By ensuring that healthcare providers adhere to procedures for handling sensitive health information, maintaining secure systems, and putting in place appropriate measures against data breaches, compliance helps preserve patient safety and privacy.
Healthcare organizations show their dedication to upholding the highest standards of care and moral behavior by following compliance laws.
Additionally, adhering to healthcare regulations reduces financial and legal risks. Serious repercussions, including expensive fines, penalties, and legal proceedings, may arise from non-compliance and have a substantial influence on an organization’s finances.
Companies that provide healthcare and healthcare organizations may reduce the likelihood of infractions, safeguard their brand, and avert any legal action by taking proactive measures to ensure compliance.
Lastly, adherence to healthcare regulations fosters a transparent, accountable, and honest culture. It promotes appropriate billing procedures, adherence to ethical standards, and accurate record-keeping for healthcare practitioners.
Programs for compliance also support internal audits, reporting, and monitoring, creating an atmosphere in which dishonest or fraudulent activity is quickly identified and dealt with.
The major compliance-related goals for 2024 health, leave, and fringe benefit planning are outlined in the list below, along with basic recommendations for each issue.
Patient Privacy and Data Protection
Jonathan Rosenfeld, a lawyer at Rosenfeld Injury Lawyers says: “Although it’s the most well-known regulation in the field, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is by no means the only one that addresses data protection.
Additionally, there is the Patient Safety Rule, which has specific guidelines regarding confidentiality.
Additionally, companies must abide by any state-level regulations that apply in their jurisdiction. These regulations may address how personal data is used as well as how it is kept, transported, and safeguarded.
Look for HIPAA standards to become even more difficult to follow in the future.
Certain factions are advocating for its reinforcement or implementation of new laws pertaining to more advanced technologies such as data encryption and machine learning.”
Transparency in Finance and Prices
In the healthcare industry, a large number of compliance issues are related to incorrect or misleading referrals, payments, claims, or other “kickbacks.”
Staff members may avoid heavy penalties and legal risks by adhering to the False Claims Act regulations and introducing more pricing transparency.
However, just sixteen percent of audits now include financial and pricing transparency, according to Crowe LLP.
After-Pandemic Changes
Aliza Naiman, founder at Olgam shares: “Certain regulations are reverting to their previous forms as the industry emerges from the pandemic. However, that does not, as of yet, include them all.
Both the telehealth waiver program and the declared COVID-19 public health emergency (PHE) were terminated in May 2023.
Because of this, a large portion of care delivery now follows different regulations than it did at the start of the year.
However, a few of the pandemic guidelines that were designed for remote treatment are still in effect. The 2023 Appropriations Act extended the Medicare beneficiaries’ ability to obtain telehealth services by removing limitations until December 31, 2024.
The Acute Hospital Care at Home program run by the Centres for Medicare & Medicaid Services (CMS) will also continue into the next year.”
Technology compliance
Technology is altering healthcare delivery almost instantaneously with the rise of healthcare AI. Ensuring that an organization’s IT base is capable of protecting patient data is one of HIPAA’s objectives.
But they are only the start of technology’s compliance requirements.
The HITECH Act, for example, establishes guidelines for the use of healthcare technology and provides a structure for compliance to guarantee best practices.
By doing this, you may enhance business continuity, mitigate the risk posed by third parties, and defend against cyberattacks. Additionally, it will aid in guaranteeing the appropriate use of biomedical equipment, such as telehealth software and hardware.
Preventive Care Benefits
A wide variety of preventive care services must be covered by non-grandfathered health plans and issuers under the Affordable Care Act (ACA) without requiring copayments, coinsurance, or deductibles when the services are provided by in-network providers.
Every year, when preventative care standards are revised, the mandate’s scope varies somewhat. Health plans and issuers should update their first-dollar coverage of preventive care services to reflect any new regulations in time for each new plan year.
Employers should be aware of recent events that may affect their preventive care coverage for 2024 and beyond, in addition to these regular updates. Among these advancements are:
- The repeal of certain COVID-19-related coverage requirements
- Ongoing legal challenges to a significant portion of the Affordable Care Act’s preventive care mandate
- And Indications from the Biden administration that it may increase access to coverage for contraceptives.
Management of Vendors
Chris McDermott, founder at Intercoastal Consulting & Life Care Planning says: “Risk management for healthcare compliance also needs to demonstrate control over outside suppliers, subcontractors, and vendors.
Whether any of these parties falters or is corrupted, companies may still be held accountable.
Therefore, it’s crucial to make sure that compliance and risk management initiatives cover all of them, including thorough audits, honest evaluations of monitoring, security checks, and business continuity planning.”
Surprise charges
Check that plan administrators are correctly handling emergency service claims and that emergency services are covered to the fullest degree necessary.
Verify that plan administrators are adhering to the external review and cost-sharing guidelines for services covered under the 2021 CAA’s No Surprises Act (NSA).
Verify that the plan is providing the necessary NSA notifications in explanations of benefits (EOBs) and online.
Examine the incidence and results of procedures known as independent dispute resolution (IDR). Examine if extra vendor fees for surprise billing compliance and/or any costs associated with shared savings programs are reasonable.
Keep an eye on existing legal disputes and keep an eye out for updated or new rules and other guidelines.
Transparency in group health plans
As mandated by the final TiC regulation, get ready to provide the self-service cost-comparison tool (with data accessible for all goods and services) for plan years beginning on or after January 1, 2024.
Verify the monthly updates of machine-readable files (MRFs). Verify that the in-network provider rates and out-of-network permitted payments, including facility fees, are correct and comprehensive in those files.
Since nonenforcement relief is ended, provide extra information regarding alternative reimbursement arrangements where appropriate. Get ready to publish MRFs for prescription medications and keep an eye out for further MRF agency information.
Make sure that in 2024 the necessary attestations to the gag order and the prescription medication RxDC reports are filed on time. Seek for studies of healthcare costs released by TPAs, insurers, and hospitals under the final transparency rule.
Keep an eye out for any upcoming transparency laws and guidelines, particularly those pertaining to enhanced explanations of benefits (EOBs), and in the meantime, keep up your sincere compliance efforts.
Most plan sponsors lack the data needed to make these disclosures, so work with suppliers to guarantee compliance and adjust contracts as needed. Think about asking suppliers to provide transparency compliance reports and performance assurances.
