There are many complex issues in the healthcare industry. With looming government regulation and drastic changes in policy, 2018 is projected to be a year of unknowns and change. In addition to implementing new regulations, the industry must still meet current compliance requirements without fail. The Office of Inspector General’s (OIG) 7 Key Elements of Compliance are the minimum standard and mandatory for all hospitals. Using an automated system that will streamline and reduce potential risk while also adapting to the needs of an individual hospital is paramount in this uncertain climate.

There are many complex issues in the healthcare industry. With looming government regulation and drastic changes in policy, 2018 is projected to be a year of unknowns and change. The PwC Health Research Institute released their top health issues of 2018 report titled, “Top Health Industry Issues of 2018: A Year of Resilience Amid Uncertainty” and it describes many of the difficulties healthcare professionals and personnel will face this year. In addition to implementing new regulations, the industry must still meet current compliance requirements without fail.

The Office of Inspector General’s (OIG) 7 Key Elements of Compliance are the minimum standard and mandatory for all hospitals. Using an automated system that will streamline and reduce potential risk while also adapting to the needs of an individual hospital is paramount in this uncertain climate.

LogicGate has a solution to meet compliance requirements with a robust and agile system that automates processes and creates custom workflows that grow with your organization and changing regulations.

The 7 Key Elements of Compliance

1. Written Policies and Procedures

A clear set of policies and procedures developed and distributed to every personnel or third-party vendor that is affected by the policy and/or procedure. The polices are the standard of measurement that will be included in the evaluation of management and employees.They must clearly identify specific areas of risk to the hospital such as:

• Potential fraud
• Claims development and submission processes
• Code gaming
• Financial relationships with physicians and other healthcare professionals

Policy Management Solution

LogicGate’s Policy Management solution provides a central repository where policies and procedures can be created, approved, revised, published, and communicated to all parties. This solution allows the Chief Compliance Officer or other approved personnel to create custom workflows that support controls for any new, updated, or decommissioned policy and procedures.

2.  Assign a Chief Compliance Officer

The guidelines state that a Chief Compliance Officer and other appropriate bodies such as a Corporate Compliance Committee are responsible for the operations and monitoring of the compliance program, and must report directly to the CEO.

3. Education and Training

All affected employees must undergo regular and effective education and training. The guidelines require that any training completed as a part of the compliance program be documented by the Chief Compliance Officer. This includes new employees, corporate officers, managers, employees, physicians and other healthcare professionals. For many hospitals, that is a large workforce to manage and document.

Policy and Procedure Management

LogicGate’s platform has a specific solution designed to communicate, distribute, and record  that every affected employee has read and comprehends the policies and procedures. This streamlined solution eliminates unorganized documentation of certifications and attestations on spreadsheets and emails. If you’d like to learn more about this solution read this post.

4. Open Lines of Communication

There must be an open line of communication between all hospital staff and the Chief Compliance Officer, without interruption from supervisors or other personnel, in order to report any cases of fraud, abuse, or waste. Violations of compliance policies, regulations, or statutes need to be documented and investigated promptly.

Incident Tracking Solution

LogicGate’s Incident Tracking Solution keeps lines of communication open and allows for a single source of documentation. This solution captures events and incidents in a centralized platform to help reduce operational risk, while ensuring that the right parties are involved to address HIPAA, insurance, and medical rules and regulations. This solution allows the Compliance Officer to assign tasks, investigate reported events, and take corrective actions in a timely and effective manner.

5. Discipline Policy and Actions

This element addresses the need for consequences to be in place for personnel who have failed to meet compliance standards of conduct, policies, and procedures. The guidelines allow for an individual organization to determine the level of sanctions for infractions, but recommends severe sanctions for those with intentional or reckless noncompliance, and a range of disciplinary actions from oral warnings to termination or financial penalties for other levels of noncompliance.

Compliance Solution

The LogicGate platform finds gaps in organizational compliance and streamlines the process. To meet the OIG’s 7 key elements of compliance, compliance must be continually monitored and assessed. As gaps in organizational compliance or noncompliant individuals are discovered, decisions must be made to prioritize, fund, and initiate corrective actions deemed necessary by the Chief Compliance Officer.

6. Internal or External Audits and Monitoring of Compliance

The OIG states that ongoing evaluation is critical to a successful compliance program. Regular audits performed by experts in Federal and State Health Statutes should include all the hospitals programs and divisions including third-party contractors. The reports conducted in the audit should be monitored by the Chief Compliance Officer.

Third-Party Risk Management

LogicGate’s third-party risk management solution ensures that the hospital is not put at risk because of third-party vendor relationships. This solution allows for simple remediation and mitigation tracking of every third-party vendor.

Policy Management Solution

A specific feature of the policy management solution are version controls, ensuring the organization has the ability to track and manage changes as time goes on.

7. Response to Detected Deficiencies

The core of every compliance program is to find, asses, and reduce risk to the organization. The OIG states that consistently responding to detected deficiencies will help to develop effective corrective action plans and prevent further losses to Federal health care programs.

Compliance Action Plans

LogicGate leverages cutting-edge technology in order to support organization’s governance, risk and compliance processes by enhancing controls, increasing flexibility and reducing risk. Quickly identifying and responding to deficiencies within an organization is a core function of our platform.

Benefits of a Compliance Program

• Reduces fraud and abuse
• Enhances healthcare provider operations
• Improves the quality of healthcare services

The benefits of a successful compliance program impacts physicians, hospital management, the entire healthcare industry, and patients.

With the immense changes predicted in the healthcare industry, it is paramount to automate and streamline compliance policies and procedures. Implementing LogicGate’s Governance, Risk, and Compliance solutions for your organization will allow you to quickly adapt to any new changes while remaining compliant with older regulations.