How Healthcare Workers Impact Healthcare Compliance

Healthcare compliance is essential to building trust among patients and providing high quality care. From physicians and nurses to health administration professionals, workers across all specialty areas have healthcare compliance responsibilities. Knowing how workers impact healthcare compliance and understanding the role of compliance in a rapidly changing landscape can help you prepare for your health career.

If you’re curious about healthcare compliance training and pursuing a health career, continue reading this blog. Or, if you are ready to start today, check out Bryant & Stratton College’s healthcare degree programs and nursing degree programs.

What Is Healthcare Compliance?

According to the U.S. Department of Health and Human Services, healthcare compliance refers to the efforts that are made at all levels of the healthcare system to ensure that laws and industry regulations are adhered to. Healthcare compliance includes: 

• Adhering to local, state and federal healthcare laws, such as HIPAA compliance
• Monitoring and adhering to industry regulations, such as medical billing compliance

Why Compliance Matters

Compliance is the key to building trust within a local community. Patients who understand that their healthcare facilities and providers maintain compliance know they are going to receive safe and effective care, and they are confident that their privacy will be protected.  

Why Healthcare Workers Play a Critical Role

While compliance may refer to a broad, large-scale approach to adhering to laws and regulations, it’s a process that takes place at every level of healthcare. Knowing how workers impact healthcare compliance can help you choose a health career path that aligns with your professional goals and personal interests.

Compliance Happens at the Front Lines

There are specific healthcare compliance jobs in which professionals work to collect and analyze data, identify risks and develop proactive solutions to maintain compliance. However, all health professionals play an active role in maintaining compliance, regardless of whether they provide patient care or work in administrative settings. Compliance is an active and evolving process that takes place not only through leadership decisions, but also at the direct point of patient care.

Small Errors Can Have Big Consequences

Something as simple as a minor documentation error can have lasting consequences on quality of care provided, patient outcomes and liability. Non-compliance can lead to: 

• Legal ramifications
• Higher healthcare costs
• Decreased patient satisfaction ratings
• Poor patient outcomes

The impact of non-compliance highlights the importance of ongoing training among the healthcare regulations workforce.

Shared Responsibility Across Roles

In healthcare compliance jobs, professionals focus solely on maintaining compliance within the healthcare facility. In reality, though, all health professionals have a shared responsibility to ensure compliance. For example, nurses must employ precise documentation techniques to facilitate proper reimbursement during the medical billing and coding process.

How Nurses Impact Healthcare Compliance

Nurses’ role in healthcare compliance is substantial. Professionals at all levels actively work to follow all safety and privacy protocols that are in place, with the goal of creating a secure, nurturing environment for patients and caregivers where they feel supported.

Nurses support healthcare compliance through:

Accurate Documentation and Recordkeeping

The American Nurses Association describes documentation as the foundation for providing safe, high-quality and evidence-based care in nursing. All documentation should be clear, concise and objective, and nurses must use strategic documentation practices to facilitate care, protect patient privacy and minimize risks to health records. 

Patient Privacy and Confidentiality

Nurses have both an ethical duty and legal responsibility to always maintain patient privacy and confidentiality, and in the age of electronic health records, social media and rapidly advancing technology, privacy compliance has become more complex. Nurses must be aware of all HIPAA regulations and actively work to always protect the privacy of their patients.

Adherence to Clinical Protocols

Individual healthcare facilities will create and implement clinical protocols designed to maintain compliance, such as:

• Requiring informed consent from patients.
• Implementing safety monitoring protocols.
• Creating strict documentation procedures that must be followed.

How Administrative Workers Support Compliance

Medical receptionists and other administrative healthcare workers support the office operations of a healthcare facility, and as such, they play an active role in supporting compliance.

According to the Bureau of Labor Statistics (BLS), the compliance responsibilities of medical secretaries and administrative assistants may include:

Managing Patient Records and Data

Administrative workers in healthcare settings play a primary role in managing patient records, and they are responsible for following protocols for inputting and updating patient data. They may receive compliance training so that they know how to carefully handle patient data. 

Scheduling and Intake Processes

In office settings, medical receptionists may be the first point of contact that a patient has, often assisting with scheduling and patient intake. HIPAA-compliant scheduling systems and intake processes can ensure that patient data is secure, per information from HIPAA Vault. These protocols involve:

• Implementing advanced scheduling systems that offer end-to-end encryption when collecting protected health information
• Training staff to collect information in a way that protects patient privacy and ensures patient dignity

Policy Implementation and Oversight

Healthcare administrative workers typically work closely with healthcare managers to enforce compliance-friendly policies. Once those policies are in place, it’s the medical receptionists who share information and ensure that those policies are complied with throughout the facility.

The Role of Medical Billers and Coders in Compliance

Compliance in healthcare is a proactive and constant process, with medical billers and coders playing a critical role in following all local, state and federal regulations for handling private patient health data.  

