A guide to creating a culture of healthcare compliance in your organization

Published on: August 17, 2021

Healthcare is one of the most regulated industries globally, and it will come as no surprise that organizations spend considerable sums on compliance programs every year. According to the PwC State of Compliance Survey, close to a third of U.S. healthcare organizations claim to spend over $1 million annually on corporate compliance.

Once, compliance regulations primarily impacted hospitals, but responsibility has shifted to cover care centres, physicians’, and other medical offices. Many of these organizations simply do not have the infrastructure to deal with the demands imposed by healthcare regulators and need to put a compliance program in place.

This blog serves as an introduction to healthcare compliance. It offers guidelines and best practices, as well as common hurdles you might face as you try to define and implement your healthcare compliance program. Below is a list of links to the various topics covered, which will help you navigate to the section most relevant to your specific needs.

Click on the healthcare compliance topic you’re most interested in to skip ahead:  

What is healthcare compliance?

Regulatory healthcare compliance is the continuous process of abiding by professional, legal, and ethical standards that govern healthcare organizations and medical practices. It requires effective implementation of processes, policies, and procedures to define appropriate conduct, educate teams, and provide for the continued monitoring of the adherence to these standards.

Compliance in healthcare covers many areas of the industry, including patient care, reimbursement, billing, managed care, and privacy and security. Healthcare providers must meet numerous standards and regulations to prove compliance, and we go into these in more detail below.

total annual budget spent on compliance by healthcare organizations

The purpose of establishing a healthcare compliance program

One of the primary purposes of developing an internal compliance program is to ensure your organization is adhering to standards and protecting itself against waste, malpractice, fraud, and potential liability. A program like this aims to establish and enforce an ethical and lawful culture where detection and resolution help organizations conform to industry regulations.

Establishing an effective healthcare compliance program will cost both time and resources, perhaps making it seem like an unattractive option to some. However, the risk of non-compliance is much more costly, and a lack of adherence to the governing standards of the industry will lead to fines much heftier than the amount you would spend on remaining compliant in the first place.

Common hurdles healthcare providers face when establishing compliance programs

Although this list is by no means exhaustive, it does cover many of the key challenges organizations face when creating a comprehensive culture of compliance.

Although this list is by no means exhaustive, it does cover many of the key challenges organizations face when creating a comprehensive culture of compliance.

1. Copying competitors without first checking compliance standards

Rather than adopt new ideas or competitors’ practices without conducting due diligence on those practices, first, check that they meet industry regulations. For instance, they may be collecting data in a way that fails to meet compliance requirements. Before you start any new initiatives, be sure to read the fine print and check for any compliance regulations.

2. Failing to make compliance a constant conversation

If your team is not fully aware of the risks involved or they only hear the word compliance once a year, it can make implementing an effective program seem like a low priority.

3. Lack of accountability or ownership for the compliance program

Everyone on your team needs to feel as if compliance is a critical part of their role. A failure to communicate this responsibility can result in the poor implementation of standards. It’s wise to consider appointing someone to oversee all efforts.

Role in charge of compliance in healthcare organizations | stand-alone vs multiple hats

4. Teams don’t know how to report compliance issues

There may well be members of your team who’ve noticed issues but aren’t sure how to speak up or if feedback is welcome. Creating a culture where they’re encouraged to query anything that doesn’t seem to meet regulations is critical.

5. Absence of reference material and no code of conduct

Communicating a desire for compliance is rarely enough. Organizations must establish referenceable written materials that clearly outline regulations, procedures, and codes of conduct.

6. Not enough time to adequately monitor compliance

Although most organizations will have only the best intentions for healthcare compliance, it’s too often the case that teams are buried in manual processes. Healthcare administration has many challenges, and one of them is working long hours simply to get financial reports compiled and consolidated. This kind of work can leave teams without the bandwidth to double and triple-check they’re meeting all regulations appropriately.

How do you create an effective healthcare compliance program?

A few measures contribute to an effective healthcare compliance program, and they vary between organizations. For example, a smaller company may require fewer measures to remain on top of their compliance strategy but may want to consider adding extra elements as they scale. It’s also common for standards to be different across borders, and so any expansion needs to be conscious of changes to regulations in new geographies and under other governing bodies.

Your organization will likely need to take a step back and consider all aspects of your work that need to meet industry regulations and standards. Healthcare is one of the most regulated industries in the world. The following are simply examples of best practices employed in healthcare organizations where compliance is regularly achieved with standards like the ACA (Affordable Care Act) in the U.S.

 6 tips for an effective healthcare compliance program

6 tips for an effective healthcare compliance program 1. Create comprehensive written policies and procedures that cover every level of the company’s commitment to complying with regulations.

2. Develop a code of conduct with clear and enforceable standards that allow for appropriate disciplinary action in the event of breaches of compliance requirements by your team.

3. Appoint a compliance officer responsible for monitoring and maintaining all areas of compliance and ensuring the implementation of policies and procedures.

4. Establish a reporting system for “compliance complaints” and encourage a culture of feedback within your organization, allowing members to make complaints without fear of retaliation.

5. Invest in the continued education and training of all employees on compliance standards and best practices.

6. Continuous monitoring and auditing of your compliance program to effectively identify ongoing issues as they arise.

CTA -complete guide to financial management in healthcare

Common healthcare compliance standards

Healthcare compliance is a continuous effort and impossible to cover comprehensively in one single blog post. Rather than try to provide insight into every relevant healthcare regulation you should be aware of, we’ve instead compiled a list below of U.S. regulations as a jumping-off point and an introduction to the complexity in just one region.

Each item listed links to relevant guides or additional resources to help you fully comprehend the requirements of each regulation. It’s important to note that different regions and governing bodies will have different standards. This list merely gives an impression of just how complicated keeping track of all the requirements can be.

8 healthcare compliance standards in the U.S.

How an ERP solution helps develop a culture of compliance

One of the biggest hurdles in the way of a culture of compliance in healthcare is the sheer amount of manual work required. Many organizations use systems to help them automate some processes but not all. It’s possible to invest in an ERP that will centralize all your information, allowing for greater transparency and ease of automation across various departments.

Investing in software like this enables you to manage finances with transparency, using a centralized database and automation to reduce human errors and empower your team to take ownership. In addition, it reduces the overall team’s workload allowing them to focus more on issues of compliance as well as monitoring and auditing financial reports. Why not check out our blog on the benefits of an ERP system to learn more about how effectively you can reduce your overheads and streamline operations.

Healthcare compliance for Microsoft Dynamics 365 Finance and Microsoft Dynamics 365 Business Central

Pre-configured settings and processes that enable global compliance for healthcare organizations are readily available through the Microsoft Cloud for Healthcare. The cloud provides capabilities to manage health data at scale and make it easier for healthcare organizations to improve the patient experience, coordinate care, and drive operational efficiency, while helping support security, compliance, and interoperability of health data. With a growing community of partners developing add-on solutions for common problems faced by healthcare organizations, you can rest assured you can meet your compliance goals without hassle.

Further reading for healthcare administrators:

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