Healthcare Compliance: How to avoid the HIPAA police and other scary fines

Compliance — or, rather, not in compliance. It doesn’t matter what the business is, when you’re not in compliance, it can be a big red flag for your company.

Healthcare compliance and regulatory management often feels like a game of Whac-A-Mole, with new risks or rules popping up every day. And given the current state of politics and regulation – or deregulation – it may feel like you need a time machine to ever get ahead of it.

That’s why healthcare compliance is an integral part of every practice. That’s why at Med USA, watching government enforcement actions can be almost as good as a time machine — without the costs.

Trends that we have observed and which look likely to continue through 2019 and beyond include:

• HIPAA enforcement going beyond simple program existence to auditing and monitoring effectiveness.
• False Claim Act actions, including medical necessity documentation and whistleblower suits.
• Cybersecurity and breach incident management.
• Opioid prescription patterns.
• Physician compensation agreements that run afoul of Stark and Anti-Kickback rules.

In addition, there are great opportunities and new risks presented by MACRA (Medical Access and CHIP Authorization Act of 2015), value-based payment arrangements, telemedicine, AI, and digital therapeutics, to name a few.

If you have not reviewed your compliance efforts recently, particularly when it comes to some of the hot topics listed above, you need to immediately! Making sure that your HIPAA security risk assessment is current is vital to your practice’s viability. In addition, consider penetration testing to address any cybersecurity vulnerabilities, implement regular audits for chart documentation and prescription patterns, provide regular compliance training to all staff members, and encourage open communication about any concerns and questions.

The biggest hurdle when it comes to healthcare compliance is making sure you have effective compliance processes in place, then maintaining and monitoring them. Over many years, Med USA has developed effective, functional processes that make compliance work for us. As a healthcare revenue cycle management company with our own fully-developed compliance program, we understand the push-pull relationship between managing risk and getting work done. Staying on top of changing regulations and their application to your practice can feel like a time-consuming, sometimes frustrating, process with little reward. But the penalties are too high to ignore.

We know that it can be hard to find the time and staff resources to dedicate to these necessary healthcare compliance efforts, but that is where Med USA can help. After all, it’s one of our core areas of expertise. Contact us today to learn how we can help your practice maintain healthcare compliance standards.