Ultimate Guide to Healthcare Compliance

Healthcare compliance is one of the most integral aspects of health practices, as not only is it a legal obligation, but it is a surefire way to build trust amongst your patients, and provide your clients with the confidence that their sensitive medical information is in good hands. We recognize that it can feel overwhelming, and somewhat complicated, especially with ever-changing laws and regulations. That’s why we’re here, to simplify everything when it comes to healthcare compliance, and make sure you’re covering all bases. 

What is healthcare compliance?

Healthcare compliance refers to the policies, procedures, laws, and regulatory guidelines that pertain to healthcare practices. Healthcare compliance ensures smooth operations of businesses, and that patient information is handled correctly, with minimal risk of jeopardization. Above all, it holds healthcare businesses accountable for their actions, and attributes responsibility to their business processes. 

There are a plethora of internal and external policies covered under compliance that ensure all medical and financial data is kept private, and is regulated properly. The healthcare industry deals with highly sensitive information, including evidence such as medical histories and personal details, and so healthcare compliance is an excellent way to outline the regulations that you should be following, as well as the consequences if you fail to do so. Most healthcare practices work tirelessly to maintain compliance and uphold regulations, with some having established committees and teams dedicated to resolving and working through compliance issues. Especially considering that healthcare compliance is quite fluid, and changes constantly, it’s of utmost importance that you keep up-to-date with compliance regulations.

When healthcare professionals and practitioners refer to healthcare compliance, they’re commonly referring to the backbone of compliance standards; HIPAA. 

HIPAA

Health compliance mainly incorporates HIPAA guidelines, which refer to the Health Insurance Portability and Accountability Act of 1996. This act serves as the foundation for how security is monitored and regulated within practices, and outlines the requirements that all businesses must adhere to in order to fulfill legal obligations. More specifically, HIPAA outlines the safety processes that should take place in regards to transferring, sharing, and receiving medical information, as well as the overall handling of healthcare information. HIPAA also supports businesses when it comes to health insurance coverage, which includes around 200 million Americans. It establishes industry-wide standards for medical billing and coding processes to ensure that the appropriate amount is reimbursed for businesses. It is an excellent way to elevate the quality of care within your practice, and abiding by HIPAA guarantees security when it comes to your legal position within healthcare. 

5 Main Guidelines

HIPAA guidelines refer to 5 main areas that you must consider when fulfilling legal obligations, and handing patient medical information. To support confidentiality and ensure that your patients are in the best hands, HIPAA privacy and compliance programs outline the steps to take to achieve the security requirements. You can effectively minimize risks of security breaches, as well as boost patient satisfaction by improving security systems and ensuring that your medical information is highly secure and private. 

1. Privacy - This outlines the various conditions that cannot be conducted without patient authorization, and the disclosures that must be submitted. When it comes to privacy, all patients should have full rights to control their private information, which means having appropriate access. Patients should be able to access medical history, medication forms, finances, and treatment plans, and have full confidence that only authorized users can view and assess their medical data. Upon request, clients should be able to correct their information as well as obtain a copy of their details if needed. 
2. Security - Security refers to the protocols and regulations that protect patient information, and ensure that only authorized users have access to the right data. When it comes to safeguarding your information, it is important that you implement the proper authentication and encryption standards so that patient information is of the highest protection. These also include various hardware and software evaluations, especially concerning management processes and risk assessments, to ensure that holes are quickly identified to prevent hacking or data leakages. 

1. Transaction - Inclusive of ICD-9, ICD-10, HCPCS, CPT-3, CPT-4, and NDC codes, you can improve billing and coding processes by using the correct HIPAA identification. Utilizing the right security codes allows you to improve and speed up business transactions, which can increase patient satisfaction and work towards better business processes. 
2. Identifiers - When it comes to HIPAA regulations, there are three main identifiers that healthcare businesses use, which include the National Provider Identifier (NPI), National Health Plan Identifier (NHI), and Center for Medicare and Medicaid Services (CMS). The NPI is a 10-digit number that covers the healthcare businesses across and within every HIPAA transaction, with NHIs used for a health plan and payer identification, and CMS correlating to their codes. 
3. Enforcement - This outlines the areas within healthcare that practices must adhere to and acknowledge, with its use derived from the ARRA HITECH ACT. It includes HIPAA security requirement applications, mandatory federal privacy formation and security breach requirements, marketing and sales restrictions, criminal and civil penalties, and non-compliant enforcement methods. By covering a variety of bases, enforcement is a central aspect when it comes to HIPAA, as it promotes healthcare businesses to inject more effort into upholding regulations and maintaining universal security protocol. This way, patients can have more confidence that they are in safe hands when it comes to protecting their data from potential breaches. 

Why is healthcare compliance important?

