Reporting on healthcare compliance - where to find out what you're responsible for covering

Definition of compliance in healthcare

Healthcare compliance refers to the following policies, laws, and regulatory guidelines that pertain to healthcare practices. Covering a plethora of internal and external policies that are often subject to change, healthcare compliance is essential to the smooth operations of businesses and is vital to protecting client information. Healthcare compliance ensures that all medical and financial data is kept private, and is a preventative measure that upholds and regulates the safety of client data. Considering that compliance mistakes make up almost 60% of healthcare errors, it is important that you take extra care to implement security protocol to combat these occurrences and prevent potential breaches. Compromised data is a huge HIPAA violation, and can result in various penalties for your business, including large financial losses, and a damaged reputation. Once the information has been jeopardized, it is much more difficult to gain control of, and so implementing compliance practices will work to avoid this, as well as provide better treatment for your patients. 

List of governing bodies & federal regulation that govern healthcare compliance

There are various governing bodies and federal regulations that guide healthcare compliance policies, and taking the time to examine these laws could prove immensely beneficial for your practice. If you are familiar with these guidelines, you are more likely to abide by their rules, and provide a higher level of protection and care when it comes to your patient data. 

Perhaps the most common standard is the Health Insurance Portability and Accountability Act (HIPAA), which is used in conjunction with the HITECH Act to protect patient data, and requires security regulations across business processes. It also outlines the penalties that businesses may face if found to be in violation of its rules, which can be up to a $1.5 million fine. Healthcare businesses must also comply with regulations such as the Social Security Act, where funding is governed with requirements outlined for Medicare, Medicaid, and more. Insurance providers are central players when it comes to healthcare, and through these laws, as well as the Patient Protection and Affordable Care Act,  and the False Claims Act, requirements can be regulated for insurance and patient data purposes. False claims cannot be filed for funds from federal programs, and patient information is secured along with all business process steps. The Department of Health and Human Services and the Office of the Inspector General also help protect against fraud and combat suspicious business practices. Lastly, the Drug Enforcement Administration and the Drug Administration act, ensure that the distribution of medication is fair and proportionate. Being compliant with these regulations is an essential component of operating a healthcare business, and will set you on the best footing for your practice.

Compliance reporting: Basic recommended steps

To ensure high-quality compliance, we have compiled our most recommended steps for you to follow and implement into your healthcare business. Following these will provide the best treatment and care for your patients, and ensure that you do not fall into common pitfalls associated with the complexity of compliance regulations and laws.

Stop engagement - If you have any inkling that the activity you’re participating in is a violation of compliance, it is important that you cease engagement immediately. This can prevent complications before they spiral out of hand. 

Raise concerns - If you are unsure about anything, it is always good to check with your supervisor to make sure that concerns and queries are addressed directly. Compliance officers are also legally bound, and cannot expose you or your questions openly, with privacy ensured. 

Consider external channels - If you cannot resolve issues internally with compliance officers or inside workers, you may need to resort to external organizations. These include reporting to the Department of Health and Human Services, as well as the Officer of Inspector General for Medicare and Medicaid compliance issues, or an ombudsman. 

Reporting healthcare compliance: where to find out what you're responsible for covering

As a healthcare compliant business, there are multiple areas that you are responsible for covering to ensure that you keep patient information private, and that you maintain a high standard of care and compliance. While there are many areas that you are responsible for, including all federal and state standards, laws, and professional regulations, it is important that you understand how to apply them to your practice to ensure confidentiality and adherence. You must conduct legal frameworks that represent an ethical perspective, covering medication, financial and legal information with integrity in regards to patients. You must cover information that pertains to your organization, and your internal staff, as well as your patients and their healthcare treatment. This includes any potential violations that may be considered fraud and abuse, and any instances where confidentiality has been breached. The information covered should be reported to the Officer of the Inspector General, and any official reporting organizations. 

Staying on top of regulations

Because healthcare regulations can quite easily become highly complex, there are various reasons why you need to stay on top of them. You certainly do not want to fall behind, in the case that you fail to meet regulations and investigations and concerns begin to pile up. Dealing with one security breach in itself can be strenuous, so dealing with multiple will prove particularly difficult. Keeping up-to-date with regulations is the best way to protect yourself and your patients from breaching security violations, and keeping information private.

Have experience - It is always useful to have experience in either the public or policy sector, or, have experience with loss prevention and strategic management. Compliance deals with a variety of these disciplines, so handling this information with certain backgrounds can be much easier. 

Develop the right skills - It is important to have an innovative perspective and mindset, with the ability to employ the right agile workstyle tools. This way, you can easily pick up the right practices, and apply them in a way that is relevant to your workspace, and that is on top of regulations. Having the right skills enables you to easily identify suspicious activity faster, and encourages a greater developed detection wall. 

Employ the right credentials - Having the right expertise and credentials is vital towards establishing compliance standards, as it can help provide the relevant background to fulfill legal obligations and standards. Credentials may include a master’s degree in healthcare management, with a specific focus on healthcare compliance. 

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Further reading:

• Why Is Health Care Regulation So Complex?
• Major Laws Related to Compliance