In the healthcare industry, compliance is key. There are many complex topics that must be understood for a practice to remain compliant. And with constantly changing regulations, keeping up with the latest rules and regulations can be difficult.

With the U.S. healthcare industry valued at about US$17.03bn,  healthcare providers must ensure they operate within the legal and ethical boundaries of their respective jurisdictions. This guide explores the basics of healthcare compliance, plus essential tips for staying compliant. Here’s healthcare compliance 101:

Healthcare Compliance 101

Healthcare compliance is all about adherence to and implementation of federal laws, regulations, and guidelines in the healthcare industry. Read more on compliance laws here.

This set of policies, procedures, and processes help healthcare professionals:

• Protect patients’ rights

• Ensure the quality and safety of healthcare services

• Prevent fraud, abuse, and misconduct within the healthcare system

• Uphold ethical standards

Adhering to compliance standards reduces the risk of legal issues that arise from not following established guidelines. Non-compliance can also result in financial penalties, reputation damage, and compromised patient safety. 

How to Observe Compliance Regulations

Here are some tips to ensure your practice is compliant::

• Stay informed: Keep up-to-date with relevant laws, regulations, and industry guidelines that apply to your specific area of healthcare. Regularly review official sources, such as government websites and professional associations, to stay informed about any changes or updates.

• Develop compliance policies and procedures: Establish comprehensive policies and procedures that outline compliance expectations, processes, and responsibilities.

• Implement internal controls: Establish internal controls to mitigate identified risks and ensure compliance. This may include segregation of duties, access controls, regular monitoring and auditing activities, and implementing checks and balances.

• Conduct risk assessments: Perform risk assessments to identify potential compliance vulnerabilities and areas of improvement. Evaluate processes, data security, billing and coding practices, privacy measures, and other areas specific to your practice.

• Monitor and audit compliance: Regularly monitor and audit your organization’s operations to assess compliance. Conduct internal audits or hire external auditors to evaluate processes, identify non-compliance issues, and implement corrective actions where necessary.

• Provide training and education: Conduct regular training sessions to educate employees about compliance requirements, policies, and procedures. Training should cover patient privacy, data security, proper billing and coding, ethical considerations, and fraud prevention.

• Hire specialists: Designate a team to oversee compliance efforts within your organization. The practice management firm should have a thorough understanding of applicable regulations. They must be qualified and empowered to enforce organizational compliance standards and conduct audits. 

The Bottom Line

Healthcare compliance is a vital component of running a successful healthcare practice. It is necessary to ensure you meet regulations and keep up with the constantly changing landscape in the industry. Fill out the form below to learn how we can help you ingrain a culture of compliance in your organization.