An Effective Compliance Program Can Lower Costs, Increase Productivity & Improve Patient Care

By Neelendu Bose, AccordMS

Employers, insurers, and providers face the challenge of complying with an increasing number of regulations that affect business practices and health care plans. Federal departments are stepping up their plans for compliance audits, and the fines and penalties associated with violations continue to increase. Faced with such difficult regulations, businesses are forced to consider the potential benefits of having an effective compliance program. While developing and employing such programs requires ongoing company resources, the potential benefits far outweigh these initial costs. A well-designed compliance program will ultimately save money, create a more productive working environment for employees, and result in better outcomes when compliance audits and reviews are performed.

Consider the following scenario. The United States Department of Health and Human Services (HHS) recently announced that its Office for Civil Rights (OCR) has begun its Phase 2 HIPAA Audit Program.

The OCR has already submitted e-mail requests to verify contact information. Entities are provided only 14 days to respond. The next step in the audit process is to respond to a pre-audit questionnaire. Non-responders may face additional scrutiny or an on-site audit.

Does your business have the necessary safeguards in place to identify this compliance request and to address the OCR’s requirements in a timely manner? Is your staff prepared for an audit? With potential penalties that range from $100 to $50,000 per violation, it’s easy to see why a compliance program is no longer a luxury but a necessity to protect your business and its assets.

Effective, measurable success is key for anyone that undertakes the development of a compliance program. The first step forward is to review current business practices and to identify areas of concern. Afterward, an individual should be named to the role of compliance officer, or a committee of compliance members should be formed.

After the key personnel have been identified, a written document should be created that outlines your various compliance policies and procedures. After the written policy is finalized and well-documented, a training program should be conducted in order to help employees understand their requirements and their role in preventing compliance violations

Once training has been completed and any necessary safeguards have been implemented, employees should be able to perform their day-to-day functions with greater speed and more confidence. Whereas employees may have previously been unsure of how to comply with HIPAA regulations, clear, written expectations and procedures will enable employees to move through their daily required tasks with assurance. When a compliance issue arises, employees will know how to react and where to direct a question or concern. Employees that are well-versed in the law and its requirements will also be better able to identify compliance concerns.

Even after comprehensive training, some employees may not realize that they are violating or potentially violating a rule or regulation until an auditor discovers the issue. Having a well-trained compliance officer review your entity’s policies and procedures and update them as necessary in response to new compliance requirements or changing business practices is key to staying ahead of an auditor.A compliance program can also help retain quality employees and prevent criminal activity. When employees feel comfortable self-reporting violations, they are more likely to speak up when they notice potential violations. Employees may also be less likely to consider acting outside of the compliance policy when they understand that there is a strong likelihood that their actions will be noticed. Employees that are unable or unwilling to conform to compliance requirements will be identified and either terminated or transferred to a different role.

The final way that an effective compliance program can help lower costs is by allowing an employer, insurer, or provider to avoid costly and time-consuming audits by various federal entities. While many entities perform random compliance audits that cannot be avoided, audits are often triggered by a report of a violation or a suspected violation. Additionally, since some violations such as Medicare coordination concerns are investigated through claim reviews, a company with a low instance of errors throughout the year is less likely to be selected for a more intensive audit. While entities are typically not responsible for the cost of an auditor’s time, an audit can disrupt business operations in other ways.

It is clear that implementing a well-designed compliance program will ultimately save entities money, create a more productive working environment for employees who are impacted by compliance concerns, and result in better outcomes when compliance audits and review are performed.

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Neelendu Bose serves as an independent Ethics & Compliance Officer for small to midsize healthcare organizations. Mr. Bose has obtained his Healthcare Compliance Certification from the Seton Hall School of Law, where participants examine healthcare-related laws and regulations. The program prepares compliance professionals to work hand and hand with other compliance, ethics and integrity officers, as well as healthcare consultants, and legal professionals.

In his role as a Compliance Professional, he is responsible for establishing standards, policies and procedures pertaining to regulatory requirements to help ensure legal, ethical, and proper conduct. Mr. Bose not only has a contagious passion for excellence he has an innate ability to understand complex issues and create effective solutions all the while seamlessly integrating into almost any healthcare practice. Mr. Bose develops and enforces comprehensive Quality Management Systems that are proactive in nature by emphasizing a culture of compliance.

Neelendu Bose
2430 Highway 34
Suite 22, Bldg B Manasquan, NJ 08736
P: (862) 772-8750
F: (862) 703-3917