Compliance Pre-Discovery Call SurveyPlease enable JavaScript in your browser to complete this form.Name of Organization *Contact Person *Contact Phone# *What type of healthcare-related provider best represents your organization (Select all that apply) *Behavioral/Mental HealthClinic/Ambulatory Surgery CenterDMEHealth Plan/InsuranceHospital/Health SystemHome Health/Hospice/DialysisLaboratorySkilled Nursing/Long-Term CarePhysician/Group PracticePharmacyPharmaceutical Company or Medical Device ManufacturerHealth Record VendorOtherWhat is your #1 Compliance Challenge Currently?Has the impact of COVID-19 caused a reduction in your Compliance staff? *Yes, by less that 25%Yes, by 25-50%Yes, by more than 50%NoHow does staff access Regulatory contracts and compliance memos currently? *Regulatory Agency websiteCompany intranet for our organizationAccessible using a policy management system or repositoryAccessible via shared drive folderContract available via paper formDon't know/Not sureHow often is Compliance training conducted within your organization? *Bi-AnnuallyAnnuallyNew Employee Orientation onlyNew Employee Orientation and annuallyDon't know/Not sureIs Compliance training mandatory for all employees and business associates? *Compliance training is mandatory for all employees and business associatesCompliance training is mandatory for all employees, but not business associatesCompliance training is only mandatory for select employees within the organizationCompliance training is encouraged, but not mandatoryHow are most Compliance incidents detected at your organization? *Patient reports/complaints/grievancesMonitoring of workforce/user accessEmployee reports directly to management/HIPAA/Compliance OfficeRegulatory report monitoringInternal Reporting System ReportsGoverning agenciesDon't know/Not sureWhen was the last time your Contract Compliance was independently evaluated? *Within the last 12 monthsWithin the last three yearsOver Three years agoNeverDon't know/Not sureName top 3 priorities to be addressed regarding Contract Compliance in the next 12 months *Which of the following Compliance responsibilites take the most planning for your organization. *Updating Policies and ProceduresProviding education and training awarenessConducting investigationsInforming staff of new Compliance updatesHow confident are you that your organization is meeting Contract Compliance Requirements? *Very ConfidentSomewhat ConfidentNot Very ConfidentDon't know/Not sureHow prepared is your organization for a regulatory audit? *Very preparedMostly preparedSomewhat preparedNo well preparedHow much was last remedy (liquidated damage) assessed to your organization? *under $25,000$25,001-$100,000$100,001-$500,000$500,001-$1milover $1milSubmit
