Keeping up with regulatory changes is vital to your business. Whether they are born from government action, Medicare, or even from particular payers, staying compliant with the latest regulations is important for clinical and operational reasons as well as for maintaining a healthy revenue cycle.
With rules coming from multiple entities and changes seemingly happening daily, it can become challenging to understand and interpret how you should comply. How you documented a visit or procedure, filed a claim, or reported outcomes last year might be different this year and change yet again the next year. If you don't know the nuances of each payer, then your claims may not be processed correctly and you miss out on full reimbursement. If they are coded or submitted incorrectly, your cash flow will be affected by increased denials and appeals. And it all could ultimately result in disruption to the revenue cycle and a decrease in the money in your pocket.
How can you ensure that when regulatory changes occur, you're properly educated and taking the necessary steps to avoid noncompliance and loss of revenue? Here are 3 ways:
- Assign responsibility. Every facility should have at least one person who is responsible for leading the charge in ensuring compliance—everything from HIPAA regulations to payment changes to different reporting requirements. This person or committee should assume ownership of gathering and communicating regulatory information. It's also important that this person work to not just know, but truly understand new rules so that they can adequately share with the staff what policies and procedures may have to change and how they affect the way you engage patients, other providers, payers, etc. This compliance champion should make it a point to routinely schedule time to learn, review, and discuss current and upcoming regulations.
- Actively participate. Professional associations, community groups, conferences and workshops are great ways to learn and share the latest regulatory updates. Active discussions with experts and your peers can help clarify how new rules relate to your specialty and practice. Sharing best practices and experiences with other providers can spark ideas for creating a game plan for your team. Plus, hearing what issues other practices have come across regarding rules and regulations can help you to know what to avoid in your own.
You can also sign up for newsletters and email alerts from numerous entities, including CMS (Medicare/Medicaid), HHS, and even individual payers. These also often have links to additional resources. Podcasts and webinars are other great ways to receive information regarding the complexities of the regulatory changes and how they will affect your revenue cycle presented in a comprehensive way.
- Assemble a strong set of resources. Leverage technology to aid in keeping up with, and complying with, changes in regulations. There are new tools and mechanisms developing that can do it all automatically, too. Automatic charge capture, for example, can populate data like procedure codes straight from its practice management solution, ensuring accurate and up-to-date information. Such technological resources can also flag potential issues and correct them. For example, a computer system can start to recognize the types of denials that come in constantly and create a rule to alter particular circumstances in order to avoid those denials in the future.
We know that the regulatory landscape is constantly changing along with the healthcare industry, and each year brings a new set of changes to adapt to. But we also know that there are ways to mitigate the large undertaking of keeping up with those changes. Develop a plan of action incorporating the three strategies above and you'll not only stay compliant, but also avoid many of the roadblocks that disrupt your revenue cycle processes.