Healthcare is a field filled with rules and regulations. These rules have taken decades to develop and constantly evolve to accommodate new medical advancements and global changes. Following these rules in the ways required by regulatory bodies is called healthcare compliance, often shortened to compliance in healthcare-specific contexts. Healthcare compliance actually makes up its own field of study and employment because of how complex it is. It’s an industry-critical field because it protects not only patients in the healthcare system but also healthcare providers.
Now that you know a little more about healthcare compliance let’s discuss one of the important elements it involves: compliance risk assessment.
What is Healthcare Compliance Risk Assessment?
The New England Journal of Medicine defines healthcare risk management as “the systems and processes employed to uncover, mitigate, and prevent risks in healthcare institutions.” Risk assessment comes one step before risk management. Risk assessment is the practice of investigating the possibility or threat of current and future risks before developing the systems and processes involved in management.
“Risk” is a word chosen on purpose for its broad and various definitions. In the context of compliance, a compliance risk specifically defines a penalty or consequence your organization or facility might face if found guilty of non-compliance.
Putting all of this information together gives you the basic idea of compliance risk assessment in healthcare: evaluating the possible compliance risks you might face, both in the present and further down the line, to ensure your facility maintains effective compliance.
Why is Healthcare Compliance Risk Assessment Important for Hospitals?
Non-compliance isn’t something any business, organization, or group wants to be found guilty of due to implications of negligence, incompetence, and even financial mismanagement. Healthcare is especially fraught with danger in this regard because of the potential for harm to patients and staff. Compliance risk assessments in healthcare are critical because risk management programs cannot be enforced without an initial analysis of risks. If you haven’t assessed and identified risks, your facility or organization might be in the dark about what to do to stay compliant until it’s too late.
The Benefits of Incorporating Compliance Risk Assessment Programs
Most accredited healthcare organizations and facilities have compliance risk assessment programs they use to keep on top of the compliance assessment process. These programs can range from a broad bullet-point style list to a detailed packet of requirements, depending on your workplace. However, if your organization still plans on paper, you might be running into trouble as the healthcare sector increasingly relies on technology. Even with dedicated staff available to ensure compliance and keep a compliance risk assessment plan up-to-date, you still might encounter issues during a healthcare compliance evaluation because things change so quickly that it can be hard to keep up using traditional paperwork methods.
That’s where MedTrainer comes in. Utilizing software is a great way to improve the process of risk assessment in healthcare facilities or organizations. These are some of the benefits of incorporating software-based compliance risk assessment programs into your healthcare organization:
Simplified Compliance Assessment Process
The process of ensuring your facility meets compliance regulations is complex but critical. With so much to read and process, every time something new is released or something additional is required, it can be hard to make sure you’re really absorbing everything you need to know.
Software helps you identify what you need to ensure you’re meeting your goals and illuminates what you need to understand to create realistic goals for your organization. It also breaks down dense, jargon-heavy blocks of text into easier-to-understand sections that you can actually remember and utilize during day-to-day work.
Improved Access to Information
MedTrainer software’s cloud integration enables your staff to access documents easily and on multiple devices, eliminating the many problems caused when files are inaccessible. It also makes training and learning more straightforward because it takes place through one centralized, comprehensive platform.
Reduced Administrative Work
There is a lot of paperwork, scheduling, and organization that goes into healthcare compliance assessment. Using a compliance program that digitizes your documents, sorts them automatically, and can be searched with just a few clicks can free you from hours of tedious clerical work.
Because MedTrainer is constantly updating and changing to add new compliance requirements your facility needs to meet, you can be assured that your next healthcare compliance evaluation will go smoothly. You’ll never again have to worry about your processes or analyses becoming obsolete and taking up space you don’t have. Wouldn’t you rather stay on top of your training and programs instead of trying to research what’s next on your own?
