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Saturday, September 21, 2013

Healthcare contract management software and compliance with federal law

Patient information is protected by HIPAA compliance
HIPAA protects the public
Healthcare organizations must manage numerous regulatory requirements and vendor relationships to maintain operations in the modern medical marketplace. For many smaller healthcare providers, contract management software can provide valuable assistance in juggling all these requirements and relationships effectively. Among the advantages and benefits of these advanced software packages is the ability to ensure complete compliance with federal mandates and regulations, including the following:

• Health Insurance Portability and Accountability Act, or HIPAA
• Federal Civil Monetary Penalties Law, or FCMPL

Contract management software can provide valuable tracking and monitoring functionality to streamline reporting and help healthcare providers to maintain compliance with the requirements of these regulations.

Maintaining HIPAA compliance

HIPAA was enacted by Congress in 1996 and outlines a number of requirements designed to ensure that healthcare providers maintain proper security for confidential health information and that patients can readily transfer their health records from one provider to another as their insurance coverage and medical needs change.

Contract management software provides tiered access
Contract management software can provide tiered access levels to maintain patient information on a strict need-to-know basis within the healthcare environment.

Additionally, because information is stored in a centralized location and retrieved electronically, unique health identifiers and patient numbers can be readily retrieved and forwarded to the necessary parties without extensive copying and physical transfer of patient records. Instead, the entire file can be transferred through secure electronic delivery, making it easy to maintain the required level of protection for these confidential medical records.

Avoiding FCMPL violations

Designed to help prevent fraud and malfeasance during the claims process, FCMPL provisions outline severe financial penalties for healthcare providers who submit claims for procedures and treatments that were not performed or that were not eligible for payment during the period in which treatments were delivered to the patient.

Medical fraud is penalized via FCMPL regulations
Medical equipment kickbacks are illegal
FCMPL regulations penalize healthcare providers who knowingly engage in fraudulent activity; however, they also assess penalties for those who should have known regardless of their actual state of knowledge. Other FCMPL violations include offering Medicare and Medicaid patients items of value or cash payments to select a specific provider or providers.

Exceptions exist for healthcare providers who offer financial assistance to low-income patients in cases of genuine need; these assistance packages cannot be publicized or made available generally to patients who receive federal healthcare assistance through Medicaid or Medicare programs. Contract management software packages can provide oversight and monitoring to ensure that administrators are kept in the loop and aware of any possible violations within their healthcare facilities.

Other regulations prohibit kickbacks or rebates for the purchase or lease of equipment and other healthcare products in facilities that receive funding through Medicare or Medicaid programs and restrict referrals where conflicts of interest exist. Healthcare contract management software offers centralized tracking and management of all these regulations and provides medical care providers with the in-depth information and reporting functions needed to avoid violations of these regulations. By managing vendor and patient information in one convenient software system, healthcare providers can streamline the storage and retrieval of important data and create necessary reports to prove compliance with all applicable federal and state laws.

About the author: A former registered nurse, Suzanne knows the ins and outs of the paper trails that often frustrate patients. She understands the importance of a tightly run records office, and loves to write about how medical providers can streamline their record-keeping.

* All image licenses: US-PDGov