Contributing to up to 60% of healthcare errors, it’s of utmost importance that you implement security protocol as a preventative measure to combat potential hacks and data leakages. If data is compromised, it can be much more difficult to gain control over, which can result in severe financial penalties and fines for your practice. A damaged reputation is difficult to recover, and so to avoid this, it’s best to incorporate effective compliance practices, allowing you to also provide better treatment for your patients. The reality of managing healthcare compliance can quickly become complicated without the right safeguards in place, and without proper care taken to adhere to the guidelines in place for your benefit. It is highly important to forestall security oversights, limit security dangers, guarantee innovation use, and ensure the classification of patient information. 

Compliance also ensures that patient data is connected within the right databases and to the right IDs, with information only accessible to particular users. This means that healthcare professionals across practices and organizations can easily receive the file transfers, and be able to treat patient conditions regardless of their location. With moral and lawful principles developing more intricately, more and more organizations are executing different HIPAA frameworks to continue providing a high-quality coordination and order of care, whilst ensuring clinical consistency. There must be an objective measurement that is applicable to all forms of healthcare, as it guarantees that all healthcare businesses are subjected to the same compliance standards; and this is why HIPAA works so well. You can protect against all forms of fraud and liability issues, and protect the longevity of your healthcare practice, as well as ensure that your patient medical information is locked tight. 

How does the public health system in the US work?

The public health system is consistently framed within the context of medical services and healthcare, and is often discussed together and considered connected. Public health is the core foundation of all medical service activities, and actively manages diseases, while also advancing health within general and state wellbeing offices. It is a widespread network, and can very easily become complicated with the number of regulations and standards in place. Especially considering that many of these bodies oversee their own frameworks differently, and in a way that works for them. They each have their own capacities concerning their level of power and construction within the health industry.

Inside the US, the general wellbeing framework comprises an assortment of public and private associations, which all serve as a component of a wider organization. These associations cooperate to advance and expand general wellbeing, and actively prevent diseases while ensuring businesses are held accountable for their actions. The government public health system itself is composed of 51 states, 2794 local governments, and 565 federally recognized agencies. 

How are health departments structured?

To better understand how departments are structured, you may need to know the following terms. 

• Centralized/state - Includes all local health departments, which are all units of state government.
• Local or decentralized - Local governments make the tax decisions and govern local health departments. 
• Mixed/hybrid system - The state government leads some local health departments, and the local government also leads some local health departments.
• Shared system - All local health departments are governed by state authorities and local authorities.
  

When it comes to healthcare, you often have to work with local health departments, so it can be useful to understand their role within the overall health structure. Their authority is derived from the state, within both country and municipality levels, and varies depending on the size of jurisdictions. For instance, smaller local health practices may have fewer services due to fewer developments, technology, and staff within the health departments. However, all practices and departments must practice compliance in accordance with laws and regulations in order to fulfill legal obligations, and ensure that patient information is protected. 

List of bodies and federal regulations that govern healthcare compliance

There are different overseeing bodies and government guidelines that guide medical care compliance arrangements, and investing in the opportunity to inspect these laws is immensely helpful for your training. Becoming familiar with these rules will enable you to better understand what is required from your healthcare practice, and therefore, provide a high level of privacy and protection when it comes to your medical data. 

While HIPAA is the main compliance regulation you need to be concerned with, it’s still important to recognize the others that continue to play a role when it comes to healthcare. These include the following:

• Health Information Technology for Economic and Clinical Health (HITECH) - Specific to health information technology, these regulations outline that healthcare businesses must conduct regular audits to assess compliance in regards to their privacy. It ensures that only authorized users have access to relevant information, and that patients are notified as to who has this specific access. Given the current Covid circumstances, it is especially important that online information is protected, and that medical records are contained to specific individuals. 
• Hospital Readmissions Reduction Program (HRRP) - This regulation requires Medicare and Medicaid services to reduce pay to facilities that have excessive readmission rates of patients. Patients can be treated in healthcare practices without fear of forking out additional hidden costs and finances, with it making treatment a more viable option for those in need. 
• Medicare Access and Children’s Health Insurance Program (MACRA) - This includes the use of electronic health records by medical practices and facilities, as well as doctor payments, Medicare costs, and treatment models that can be administered. 
• Healthcare Quality Improvement Act of 1986 (HCQIA) - This provides protection and immunity for healthcare professionals in the case of law, and supports an equal playing field when it comes to healthcare perspectives, treatments, and services. The act promotes audits and reviews, and also protects clinicians from lawsuits from fellow physicians. 
• Chain of Custody (CoC) - A chain of custody supports you in creating a paper trail of evidence concerning interactions with patients, and regulates record-keeping. It is an excellent way of holding you accountable for all your actions, especially when it comes to legal issues. 
• Affordable Care Act of 2010 - Healthcare professionals can play a larger role in the patient healthcare experience, as the affordable care act ensures that all relevant services are covered, so doctors can increase their quality of care. It specifically outlines specifications concerning the provision of healthcare coverage, and works to reduce care expenses, which increases the protection of patients.
• Patient Safety and Quality Improvement Act of 2005 (PSQIA) - Healthcare professionals can now report medical errors without fear of being exposed. Many mistakes go unnoticed and unreported due to fear of your job being at risk, and so this act works towards creating conditions where those in medical professions feel comfortable coming forward. 

