Any list of 2023 healthcare compliance trends should start with what is currently going on healthcare. An increasing number of healthcare organizations have transitioned from paper-based recordkeeping systems to more efficient digital processes that save time and eliminate human errors. In addition, the pandemic accelerated the adoption of telehealth visits, digital payment options, and data-sharing capabilities that rely on the internet.
Digitization can drive great efficiency and enhance the patient experience. However, digital solutions can introduce risks with the potential to leave patient data and financial information open to compromise by hackers. These new risks require controls and mitigation to safeguard the organization and meet regulatory approval at a time of increased scrutiny. A robust compliance program in healthcare organizations has become table stakes for success and an indispensable aid in preventing financial losses.
In 2023, hospitals that wish to stay in the good graces of regulators while maintaining positive revenue growth and patient trust must be prepared for future changes in compliance requirements while working with partners that can help them meet their obligations.
With all that in mind, we predict five healthcare compliance trends for 2023 that will affect organizations in this year and beyond.
1. “People-based” security violations will threaten patient data
Computer systems and expert hackers often get the blame for costly errors. However, most compliance violations are caused by humans. For example, a data entry error sends a medical bill to the wrong intended recipient, exposing confidential patient data. An employee clicks on a suspicious link and becomes a phishing scam victim. A sticky note featuring a password is swiped from a desk by someone who uses it to access a hospital computer. In every case, human error is to blame, but the organization and patients suffer the consequences.
Many healthcare providers rely on contract employees, such as traveling nurses or guest physicians who may have worked previously in healthcare systems with different compliance policies. While their intentions may not be malicious, the unfamiliarity with current policies, procedures and controls can lead to inadvertent breaches.
For these reasons, it is imperative in 2023 to ensure that all employees and contractors are trained to the same standards of conduct, comply with IT policy, and attest that they understand and will adhere to your organization’s IT Security program.
2. Expect more scrutiny from regulators
Healthcare is designated crucial infrastructure, and government regulators will raise the bar on what they expect. Along with documentation, be prepared to demonstrate evidence and materiality. The goal is validation.
Adopting frameworks from the National Institute of Standards and Technology (NIST) and International Organization for Standardization (ISO) regulations will provide controls, standards, policies and guidelines essential for a best practice IT risk program.
Regulators will also apply increasing pressure on those receiving federal funds through Medicare to prevent fraud, waste and abuse. In 2023, oversight and scrutiny will increase, forcing justification of billing processes backed by proper documentation. Being proactive, scrutinizing business associates and implementing clear procedures and discipline in coding and billing will help avoid fines and reputational damage.
3. Telehealth surges, as does fraud
Telehealth became both necessary and popular during the pandemic. Unfortunately, it also introduced something else on the rise in 2023—fraud. In fact, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a special fraud alert for providers entering arrangements with “purported telemedicine companies.”
Healthcare entities should put prospective telemedicine partners through a vigorous background check with ongoing monitoring and assessments if selected. Being able to show regulators exact steps taken to safeguard against telehealth fraud lowers the risk of both fraud and the penalties associated with it.
4. Lack of skilled staff will threaten safety and security
Patient safety and security are paramount at hospitals and other healthcare facilities. The shortage of skilled nurses and practitioners increases the risk of incidents. It is crucial in the year ahead that healthcare organizations work toward a culture where workers want to stay and have the tools and training to ensure patient safety. Here are a few tips:
- It is not always about money. Staff want to be respected and not overworked due to bad policies and cultural faults. Both can lead to a dangerous environment prone to mistakes and data breaches
- Create a “speak-up” culture that provides hotlines for whistleblowers and reinforces positive behaviors, safe practices and fair and equitable hiring
- Double down on policies that serve as a bedrock to a safe, secure, respectful and inclusive work environment and ensure the protection of PHI (patient health information)
Healthcare organizations cannot on their own fix the shortage of available talent. In 2023, the goal should be staff retention and improving the culture and operations, resulting in stability and improved safety and security.
5. Added pressures to manage revenue
One thing that is not changing in the New Year. Hospitals will continue to operate on razor-thin profit margins. It is crucial for healthcare organizations to protect revenue integrity by ensuring billing accuracy, adherence to the documentation requirements, and defending denials. As part of a recommended best practice, it is wise to revisit the records process regularly, looking for more efficient and streamlined ways to ensure the appropriate documentation is provided when claims audits occur.
The front lines of healthcare organizations are stretched thin and the same goes for compliance teams. Both are challenged to manage increased risks and meet compliance requirements with fewer resources. Fortunately, healthcare organizations can bolster compliance and thrive in 2023 by directing them to compliance leadership training and investing in a healthcare-specific compliance platform.
You have read our five healthcare compliance trends for 2023. If you empathize with these, then connect with SAI360 to learn more about how to meet these trends head on and thrive.