As a healthcare provider, you know that it is important to provide the right care at the right time for the right consumer. With that in mind, you take detailed notes, document treatment plans, and so on. While it’s beneficial both for you and the consumer to have complete access to their entire medical history, it’s also important to ensure that there is no breach of confidentiality so that you are in compliance at all times.

One of the best and easiest ways to ensure compliance is to use an effective healthcare service management software. At FOCOS Innovations, we believe that the best health outcomes are achieved when a person-centered model is used by all of the members in a consumer’s circle of support. With that in mind, we offer software modules that can easily integrate with your current system. Our software provides consumer relationship management tools, real-time alerts and reporting, and electronic visit verification (EVV) to not only improve the quality of care, but also improve compliance. Learn more about our service management software and how it can help. Contact us today to schedule a free consultation.

What Is Healthcare Compliance?

Healthcare compliance is the continual process of following the legal, ethical, and professional standards that apply to those working in the healthcare industry. Compliance requires the development of processes, policies, and procedures to define appropriate conduct, monitor adherence to the guidelines, and more. Healthcare compliance covers a wide array of topics, including consumer care, reimbursement, billing, managed care, OSHA (occupational safety and health administration), and HIPAA (health insurance portability and accountability act) privacy and security.

What Is Required for Healthcare Compliance?

Since there are many different aspects included under the umbrella of healthcare compliance, they are governed by a number of different federal and state agencies. With the almost constant stream of changes in laws and regulations, it can be challenging for cre providers to stay in compliance. Additionally, there are different requirements between state and local governments. Having said this, there are some governing bodies and federal regulations that work to govern healthcare compliance. Some of these include:

• Social Security Act — governs Medicare, Medicaid, CHIP, and more
• HIPAA and HITECH Act — govern patient privacy
• Drug Enforcement Administration (DEA) and Food and Drug Administration (FDA) — govern creation and distribution of medication
• Department of Health and Human Services and Office of the Inspector General — protect against fraud
• False Claims Act — makes filing false claims to receive funds from federal programs illegal
• Patient Protection and Affordable Care Act (ACA) — implemented new requirements for insurance and more

Who Is Responsible for Healthcare Compliance?

With all of the healthcare laws and requirements that currently exist at the federal, state, and local levels, not to mention the continual changes and updates to laws, it might be challenging to determine who is responsible for ensuring that medical practices are in compliance. With that in mind, most large care providers have a department that works to maintain compliance. The compliance department should have the authority to create programs that enforce compliance, and the authority usually comes from the organization’s leadership or governing body.

For smaller care providers, it can be difficult to maintain accurate records and meet electronic visit verification requirements without the help of healthcare service management software like the one from FOCOS Innovations. Our software provides you with the means to maintain accurate and complete records that can be easily accessed when needed. Plus, with role-based access to data, consumer information and care plans can be made available to whoever needs it, including caregivers, government entities, and approved family members.

Create a Healthcare Compliance Program

While a care provider can take the necessary steps to set the right tone, encourage transparency, and spur ethical behavior, a compliance program helps maintain adherence to these requirements. Effective compliance programs can protect you, consumers, and the healthcare system from fraud, abuse, waste, and other areas vulnerable to liability. The Affordable Care Act requires medical practices to establish compliance programs as a condition of enrolling in the Medicare program.

Tips for a Healthcare Compliance Program

As you consider the right compliance program to implement in your organization, here are some tips that should guide you in the right direction.

• Implement written policies, procedures, and standards of conduct.
• Designate a compliance officer and committee.
• Conduct effective training and education.
• Establish open lines of communication.
• Conduct internal systems for monitoring and auditing the effectiveness of the program.

Create a Culture of Compliance

You may have the most well-written healthcare compliance policy, boast a well-run compliance department, and have great auditing processes, but if you do not promote a culture of compliance, however, you will constantly be working to foster buy-in from your employees. You can take some steps toward creating a culture of compliance by properly managing your financial relationships, making compliance a priority, and understanding the risk areas for fraud and abuse.

Effective Healthcare Service Management Software

Perhaps the healthcare software you’ve been using is no longer current for your operating needs, or maybe it doesn’t provide the right tools to help you meet compliance standards. Some software doesn’t work on mobile devices, and it’s difficult to use. No matter what challenges you may currently be facing, we can help. At FOCOS Innovations, we are proud to offer integrative software modules with outstanding core features, including:

• Consumer relationship management (CRM)
• Historical tracking
• Complete service and utilization management
• Electronic visit verification (EVV)
• Real-time alerts and reporting
• And flexible service scheduling

Our service management software can help your organization improve compliance, increase productivity, and enhance the quality of care you offer your consumers. If you’re ready to see how our platform can improve the way you do business, then contact FOCOS Innovations today to schedule a free demonstration.