Why do we need compliance in healthcare?
The main aim is to prevent fraud and abuse in in the submission of claims for clinical
services, which is where the industry is most vulnerable. The process of healthcare
compliance helps in implementing the regulations and laws made for health care
facilities’ protection. Even if the law doesn’t exist, compliance also means following an
ethical standard to meet the needs of today’s high technology and fast driven world to
prevent corruption. Healthcare facilities want to attract and retain quality compliance
and ethics officers who will support, model and enforce ethical compliance. With strong
leadership, systems and processes, training, auditing and support of finance in
allocating funds for implementation, the organization will have an efficient compliance
and robust privacy program.
Keeping your eyes and ears open
The role of a compliance officer is to have great observation and effective listening skills that
enable them to stay ahead of the game. Compliance and ethics officers always keep their eyes
and ears open. They are continually thinking strategically and looking out for areas to improve
upon. It is critical for them to create and implement stable policies. Their main aim is to look out
for areas to increase transparency and reduce risk.
Creating awareness through education
Effective compliance officers educate others in the health organization on ways to identify and
reduce potential current and future risks. For creating an ideal culture for compliance, it’s
essential to make sure that people are able to understand the direction and goals of the facility
and create a structure of communication that enables them to convey this process.
To promote ethical behavior within the organization, it’s a top down approach, it starts with
senior leadership and the board. The senior leadership and board model and execute the core
principles of an ethical culture and compliance. Accountability comes in many forms from
transparency of action and modeling behavior to performance evaluations.
The importance of a compliance officer with macro and micro experience can promote an
interdisciplinary approach to the complex processes of compliance. A robust compliance
program incorporates team members that include: finance, reimbursement, human resources,
operations, clinical and medical services, quality, risk management and information technology.