7 Important Areas of Compliance in the Healthcare Industry

Posted on 31st July 2023

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Healthcare compliance is a facet of the healthcare industry that ensures patient well-being and health institution integrity. 

It covers a broad spectrum, including adherence to laws and regulations, ethical standards, and internal procedures, to maintain a safe and effective healthcare environment. Here are seven crucial areas of compliance in the healthcare industry and why you need them. 

Our guide will help patients and healthcare providers to better understand their responsibilities, rights, and the steps they can take to ensure compliance – ultimately leading to improved patient care and operational efficiency

1. Billing and Coding Compliance

Billing and coding compliance is one of the most critical areas of healthcare compliance. Incorrect coding can lead to overbilling or underbilling, placing providers at risk for fraud charges. 

Providers should use codes that accurately reflect the services they offer and keep updated records about the care given. 

To ensure billing and coding compliance, it’s essential that healthcare providers have adequate documentation, maintain accurate records of services provided, and ensure proper training for their staff on coding practices – all of which is easy with the right Revenue Cycle Management Guide.

2. HIPAA and Patient Privacy Rights

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that establishes patient privacy rights. It requires healthcare organizations to secure confidential health information (PHI), including electronic, paper, and verbal records related to patient care. 

Healthcare providers must adhere to HIPAA regulations by taking necessary measures such as storing PHI in secure locations and providing employees with training on proper security and privacy protocols.

3. Fraud, Waste, and Abuse Control

Fraud, waste, and abuse should be minimized. This means having policies and procedures to detect and prevent fraudulent activity. 

Healthcare organizations should also have a system in place to detect and address billing errors or overpayments due to incorrect coding and establish processes for the proper documentation of services rendered. 

By implementing robust systems for monitoring and auditing, healthcare providers can reduce the risk of fraud, waste, and abuse.

4. Quality Improvement Programs

Quality improvement programs are designed to ensure that organizations maintain high standards of care. 

Initiatives should include measures such as developing goals for patient outcomes, monitoring performance indicators, collecting data on process improvement efforts, conducting staff surveys, and using patient feedback to inform improvements. 

Quality improvement programs help ensure that healthcare providers meet their commitments and provide patients with the best possible care.

5. Environmental Health and Safety Regulations

Medical professionals must maintain a safe and healthy working environment by following all applicable state and federal laws. 

This includes ensuring proper storage of hazardous materials, providing safety equipment to safeguard staff from workplace hazards, implementing emergency procedures, and adhering to infection control protocols.

6. Infection Control Compliance

Infection control compliance is all about adhering to stringent protocols, including hand hygiene, proper cleaning and disinfection of patient care areas, using personal protective equipment (PPE) when needed, and following standard precautions for handling infectious materials. 

Organizations should also develop strategies to ensure that staff are trained on infection control practices and that staff compliance is monitored regularly.

7. Labor Law Compliance in Healthcare

Employees in the medical field take care of patients. But who takes care of the workforce?

Labor law compliance protects the rights of healthcare workers and ensures equitable working conditions. 

Healthcare organizations must comply with all applicable labor laws, including those related to wages, hours worked, overtime pay, vacation and holidays, termination procedures, payroll records, employee benefits, discrimination and harassment prevention policies, and workplace safety regulations.

Conclusion

Compliance in the healthcare industry is a multifaceted endeavor, encompassing a wide range of areas. 

Each aspect plays a vital role in ensuring safety, quality, and ethical conduct in healthcare provision. Adherence to these regulations safeguards healthcare organizations against potential legal liabilities and builds trust among patients and stakeholders. 

Achieving comprehensive compliance requires continuous effort, monitoring, and education. As the healthcare landscape evolves, so too must our commitment to upholding these crucial standards, in pursuit of the ultimate goal – the well-being of patients and the broader community.