There are also various other regulations that you should be aware of as additional resources that can influence the healthcare industry in the broader context. Anywhere from $50,000 to $1.5 million, violating these acts and regulations can result in severe financial losses for your practice, and thus, a damaged reputation. As a result, it’s important that you take note of the following standards that can protect you, in addition to the Department of Health and Human Services, and the Office of the Inspector General:

• Social Security Act - This act outlines the funding requirements for Medicare, Medicaid, as well as other reimbursement programs. 
• False Claims Act - Insurance is a central component of healthcare programs, and this act regulates insurance programs to ensure that patients and healthcare providers are reimbursed with the correct amount. It helps sort through claims to find genuity and authenticity.   
• Drug Enforcement Act - This works towards ensuring that drug distribution is even and fair, and is proportionate to what is needed. 

Regulation and governance impact on public health

When it comes to the impact of home rule within the ability of local governments to regulate and monitor public health, most refer to Dillon's Rule, which specifies that local governments can only exercise power through explicit state grants. However, local governments sometimes have more authority than the rule specifies depending on what states grant. This home system allows cities and countries to have a sense of governance, with law-making procedures needing to be transferred from the state legislature to local so they can make their own decisions. They have the authority, autonomy, and flexibility to implement standards and regulations that they see fit, and within reason. 

Health regulation regional links and resources

If health regulations seem daunting, there are a multitude of resources available to help you adhere to healthcare protocol and ensure that you keep patient information private. As a result, we have compiled some of the most useful resources and links to guide you in remaining compliant and making sure that patient information is regularly monitored, and stays confidential. 

• 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 Role of Non-Compliance in Healthcare  

Risks of non-compliance 

In order to understand the full importance of healthcare, it’s important to know and understand the consequences so you know what to avoid, and how to elevate the quality and service of your practice. Failing to comply with healthcare regulations can result in heavy costs, financial or otherwise, so it is important to stay informed, educated, and up-to-date on healthcare standards.

• Fines, penalties, and other fees - If you fail to comply with regulatory standards, you may face expensive fines and penalties. These can vary greatly depending on the offense, and according to the General Data Protection Regulation (GDBR), low-tier fines can go up to $11.03 million for large businesses, or two percent of the company’s annual revenue, which can cause vast financial losses. If no action is taken, this could further escalate to confiscation of healthcare resources and equipment, which can have immense flow-on effects. Maintaining compliance early can significantly reduce the chances of running into problems that are potentially irreversible. 
• Business disruption - Patients need to be sure that you’re able to handle private information, and that their data remains confidential. If you cannot fulfill this need, clients are far less likely to trust your organization, which can prove difficult when retaining clients. Your patients may look at competing businesses, and you will have to spend double the amount of time to attract clients back! Privacy should be the highest concern when it comes to your business, so you can continue with smooth operations and prioritizing patient care.  
• Loss in revenue - If you fail to comply with healthcare security standards, you may have to cease operations in part, or entirely. Temporarily disabling business processes can restrict income, and thus increase overhead costs. For practices facing significant data violations and breaches, the large incurred costs make it difficult for businesses to recover, with fewer finances to be able to invest in medical services and equipment. This means the quality of service can also decrease, which can have devastating effects on your patients.   
• Loss in productivity - Productivity can also decrease if you breach particular security guidelines and compliance standards, as you may need to halt production, or disable areas of operations. Restricting output, labor, and working capacity mean you can’t treat as many patients as your resources allow.  
• Reputation damage - Above all, failing to comply with regulations can cause distrust amongst your patients, and can damage your reputation, which can be incredibly difficult to fix. Depending on the size and impact of your violation, this could be permanent, where your ability for patients to trust you is irreparable. This restoration process could take a long time, so it is important that you consider your impact on clients at all steps in the business process.

HIPAA violation tier

To reinforce the consequences that can occur when failing to comply with HIPAA standards, it is important to acknowledge the four tiers of penalties. These four tiers outline the financial repercussions that any security offense may incur, and taking note of these will ensure that you are aware of the penalties concerning violations. 

Tier 1

As the lowest level, this tier usually starts around $100, depending on the number of patients involved, and is the smallest penalty you can incur. At this tier, the individual cannot have been aware of the violation they committed.

