What Is a Healthcare Compliance Audit?

Oct 19, 2021 | Compliance, Monitoring, Verisys Blog | 0 comments

All Blogs

Healthcare is a high-risk industry; auditing is the systematic and objective process that mitigates risk. Healthcare compliance requires objectivity and accountability through independent review by a variety of auditing boards and institutions. A healthcare compliance audit evaluates strengths and weaknesses within a compliance program. Best compliance program practices also include exclusion screening for your providers, secure patient information technology, and optimized billing systems.

Healthcare compliance audits are accompanied by reports that specify corrective actions and process changes to maximize security and minimize risk. By following the processes, regulations, and laws related to healthcare compliance and implementing audit recommendations, institutions and providers can reduce error, improve patient safety, and provide the highest quality of care.

What To Know About HIPAA and OIG Compliance

HIPAA

In the current healthcare landscape, information is king. Unfortunately, healthcare data is also valuable to criminals. Malicious attacks to gain patient information and breaches of Protected Health Information (PHI) are rising at alarming rates. In 2020, more large healthcare data breaches were reported than in any other year since The Health Information Technology for Economic and Clinical Health (HITECH) Act made healthcare data breaches public. With a 25% annual increase in breaches, healthcare institutions must fortify both their offenses and defenses. Processes and technology must be put in place to protect how health data is used, shared, and stored by organizations.

Over the last year, patient care methods have changed, including the significant rise in telehealth and the transfer of patient information via remote patient/provider visits and monitoring. With these changes, new HIPAA rules and regulations around technology prioritize patient privacy, regulating the use of technology and online prescribing standards.

Noncompliance holds severe penalties. If found in noncompliance, healthcare institutions risk fines, delays or denials of reimbursements, and litigation, which can include criminal charges and incarceration. To avoid financial and reputational risk, your healthcare organization should regularly conduct a HIPAA compliance audit to identify gaps in your data security and processes.

OIG

Noncompliance with the Office of the Inspector General (OIG) can also result in significant consequences including (but not limited to):

  • Exclusion from federal healthcare programs (Medicare and Medicaid)
  • Civil and criminal penalties
  • Referrals to the provider’s state medical board

To help organizations navigate constantly changing state laws and compliance regulations, the OIG provides resources for healthcare compliance.

The OIG advises that to stay up to date with changes, auditing and monitoring should be an ongoing process. Auditing and monitoring should include routine security maintenance and automated notifications to immediately identify weaknesses in your system and any potential threats to data security. By immediately identifying areas that require attention, healthcare organizations can safeguard both their organization and their patients from any harmful consequences.

Technology-Powered Compliance Programs

Healthcare is one of the most highly regulated industries and staying up to date with regulatory changes is complex. Although technology has created increased challenges in keeping data secure, it also provides many options to safeguard that data. Automated notifications and continuous monitoring technology can meet increased demands in healthcare security and compliance. Integrated software that continuously audits and monitors your provider population, allows healthcare organizations to be confident in providing quality care. Automatic notifications that alert organizations of noncompliance allow any issues to be addressed quickly and efficiently.

Verisys’ FACIS®  is the most comprehensive database in provider exclusion screening. Our software continuously monitors thousands of primary sources for exclusions, debarments, sanctions, and disciplinary actions alerting you immediately of any changes to your population. To ensure compliance, increase efficiency, improve your risk management program, and protect your patients, contact Verisys for a customized exclusion screening and staff monitoring program.

Juliette Willard Written by Juliette Willard
Healthcare Communications Specialist
Connect with Juliette on LinkedIn

 

SHARE ON SOCIAL