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As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare complianceofficers (HCOs) are more important than ever. Accordingly, maintaining compliance has become a key focus for healthcare facilities. Creating a culture of compliance.
HIPAA Journal is conducting interviews with healthcare professionals and service providers to find out more about their compliance journeys, how the HIPAA Rules have affected their working lives, and the successes and challenges they have faced with HIPAA compliance. Tell the readers about your career in the healthcare industry.
Licensure actions Disciplinary actions from state medical boards, like suspensions or revoked licenses. Exclusions from Medicare and Medicaid Instances where a provider has been banned from participating in government-funded healthcare programs. Civil judgments Lawsuits that reveal unethical behavior or misconduct.
Sharon Parsley, JD, MBA, CHC, CHRC , is a health law attorney, complianceofficer, author, speaker, investigator, and problem solver. She has nearly 20 years of healthcare compliance and legal leadership experience, and she believes that mentorship and on-the-job training are critical to compliance professional success.
Credentialing involves a detailed review of a provider’s qualifications, including their: Education Work experience Certifications Licenses Professional standing This process ensures that patients see professionals who are properly trained and certified to provide the level of care they require.
Healthcare executives and complianceofficers must consistently update and verify provider data to enhance patient care, adhere to regulatory standards, and streamline administrative tasks. Similarly, insurance companies that process thousands of claims daily require up-to-date provider information to avoid claims delays and denials.
While federal operations are slowed, reduced, or put on pause during a government shutdown, healthcare services must continue to operate. Complianceofficers, human resource leaders, credentialing teams, and administrators are all asking themselves these critical questions. What Is a Government Shutdown?
With it, complianceofficers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how complianceofficers can support patient care and help their organizations stay up to date.
All healthcare organizations, along with their providers and complianceofficers, must understand the requirements of each regulatory state agency that provides oversight. This article offers a summary of essential aspects of healthcare compliance specific to Hawaii.
State licensing boards nationwide have annulled the licenses of dozens of nurses who obtained fake degrees and used them to gain or secure employment. In Delaware, 26 nursing licenses were revoked when the nurses’ credentials were tied to the scheme. ProviderTrust recommends conducting license verification monthly.
State-specific governing bodies, such as the Bureau of Facility Standards , provide oversight with certain standards, adding a layer of complexity to successfully managing healthcare compliance in Idaho. Continue reading this overview for key aspects of healthcare compliance specific to the state of Idaho.
Reviewing the Office of Inspector General's (OIG) enforcement actions is important for complianceofficers because it can help them understand the OIG's focus and priorities, and how to comply with federal health care laws and regulations. Government agencies expect your organization to stay informed.
Healthcare compliance auditing software helps compliance managers prepare their organization for an audit. As the regulatory landscape evolves, having robust healthcare compliance software to ensure you’re audit-ready will become increasingly important for complianceofficers in 2024.
Document Expiration Notifications Tracking license expiration dates for every provider and sending reminder after reminder until they renew is a perfect job for technology. A human needs to verify the license and enter the expiration date, but software can — and should — take it from here! See how much time you can save.
District Attorney alleges that Pickering was hired in 2019 as a licensed physician’s assistant at a family practice in Norcross, Georgia but had not been a licensed physician’s assistant in Georgia, or any state, since March 2014. The Importance of Conducting License Verification and Monitoring. According to the U.S.
Let’s delve into the world of compliance with answers to the most common compliance FAQs. What Is Healthcare Compliance? Healthcare compliance refers to the process of adhering to the laws, regulations, and ethical standards that govern the healthcare industry. What Is a ComplianceOfficer?
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Maintaining compliance in hospitals, health centers, and other clinically based pharmacies goes beyond the handling, dispensing, and prescribing of drugs. Pharmacy compliance rules require staff to properly manage electronic prescriptions, maintain mandatory licenses, and complete continuing education (CE) courses.
This article gives a clear and detailed look at the important things you need to know about following healthcare laws in Kentucky, especially for those who provide healthcare and manage compliance. Healthcare leaders and complianceofficers should refer to CHFS for guidance and specific compliance information.
Controlled dangerous substances (CDS) have extremely strict compliance regulations due to the high potential of abuse associated with them. Any healthcare practitioner looking to prescribe controlled dangerous substances must obtain a DEA number, also called a license, from the U.S. Most states mandate annual renewal of CDS licenses.
While learning of an inspection can cause alarm, oftentimes it’s a routine occurrence required by the federal government to ensure the overall quality and delivery of healthcare services. In healthcare, an OIG inspection, also known as an audit, survey, evaluation, or investigation, occurs as a result of various factors and triggers.
Avoid feeling lost in a sea of rules — use this article as a compass for building a sturdy compliance program as steadfast as the coastline. Regulations Unique to Maine To meet the standards of healthcare compliance in Maine , there are a few additional regulations.
