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An Ounce of Prevention: Why Compliance in Healthcare is More Important than Ever

| October 9, 2019

An Ounce of Prevention: Why Compliance in Healthcare is More Important than Ever

Compliance around medical laws and regulations is top of mind for healthcare practices now more than ever. Over the years, more and more regulations have been put into place, and it can feel nearly impossible to keep track of them all.

To operate a successful practice, it’s crucial you remain educated and compliant. By outsourcing some of this, you can better focus your energy on patients rather than cutting through bureaucratic red tape.

Among the most important issues in today’s world is to stay vigilant about HIPPA compliance; fraud, waste, and abuse as they relate to coding and billing; cybersecurity concerns around Electronic Health Records; and staying compliant with the Affordable Care Act. We’ll take a closer look at each of these issues and how Med USA can help you remain at the top of your game while keeping regulators happy.

Fraud, Waste, and Abuse

Don’t let the term “fraud” mislead you. Many cases of improper billing through the wrong codes is unintentional. Unfortunately, healthcare practices pay the price either way. Waste and abuse also fall into this category, with some practices inadvertently overusing resources or accepting payment for services not provided.

This is also an issue for Advanced Practice Providers, including physician assistants and advanced practice registered nurses. Because this is a rapidly growing area of medicine, it’s vital that billing and coding are performed correctly the first time to avoid regulatory stumbling blocks. Med USA can help your office detect incorrect practices that might lead to costly fraud, waste, and abuse charges by assessing your current compliance efforts and auditing your billing practices.

HIPPA Compliance and Cybersecurity

While it has proven to be an excellent way to protect sensitive patient information in the digital age, the Health Insurance Portability and Accountability Act (HIPPA) of 1996 also presents a host of challenges for healthcare providers. As many practitioners will attest, it’s no small feat to protect private data as technology progresses.

Additionally, as the Internet of Things expands to include personal fitness trackers and other health-monitoring devices, the potential for security breaches that expose patient data increases every day. Med USA can assess your policies and procedures related to HIPPA and help spot any potential problem areas before they develop. This includes the way practitioners handle sensitive data, regardless of whether it’s stored on premise, in the cloud as an Electronic Health Record (EHR), or even a seemingly innocuous social media post by a staff member.

If needed, we’ll help update your policies and procedures to be inline with HIPPA and other healthcare-related regulations, such as the Affordable Care Act. We’ll also support you with incident management should you end up violating HIPPA or experience a data breach.

The Price of Noncompliance

As mentioned, not all acts of noncompliance are intentional. Regardless, stiff, potentially career-ending penalties can result from such actions. For instance, under the False Claims Act, incorrectly coded line items can result in fines up to $11,000 each plus three times the amount originally billed for. This, coupled with being barred from serving certain patients, can result in well-meaning physicians losing their ability to practice. Suffice it to say, in some areas of practice, this would be devastating not only in lost revenue but in the eroding confidence of patients who might leave the practice.

HIPPA violations can carry criminal charges with up to 10 years in prison and fines of up to $50,000. And that’s per violation. Typically, when HIPPA is violated, it’s done so on a larger scale than just a single error. In most cases, multiple violations are found, particularly in a cybersecurity breach, which is why outsourcing your compliance is critical in today’s legal climate.

Outsourcing Your Practice’s Compliance Needs

We want to be your healthcare practice’s compliance department, or at least a powerfully supportive extension of your existing compliance department. If there is a breach or regulation violation, we run it through a meticulous, technology-driven breach analysis process and help determine whether incidents needs to be reported or corrected. We’ll support you every step of the way, from initial detection of a problem to its full resolution, through new and better policies and procedures. And because we’re current on the ever-changing laws and regulations for medical practitioners, we offer training for your staff along with informational newsletters that share the latest changes in the law and how they impact your practice.

Ultimately, the physician’s job is to heal patients and make their lives better, not to spend time dealing with the minutiae of red tape. By working with Med USA, healthcare practitioners can get back to doing what they do best: caring for those most in need.

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