Contrary to popular belief, healthcare compliance rules and regulations are not only about patient data. They also play a vital role in ensuring that patients receive high-quality and effective healthcare.
There are three main areas where healthcare organizations have to demonstrate compliance with healthcare regulations, namely patient safety, data privacy, and billing of services.
To ensure compliance in these three areas, healthcare organizations and their business associates must conduct rigorous inspections and reviews from the following agencies:
- The HHS's Office for Civil Rights (OCR)
- The Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA)
- The Department of Health and Human Services and the Office of the Inspector General
What should a HIPAA compliance program accomplish?
The number one focus of any HIPAA compliance program is patient safety and privacy. That isn't limited to IT security. Company operations, billing, staff competency, and internal workflows are also affected by these regulations.
A program should also enable your organization to juggle the different governing bodies and federal regulations that oversee healthcare compliance. Aside from HIPAA, healthcare organizations have to likely comply with:
- The HITECH Act
- The Affordable Care Act
- The Department of Health and Human Services to protect patients from fraud
- The Social Security Act for funding and requirements in Medicare and Medicaid
Complying with these strict regulations without a well-documented compliance program is nearly impossible.
Noncompliance with HIPAA’s provisions such as its Privacy and Security Rules can net harsh and hefty fines. The smallest violation can exact a penalty of $100 to $50,000, while the worst leads to fines of up to $1.5 million. Organizations with comprehensive HIPAA programs don't have to worry about HIPAA fines or penalties.
What are the elements of an effective healthcare compliance program?
Healthcare compliance software
Healthcare compliance software will allow you to automate some of the required processes, revise compliance practices based on changing regulations, decrease costs and resources dedicated to maintaining compliance, and train employees to ensure their participation in compliance.
Policies and standards of proper conduct
Having policies and standards of conduct in accordance with healthcare regulations helps you and your staff achieve compliance for your organization in your day-to-day functions and tasks. These rules have to be easily understood and in plain language.
Policies and standards also have to be constantly reviewed for relevance with current federal or industry regulations and changes within your organization. Make the documents easily accessible on a common platform such as a knowledge database, an employee portal, or any other widely circulated documents.
Job roles that oversee compliance
A compliance officer or a compliance committee are roles focused on preventing, detecting, and correcting noncompliance. Personnel dedicated to compliance will help you maintain standards and report noncompliance, without burdening already stretched-out medical staff.
They also ensure that the program receives proper focus and resources, therefore not just a means to avoid penalties, but also to achieve better patient service and outcomes.
Regular staff training
Compliance training and education must be part of every employee’s job requirements. Healthcare staff can stay current on compliance issues and trends through conferences, articles, and professional networking.
Effective lines of communication
The more visible and approachable your compliance offers are, the easier it is to protect data privacy, collect feedback, and ensure good-faith reporting. Every employee should be able to identify your organization's compliance officer without needing to check any documentation.
Risk monitoring and auditing
These two essential processes ensure that the program addresses both online and offline areas of concern while sustaining its effectiveness. This goal can be accomplished by establishing an annual work plan, determining areas of risk, and reviewing the compliance program.
Disciplinary actions for violations
Given the risks of patient care negligence, data breaches, and noncompliance penalties, a provider should never assume that standards are being followed. Disciplinary actions for violations within your organization will ensure that policies and standards for proper conduct are followed consistently, regardless of the member’s position, title, or rank.
Document compliance issues
In tandem with a guideline for disciplinary actions, establish a method for tracking compliance issues within your organization. This will help thoroughly document issues with the goal of investigating and correcting them, as well as resolving complaints linked to noncompliance.
SpectrumWise understands the complexities of healthcare IT. Your software and hardware devices must be optimized to deliver high-quality care without putting any data at risk. In an increasingly regulated healthcare industry, you can leverage reasonably priced, professional technology management to improve efficiency and productivity. Contact SpectrumWise.
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