Gorman Health Group | Root Cause Analysis - Medicare - Gorman Health Group
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Root Cause Analysis

Most compliance crises begin as operational problems

A complex and fast-moving operational unit is critical to success.  But keeping pace with your organization’s everyday needs often means dysfunctions are ignored, perhaps even missed entirely.  In fact, most operational problems go undetected for months. They quietly but thoroughly damage the business unit, going unnoticed until suddenly there is a compliance crisis on your hands.  And unfortunately, most organizations don’t find the compliance problem – the auditors do.

 

Gorman Health Group has decades of experience stress-testing hundreds of operational business units and can assist with implementing CAPs post-audit or in proactively addressing operational problems before regulators come knocking.  Our comprehensive root cause analysis service focuses on every segment of your organization’s value chain – we can help you address the immediate operational problem and also uncover the root cause behind it.

 

No functional area is a silo unto itself and each receives inputs, processes and outputs from the other areas. The enrollment department value chain, for example, has strong performance ties from Sales, Customer Service, Compliance, Medical Management, Claims Processing, and Finance.  GHG experts analyze the flow of information from one segment of your value chain to the next, ensuring every weak link is identified and repaired.

 

Our root cause analysis service supports optimal performance in virtually every operational area, including:

 

• Application development
• Oversight
• Compliance
• Customer Service
• Enrollment
• Finance
• Appeals and Grievances
• CTMs
• Health Risk Assessments
• Medication Therapy Management
• Quality Assurance
• Part D Coverage Determinations
• Sales

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