Compliance remains a critical priority for healthcare organizations, even as the industry faces ongoing changes in regulations and operational practices. At this year’s MGMA Leaders Conference, Laura Weeks from HelpUCompli provided insights on how medical practices can stay compliant in the regulatory landscape. Her expertise shed light on the most pressing compliance challenges and offered practical solutions for medical practice leaders. Here are some key highlights from her conversation on the MGMA Podcast.
1. HIPAA Privacy and Security: A Foundation for Compliance
Weeks emphasized that HIPAA privacy and security continue to be foundational elements in any compliance strategy. “Making sure that their systems are intact so they don’t have a breach and knowing exactly what to do if a breach occurs because it’s not if, it’s when,” Weeks noted. She stressed the importance of knowing how to respond when a breach happens, as the speed and accuracy of reporting can make a significant difference in mitigating damage.
Ensuring your practice has the necessary safeguards in place to protect patient information is non-negotiable. Equally important is the readiness to act when a breach happens—something Weeks referred to as a practice’s “compliance reflex.”
2. Documentation: The Critical Missing Piece
One of the common compliance pitfalls Weeks discussed is documentation, particularly in the realm of fee forgiveness. “It’s not the actual doing and follow-through. It’s the documentation of doing and following through,” she explained.
For example, when practices offer fee forgiveness or extend payment deadlines, they must document these actions thoroughly. “When an audit happens, they can prove their efforts,” Weeks warned. Ensuring accurate and timely documentation is not just good practice—it’s essential for compliance.
3. Proactive Compliance: More Than Just Avoiding Penalties
A key takeaway from the conversation was the need for proactive compliance measures. “What we like to do is to help providers from a proactive perspective to put those measures in place to give them checklists, to give them templates, to give them how-tos so they can be compliant,” Weeks said. This approach is not just about meeting current regulatory standards, but staying ahead of future audits and potential investigations.
Weeks emphasized that waiting for an audit or compliance issue to arise is a recipe for disaster. Instead, practice leaders should work continuously to update their compliance protocols and keep abreast of regulatory changes.
4. Navigating Complex Regulations: Stark and Kickback Laws
Weeks also pointed out the complexities of Stark and kickback laws, which can easily trip up well-meaning healthcare practices. “There’s a lot of different business ideas that are brilliant but can cross that line very quickly,” she said. Practices must be aware of the regulatory guardrails that exist and ensure that any business arrangements fall within them.
Understanding the nuances of these regulations and how they intersect with business decisions is crucial. Practices that stray outside of compliance, even inadvertently, can face serious financial and legal repercussions.
5. Learning Through Networking and Continuous Education
Weeks highlighted the importance of staying informed about compliance changes and learning from others in the industry. “Attend conferences like this, attend the different compliance sessions, read different blogs, and just keep yourself up to date with regulatory changes because they change all the time,” she advised.
One of the biggest benefits of attending the Leaders Conference is the opportunity to network with peers and experts. As Weeks noted, the conference offers “phenomenal opportunities to meet people from a lot of different specialties and subject matter expertise.”
Conclusion
For healthcare practice leaders, compliance is not just a regulatory requirement—it’s a vital component of patient trust and operational integrity. By focusing on key areas such as HIPAA, documentation, and proactive measures, practices can mitigate risks and ensure long-term success.
As Weeks put it, “There is no one-size-fits-all.” Each practice must tailor its approach, leveraging tools, templates and expert guidance to build a sustainable and compliant operation.
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