Establishing Compliance Plans In Managed Care

HIPPA compliance in billing and managed care requires both a careful set up and consistent maintenance. With a focused investment of staff’s time and research, your facility’s administration will develop a precise and compassionate compliance plan that will both meet the requirements for audit and leave your staff the resources and attention they need to deliver stellar patient care. Prevention, detection, and correction of fraudulent or illegal behavior will all be overseen by your compliance plan.

Evaluating and systematizing the essential practices for HIPPA compliance can be a mosaic process with many phases. The highly-regulated and high-stakes healthcare sector asks a great deal of compliance-attention from workers, whose day-in-day-out focus is instinctively turned towards patients and their fluctuating needs. However, through technical facility informed by background practice, as well as audit expertise, the compliance set-up can look straightforward and uncomplicated.

To establish compliance plans accurately from inception, you are likely to be amending an already established set of protocols to fit your unique circumstances, patients, and building infrastructure. The first step will be to strengthen existing internal controls as you plan for the set up of current compliance measures. It is crucial to develop internal systems that will and can talk to external systems, internal policies and procedures that inform and ensure staff compliance in all HIPPA rules, as well as live and evergreen trainings and materials that lead everyone in preventing, discovering, and improving false or illegal moves.  

As you develop your compliance plan, keep these pitfalls in mind so that you are ready in the event of an audit:

  1. Incomplete Document Review
    Before your team begins to organize and codify your facility’s HIPPA compliance procedures, it is important to make a comprehensive document and policy review. Not only will this establish for your team where they can begin, it will help them see clearly where the potential risk exposures are. Planning a comprehensive compliance program includes setting up for the potential for an audit.
  2. Lack of Program Oversight/Unclear Accountability
    Clear guidelines of responsibility are crucial to avoid missing compliance matters. Establishing who is responsible for setting up the compliance program, overseeing its function, training new and veteran employees in its applications, and assessing internal compliance can help your facility avoid risk exposure.   
  3. Insufficient or Incomplete Staff Communication and Training
    The next step will be to develop all the digital and tangible systems your staff will need to enact the new plan. Staff training modules for both come next, along with materials your employees can review after the trainings. With well-developed training, you can ensure that all of your staff have the correct information and reliable access to the materials and infrastructure to follow the complete procedures.
  4. Systems for Performance Review and Policy Updates
    Ideally completed annually, this aspect of the compliance plan will outline standards for the review of both provider and staff compliance, as well as a plan for assessing the ongoing relevance and observance of all current U.S. Department of Health and Human Services policies.
  5. Technology and Data Security
    Finally, no HIPPA compliance program will function properly without the technology and data systems necessary to both allow providers access to patient information, and prevent patients from accessing private information. This two-part requirement can make many obstacles as you set up your plan.

For guidance on developing and revising compliance plans and other managed care matters, contact us

Related practices: Healthcare, Managed Care,Litigation


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