Understanding the importance of healthcare policy and procedures

Healthcare policies and procedures refer to a set of standards that are in place to ensure that patient data and information is being handled properly, and that your organization is not breaching any legal, ethical or professional responsibilities. Whilst the necessity of implementing standardized policies is universal for all healthcare organizations, different practices will have their own way of managing these procedures. Establishing compliance guidelines in the medical environment protects patients, but it is also an effective way to communicate to employees exactly what is expected of them. However, the reality of managing compliance policies is generally a lot more complicated than originally anticipated. Regulations dictated by state and federal law are continuously changing, and whilst this is an important aspect of keeping patients safe, it can make it extremely challenging for healthcare organizations to keep up. Nevertheless, given that compliance mistakes make up almost 60% of healthcare errors, it has become more important now than ever to ensure that you are maintaining adherence to the latest medical regulations. There are different strategies that healthcare organizations have adopted to elevate their adherence, the most effective likely being the implementation of compliance software. These systems update you and your staff on changes in rules and regulations, allowing you to guarantee that you are protecting not only your patients, but also your practice.

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5 important regulations in United States healthcare

The first step to improving medical compliance within your practice is understanding the different policies you need to adhere to. Although your practice will have its own set of rules that manage compliance, the following are 5 important regulations that are dictated by United States law:

HIPAA: The Health Insurance Portability and Accountability Act is concerned with the protection of patient information. HIPAA presents guidelines that organizations are required to follow in relation to the use and release of all patient records. Additionally, as we are seeing an increase in healthcare organizations using EHR systems, HIPAA ensures that the software complies with healthcare regulations.

The HITECH Act: The Health Information Technology for Economic and Clinical Health Act is the enforcement aspect of HIPAA. It conducts audits of healthcare organizations and any breaches that are discovered can result in negative consequences ranging from a fine to losing your medical license.

MACRA: Medicare Access and CHIP Reauthorization Act is concerned with the payment of doctors. It facilitates the healthcare industry’s shift to value-based care, and acknowledges the increased use of EHR systems.

Chain of Custody: Chain of Custody dictates that there must be a document trail for any type of human specimen test, including drug testing and DNA testing. The Chain of Custody is a legal document and tampering or failure to properly handle the test can lead to invalid results.

Medical Necessity: Medical necessity states that any treatment that is not medically necessary will not be covered by the payer. Understanding how medical necessity works will help you process your bills successfully and minimize the chance of denied claims.

List of regional links and resources for official health regulations

Knowing the overarching Acts that dictate regulations is only the first step to understanding and adhering to medical compliance. The rules and policies that are governed by law change extremely frequently, particularly given the widespread adoption of new technologies into the healthcare industry. Although it can be daunting thinking about how you can maintain compliance, there are a massive amount of resources designed to enable adherence. Additionally, the development of medical compliance software can allow you to keep up with the continuous changes in regulations. Compliance software tracks, monitors and audits the various processes within your practice to ensure that they are adhering to the most recent medical compliance regulations.

To help you ensure that you are following regulations appropriately, we have compiled a list of resources that provide information regarding compliance regulations:

Guide to Privacy and Security of Electronic Health Information: This is a basic overview of HIPAA guidelines. The website has links to training games and risk assessment tools.
State Attorneys General: A more comprehensive overview of what HIPAA and HITECH entail.
CMS HIPAA Basics for Providers: Details of the role that providers play in adhering to HIPAA compliance, with additional information on how the breach notification rules and possible consequences of non-compliance.
World Health Organization: Catalog of resources to support health services delivery transformations.

The World Health Organization Catalog separates its resources into four domains; populations and individuals, services delivery processes, system enablers, and change management. Depending on the services offered by your healthcare organization and the different methods you employ, you will be able to utilize the resources on offer and elevate your medical compliance. We understand that maintaining adherence to changing regulations is both stressful and difficult, and hopefully, this list of resources can help ease your concerns. The other important thing to be aware of is the actual consequences of non-compliance. Each instance of non-compliance will vary, and although the intent is taken into consideration, there are still severe consequences for accidental breaches. Given the importance of compliance for both your practice and your patients, it is in your best interest to utilize the above resources and ensure you are staying on top of your compliance.

Final thoughts

Understanding medical compliance is a necessary aspect of ensuring patient privacy. In the healthcare industry, practitioners handle a significant amount of confidential information, ranging from personal details to compromising medical history. Knowing how to safely produce, store and access this type of data will help keep patients safe and improve health outcomes. One of the best ways to adhere to these rules and regulations is by implementing compliance software into your practice. These systems are designed to track, monitor and audit all of your business processes to ensure that you are adhering to the most recent regulations. If this is something you are interested in, we recommend having a look at Carepatron. Carepatron provides a HIPAA-compliant platform that is guaranteed to optimize your medical compliance and help reach target business goals.