadership use the need to comply
with these new regulatory requirements to
build upon initiatives already underway in
· Educate your organizational leadership
about upcoming regulatory changes
and enforcement activities and advocate
for a collaborative response that leverages already existing processes within
· Many regulatory bodies at both the
federal and state levels regularly host
working groups, seminars, or email
lists for healthcare organizations to
better understand and provide feedback
regarding regulatory changes. Ensure
that your compliance team is involved
in these working groups, not only to
stay abreast of upcoming changes and
to provide the regulator with valuable
feedback, but to network with other
organizations and learn from them.
· Proactively develop and consistently
review the results of performance
measurements and/or audits with all
organizational leadership through the
existing quality improvement or compliance functions that clearly measure
data integrity in general and whether
your organization is able to evidence
compliance with specific regulatory
requirements. These need not be complicated or overly time consuming, but
should be reviewed regularly, not just
when an audit is upcoming. If deficiencies exist, they should be acted
· Remember: if it is not in writing, you
cannot evidence compliance. Keep
meeting agendas and minutes that
memorialize the reporting of quality
improvement and compliance efforts.
Document processes, such as regular
monitoring and auditing, in current and
formal policies and procedures.