A Primer on Compliance for Healthcare

A Primer on Compliance for Healthcare

With rising operating costs, concerns about protecting patient records, and meeting the demands necessary to maintain compliance, the healthcare industry is facing more challenges every day. Take a look at this primer to better understand the role of those in compliance for healthcare organizations, and how they support those businesses that fall under stringent regulatory guidelines.

Compliance for healthcare covers ample territory, from protecting patient records from a security breach to adequately meeting certain regulations for patient care. All are designed for the protection of patients, but that purpose often gets lost in the effort to avoid fines and penalties. Full-time compliance roles are not only common for most healthcare organizations, they are actually required.

Healthcare compliance is, in short, the practice of following rules, laws, and regulations in order to meet expectations for organizations involved in healthcare. This means not just healthcare providers like clinics, hospitals and doctors’ offices, but also health insurance companies, medical device manufacturers, and more. 

Also, every single one of these entities (called covered entities) have associates they work with who are called Business Associates. These include, but are not limited to – you guessed it – cloud providers.

This means that a cloud provider that handles data storage is considered a Business Associate under Federal regulations, and they must comply with the same regulations as the healthcare company itself. This ensures that the records housed in the provider’s care are protected according to the regulations. To better understand the different areas of healthcare compliance and the governance of those areas, here is a short list to start with:

  • The Health Insurance Portability and Accountability Act (HIPAA) of 1996 put protections surrounding patient privacy into effect, requiring every healthcare organization to use measures that secure patient records.

  •  The Patient Protection and Affordable Care Act instituted new measures for insurance, Medicaid and other areas.

  • The Drug Enforcement Administration and the Food and Drug Administration oversee the creation and safe distribution of medications.

  • The Department of Health and Human Services protects against fraud, along with the Office of the Inspector General.

  • The Social Security Act oversees compliance and funding for Medicaid and Medicare.

Creating a compliance program: In many organizations, compliance for healthcare is handled by a dedicated team, but some organizations that are not primarily focused on healthcare may struggle to dedicate a team of employees to compliance. For Business Associates of healthcare providers, there are some steps to implement a compliance program that will help meet the demands of HIPAA and other regulations:

Get educated on necessary compliance elements: The Office of the Inspector General provides specific guidelines for creating a compliance program.

Designate a compliance officer: While an organization may not have an employee that’s specifically hired to handle compliance, the initiative requires ownership by someone in the organization that can mobilize efforts surrounding compliance and stay up to date on the latest requirements. This person should have significant education in healthcare compliance and be fully dedicated to this task.

Invest in a policy management solution: It’s important to distribute established policies and regulations, and a policy management software can help the organization stay on task with tracking which employees have read and signed the policies. There are also training management software solutions that help companies keep their employees current on the latest changes in compliance.

Consider partnering with a cloud provider who specializes in healthcare: The cloud is a cost-effective way for healthcare organizations to maintain HIPAA-compliant applications, storage, and networking. If you are responsible for bringing a compliance solution to a healthcare company, cloud may be the way to go. You can improve existing infrastructure to support critical operations and improve the adherence to healthcare compliance standards for technology all at one time. Plus, if you select the right provider, everything can be built to scale and by professionals who understand the world of healthcare.

In closing, a provider of enterprise-grade cloud solutions can help a healthcare organization determine which cloud services will best fit their needs, and functions as a trusted advisor for compliance in healthcare.

To learn more about tools and solutions for handling compliance management, contact us at Effortless.