SANTA CLARA, Calif., June 22, 2017 /PRNewswire/ -- There is a pressing need for a best-in-class system to consistently support regulatory, reimbursement and compliance professionals in the United States (U.S.) healthcare industry. Managing regulatory and compliance risk in the face of constantly evolving rules and guidelines is a significant challenge for both payers and providers.
A recent whitepaper from Frost & Sullivan, The Increasing Challenge of Managing Regulatory and Compliance Risk, explores the characteristics of an ideal information platform to manage compliance needs.
"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 Digital Health Principal Analyst Victor Camlek. "The potential for massive disruption to the regulatory and compliance process is intense and uncertain. Having access to a best-of-breed source of targeted information and alerts is a critical success factor for all stakeholders."
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, Frost & Sullivan discusses the state regulatory issues in flux, health insurance exchanges (HIXs) and how they will be governed by regulations issued by the Department of Health and Human Services in December 2016, effective for plans and plan years beginning in 2018.
Do You Want to Learn More? Join us on Tuesday, June 27, 2017 2:00 p.m. - 3:30 p.m. ET on the complimentary webinar "The Increasing Challenge of Managing Regulatory and Compliance Risk." Click here for registration.
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SOURCE Frost & Sullivan