Why Do We Need Healthcare Compliance?

Filled under: Healthcare Compliance on October 2010

With all of the regulations that are set in place by various governing bodies there are many people who may be wondering why there is even a need for healthcare compliance. Many times, when ensuring that your facility is compliant with all Medicare and Medicaid rules and regulations, there are a certain amount of complications that are generally associated with the process.

However, with the healthcare compliance regulations that have been set by the Centers for Medicare and Medicaid Services (CMS) there is actually a great deal of good that is being done. The most obvious of the steps forward with the current compliance regulations is that, since they were instated, there has been a drop in the amount of fraudulent claims to CMS which then drops the amount of money that they pay out. This means that, outside of creating jobs for MIP (Medicaid Integrity Program) contractors, it also reduces the costs to the system which can then ensure healthcare for many more people.

Another, more overlooked, but more important aspect of compliance is that it increases the quality of care that the patients receive. By ensuring that the guidelines are being met for billing to Medicare/Medicaid, facilities are more likely to find a more feasible solution to the problem. What this means is that when a patient comes in, a doctor will draw on experience and only order the needed tests to come to a diagnosis and not make them spend days waiting for some result. Compliance programs also reduce the cost to the facility if there is a mistake that is made by reducing the chances of an erroneous claim that could cost the facility a good deal of money in fines or other punishment.

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