When you work in healthcare, you must comply with the most rigorous regulations that safeguard patient health and privacy, protect workers, and prevent fraud, waste, and abuse of federal funds. Anyone in this industry should know the healthcare compliance laws and regulations that guide how they do their jobs and provide quality care.
Federal healthcare compliance involves following regulations that cover various aspects of healthcare delivery, including treatments, prescribing medications, maintaining electronic medical records (EMRs), and protecting communication technologies from cyber threats and attacks. Here’s your healthcare compliance 101 for the critical federal regulations all employees should know.
HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) requires protecting the security and privacy of medical records and all patient data. More specifically, it regulates how organizations use and disclose protected health information (PHI), such as names, phone numbers, financial information, medical records, and other sensitive data.
Healthcare compliance under HIPAA includes adhering to the Security Rule, which covers the handling, maintenance, and sharing of PHI. The HIPAA Privacy Rule addresses patients’ rights to their PHI and mandates the use of release forms that patients sign to authorize providers to share and use their PHI.
HITECH
The Health Information Technology for Economic and Clinical Health Act (HITECH Act) is an extension of HIPAA and part of the 2009 American Recovery and Reinvestment Act. The HITECH Act pertains to the digital transmission of PHI and the measures organizations must take to uphold strict security and privacy standards.
OSHA
The Occupational Safety and Health Act (OSHA) of 1970 protects employee safety and upholds safe working conditions. Healthcare compliance laws and regulations regarding OSHA require organizations to:
- Identify and mitigate hazards and chemical exposures
- Provide personal protective equipment and train staff on its proper donning, doffing, storage, and disposal
- Train workers on workplace safety practices relevant to their jobs
- Control exposures to bloodborne pathogens
- Develop and implement a hazard communication plan
- Establish an emergency response and action plan
- Provide portable fire extinguishers and establish a fire prevention plan
- Implement a respiratory protection plan for workers exposed to airborne particles and contaminants
- Mandate electrical safety practices
- Report and record work-related injuries and illnesses
FWA
Based on governance from the Centers for Medicare and Medicaid Services, healthcare compliance must include measures to identify, prevent, and mitigate fraud, waste, and abuse (FWA) of federal funds. Organizations that file claims for Medicare or Medicaid coverage must keep thorough documentation of claims, conduct regular audits and assessments of their billing practices, ensure accuracy in billing coding, and report incidents that cause or contribute to FWA.
Anti-Kickback Statute
The Federal Anti-Kickback Statute removes financial incentives for making medical decisions. More specifically, the Statute makes it illegal for providers to exchange or receive a payback or anything of value for making a patient referral.
Stark Law
Stark Laws, also known as physician self-referral laws, prohibit healthcare providers from referring Medicare patients to service providers with whom they hold a financial interest. A provider is in a “financial relationship” with the healthcare service if they have an investment interest or are a direct or indirect owner.
Manage Healthcare Compliance Laws and Regulations With Software
Healthcare compliance requires attention to multiple tasks and numerous federal regulations that change constantly. Compliance software from Compliancy Group can keep you on track by alerting you to regulatory updates and creating templates for policies and protocols for each law. Our software can also provide access to specialized training modules, automate administrative tasks, and provide a repository for information on all healthcare compliance laws and regulations.
At Compliancy Group, we understand how important it is to maintain healthcare compliance while preserving your organization’s financial stability. We’re proud to educate you on healthcare compliance 101 and related topics. To see how our software and other tools can help you stay compliant and streamline your workflows, contact Compliancy Group today.
