Big Business and Corporations

Regulatory Compliance in Healthcare Organizations



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Technological advancements keep on infusing and transforming every facet of the society today, and the healthcare sector is no exception. Although some people argue that technology in healthcare is sluggish, patients, consumers, and providers can now enjoy the benefits of the technology thanks to the solutions provided by regulatory organizations. Being a company leader in the healthcare industry, it is your responsibility to ensure you comply with the set regulations. Compliance helps you recognize, prevent and address all the risks associated with keeping your patients’ electronic health records.

This post will outline the key details you need to know about healthcare regulatory compliance.

What Is Healthcare Compliance?

Have you been wondering what healthcare compliance is and if it’s important? Well, this is the ongoing process that entails meeting or surpassing the ethical, legal and professional standards in a given healthcare organization. Healthcare compliance requires all healthcare organizations and service providers to adopt effective policies, procedures, and processes and adhere to them. Some areas healthcare compliance covers include patient care, managed care contracting, billing, and payments.

There are two key healthcare compliance bodies namely:

Health Insurance Portability and Accountability Act

The HIPAA was founded in August 1996, after being passed by the Congress. Their job is to guard the confidentiality of personal medical records, ensure insurance holders aren’t victims of fraud and reduce the administrative expenses of healthcare service providers. The rules apply to any healthcare service provider who transmits records and health plans electronically.

Health Information Technology for Economic and Clinical Health Act

The HITECH is tasked with advancing the data security measures that the HIPAA framework enacts. They focus on improving the security of patient’s health records during transmission and preserving electronic information. Other than HIPAA, HITECH also modified the Social Security Act.

Differences between HIPAA and HITECH

Although there are many similarities between HIPAA and HITECH, they differ on numerous critical details. HITECH may have extended HIPAA, but HIPAA still focuses on privacy and breach notification, protecting against identity theft and fraud.

HITECH, on the other hand, differentiated itself from HIPAA by creating updated criminal and civil compliance penalties. They also extended breach notifications requirement beyond integrated business associates and covered entities.

Lastly, it’s the responsibility of compliance manages to ensure that patient data, whether it’s stored or being transmitted, is encrypted effectively. Encryption makes the data unreadable, meaning your organization might not be penalized. Remember your firm can only prove the data is effectively encrypted if you comply with NIST Federal Information Process Standard.  Therefore, you must understand your company’s information technology architecture to succeed in healthcare regulatory compliance.

Reasons Healthcare Regulatory Compliance is Essential

The primary benefit and purpose of healthcare compliance is improving patient care. Your organization will improve patient care when healthcare decisions are based on current and appropriate clinical standards. Decisions based on improper motives do not result in the provision of quality care.

You will avoid trouble with the relevant government authorities through healthcare compliance. By having an efficient healthcare compliance program, it will be easy for your firm to identify issues and find solutions before the problem is found by a government agency. Effective compliance programs also mitigate the burden of financial penalties or sanctions that may be imposed on healthcare providers or organizations.

Healthcare compliance will also help you avoid liability for malpractice. If you always follow the best clinical practices, the chances of being subjected to malpractice claims reduce.

How HITECH’s Compliance Will Affect HIPAA Business Associates

To be compliant with healthcare regulatory, you have to understand how information is shared between business associates and how this impacts the entire supply chain. A Business Associate can be defined as an entity or a person who offers services to or implements activities or functions for a covered entity. Traditionally, the definition of business associates brings healthcare plans, healthcare management companies, and healthcare reimbursement organizations under HITECH and HIPAA. But, additional services can also be integrated under the compliance requirements if you work with Medicaid. Although a business associate is only a service channel to the core entity, the information they collect shouldn’t violate the set HIPAA and HITECH regulations.

What the Board of Directors Needs to Know

If your organization plans on shifting to the healthcare sector, make sure your Board of Directors recognizes all the compliance implications. The board also needs to understand the role they play in the supply chain should the company choose to incorporate vendors and healthcare providers as part of the business plan.

The board should always act independently especially when reviewing HITECH and HIPAA. This helps them access the risks involved and design critical measures for safeguarding the company.

You can only earn your patients’ trust, keep their records safe, and maintain your firm’s reputation if you observe the regulations set by healthcare regulatory bodies.

 

Author Bio

Ken Lynch is an enterprise software startup veteran, who has always been fascinated about what drives workers to work and how to make work more engaging. Ken founded Reciprocity to pursue just that. He has propelled Reciprocity’s success with this mission-based goal of engaging employees with the governance, risk, and compliance goals of their company in order to create more socially minded corporate citizens. Ken earned his BS in Computer Science and Electrical Engineering from MIT.  Learn more at ReciprocityLabs.com.