Tier 2

While this also depends on the number of patients involved, this tier recognizes that individuals do acknowledge a degree of awareness when it comes to HIPAA regulations and standards. However, because they do not act with gross negligence, these costs start at around $1000, and don’t reach higher than $10,000. 

Tier 3

Employees knowingly commit a HIPAA violation, but also make a correction within 30 days. This must be made promptly to minimize penalties, as, at this level, violations start at around $10,000.

Tier 4

Beginning at $50,000 per violation, and with the potential to reach up into the millions, this is the most costly tier. The employee charged is acting with purposeful negligence, and does not correct their violation, which can cause immense damage for your practice; both financially, and concerning your reputation. 

‍Creating a culture of compliance within healthcare

To prevent extensive HIPAA violations and penalties, it's important that you create a culture of compliance within the workplace, so all employees are aware and up-to-date on security standards. This way, you can ensure that your employees follow and adhere to regulations to ensure that patient privacy is prioritized, and that you fulfill legal obligations concerning federal and state laws. Doing so will significantly reduce the risk of fraud, hacking, and other security breaches that can massively disrupt the operations and success of your practice. To avoid negligence, your staff need to be aware of how to recognize and report suspicious activity, as well as create a culture where employees feel safe to reach out and communicate if needed. Investing in healthcare compliance software is a good way to encourage a culture of compliance.

Considering that the healthcare workspace deals with highly sensitive medical information, it is highly important that you implement security measures within all business processes. Insurance providers often require the medical information you store, so with high transferability and verification levels of information, it is of utmost importance that you uphold compliance values. This means that only authorized users should have access to relevant medical records and history, and that encryption services are incorporated at each step along the way. All businesses, regardless of their size, must implement compliant processes as part of the healthcare governance, risk management, and compliance (GRC) act. No business is exempt, and your patient data should be regularly monitored and stored whenever possible.

In order to create a compliance culture that can properly handle security procedures, it’s important that you consider the following factors. Incorporating these can drive your business to success, as well as meet your patient needs. 

• Educate - The most important step to establishing a solid foundation when it comes to compliance, is making sure that your employees are aware of security procedures, as well as what happens in the case that they are violated. This can be accomplished through a variety of different methods, including providing the relevant resources to reduce the likelihood of negligence charges. Through a committed team dedicated to healthcare compliance, compulsory programs to ensure that your staff are qualified, or simply having physical resources that staff can use; it’s important that you incorporate a way to clearly convey the significance of compliance. 
• Quiz your employees! - Sometimes it’s good to use surveys to evaluate your staff’s knowledge of compliance, and to establish a baseline of what the current state of affairs is when it comes to security in the workplace. You can assess how comfortable employees are when reporting information, whether they know the right procedures to use, and how they typically go about security measures. This is a great, non-invasive way to gauge your employees’ knowledge and, as well as shedding light on areas that can be improved going forward.
• Campaign - Don’t shy away from clarifying compliance policies within your workplace through common marketing strategies. Sometimes, sending posters and emails is all that’s needed when it comes to reminding staff about their security requirements. 
  

‍Basic compliance reporting steps

When it comes to healthcare compliance, it can be tricky to understand what is considered an offense, and when dealing with highly confidential patient information, you definitely don’t want to overstep. As a result, we have compiled a few simple tips to help simplify the reporting process, and to help you recognize and work through the complexities of compliance. 

• Stop! - If you have a suspicion that you’re participating in the harmful activity, or that it is a violation of compliance in any regard, it’s important that you stop immediately. This is to ensure that you don’t complicate matters further, and can potentially save your practice from thousands of dollars in penalties and financial losses. 
• Speak up - If you’re uncertain, it’s best to speak to a supervisor or manager who is in charge to ensure that you’re not violating any security standards. It’s always good to double-check, and if you’re ever unsure, asking someone is the best way to make sure your concerns and queries are directly addressed. If speaking to a compliance officer specifically, your questions can’t be exposed, as your privacy is secured through legal binding. 
• Get external help - Sometimes internal help doesn’t work, and compliance officers, fellow practitioners, and other employees aren’t enough, which is okay! You may need to resort to external organizations such as the Department of Health and Human Services, the Officer of Inspector General for Medicare and Medicare issues, or an ombudsman. 

Keeping up-to-date with regulations

Healthcare compliance guidelines are widely known for their complexity, due to their ever-changing nature. New technology is continuously being developed, and the healthcare landscape is forever evolving as it adapts to new forces. You want to ensure that you stay on top of healthcare regulations to avoid dealing with security breaches that can jeopardize private information, and put your practice at financial risk from HIPAA penalties and fines. One violation is difficult to contain, let alone dealing with multiple, and so to protect yourself, you must make an effort to be knowledgeable about relevant legal laws and standards. 

