Healthcare compliance teams do a lot of work that never fits neatly into a single report.
They monitor regulatory changes. They coordinate with departments. They investigate issues. They respond to concerns. They train staff. They track corrective actions. They prepare updates for leadership. They answer questions from auditors, boards, regulators, and internal stakeholders.
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When a new regulation or update is enacted, the clock starts ticking toward its inevitable effective date and another compliance deadline. Regulatory change management is a moving target with constant deadlines and uncertain task status.
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This is the first article in a series on medical necessity — an area that many compliance programs struggle with. In this piece, we explain the medical necessity compliance risk in general, while subsequent articles highlight specific examples of enforcement actions experienced by medical providers such as hospitals and health systems.
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The overwhelming pace and complexity of healthcare regulatory change have become so routine that the constant grind now poses a distinct risk to the organization it’s intended to protect.
Yet, many hospitals still treat regulatory change as a routine monitoring activity, failing to adopt the systems thinking and discipline necessary to truly mitigate the risk.
This article by a top healthcare compliance expert explains what it takes to make that transformation. (She also explains what spinach has in common with compliance risk assessment.)
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A good healthcare compliance program is all about reducing risk, both in patient care and in financial reimbursement. This detailed blog by compliance expert, CJ Wolf, will bring you up to date on the compliance risks associated with certain anesthesia services.
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In this blog, experts offer the real scoop on audit readiness in healthcare. Learn the unfiltered truth about compliance audits and what audit etiquette means. Get essential tips on preparing for audits, the role of healthcare compliance auditors, and what to do (and what not do) during an audit.
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A conflict of interest (COI) in healthcare occurs when a person or organization involved in medical decision-making, such as a doctor, researcher or healthcare administrator, has a secondary interest (financial, professional or personal) that could compromise or influence their objectivity and clinical judgment.
This secondary interest has the potential to affect decisions about diagnosis, treatment, or research in a way that’s not aligned with the best interests of the patient or public health.
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Compliance orientation educates new staff members about company policies, procedures, and various regulations that govern their specific roles. Ongoing compliance training ensures that as regulations evolve, all employees are appropriately educated on implications and requirements. Read on to learn what it takes to consistently hit the mark with all your compliance education.
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In Q3, the exclusion screening software glitched. It missed a monthly sync. Then a second. By the third missed month, the compliance officer dismissed it as “a minor lag,” promising the HR department everything would be rerun soon.
Unfortunately, even a seemingly small glitch can have major consequences for healthcare compliance.”
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