Importance of Comprehensive Compliance Strategy

Many home care, home health, and hospice providers have not had the scope and ability, through no fault of their own, to develop as comprehensive a compliance program as they would like. However, in a world of ever-changing healthcare regulations and standards, the risks of failing an audit are becoming too great and potentially too costly for providers to reasonably take on the business risk of failing to have a consistent, reliable, and comprehensive compliance strategy in place.

Where the budget, size, or growth rate of an organization may not allow for a robust full-time in-house compliance support team or where there are difficulties with retaining compliance staff or filling vacancies, outsourcing compliance can be an excellent option. While there has long been hesitation in the home care, home health, and hospice world when it comes to outsourcing compliance, if you choose the right company then the risks are incredibly low and the benefits are robust. As the complications and regulatory nuances of being a home health care provider grow, it has become increasingly more important that clinical management teams are able to maintain focus on the core points of service delivery. As a result, outsourcing the activities that are not grouped among these core services is becoming an increasingly popular option for health care providers.

Where there are often concerns expressed around the risks and process of outsourcing compliance services, The Department of Health and Human Services Office of the Inspector General has stated that health care organizations may reasonably decide to outsource compliance duties and activities. Its Compliance Program Guidance states: “For those companies that have limited resources, the compliance function could be outsourced to an expert in compliance.”

Compliance outsourcing companies employ clinicians and experts with the clinical experience and regulatory familiarity required to support health care providers with their compliance programs. Additionally, the often lower cost of outsourcing allows organizations to remain up to date with both current and evolving compliance standards and supplement limited internal resources where required.

The cost advantage also allows providers to review a much larger volume of charts, which helps in tracking deficiencies more effectively over time. This, in turn, helps in offering targeted feedback and training for the clinical staff who may need more support with documentation improvement. The ideal scenario for providers would be to have an in-house clinical manager who will oversee the chart reviews performed by the outsource compliance vendor, assess their quality periodically, and work with them on analysing the data generated from the reviews to spur both short and long term improvements in compliance.

Compliance outsourcing can offer a number of different possible benefits for the improvement of an organization’s compliance and service delivery, as long as your outsourced clinical compliance support provider can offer your organization the following:

  • More efficiency. Their teams are experienced in compliance support and require minimal learning to meet your needs.
  • An understanding of all relevant regulations, laws, clinical standards, coding/claims processing, etc.
  • Experience in a wide range of compliance issues.
  • Reduced costs related to recruiting, onboarding, and maintaining full-time employees.
  • Regular and accurate reporting, including for your executive management teams.
  • Improved risk protection.
  • The ability, due to lower set costs, to offer you the option of a larger compliance program than you may otherwise be able to manage or afford in-house.
  • Reduced workload for your clinical management and support teams, often resulting in improved employee satisfaction.
  • The ability to consistently invest in your compliance outcomes and better plan your compliance budgets.
  • HIPPA/GDPR/SOC2 Type 2 Data security compliance, which ensures that your patient and organizational data is protected.

If a healthcare company decides to undertake a compliance support partnership with a compliance outsourcing vendor, it is essential that the vendor they outsource to is qualified to perform these responsibilities. Also critical is that healthcare organizations designate a consistent point of contact to liaise with key team members of the outsourcing vendor, so that the compliance outcomes that emerge as a result of outsourcing have a path towards accountability both within the healthcare organization and the compliance outsourcing vendor. #Powerofmore