• Have experience - Having experience in either the public or private policy sector is always a benefit, as it ensures that you are more equipped to handle various security breaches. If you have experience within the loss prevention and strategic management sector, this is even more beneficial as it can make dealing with compliance much easier. 
• Equip the right skills - You should have the ability to employ the right agile workstyle tools, including healthcare compliance software, and be able to easily pick up practices and apply them in a correct context. The rightly developed skill set should enable you to identify suspicious activity more quickly, and honing in on these skills encourages greater detection. It allows for an innovative and intuitive perspective when it comes to healthcare compliance.
• Have the right credentials - Sometimes employing relevant backgrounds and qualifications is the best way to fulfill legal obligations and standards, as it ensures that you have a theoretical understanding of security, and can approach situations with a critical lens.  

Top compliance mistakes

When it comes to playing your part in healthcare, it’s important that you take note of the common mistakes so you know what to avoid in your practice. This way, you can prioritize patient needs, and ensure that medical data is kept private, and at minimal risk of fraud, security breaches, hacking, file corruption, and any other security-related issues. 

• Unrestricted access - If access isn’t restricted, information can easily be shared between the wrong people and end up in the wrong hands, which may prove difficult to manage. Large violations of HIPAA privacy laws can damage your reputation, and if found fraudulent, patients may lose trust in your services which can be challenging to rebuild. Only the patient and specific authorized users should have access to certain information.  
• Insecure provider use - Despite their claims, many software platforms aren’t 100% HIPAA compliant. You need to ensure that the provider you go with actually assesses patient needs, with a proper security system in place to protect hacking and data leakages. They should have clear and accessible compliance practices that they abide by, and that anyone can view. 
• Lack of risk assessments - To better safeguard your financial and medical information, you need to conduct risk assessments to examine any vulnerabilities and weaknesses. This is an easy way to patch up any holes when it comes to data leakages and ensures that you are always prioritizing patient needs with secure locks on medical information. 
• Lack of training - Healthcare staff must know how to manage sensitive information in order to provide high-quality care to patients, and to avoid costly HIPAA violation penalties. Most errors when it comes to HIPAA compliance are human ones, and as a result, training staff is one of the most effective ways to minimize risk. 
• Releasing information without warning - You must be cautious about who you share data with, as patient information is highly classified and only specific users have access to it. 
• Non-Attendance - All patient information should be monitored constantly to minimize theft and fraud, as well as the viewing of information by unauthorized individuals. 
• Disclosure concerns - Patients must be able to request and have access to a copy of their medical records, as part of their rights to autonomy.

Top compliance practices to avoid mistakes

Now that you know common mistakes within healthcare practices when it comes to compliance, it’s important that you recognize how to overcome these pitfalls, and dodge high violation costs. Being educated about practices that you should be implementing will allow you to effectively safeguard your business and patient data. 

• Training and education system - Make sure that your employees are all up-to-date with compliance and security measures, and that they know how to handle breaches and safety issues. Part of this process may involve implementing ongoing training to foster a culture of compliance, or providing additional resources for staff to view and assess when needed. Because you’re dealing with highly sensitive medical data it’s important that you ensure you and your staff are educated on how to approach compromising situations, and how to avoid costly penalties. 
• Restricted access - Make sure that only authorized users have access to the relevant, specific information that is needed. This can minimize the risk of information ending up in the wrong hands, as well as ensure that everything is contained within the confines of your practice. Simply restricting access to a few users can dodge costly privacy breaches and data leakages that could severely damage your reputation.
• Risk assessments - A vital component of compliance practices is to conduct regular risk assessments that analyze various aspects of your business to ensure your security standards are up to scratch. Risk assessments are the easiest way to perform an overall review to identify strengths and weaknesses that may need maintaining or developing and allow you to further your practice with the needs of patients prioritized. 
• Research into providers - Every healthcare software platform offers a variety of different features, with some proven to be more useful than others. You must take the time to research your options when it comes to choosing a provider, as not only do you need to be able to carry out essential business processes, but the software must also comply with legal obligations and regulations. Spending additional time on this step can prevent complications in the future, if your software is found unsuitable. 
• Compliance officers - It can be helpful to hire a designated compliance officer that directly reports to the senior position of the healthcare practice, or have a compliance committee. Having specialized job positions means there is always someone to regularly monitor security protocol and any activity concerning privacy, and employees are stuck, they know a direct route for help. ‍
• Reporting hotlines - Despite protection laws in place, some employees don’t always feel comfortable reporting suspicious activity for fear of job loss or other consequences. A reporting hotline is a great way for employees to continue monitoring activity without shame, as its anonymity allows for a high level of confidentiality. Any client questions can also be answered at any time, with the specific hotline designed for the exact purpose of fulfilling security-related queries. ‍
• Written policies - Your practice should have a clear set of outlined policies pertaining to your healthcare compliance processes and standards. As a code of conduct, they should also detail and outline the operations and structure concerning compliance to convey a high degree of transparency. Anyone should be able to view and assess the steps you’re taking to overcome and oversee security issues, and at one glance they should be able to recognize the care you take towards patient security and data.  ‍
• Disciplinary policies - It’s important to acknowledge the individuals who do commit unlawful or criminal activity, and that they are aware of the consequences that follow such partaking. These should be clearly outlined, and consistent across the organization. There should also be varying degrees of disciplinary policies, with termination considered for more serious misconduct. Performance reviews can aid in the evaluation process of whether individuals have breached compliance practices. ‍
• Install security updates - Although somewhat of an obvious point, you need to make sure that you have the latest security updates across all of your software to protect against potential hacks and data leakages. As technology develops, hacking processes become much more sophisticated, and so it’s important that you have the right defenses to be able to accommodate such advancements. Security updates, and software such as anti-virus and malware defense, are some of the easiest ways to screen out most malicious security breaches.  ‍
• Good password management - All devices should have different passwords that fulfill the criteria for strong passwords, which significantly reduce the chances of hacking. This means including upper and lower case letters, in addition to numbers and special characters, as well as being all at a sufficient length. ‍
• Two-factor authentication - As an additional precaution, two-factor, or multi-factor, authentication processes are the easiest way to authenticate the identity of users. Having to pass multiple security measures can make things more difficult for unauthorized users wanting access.

