How Healthcare Revenue Cycle Consulting Services Help Maintain Compliance With today’s complex regulatory requirements, compliance is more important than ever for healthcare organizations. That’s why leading healthcare organizations hire healthcare revenue cycle consulting services to help maintain compliance. Today, we’re explaining how consulting services like HMI Corp. help organizations maintain compliance at every level of a healthcare organization.
What is Healthcare Compliance? Compliance means meeting or exceeding the standards set for legal, ethical, and professional operation of healthcare organizations. Any organization handling electronic protected health information (ePHI) is required to maintain compliance by implementing appropriate processes, policies, and procedures.
Consulting Services Help Maintain Compliance in 7 Targeted Areas The Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG) have identified seven areas where healthcare organizations should focus for compliance. By focusing on these areas today, organizations can avoid healthcare issues in the future. An effective healthcare compliance program must, at the very least, address the following seven areas: •
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Development, distribution, and implementation of written standards of conduct and written policies and procedures that explain the organization’s commitment to meeting and exceeding legal and ethical standards of compliance Designation of a chief compliance officer and other appropriate committees and individuals dedicated to maintaining compliance at every level Development and delivery of effective employee education programs Development and maintenance of effective lines of communication for reporting of compliance concerns Development and implementation of an effective response system or discipline system when compliance issues are identified with specific employees Development of internal auditing and monitoring system to observe and maintain compliance Creation of appropriate response system to quickly fix detected compliance issues
Consulting companies – including HMI Corp. – can help organizations develop or improve all seven of these areas.
How Healthcare Organization Compliance Assessments Work A consulting company can perform a compliance assessment on your organization. An assessment determines where your strengths and weaknesses lie. Then, experts work to correct those weaknesses and improve those strengths. During an assessment, experts will answer all of the following questions:
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How does the healthcare organization collect, receive, store, and transfer data? What does the current security system cover? What does the current security system not cover? What potential threats or vulnerabilities could disrupt the organization? What are the chances of a threat being carried out against the organization? How much would an attack cost if an attack were to occur?
Healthcare Organizations Are Required to Conduct Assessments Annually Compliance assessments are not optional for healthcare organizations. The HIPAA Privacy Rule requires healthcare organizations to undergo assessments like the one above annually. Healthcare organizations must collect this information, then compile a report on their findings.
Common Compliance Changes Required for Healthcare Organizations Healthcare organizations have different compliance needs. Some of the most common areas of improvement required for healthcare organizations, however, include: Standardizing Policies and Procedures: Healthcare organizations may have a mess of policies and procedures for different departments. This makes things difficult for staff. It’s more than just a compliance issue – it can also be an efficiency issue. Standardizing password management, PHI storage and usage, encryption, privacy, and other elements can vastly improve compliance. Reviewing Access Control Clearance: Compliant healthcare organizations carefully limit access to sensitive files and patient data on the network. An assessment might recommend limiting access to data only to those who require data to do their jobs, for example. Contract Coding and Medical Coding Issues: Liability issues related to coding can be significant. Coding and reimbursement are so complex and vital that healthcare organizations devote significant resources to doing it correctly. Unfortunately, many healthcare organizations still expose themselves to liability with various medical coding issues. Claims Reviews: Many compliance issues involve problematic claims. This type of misconduct can be prosecuted civilly under the False Claims Act or under a range of criminal statutes – including healthcare fraud. Claims fraud cases are common targets for regulators and prosecutors, which is why it’s particularly important to review claims issues for compliance.
Good Compliance Saves Organizations Compliance is crucial in any industry, but it’s particularly important in the healthcare space. Every organization thinks they have good compliance standards until it’s too late. Order a compliance assessment from HMI Corp today and determine exactly how and where your organization can improve all aspects of compliance.
