Want to avoid catastrophic penalties for your healthcare practice?
Healthcare compliance is quickly becoming one of healthcare providers’ biggest business priorities.
Here’s why:
The sad truth is that most practices don’t take compliance seriously until it’s too late.
They wait until they’ve been flagged by the government for an investigation. But by then…
It’s too late to avoid penalties.
The OCR already reported that federal regulators have settled 152 enforcement cases worth over $144 million. Ouch. If you’re not running your own business like complying with regulatory requirements is a priority, these numbers should scare you straight.
Thankfully, you don’t have to wait until the government is knocking on your door. Implementing a smart compliance strategy can protect your practice from these financial nightmares.
You’ll learn:
- Why Healthcare Compliance Should Be Your New Business Priority
- The True Cost of Non-compliance
- Common Audit Triggers You Need to Know
- How to Build a Compliance Strategy That Works
Why Healthcare Compliance Should Be Your New Business Priority
Imagine putting your business in a position where you’re faced with fines that could put you out of business. Not so scary when you think of it as healthcare compliance, right?
Here’s the reality of compliance these days:
Government agencies are cracking down harder than ever.
The OCR announced its HIPAA audit program will kick off in 2024-2025, targeting 50 covered entities for review. And it doesn’t stop there.
Think about how many agencies may take an interest in your practice.
State and federal regulators are scrutinizing healthcare providers like never before. Between cyber attacks, billing audits, and privacy complaints… Providers are exposed on all sides.
If your practice is hit with a Medicare audit or HIPAA investigation, having experienced healthcare audit lawyers on your side can make all the difference. Firms help providers avoid common pitfalls and limit their exposure during these types of investigations.
The moral of the story?
Healthcare compliance is the difference between thriving and suffering extreme penalties that could damage your practice.
The True Cost of Non-compliance
Ok, let’s talk about money. Because non-compliance will cost you BIG if you don’t take it seriously.
HIPAA fines can range from $141 to over $2 million per violation. And remember…
These fines can apply to each instance of non-compliance. So if you suffer a data breach that affects 500 patients, you could be fined for 500 HIPAA violations.
But the financial repercussions don’t stop there…
Failing to comply with government regulations can hurt you in many ways:
- Legal fees and costs associated with investigations
- Expenses for required changes to your practice
- Lost revenue while your practice is under investigation
- Damaged reputation causing you to lose patients
- Increased insurance premiums
A recent survey of healthcare compliance professionals found that just over half of healthcare organizations regularly audit high-risk operations. This means that over half of healthcare providers are leaving their business vulnerable. Without a strong focus on auditing your practice, you could be at risk for increased fraudulent activity, data breaches, and regulatory fines.
Yikes.
As you can see, the medical practices that make it understand the importance of compliance. And they take action to prevent penalties before they happen.
Common Audit Triggers You Need to Know
So what exactly sets you up for an audit?
The government doesn’t randomly choose who to audit. There are common triggers that raise flags with regulatory agencies. Knowing these triggers can help you avoid an investigation.
Here are the most common:
- Billing that falls outside of your specialty’s norm
- Unusually high usage of specific codes
- Patient privacy complaints
- Data breaches
- Whistleblower employees
- Any aberration in your Medicare or Medicaid claims
Here’s a little secret…
A lot of times audits are triggered by simple mistakes. You know, the little notes here and there in patient charts. Missing patient signatures. Incorrect coding. When you pile these small mistakes together, they can trigger an audit.
Small practices are just as likely to be audited as large ones. Earlier this year, the OCR started targeting smaller and medium-sized businesses.
While you can’t completely eliminate your audit risk, you can significantly reduce it by regularly auditing your practice.
How to Build a Compliance Strategy That Works
Ready to take action? Excellent. Let’s walk through how to create a compliant practice.
Don’t let this overwhelm you. The best compliance programs all start with these same foundations. They know what to focus on and where to spend their energy.
Here’s how to build your compliance plan:
Perform Risk Assessments
The first step in any compliance plan is performing risk assessments. Not only will this identify any immediate issues you need to address, but it will also establish a baseline for your practice going forward.
Your risk assessment should include:
- Patient privacy
- Security measures
- Accuracy of billing and coding
- Documentation standards
- Employee training programs
- Vendor and business associate relations
It’s recommended that you perform risk assessments yearly. However, if you’re in a high-risk niche, consider performing them quarterly.
Develop & Implement Policies
Policies are great… Until someone has to follow them.
Your practice needs strong compliance policies, but they’re useless if no one follows them. Make sure your policies are accessible to everyone who needs them.
Additionally, your policies should be living documents that are reviewed and revised regularly.
Train Employees
Let’s face it. Employees are your biggest risk.
Don’t get me wrong, your employees are what make your business awesome. But when it comes to compliance, human error is a large risk.
To combat this, train your team consistently.
Don’t just do yearly training. Hold short sessions monthly to keep compliance fresh in their minds.
Monitor & Audit
You should also be monitoring and auditing your practice regularly.
External audits are scary, but they’re just one way your practice can be audited. Take matters into your own hands by scheduling regular audits.
- Have a codifier review your coding for accuracy
- Audit patient charts for completion
- Perform mock privacy and security assessments
- Review billing processes and insurance carrier contracts
React Quickly to Correct Issues
When you do find an issue, it’s critical to react quickly.
The longer you let an issue go, the worse it can get. Document your findings, correct the issue, and don’t hesitate to reach out to a professional if you need help.
Gain a Competitive Advantage With Compliance
Here’s a benefit of compliance that many providers don’t realize…
Not only can working towards total compliance save you from costly penalties. But it can also give you a leg up on your competition.
Think about it…
Patients will feel more comfortable giving their information to providers that they know will protect it. Additionally, payers want to contract with practices that take compliance seriously.
By building a strong culture of compliance, you’re positioning your practice to:
- Gain patient trust
- Attract payer contracts
- Keep your staff confident in their work
- Run your practice more efficiently
- Continue growing for years to come
When you take the steps to build a stronger compliance program, you’re investing in your business’ future.
Conclusion
Taking your practice’s compliance to the next level is about more than just preventing penalties.
It’s about protecting your patients, your employees, and your bottom line.
Regulations will continue to change. Penalties will only get more expensive. Agencies will increase their enforcement actions.
To bring it all together:
- Learn why compliance is more important than ever
- Understand the full cost of non-compliance
- Know what triggers an audit
- Create a comprehensive compliance plan for your practice
- Use your compliance plan to gain an advantage
Compliant practices will be the ones that make it in the long run. Start strengthening your compliance plan today.
