Managing Healthcare Compliance in Wisconsin

Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. Navigating the intricate regulations of healthcare compliance in Wisconsin poses a challenge for healthcare providers, institutions, and entities as they strive to offer high-quality, ethical healthcare services without incurring legal or financial repercussions.

To handle compliance effectively, healthcare establishments in Wisconsin need to develop a solid framework for tracking and understanding regulatory changes, while keeping company policies up to date and staff informed. This post sheds light on certain aspects of healthcare compliance in Wisconsin, with tips for effectively managing your healthcare organization.

Wisconsin Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

• Department of Public Health: Wisconsin Department of Health Services (DHS) is a state government agency dedicated to protecting and promoting the health and safety of the residents of Wisconsin through various public health programs and initiatives.
• The Wisconsin Hospital Association (WHA) is an influential organization representing hospitals and health systems in Wisconsin, committed to advocating for effective healthcare policies and fostering quality healthcare delivery across the state.
• Wisconsin Medicaid is a state-administered program offering comprehensive healthcare coverage to eligible low-income residents, playing a crucial role in ensuring access to essential medical and health services in the state.
• The State of Wisconsin Department of Safety and Professional Services (DSPS) comprises a variety of boards that regulate professional licensure, including the Medical Examining Board (MEB), the Physician Assistant Affiliated Credentialing Board, the Psychology Examining Board, and a division for mental/behavioral counselors, among others.

These agencies help maintain the integrity and quality of healthcare services in Wisconsin, protecting the public and promoting patient safety. The resources provided by these Wisconsin state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Wisconsin.

Regulations Unique to Wisconsin

To meet the standards of healthcare compliance in Wisconsin, there are a few additional regulations.

Medicaid Telehealth Services

For healthcare providers and compliance professionals in Wisconsin, the Medicaid Telehealth Expansion is an important policy to consider. It extends the scope of services for Medicaid members, including a wide range of telehealth options like general healthcare, school-based, dental, case management, various therapies, and behavioral health services. It also includes interactive, store-and-forward, and remote patient monitoring methods. The expansion is key for enhancing service delivery and compliance in the evolving healthcare landscape of Wisconsin.

Cooperative Practice Agreements

For healthcare administrators and practice owners in Wisconsin, the Certificate of Public Advantage (COPA) program offers an opportunity to engage in cooperative agreements with other healthcare providers, exempting both parties from certain state antitrust laws. To participate, providers can submit an application to Wisconsin’s Department of Health Services (DHS) with an outline of the nature and objectives of the cooperation. DHS then evaluates the benefits of the agreement, like improved healthcare quality or increased cost efficiency, to justify any potential reduction in competition. While an approved COPA does offer legal protections, it can be revoked by DHS if the collaboration fails to maintain its benefits or if either party withdraws. Overall, the program aims to support strategic partnerships that improve healthcare delivery while maintaining fair market competition.

Tips To Manage Healthcare Compliance in Wisconsin

Effectively managing healthcare compliance in Wisconsin is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

• Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Wisconsin-approved training.
• Organize Policies By Requirement: Including “WI” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
• Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
• Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Wisconsin

One of the unique aspects of credentialing in Wisconsin is that healthcare providers from other states can apply for temporary licensure, allowing them to practice while their permanent license application is processed. Also, physicians must renew their credentials every odd year on October 31. The recredentialing process is completed through the Uniform Application for Physician State Licensure, which also helps to streamline multi-state licensing. Lastly, physicians prescribing controlled substances require a Drug Enforcement Administration (DEA) number. However, certain credentials, such as the Administrative or Visiting Physician Licenses, are restricted from providing patient care and prescribing rights.

Meet Wisconsin Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Wisconsin. 

MedTrainer’s all-in-one compliance platform can streamline management of Wisconsin healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!