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Healthcare Compliance

Healthcare Compliance | Healthcare and Technology news | Scoop.it

Developing a comprehensive compliance program is no longer optional for healthcare providers. Successful Compliance programs provide protections for provider entities, and patients alike. There is no single “best compliance” program. Providers with limited resources must still develop and maintain an active compliance program. Larger organizations may have entire departments dedicated to maintaining compliance standards. Healthcare providers compliance programs should be customized to each entity, based on the identifiable areas of risk. The OIG adoption of the underlying principles to provide a baseline of compliance structure that can be adjusted to the specific needs of the organization. At a minimum compliance programs should:

  1. Establish clear internal guidelines in the form of published policies and procedures relative to billing, staff behavior, and patient protections.
  2. Provide an atmosphere in which employees are free to report potential compliance issues in an unfettered risk free environment.
  3. Identify a Compliance Officer who maintains overall responsibility for the entities compliance and reporting processes.
  4. Establish strict management and control over protected patient health and financial records.
  5. Ensure technologies are in place to monitor compliance efforts and programs with the organization.

Creating Compliance Programs

Compliance programs impact the entire spectrum of a facilities financial and clinical operations.  As such it is important to develop an appropriate structure of policies and people to administrate, provide advice and ensure adherence to published compliance regulations.  Creating a compliance structure will not eliminate Audits, but can provide additional levels of protection for the providing facility.  Identifying the correct staff to implement the compliance program is the first of several steps.  Developing a compliance structure includes adherence to CMS billing standards, coding accuracy, and accurate translation of health records to the Revenue Cycle solution.

Maintaining a Compliance Program

As regulations change, facilities must adapt and evolve their internal governance processes.  Billing regulations change frequently requiring providers to stay on top of the latest software revisions, as well as monitoring the changing “code sets” that enhance the billing process.  A good compliance program will include a clearly defined process of systems maintenance and staff re training.  Staying current on the latest compliance trends is an integral part of any compliance program.

Compliance Audits

Compliance audits are among provider’s most stressful activities.  As such providers must have a clearly defined audit process.  The process must include timely provision of requested patient records/charts that are fully completed, uniform in presentation, and clearly and consistently labeled.  Having a solid compliance program in place and in practice will prepare a client well for any audit activity.

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Big Data in Healthcare: A Cause for Concern?

Big Data in Healthcare: A Cause for Concern? | Healthcare and Technology news | Scoop.it

A federal advisory panel has kicked off discussions about the privacy and security challenges related to the use of big data in healthcare, with a goal of making policy recommendations in the coming weeks.


During the Jan. 12 meeting of the Health IT Policy Committee's Privacy and Security Workgroup - formerly called the Tiger Team - members began sorting through a number of key big data themes that emerged from two public hearings the group hosted in December. The workgroup and the committee will make recommendations to the Office of the National Coordinator for Health IT, which could ultimately lead to new policies from the Department of Health and Human Services.


Last month's hearings included testimony from a number of stakeholders from various segments of the healthcare sector. For instance, testimony highlighted that while analyzing big data can bring big potential benefits, including better treatment outcomes and lower costs, it also can bring privacy risks to individuals, says workgroup Chair Deven McGraw, an attorney at the law firm Manatt, Phelps & Phillips, LLP.

The workgroup will now help to assess whether the nation has the right policy framework in place "in order to maximize what is good about what health data presents for us, while addressing the concerns that are raised," McGraw says.

Big Data Challenges

Big data concerns that emerged from the hearings in December included whether various "tools" that are commonly used to help protect an individual's health data privacy are sufficient, given the complexities of various big data use cases, McGraw says.

Those "tools" include data de-identification methods; patient consent; transparency to patients and consumers about how their data might be used; various practices related to data collection, use and purpose; and security measures to protect data.

Other concerns arising from the testimony that the workgroup plans to dig into relate to the legal landscape, such as whether there are regulatory gaps in HIPAA and other laws regarding keeping health data used for big data analytics private.

The workgroup, which will continue its discussion on Jan. 26, will also consider the harm that could be caused if big data is not kept private, including discrimination, medical identity theft, and mistrust of the healthcare system.

In early February, however, the workgroup will temporarily shift gears to discuss ONC's 10-year interoperability roadmap, which is expected to be released in late January. The roadmap will focus on secure health data exchange.

Nevertheless, the workgroup hopes to hammer out some preliminary findings or early recommendations about protecting big data so that it can make a presentation at the March 10 meeting of the HIT Policy Committee, McGraw says.


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