Healthcare Auditing

What is it, and what does it look like?

Healthcare auditing is an excellent practice to incorporate into your healthcare practice, as it provides a detailed analysis of the standards you have in place. Because it can become complicated, and is one of the most used practices to combat healthcare compliance issues, we thought it best to outline the basics when it comes to auditing. You can ensure that your quality checks identify weaknesses that need addressing, as well as strengths that may need maintenance. Implementing good audits means you can increase your reliability and reputability when it comes to medical compliance, and you can avoid expensive HIPAA violations. 

Healthcare audits can look very different depending on the needs and goals of your practice, so it’s important to note the various types. Healthcare auditing is not exclusive to a particular form and can be conducted in any way that is appropriate to your business, with each type producing its own set of valuable insights. For instance, with a clinical procedure audit, you can assess and evaluate all medical procedures and processes to analyze clinical efficacy. You can also audit patient satisfaction through surveys to ensure that you are meeting patient needs and that your clients are happy with your services. After all, your patients are the driving force behind your success, and so you should be regularly monitoring their reception to your security standards, software, and overall interface. You can also audit annual performance, which is a great way to conduct an in-depth analysis that covers all bases, and highlights areas you should work on improving when it comes to security. It provides a broad picture that can help you see aspects normally missed, and with an audit of health delivery, you can also assess your practice against established benchmarks and recognized standards. This way, your practice can be evaluated on an international and local scale, and whether you’re satisfying the requirements of your business goals. 

Why is it important?

There are a variety of reasons as to why healthcare auditing is important for your business, including that it is a legal requirement. You must demonstrate some level of care management within your practice, and healthcare audits are the easiest way to remain compliant and improve patient care. You can systematically analyze strengths and weaknesses to make improvements, which can work towards improving clinical outcomes as a whole and increasing the quality of service you deliver. Making such improvements can result in higher attraction and retention rates when it comes to your patients, which can increase revenue. This steady financial stream can contribute towards more advanced medical technology and healthcare solutions, as well as more effective treatments. 

In addition to this, in the analysis of risks and opportunities within your practice, you can also use the data to identify and highlight trends. Using historical trends and quantifiable evidence, you can improve business processes to increase efficiency and maximize resources. Producing valuable insight can help you make informed and educated decisions when it comes to your patients, and you can also improve minor areas to smoothen the client experience. For example, using healthcare auditing, you can improve waiting times, as well as check-in interactions, which all contribute to improved patient impressions. Auditing also protects patient health within times of Covid, by ensuring that the right social distancing and hand sanitizing practices are in place, in conjunction with other virus management practices. This way, you can ensure that both you and your patients are protected when it comes to healthcare and that you’re both fulfilling legal obligations. 