Saves Time and Money
It might seem obvious thinking about it now, but simplifying the process, improving access to information, reducing administrative work, and keeping compliance content up to date all really add up! Using healthcare compliance risk assessment software saves healthcare organizations a lot of time and money. You’ll be able to increase both your employees’ valuable time and your facility’s available budget.
Frequently Asked Questions Regarding Healthcare Compliance Risk Assessment
What Is a Healthcare Compliance Evaluation?
A healthcare compliance evaluation occurs when a regulatory body investigates your facility or organization to ensure it is following the rules and regulations that makeup compliance. If your organization is not meeting these benchmarks, it may receive a warning, be penalized with a fine, or be found guilty of non-compliance.
What Are Some Examples of Compliance Risks?
Compliance risk assessment in healthcare can involve analyzing these and more possible risks:
Hacking, Ransomware, or Data Breaches Targeting Protected Health Information (PHI)
Gone are the days where floods or fires were the greatest risks to patient information. In the 21st century, cyberattacks in the form of hacking, ransomware, and more pose a considerable threat to PHI and are considered highly significant risks.
Failure to Notice, Address, or Correct Misbilling
With care plans such as Medicare and Medicaid, healthcare providers must identify and take action to correct suspected overpayment within a 60-day period. A provider or practice failing to comply with these regulations poses a risk to your organization’s compliance overall.
Failure to Notice, Address, or Correct False Insurance Claims
It is your organization’s responsibility to catch issues surrounding incorrect or fraudulent diagnosis codes and insurance claims. This is a risk in the compliance world and to your organization’s budgeting and funding.
Telemedicine Provider Mis-Qualification or Misrepresentation
Telemedicine, popularized during the COVID-19 pandemic, is a growing field that’s been regulated relatively quickly due to the increasing demand for remote care. These regulations are still being changed and updated. Chances are that your organization will refer a patient to a telemedicine provider or practice at some point. Before this takes place, it’s part of healthcare compliance to make sure that providers are licensed appropriately and practice within the state they are licensed in.
Providers or Facilities Ignoring or Not Complying With Fraud and Abuse Regulations
There are over 85,000 medical malpractice claims filed every year. Fraud and abuse are huge risks to assess. A necessary form of compliance assessment is making sure healthcare system employees in your organization are behaving appropriately.
Delayed or Obstructed Patient Access to Health Records
There has been a massive wave of legislation involving patients’ rights to access their health information during the past few years, sparked in part by the Department of Health and Human Services’ Patient Right to Access Initiative. Can patients at your facility access their medical records promptly? What technology is your facility using to manage record sharing? Is it secure? Do you have multiple options available that are accessible to all different kinds of patients? These are just a few risks related to health record access.
Lack of Due Diligence While Maintaining and Updating Compliance Plans
You may not have known this, but in some cases, your facility can be considered non-compliant for failing to maintain and update its compliance plans. Your workplace failing to create or enact these plans, processes, and programs might be a risk that you have to consider.
How Do I Know if Healthcare Compliance Assessment Software Is Right for My Organization?
Check out MedTrainer’s Compliance Corner to see what we have to offer healthcare programs and facilities looking for compliance assessment software! Our compliance tracking template is easy to use and understand.
Does Using Software for Compliance Risk Assessment Violate HIPAA?
Protected health information staying protected is a considerable element of compliance. Patient confidentiality and security are of the utmost importance, and they are taken into consideration very seriously during healthcare compliance evaluations. While we can’t speak for other software programs, MedTrainer can assure that our software is HIPAA-compliant and will keep your patients’ and programs’ information protected and encrypted.
Are you ready to ditch the piles of paperwork and save time and money throughout the compliance risk assessment process? Already using MedTrainer for compliance risk assessment or looking for other ways software can make your life easier? We also offer a software-based credentialing platform trusted by over 15,000 hospitals and 300,000 professionals across the United States. Whatever you use MedTrainer for, we can help bring your organization fully into the 21st century — and beyond. Contact MedTrainer today or check out our website for more information.