This Q&A with compliance expert, Lisa Herota, RHIA, CHC, CHIAP, CHPS, CCS covers best practices for a data-savvy compliance leader. Learn about realistic compliance metrics and how to share them effectively. Read more about Lisa’s background and experience at the end of this blog.
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Revenue leakage from non-compliance with regulations exposes health systems to compliance risks and penalties. We’ve curated eleven resources to help compliance leaders be better prepared to guide alignment between regulatory compliance processes and revenue integrity goals.
Over half of all regulations deal directly with revenue cycle, billing and finance. Most providers still lack an effective system or process to monitor, assess, and validate compliance with those regulations. As a result, these organizations leave themselves open to significant risks, not to mention significant revenue leakage.
These resources are a great place to start learning more about the revenue angle of healthcare compliance.
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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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“Compliance in healthcare isn’t just about meeting regulatory requirements – it’s about protecting patients, maintaining trust, and ensuring operational efficiency. Too often, compliance is treated like a separate function and oftentimes a bit disconnected from department heads, operations and leadership.”
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“Being a healthcare compliance professional involves navigating a complex landscape where law, risk, operations, ethics and patient care intersect. These professionals play critical roles in preventing reputational and financial risks that could jeopardize their organization and its ability to serve patients effectively.”
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“Audit readiness in quality is no different than anything else – follow a pre-defined process to the letter, tweak it as necessary and continue to evolve it until it works for your organization. It’s not hard. People just panic because the auditor can shut them down. But you wouldn’t panic if you had a process to follow to minimize the damage.”
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“With regulations often spanning hundreds of pages, how can compliance teams efficiently manage the process without missing critical details?”
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“Enter the Regulatory Lifecycle Management (RLM) Maturity Model: a brand new framework that helps healthcare organizations assess their readiness to handle regulatory changes. ”
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“There’s another incredibly helpful resource that some might not be as familiar with: the list of services that Medicare Administrative Contractors (MACs) include in their Target, Probe and Educate (TPE) plan.”
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