How to prepare for a compliance audit

It’s important that you know what goes into preparing for compliance audits, as they can be lengthy processes, and it can be intensely frustrating to have to restart on the basis of misdoings that can be easily corrected. For smooth business operations, it’s vital that you spend time within the preparation process to avoid missing out on critical details. To help you, we’ve compiled the top 3 tips to effectively prepare for compliance audits:

1. Train staff - The easiest way to increase the likelihood of compliance audits going smoothly, is to assess whether your staff knows how to recognize suspicious activity and compliance violations. They should be well equipped to know who to report information to, and know exactly how to handle and adhere to security protocol. 
2. Perform internally - Internal audits are the easiest way to assess infrastructure and pick out inadequacies that can be used to improve clinical outcomes. They directly address what isn’t going well within your business, and what is booming, which is essential to elevating the quality of your service. 
3. Analyze policies - Perhaps the most core component, you must review compliance policies continually and iteratively to ensure they meet international and local standards. This is an easy way to provide high accessibility and HIPAA compliance. 

‍Essentials for healthcare compliant companies

When it comes to selecting a healthcare compliant company it’s important to take time evaluating and researching your options, as the consequences of failing to adhere to compliance rules can be pretty steep. It can involve fines, financial losses, and penalties, as well as license loss, in addition to all the other risks posed within our earlier discussion. Choosing the right software for healthcare compliance can be an easy way to avoid this, and sometimes resorting to external companies can prove beneficial as it cuts downtime and effort spent researching. 

• Customization - Having customizable software is great as it can allow you to tailor your business needs without compromising certain features. This means you can follow federal and state regulations, as well as ethical and professional guidelines, without concern over compromising, and that you can continue to reinforce and maintain your compliance policies.
• Easy navigation - It’s important that the software you choose is easy to use by all your staff as well as patients, regardless of their technical skills. This prevents any misconduct due to error, with everyone knowing how to utilize all aspects of your services. 
• High scalability - Your healthcare business should have systems that are compliant under both state and federal regulations, and should cover a variety of standards, such as HIPAA, OSHA, and fraud, as well as abuse laws. Within this, the software should have the capacity to expand and grow. Limiting features, that prove fruitless, means that your business may not be able to increase their compliance and scope of services, which is a significant con. 
• Regularly updated - Selecting a healthcare compliant company that continually conducts regular updates means that you’re using software with the latest defenses to combat potential security breaches. When choosing software, and relying on an external service, you’re essentially placing many responsibilities within their hands, so it’s of utmost importance that they also clearly evaluate their compliance obligations and policies. 
• Good documentation - Choosing a company that has a high integration of documentation features is essential for maintaining and establishing a sense of transparency within their company. This also makes things easier for when you conduct audits, as you can clearly see evidence of how your practice is staying compliant. 

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Healthcare trends and opportunities

Sometimes it can be easier to note the value of ideas when overseeing it in regards to the big picture, and healthcare compliance is no exception. With the rapid development of technology, compliance protocol and software are becoming increasingly commonplace, and as recent research suggests, these innovative trends are only expected to grow. To capitalize upon these opportunities, we have compiled some of the most up-and-coming trends that we highly recommend you take advantage of if you want to reap financial and organizational benefits within your healthcare practice. 

Artificial Intelligence and Machine Learning

Artificial intelligence (AI) is revolutionizing the healthcare workspace, as it allows health professionals to streamline their workspace, with an optimized workflow that boosts productivity and clinical outcomes. AI increases the accuracy and speed of business processes, and can save practices immense time and effort that can be used elsewhere. Because of their iterative learning processes, AI’s capabilities only continue to grow with their use and experience, which makes them an excellent asset to healthcare workspaces.  

Big Data

Within the context of your healthcare practice, big data refers to any medical data, concerning both past, present, and future. Big data can be used for predictive analytics, and can also help identify patterns and trends for you to improve and maintain. Doing so will produce immense growth and success within your business!

Cloud-based Services

Cloud services are essential to monitoring and securing highly sensitive patient information, and as a result, are becoming an increasingly popular option. Cloud-based services allow data to be stored in a remote location, improving accessibility, interoperability, and transferability across healthcare practices, whilst being highly secure with encrypted servers. 

Blockchain technology

Increasing accessibility, blockchain is also a highly effective way of preventing and combating data hacks and leaks by recording information in a way that makes it almost impossible to decrypt. Each block in a chain contains a specific number of transactions and is a shared, immutable ledger that works across numerous business networks. Although it seems complicated, all you need to know is that it is extremely effective in securing any information that needs securing. 

Using a healthcare compliance officer

A healthcare compliance officer is a great way to establish a dedicated individual to govern organizations when it comes to anything concerning healthcare compliance. Compliance issues can be dealt with effectively, with healthcare policies only needing to modify policies if completely necessary. A compliance officer may conduct the business paperwork, by organizing or storing documents that are commonly left to their own devices, and checking that all insurance paperwork supplied by providers is up-to-date, and are accurate. This may also mean looking after employment contracts, property agreements, and crisis management plans.

