To meet healthcare compliance requirements, you must have a compliance plan in place – one that includes clear policies and guidelines and a designated compliance person, as well as training and audits. Anyone doing work or studying in health care should come into contact with relevant standards, regulations and compliance guidelines, although the exact role (e.g., clinical or bureaucratic) may require additional or more specialized compliance training. Healthcare compliance programs require regular maintenance. Regular internal audits can help you identify potential problems before they become a problem. Healthcare organizations are also subject to the same workplace regulations that apply to organizations across all industries. Laws enacted, for example, by the Occupational Health and Safety Authority and the Equal Employment Opportunity Commission. The Federal Anti-Bribery Act (AKBS) was passed to prevent the deliberate misuse of the health care system for profit. Akbs prevents the exchange of something valuable for a reward or referral under the Federal Health Program. A violation of the AKBS is a crime. Healthcare compliance and regulation also protects patient privacy and safety and encourages healthcare professionals to provide high-quality care to all patients. It also dictates how to properly bill patients. Compliance program regulations protect not only people, but also valuable information.
It is almost impossible to define the scale or complexity of the ever-changing world of healthcare compliance. New laws and regulations come into play every day at all levels of government. Some of them have far-reaching implications such as the Anti-Bribery Act, the Stark Laws, the False Claims Act, and the HIPAA and HITECH laws designed to protect the privacy of patient information. As mentioned earlier, compliance programs must not only promote compliance with these rules, requirements and standards of ethical behavior, but also a culture that promotes the prevention, detection and resolution of behaviors that do not meet these requirements. To become healthcare compliant, organizations need a healthcare compliance plan, including written policies, procedures and standards of conduct. The OIG suggests that hospitals focus on areas of risk (e.g., Billing for unsubstantiated services, upcoding, unbundling, and double billing), claims development and submission processes, medical necessity, anti-bribery and self-transfer concerns, bad debts, credits, record keeping, etc. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted in 2009, is often referred to as the “teeth” of HIPAA. It requires audits of healthcare providers to ensure they comply with HIPAA privacy and security requirements. The law sets high standards of information security and provides financial security and penalties for healthcare providers and affiliates to encourage them to adequately protect patient information. Ultimately, compliance with health regulations is about safe, high-quality patient care.
Compliance with industry standards and regulations helps healthcare organizations further improve the quality of care. Most healthcare organizations have a compliance officer or department dedicated to maintaining compliance. However, to be effective, the compliance department must have the authority to create programs to enforce compliance. The Office of the Inspector General has many different resources for health care compliance. In addition to training materials, the OIG`s Compliance 101 page describes the elements of effective compliance programs in the health sector. Non-compliance issues can be an opportunity to train employees. A compliance officer can show them that a proactive response to non-compliance will help the company prevent future incidents and improve overall compliance. If you want to create a compliance program for your organization, you can use PowerDMS to promote healthy communication and update, distribute, and track your policies and training. Several government agencies and a not-for-profit organization are involved in maintaining compliance programs: the Chief Compliance Officer or committee needs the resources and tools to properly fulfill their role.
You must report directly to the CEO or governing body and have the authority to make proposals and enforce compliance. Compliance with federal laws and regulations allows a healthcare organization to protect its patients and become a credible organization. These are just a few of the areas of regulation that health officials face. If you have a question about your legal obligations or compliance requirements for your practice, are audited, or are dealing with allegations of fraud or abuse, contact an experienced healthcare professional. A variety of federal and state agencies regulate compliance with health regulations. For example, the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) both regulate the manufacture and distribution of drugs. They guarantee the safety and efficacy of medicines, biologics and medical devices. The FDA also provides the public with accurate and scientific information. This aspect of healthcare compliance is becoming increasingly challenging as technology develops.
As a researcher at the University of Illinois at Chicago wrote, healthcare organizations need clear guidelines for each component of compliance and a fully developed organizational compliance plan. Create policies that comply with all laws and regulations. This promotes consistency in production and high-quality service with your healthcare providers and employees. A compliance officer is someone who helps standardize and enforce all healthcare requirements and laws in an organization. Compliance officers also need to know how to identify risks and find remedies. In addition, they ensure that all health systems are sufficient and up-to-date to protect patient records and private information. The Patient Safety and Quality Improvement Act, 2005 (AQQP) protects health care workers who report unsafe conditions in their practices. The law encourages individuals to report medical errors while respecting patient confidentiality. Changing laws and regulations can make it difficult for companies to keep pace with healthcare compliance. And the laws differ between states and local governments.
Each health organization should take the time to review the various laws that apply to its organization. Your compliance officer conducts regular compliance audits in the healthcare industry. Compliance audits can help you identify potential hazards or risks before they become a bigger problem. The Stark Act is a set of federal health care fraud and abuse laws that prohibit doctors from referring patients to another location with which they have a financial relationship for certain health care services paid for by Medicare. The Stark Act is not a criminal law, but it does provide for significant civil penalties. There are many different aspects of healthcare compliance that are regulated by a variety of federal and state agencies. An organization must have policies in place to reduce non-compliance issues. A compliance officer ensures that policies tell employees how to report issues so they can resolve them immediately if this happens.
There are many regulations that healthcare organizations must comply with – and too many to list here. However, here are some of the most important laws: Other large companies are also focusing on compliance. For example, the Joint Commission (JTC) accredits and certifies organizations, primarily hospitals and health systems, that meet certain healthcare compliance standards for the quality and safety of patient care. The National Association for Healthcare Quality (NAHQ) fulfills a similar role to TJC, but primarily for health plans and credential verification bodies. The Centers for Medicare & Medicaid Services (CMS) and other payers have also implemented various quality initiatives to promote quality health care through accountability and public disclosure.
