Medforce Blog

Top Tools to Ensure Compliance

July 06, 2017

Category: General

Anyone who bills Medicare or Medicaid is well versed in the impact of audits and the increasing pressure they are applying on operations. In recent years there has been mounting investigation from the Centers for Medicare & Medicaid Services (CMS) and state governments for potential fraud within healthcare providers across all sectors. It seems to be all one hears about when it comes to compliance risk.

But what about the other important sources of compliance pressure? They seem to be unjustly left out of the media attention, yet can cause just as much stress on an organization.

Commercial payers are increasing their own audits and overpayment demands. The Office of Civil Rights, as the watch dog of HIPAA compliance, is increasingly involved to guard against security breaches. And then there are the healthcare organizations’ own priorities. Business metrics (such as revenue protection and reputation) are huge drivers of compliance priorities. The livelihood of the company can be at risk. Compliance officers have to answer to both internal and external forces and it can be a lot to handle with few resources.  

Yet, according to the 2017 Healthcare Compliance Benchmark Study, published by SAI Global, “48% [of survey respondents] are using manual or ad-hoc methods to manage claims denials, audits and appeals.”  As margins continue to shrink and resources remain scarce, technology is essential to help vital healthcare service providers do more with less. The right tools enable best practices, improve accuracy, strengthen cash flow, and assure compliance. 

It’s no surprise that according to the same survey, the top line item on budgets are narrowed in on investment in software. But where should that investment go? Is a niche compliance application necessary?

While compliance-focused software has its place, the vast majority of healthcare organizations can leverage applications they use for every day operations to help ease the compliance burden.  Among other products, business process management tools can be configured to empower risk assessments as well as enable internal audits for the compliance team. All of this while also acting as the framework for intake, accounts receivable, accounts payable and all other departments for the daily operations. Your compliance technology journey should begin by taking a look at what software is available to do double duty to help mitigate risk and respond to denials and audits while also supporting your mission. It’s the best way to get a return on your technology investment.

Six Tools to Ease Compliance

  1. Document Management – go beyond the rudimentary document imaging available as add-ons to other applications. A full-featured document management program not only can work in all of your departments, it can ensure more accurate files which mean cleaner claims, easier denial management, and faster audit response time.
  2. Business Process Management – A flexible workflow automation tool allows you to bake compliance guidelines into everyday activities and ensures your employees are working according to the strategic priorities. With everything being tracked in real-time, you can identify issues well before they become major problems and highlight areas for improvement.
  3. esMD – Electronic submission of medical documentation allows you to transmit documentation to CMS from any web browser 24/7. Not only can you decrease ADR and audit response times, you can request and track prior auths ensuring a faster speed to revenue.
  4. Referral Management – Most companies handle referrals manually which can result in disorganization, delays, and missing information that can have compliance implications down the line. A solid referral management technology that leverages automation and standardizes the process will provide greater visibility and control and ensure nothing falls through the cracks.  
  5. Fax Management –  Faxing endures as a HIPAA compliant mode of communication, but most fax setups are rife with inefficiency, opportunity for error, and data security challenges. Electronic faxing that is managed in email creates a decentralized challenge in terms of oversight, and also can be a HIPAA violation waiting to happen. A centralized fax application that provides not just the ability to send and receive faxes, but the capability to build a workflow around how they should be handled and provide archival storage is essential for this vital documentation channel.
  6. Electronic Signature –  Approval, authorization, and acknowledgement by patients, clinicians and even administrators are important elements in compliance. Signature in healthcare is unique. Obtaining the signature often happens at the beginning of a process, rather than acting as the culmination. E-Signature that is built for the healthcare industry and is HIPAA compliant is the logical way to ensure you are truly paperless.

Increasing scrutiny, intensifying regulations, and additional documentation burdens amount to greater work effort and higher labor costs that reduce margins and jeopardize the viability of health providers. It can become a downward spiral that has negative impact on regulators, providers, and patients.  Technology can improve collaboration, leverage automation, simplify processes, and decrease opportunities for human error. 


Want more? Download our white paper on Essential Tools for Home Health Compliance which has a full page written on each tool, plus others. Even if you operate in a different healthcare sector, the report has detailed information that will be valuable as you look to take advantage of technology to mitigate risk and improve compliance. 




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