Ensuring Healthcare Compliance through Training, Audits, and Guidelines

By: Bri Driggers and Juan Arredondo

Healthcare compliance is crucial for patient safety, billing accuracy, and privacy protection. A well-designed compliance management program, supported by training, audits, and guidelines, ensures adherence to local, state, and federal regulations. Comprehensive training empowers healthcare professionals to make responsible decisions and identify compliance risks. Ongoing audits identify weaknesses and prompt improvements. Guidelines complement policies, streamlining compliance. Combining training, audits, and guidelines creates a successful compliance program, promoting a culture of compliance and ethical behavior. Learn more about compliance programs

A healthcare compliance management program helps a facility ensure that it delivers safe and proper medical treatment, protects patients’ confidential medical information, and does not overcharge patients for their care. There are three main areas of healthcare compliance: patient safety, billing of services, and patient privacy.

The most well-designed compliance program on paper is essentially useless if your people do not know how to put it into action. Comprehensive training programs, regular audits, and clearly defined guidelines are essential to ensure your team can successfully comply with all local, state, and federal regulations.

Importance of Healthcare Compliance Training

In healthcare, there is very little room for mistakes. Doctors, nurses, physician assistants, and other healthcare professionals must undergo years of rigorous training and tests before they are licensed to treat patients. Just like medical training, compliance training helps ensure your patients’ safety. Not only does it help providers make responsible decisions for themselves, but it also helps them identify compliance risks their coworkers might make.

Compliance is not just essential for the well-being of your patients but for the success of your organization as a business. When you prioritize compliance and invest in training for your staff, your patients notice. They recognize that your facility puts patients first and grow to trust you. Patients who trust you will likely return instead of taking their business elsewhere. Over time, this enhances your organization’s reputation.

Employees who don’t receive proper compliance training are more likely to make mistakes and cause inconveniences for you and your patient. A single mistake could cause your organization to face fines, legal action, or insurance loss.

Each employee’s compliance training needs will be different based on their roles and responsibilities. The best healthcare compliance training programs are customized to each organization’s unique risks and strengths. View our customized training options. Consider the different situations your staff will most likely encounter and provide hands-on guidance for making the correct decisions. Most importantly, compliance training should be an ongoing process. One-time training, or even yearly training, is not enough to keep up with the ever-changing landscape of healthcare regulations. Supplemental training materials your team can complete on their own schedule should be available year-round.  

Conducting Effective Healthcare Compliance Audits

If there is an issue with your compliance program, you want to know before a mistake occurs that could cost you money or your reputation. Compliance audits are formal reviews designed to identify weaknesses in your compliance program and create an action plan for improvement. Audits look at your policies and procedures to see if you have the right frameworks in place, but they also evaluate how well those policies and procedures are put into action.

You can audit internally or hire an outside agency or consultant to evaluate your organization’s compliance program. First, identify which areas of risk you want to audit. Then list all the personnel and systems involved in that area of your organization. For example, if you want to do a revenue cycle audit, you’ll be dealing with your coders, the billing department, and any technologies they use. Create a thorough checklist of each step in the process that outlines what should be done and who should be doing it. Learn how to prepare for a healthcare audit

The next step is to gather information. In the example that you are performing a revenue cycle audit, you might pull a random sample of coding documents or invoices to check that they have been done correctly. You might also interview members of your coding and billing department to evaluate their knowledge of your organization’s policies and learn how strictly those policies are adhered to on a daily basis.

Once you have finished your review, write up your findings in an official report. Highlight what is going well, but note areas with room for improvement. Then, outline practical steps your organization can take to make those improvements.

How to Ensure Healthcare Compliance in Your Organization

Guidelines are slightly different from policies or procedures. Policies and procedures are mandates, while guidelines are simply recommendations. However, instituting the following guidelines can make compliance easier for your organization.

Establish Rules That Support Compliance

Your organization’s internal rules and policies should support external regulations. For example, to remain HIPAA compliant, you should establish rules about which employees can access which information. Generally, it is easier for your team to keep track of rules on an organizational level than on a federal level. If there is any ambiguity between your rules and higher-level regulations, it creates more room for mistakes.

Make Policies and Procedures Accessible for Your Team

First, it is always a good idea to have all your policies and procedures written out and posted so your team can access them. While this can include physical copies in breakrooms or other areas where staff members spend time, these days, you will also want to have a digital copy available on a central web portal. Remember, your team can’t follow rules they don’t know, and just because they were told them once in training doesn’t mean they’ll remember them.

You also want to keep a physical and digital paper trail of all services and communication, both internal and external. This includes visit notes, treatment plans, and financial documents. This makes it easier to provide evidence that you comply with regulations during an audit.

Create a Culture of Compliance

Compliance should be a basic expectation for every employee, not just a sign that someone is going above and beyond. Adhering to regulations and providing patients with the highest care possible should be baked into everything your organization does. If compliance is treated like an afterthought, people are more likely to cut corners. If you prioritize compliance from day one, however, your team will be more conscious of their actions.

Continue Monitoring and Risk Assessment

It is always best to be proactive rather than reactive. Ongoing monitoring and risk assessment can help you identify weaknesses early and address them before they can become a problem. Make a habit of regular—monthly or weekly—reviews and audits. Schedule them far in advance or have a recurrent schedule, and create templates to make the process more efficient.

How Training, Audits, and Guidelines Work Together

Training, audits, or guidelines alone won’t create a successful compliance management program. Instead, you need to use a combination of all three to support the efforts of each component. For example, the weaknesses you identify during an audit can guide future training. Training is also an excellent time to build a culture of compliance and ethical behavior.

Key Takeaways

The success of a compliance management program depends wholly on the people who carry out your organization’s daily operations. Provide your staff with the proper customized training to ensure their ability to comply, conduct audits to identify areas for improvement, and implement guidelines that make compliance easier for everyone. 

Interested in learning more about healthcare compliance programs? Check out our article about Understanding healthcare compliance programs.