When the federal government covers items or services rendered to Medicare and Medicaid beneficiaries, the federal fraud and abuse laws apply. Government programs, such as the Centers for Medicare & Medicaid Services (CMS), find the investment in their audit and monitoring programs are effective.
This article serves as a primer, highlighting crucial information you need to know about healthcare compliance in Rhode Island. The Physicians Licensing division within the RIDOH is responsible for the licensing and regulation of medical professionals in the state, ensuring they meet necessary standards for practice.
Detecting these errors resulting in potential overpayments is typically accomplished through efficient auditing and monitoring programs coordinated under the direction of the organizations ComplianceOfficer or Compliance Department. But is the oversight of the audits manipulated to achieve particular performance goals?
In this blog, we’ll outline why reporting healthcare non-compliance is non-negotiable and how software platforms make it easier to stay in compliance with the myriad regulations that govern good healthcare. What is Healthcare Compliance? Failure to report non-compliance may result in financial losses.
Read on for vital information about maintaining healthcare compliance in South Carolina. Licensing Standards for Ambulatory Surgery Centers In South Carolina, ambulatory surgical centers (ASCs) are specifically regulated to ensure safe and efficient surgical care.
Healthcare providers, organizations, and complianceofficers in Michigan State need to be aware of their state-specific laws and regulations in order to navigate compliance successfully. This article serves as a quick-reference guide for maintaining healthcare compliance in Michigan State.
Healthcare Compliance Complexities The first healthcare compliance programs began in the early 20th century as a response to concerns about the quality of care provided by medical practitioners. Licensing and credentialing were introduced to regulate healthcare professionals and ensure minimum standards of care.
The visit usually lasts three days, during which the surveyor will meet with center leaders and board members to gather information and assess compliance. Credentialing Activity LIP OLCP; Other Clinical Staff Verification of identity (for initial credentialing) Government-issued picture identification.
The Compliance Training Challenge You are working against “Here we go, again” attitude. Influence others to follow your lead in building a culture of compliance Influence is not the same as manipulation, so don’t get confused. To be an effective complianceofficer, you must achieve cultural intelligence.
Keep scrolling for a summary of the crucial elements of healthcare compliance relevant to North Carolina. The North Carolina Medical Board (NCMB) regulates the practice of medicine and ensures that medical professionals meet licensing requirements, adhere to ethical standards, and maintain competency in their field.
This article provides an overview of key factors you’ll want to know about healthcare compliance in Washington. The Washington Medical Commission oversees the licensing and regulation of medical practitioners, ensuring they meet the necessary qualifications, training, and ethical standards.
This article offers a comprehensive guide to essential aspects of healthcare compliance pertinent to Texas. With various departments and divisions, such as the Office of Compliance, the DSHS emphasizes ethics, integrity, and compliance with regulations and policies.
This article is your guide to the important aspects of healthcare compliance in New Mexico with strategic insights for effective management. The New Mexico Medical Board is responsible for licensing and regulating medical practitioners in the state, ensuring that they meet professional standards for safe and ethical medical practice.
For healthcare compliance programs in Indiana to be successful, organizations must have methods in place for tracking and applying regulatory standards, while ensuring all staff are up to date with changes by governing bodies. This article provides an overview of the important aspects to healthcare compliance specific to Indiana State.
This article provides a concise overview of Missouri’s healthcare compliance, highlighting the state-specific requirements to be aware of. Regulations Unique to Missouri To meet the standards of healthcare compliance in Missouri , there are a few additional regulations.
A professional with a severe breach can lose their license, which can negatively impact their ability to seek employment in healthcare and even disqualify them from future positions in the field. It would be wise to check if your state government has additional regulations regarding HIPAA violations.
To manage healthcare compliance in Alabama successfully, providers and complianceofficers need to know the ins-and-outs of state-specific regulations. While tricky to navigate, staying up to date with compliance requirements and standards can make the process more manageable.
Vermont Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Vermont Department of Health plays a crucial role in promoting the wellbeing of Vermonters.
Like other regions in the United States, Wisconsin is characterized by its unique blend of rules and mandates that govern healthcare compliance within the state. This post sheds light on certain aspects of healthcare compliance in Wisconsin, with tips for effectively managing your healthcare organization.
Keep reading for resources, tips, and regulations unique to healthcare compliance in Georgia. Georgia Healthcare Compliance Resources Let’s start with the important state government agencies you’ll need to work with: The Georgia Department of Public Health (DPH) plays a crucial role in safeguarding the health and well-being of Georgians.
To remain compliant in Connecticut, healthcare organizations should stay up-to-date on both state and federal regulation changes and keep their compliance program current. The Connecticut Medical Examining Board handles licensing and regulations for medical professionals.
This includes compliance with licensing requirements for healthcare providers and facilities, as well as adherence to the state’s stringent patient privacy laws, including HIPAA and the New York State Information Security Breach and Notification Act.
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