Last Updated | July 25, 2023
Most industries have a set of rules and regulations that the people working in them must follow. These rules and regulations are important to ensure that things run smoothly and effectively. Similarly, the healthcare industry has its own set of regulations.
Healthcare compliance can be defined and the process of following rules, regulations, and laws that relate to healthcare practices. Compliance extends to many areas including patient care, billing, and reimbursement, to name a few.
Healthcare compliance requires an institution to adhere to all of the requirements and rules applicable, which varies considerably depending on the kind of organization and the services provided by it.
The three main areas are: “Patient safety”: safe and proper medical care for patients, “Billing of services”: patients are not overcharged for medical services, and “Patient privacy”: information is confidential and not shared with anyone who is not supposed to see it.
Officers review inconsistencies concerning patient confidentiality, wellbeing, and payments. Compliance officers enhance the standards of the healthcare industry by protecting the confidential information of patients and co-workers and enforcing security.
Advantages of Healthcare compliance
Any company participating in healthcare programs must adhere to the standards, which can be hard to manage. By implementing an effective compliance program, a company can fulfill its legal obligations and also benefit from them.
An effective compliance program improves communication among healthcare providers. Companies stay organized when an effective database of documents and deadlines and a clear compliance manual is provided. It improves cooperation and communication.
With all the data in place, time is saved in searching for accurate documentation and answers when the time arises. It is easier to quickly and effectively address compliance concerns with the help of an efficient communications system.
An efficient compliance program enables thorough and prompt investigation of possible misconduct and establishes credibility among employees and peers. It prevents and detects unethical conduct, thereby reducing exposure to penalties.
The main benefit and purpose of healthcare compliance are to enhance patient care. Patient care boosts greatly when medical decisions are based upon proper and up to date clinical standards.
Healthcare professionals routinely gather, observe and access patient data. With high tech protection strategies, compliance officers ensure health records are kept confidential. This ensures that patient privacy is not compromised.
Healthcare compliance helps professionals and organizations to avoid issues with authorities. A successful
compliance program lowers the chance of the imposition of penalties.
A fruitful program also helps a healthcare institution or provider avoid liabilities or malpractice. It is less likely for a healthcare company or provider to be the subject of a malpractice claim if they follow clinical standards.
Healthcare professionals who understand compliance have a significant advantage in the field. People who fully grasp the complexities of compliance protocol and likely to become sought-after specialists, and can be recognized as experts.
Average healthcare workers have little knowledge of the complexities of compliance, but administrators that can communicate and competently execute protocols help to ensure quality in healthcare and the protection of patients.
Why Folio3 is your custom healthcare compliance partner?
Folio3 is a preeminent technology solution provider. It has the relevant expertise and the resources to provide its clients with industry-leading, efficient healthcare compliance management software for all kinds of Healthcare facilities.
Furthermore, Folio3 offers powerful software solutions that integrate a complete range of HL7 data integration and Interfacing Services. These services ensure effective communication, secure EMR/EHR services while simultaneously reducing manual data transfer. These services include real-life examples of integrated healthcare systems and streamline healthcare operations within such integrated setups. By providing robust HL7 integration and interfacing capabilities, Folio3 empowers healthcare organizations to achieve seamless data exchange, enhance care coordination, and optimize overall workflow efficiency.
Additionally, Folio3 offers COVID-19 compliant checklists. These checklists are made to the client’s preferences and are tailor-made to suit their needs.
Moreover, it automates workplace safety audits, sends health compliance violation alerts, and generates real-time reports. Clients can also upload documents, photo and video attachments.
Costs associated with healthcare compliance
The healthcare industry spends about thirty-nine billion dollars annually on the administrative aspects of regulatory compliance.
While agencies have put these regulations in place to ensure the very being of patients and physicians, they also have an extremely high cost for healthcare providers.
The cumulative cost of healthcare compliance for the average-sized hospitals is close to $47,000 per bed or $1200 per patient.
Code of conduct
In an industry such as healthcare, where trust and expectations are particularly high, it is necessary to be held to a higher standard, which is ensured by an organizations’ Code of Conduct, referred to as The Code.
The Code is an integral and essential component of the institution’s culture. A Code of Conduct encourages each physician, employee, stakeholder, or vendor to be aware of their actions and the possible consequences in the workplace.
The main values defined in healthcare providers’ rules typically are: To provide quality, cost-efficient, and medically necessary patient care, to be of service to the organization’s community, and to conduct organizational business with transparency and ethics.
Lastly, a healthcare company’s employees and institutions affiliated with it show ethical behavior by doing what is correct and reporting what is unethical. The values outlines in healthcare providers’ Codes of Conduct may vary.
Top 5 healthcare compliance consulting companies
HIIPA consulting companies consist of a team of compliance experts with a proper understanding of the legal complexities regarding compliance. Maintaining HIPAA compliance is vital to ensure the safety of patients and maintain standards.
The top five healthcare compliance companies include:
CynergisTek is top cybersecurity and information management company. It provides compliance services, cybersecurity, solutions, and privacy, primarily to the healthcare industry.
CynergisTek has formed a partnership with many healthcare organizations within the industry. Furthermore, it has been recognized as an industry leader and has been named as the best performing firm of healthcare cybersecurity.
Colington Consulting Offers a wide range of services for all types of healthcare companies to meet regulatory HIPAA requirements and address all these situations and more.
It has around sixty years’ worth of experience in law enforcement, healthcare policy writing, risk management, and regulatory compliance. Colington Consulting also has an extensive understanding of compliance regulations.
Clearwater Compliance was established in 2009. It manages more than four hundred customers with all of their compliance needs and cyber risk assessment. It has become the industry leader in healthcare cyber risk management and compliance software.
Its cyber risk management software allows customers to limit the chances of a breach, meet HIPAA requirements and conserve time and resources. Moreover, Clearwater Compliance assists with HIPAA policies and regulations, procedure development, and trains healthcare providers as well.
EnviroMerica is a family-run company, founded in 1999. The team has over eighteen years of experience in consulting. It streamlines the process of compliance and waste regulation for healthcare workers. Furthermore, its main aim is to make it easier for organizations to stay HIPAA compliant.
InCompliance has a team of attorney and non-attorney advisors with vast practical experience, hence allowing their team to have a distinct and proactive approach.
This enables the team to better understand the complexities faced by their customers during the execution of a HIPAA compliance program. Customers face lesser investigations and those too are dealt with promptly.
To conclude, a healthcare compliance program is vital to maintain a high caliber of patient care, and to establish an effective system that prevents misconduct, enforces government rules/ regulations, and provides the best possible patient care.
Q ) What is HIPAA?
Ans) HIPAA (Health Insurance Probability and Accountability Act) is a US law designed to protect patients’ medical records. Furthermore, it provides privacy standards to healthcare institutions and physicians.
Q) What are Healthcare corporate compliance programs?
Ans) Corporate compliance programs cover both internal policies and procedures as well as laws and help to detect contravention of rules and regulations.
They protect the organization from lawsuits and fines. Corporate compliance companies can recognize problems promptly and enable an organization to take responsibility to avoid fines/ penalties imposed by the government.
Q) How can compliance programs help a healthcare organization?
Ans) Compliance makes sure that institutions uphold their legal/ ethical responsibilities. An effectual compliance program optimizes billing and reimbursement, increases awareness in the entire institution, and promotes employee communication.
An effective compliance program may lessen imposed fines or penalties for any disorderly conduct in the event of an audit. Most importantly, it ensures the protection of data without compromising patient care.