Compliance

Change is the name of the game in healthcare, and risk managers are often on the cutting edge of it. As the way healthcare is provided and paid for evolves, risk managers must juggle a wide variety of issues — financial, operational and strategic — to serve their organizations in the best way possible.

Auditing from regulatory agencies and payers is increasing, driving the compliance program priorities across the healthcare industry. The latest research from SAI Global indicates healthcare compliance departments are shifting their focus in response to the ever-changing nature of the industry.

Healthcare human resources leaders continue to face challenges in adapting to today’s changing healthcare demands. For example, with the Affordable Care Act (ACA), hospitals and other health systems are now held at higher standards of accountability in delivering quality patient care.

Last week, the 21st Health Care Compliance Association (HCCA) Compliance Institute was held in National Harbor, Maryland. Adjacent to our nation’s capital, Washington, D.C., National Harbor was the perfect location to hear from regulators such as the Office of Inspector General (OIG) and its various departments.

Moving through 2017, employers and human resources leaders can continue to expect changes to their background screening process and policies.  The new year is always an ideal time to take stock of emerging best practices and any newly passed regulations that may impact  an employer’s hiring and screening practices.

While some of these topics may not be new, PreCheck’s Vice President of Compliance Vu T. Do recommends that employers and HR leaders closely consider the following three tips:

Annual compliance reviews are an important tool to protect your organization against risk. But healthcare organizations often simply go through the motions without really digging into issues and looking for improvements.

“Most assessments focus too much on the standard seven elements of a compliance program, and too little on the extent to which the compliance program actually mitigates risk,” says Jessica Santos, Global Compliance and Quality Director at Kantar Health.

Healthcare exclusion screening can be seen as one of the most complex and challenging areas of compliance. It’s one that demands your time, attention, and most importantly, due diligence to ensure you’re not working with excluded or sanctioned individuals.

Earlier this year, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) issued a revised policy statement containing new criteria that OIG intends to use in implementing its permissive exclusion authority under the Social Security Act. The revised policy, titled Criteria for Implementing Section 1128(b)(7) Exclusion Authority, was issued on April 18, 2016 and replaces a policy statement the OIG previously published in December 1997.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released its Work Plan for fiscal year 2017, which serves as an important tool for healthcare compliance professionals in optimizing their organization’s compliance program for the new year. The Work Plan summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. The latest Work Plan includes new items that have been started or planned since April 2016, according to the OIG’s website.

Managing and maintaining a compliant healthcare workspace can be a daunting and intimidating task. One wrong step can result in damaging claims, costly fines, and much more. From the Office of Inspector General (OIG) to the Equal Employment Opportunity Commission (EEOC), regulators are increasing deterrents efforts to ensure employers are proactive in establishing fair hiring practices and safe working environments.

With so much on the line, here are a few things healthcare HR should consider when reviewing their organization’s compliance and safety initiatives.