Healthcare compliance officers may work with digital security by also ensuring that you have high-quality and grade systems within the business, with established security protocols. All information should be highly protected with encryption, and training programs that may need to be put in place to ensure that employees are fulfilling such needs. The officers make great directors for such training programs, and can guide practitioners on how to avoid high-casualty mistakes, and reduce accidents. As the crux of the matter, it’s vital that compliance officers work to make sure that employees can appropriately handle digital security. In addition to this, healthcare compliance officers can effectively filter through and investigate relevant complaints regarding compliance and any security breaches. Practitioners don’t have to concern themselves with significant issues of which they have no expertise, or deal with situations with trivial outcomes. With anonymous reporting, compliance officers can analyze the issue at hand and make any amendments to regulations if needed. 

Healthcare compliance officers are a great asset to healthcare practices when it comes to maintaining and establishing a high degree of compliance. Their responsibilities can be summarized as the following five factors:

1. The quick implementation of effective policy changes
2. Minimizing the risk of security breaches
3. Incorporation of new systems adheres to compliance standards
4. Improving corporate compliance and accountability
5. Promoting compliance security management

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Fast Healthcare Interoperability Resources (FHIR)

Fast Healthcare Interoperability Resources, or FHIR, is the standard concerning the exchange of any form of healthcare electronically. It is an increasingly common practice, as the digitization of records has brought about immense growth in terms of the number of businesses using EHR systems, and so it is important to recognize the term. FHIR can significantly simplify the process of digital healthcare and increase interoperability, with effective transfers of medical data over various systems. It establishes a high continuity of care when it comes to clinical information and promotes effective communication. 

FHIR differs from most other methods of file transfer, as the resources have their own unique tag that serves as an identifier and allows for the synthesization of separate systems. All authorized users can have immediate access to the same information, without needlessly having to communicate back-and-forth continuously. Patients don’t need to log on to multiple portals to review medical data, rather, their records are available under one comprehensive document with all relevant information. This can significantly reduce the amount of time and effort spent when configuring different systems, and having to coordinate databases to examine documents. Simply, FHIR provides a way for data to be highly standardized, highly transferable, and presents a unified patient record. 

Business Associate Agreements

When it comes to healthcare, you should also be aware of business associate agreements. These are essential regarding outlined responsibilities of all parties involved in personal healthcare information, and it is vital to ensure that your private information is handled in an appropriate manner. Most platforms should require you to agree to a Business Associate Agreement, Privacy Policy, and Terms of Service so there is a legal contract concerning your use with the chosen software platform. 

Encryption requirements

As discussed, encryption plays a large role concerning healthcare and maintaining private medical records, and is an essential aspect of HIPAA compliance. It is the easiest and most effective way of protecting patient data, and minimizing the risk of hacks and data leakages, which can prove especially complicated if they escalate. With encryption, any medical text is converted into ciphertext, where the information is random letters, and only those with a unique key can decipher the code. According to HIPAA regulations, AES-256 is the recommended minimum encryption standard when it comes to protecting your data. This is the Advanced Encryption Standard (AES), as approved by the US National Security Agency (NSA) and works to protect most, if not all, patient information, and is the standard you must be incorporating within your security networks. 

To conclude

Healthcare compliance is a complex issue, yet a vitally important one for all healthcare businesses. Patient medical information is highly sensitive and private, so naturally, when managing and storing this type of data, you must take all the necessary precautions to avoid costly violations. Through our extensive guide, we hope you have grown in your understanding when it comes to prioritizing patient needs and protecting client information, as well as consolidated your knowledge when it comes to compliance and HIPAA guidelines. 

While there are nuances to the topic, it’s important to recognize that the best way to become acquainted with its services is to put it into practice, as there are a variety of resources out there to guide you. As a result, we have collated some further reading for you to check out below, if you’re interested in delving into this area of healthcare compliance any further. 

One healthcare compliance system for practitioners and their practices: Try Carepatron for free today!

• Why Is Health Care Regulation So Complex?
• Major Laws Related to Compliance
• Importance of patient adherence and compliance in the present day
• Strategies for improving patient compliance
• A Guide to Healthcare Compliance Regulations
• Core Elements of Compliance
• Current Challenges and Opportunities in Clinical Research Compliance
• Draft Guidance on Clinical and Patient Decision Support Software
• Common HIPAA Violations by Healthcare Employees
• Status, Challenges of Information Blocking Rule Compliance
• FHIR: Its components and approach
• Can America’s Healthcare Crisis Be Solved?
• To Future-Proof Healthcare, Collaboration Between The Public And Private Sectors Is Key
• How to conduct a clinical audit and quality improvement project
• Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology
• The Use of Technology and HIPAA Compliance
• Accelerated Cloud Adoption Driven by the Need for Compliance and Telehealth