U.S. Healthcare Industry Urgently Requires Platforms to Manage Regulatory and Compliance Risk
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"The healthcare industry must remain functional while enduring a major upheaval, based on as-yet undetermined impacts of policy changes on insurance markets, value-based care reimbursement structures, and other possible policy and regulatory shifts," said
Factors underscoring the need or an information platform that enables easy and precise searches as well as timely, customized alerts include:
- Organizational Complexity:
U.S. healthcare is heavily regulated by a combination of federal, state, and local government agencies as well as private standard-setting organizations. - New Payment Models: Laws and regulations are continually revised or reinterpreted. For instance, recently passed federal-level legislation, such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the 21st Century Cures Act, are set to disrupt current physician payment and hospital reimbursement under Medicare.
- Evolving Compliance Risks: Changes to procedures and diagnostic codes in the ICD-10, standards for electronic patient records and privacy, and basic operations regulated by government agencies will require immediate compliance for providers to reduce their risk.
The healthcare space is seeking an information management solution that is comprehensive, authoritative, and tailored to the needs of coders and healthcare officials. "Up-front coding accuracy is crucial to achieving the regulatory compliance needed to ensure fast and timely reimbursements," noted Camlek. "Such a resource will also provide the basis to develop and update training programs, documentation and policies in the highly-regulated healthcare industry."
The ideal information platform will possess several key characteristics:
- Software as a Service (SaaS) option that provides current awareness on a daily basis and is a complete workflow solution.
- A very deep archive of primary source regulatory and reimbursement content, plus treatises, guides, cases, and white papers developed by industry experts.
- Access to a high-quality legal research platform.
- Up-to-date coding and coverage information.
- Ability to connect fragmented processes and silos of information along the governance, risk management and compliance (GRC) continuum.
- Possess applications that comprehensively cover incident reporting, issue tracking and management, surveys, and audit management, as well as contract, vendor and document management.
- Allows healthcare organizations to assess and mitigate privacy and information security risk across the enterprise.
In this analysis,
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