The American Academy of Professional Coders (AAPC) highlights what medical billing compliance involves:

Accurate Coding and Classification

Medical billers and coders undergo specialized training to become fluent in the universal medical billing coding systems that are used across healthcare facilities. The AAPC notes that through ongoing internal and external audits, medical billers and coders can ensure that they are accurately classifying medical claims and coding medical services. 

Preventing Fraud and Billing Errors

Accuracy and precision play a significant role in preventing billing errors, which can have costly consequences for both patients and healthcare facilities. Medical billing and coding specialists have a responsibility to create and implement procedures that are designed to prevent healthcare fraud.

Supporting Audits and Reimbursement Processes

Regular internal and external audits allow healthcare facilities to evaluate the work being performed by medical billers and coders. Following audits, medical billing and coding professionals should work with organizational leadership to learn more about what they can do to improve reimbursement processes and support compliance efforts.

How Medical Assistants Contribute to Compliance

Medical assistants are health professionals who assist providers, and according to the BLS, they work directly with patients to collect information and also support administrative processes in healthcare facilities. Their blended role requires them to be aware of compliance-related issues and actively work to maintain compliance. 

Whether scheduling appointments for patients, taking vital signs or sharing information with healthcare providers, medical assistants maintain compliance by:

Maintaining Clean and Safe Environments

Standardized disinfection protocols should be in place in all clinical facilities to ensure that exam rooms and treatment areas are clean. Medical assistants are required to be aware of these protocols and to take all measures necessary to maintain welcoming environments that ensure safe, effective care.

Handling Patient Information Responsibly

As part of their roles, medical assistants collect patient information and record patient data. They should receive healthcare compliance training to ensure that they handle all information responsibly and adhere to all HIPAA protocols. 

Other Roles That Influence Healthcare Compliance

The broad scope of healthcare compliance requires all health professionals to play a role in conforming to standards and abiding by all legal and regulatory guidelines.

These are other healthcare compliance jobs to consider:

Healthcare Managers and Administrators

Medical health and service managers are responsible for planning and coordinating the business operations of a healthcare facility, and they take an active role in developing and implementing compliance protocols. In addition to creating compliance-friendly policies and clinical procedures, they may work with auditors to evaluate and analyze compliance success.

IT and Health Informatics Professionals

Health information technologists oversee the health information systems that are used within a healthcare facility. They also may be responsible for developing procedures for leveraging patient data to provide better, more personalized care. They handle private health data on a regular basis, requiring them to have an advanced understanding of HIPAA compliance and healthcare data security measures.

Compliance Officers and Specialists

Health compliance officers and specialists take on high-level roles in the healthcare industry. They may be responsible for:

• Developing and implementing medical compliance plans
• Creating comprehensive healthcare compliance training programs
• Maintaining detailed compliance records and generating reports for healthcare leadership
• Performing compliance risk assessment to mitigate potential issues

Why Compliance Knowledge Matters for Your Career

Regardless of the health career pathway that you are most interested in, compliance knowledge will be indispensable. You should prioritize healthcare compliance training because it:

Builds Trust and Professional Credibility

Compliance is the backbone of the healthcare industry, and it is essential for building trust among key stakeholders. With compliance knowledge and practical skills, you can potentially improve your professional standing in an industry that’s truly always evolving.

Reduces Risk and Improves Patient Care

A strong foundation in compliance protocols can help you reduce risk in both clinical and office health settings, ultimately helping you provide patients with improved experiences and safer, more effective care overall.

Opens Career Opportunities

Building a strong background in healthcare compliance can possibly lead you to an agile career path, one in which you can explore specialized opportunities that focus primarily on compliance monitoring.

How Healthcare Workers Can Strengthen Compliance

A well-rounded healthcare compliance skill set involves practical, technical and interpersonal skills. If you go on to complete training and build a foundation in healthcare compliance skills, you should incorporate them into your resume and mention them during interviews. Employers are constantly searching for healthcare workers who are aware of their compliance responsibilities and who are prepared to comply with all protocols in place.

Ongoing Training and Education

Regular healthcare compliance training is necessary in any health role, as legal frameworks and regulatory guidelines are constantly changing. In addition to completing a degree program that offers a compliance-friendly curriculum, you also will have to prioritize compliance-related training throughout your career.

Clear Communication Across Teams

If compliance is the backbone of the healthcare industry, then communication is the beating heart. Clear and professional communication across healthcare teams as well as between staff and leadership supports collaboration and ensures that everyone is aware of what policies and procedures need to be followed to create safe, effective care environments.

Attention to Detail in Daily Tasks

In the healthcare field, even minor mistakes can become costly compliance issues. By staying organized and paying attention to the details when you are talking with patients, documenting private health information and inputting data into electronic health records, you can avoid potential compliance challenges.

Using Technology Effectively

Technology is embedded into nearly every healthcare process, and in any health profession, you will need to know how to use technology to accelerate tasks, streamline operations and provide patients with the best possible care. By following all HIPAA compliance protocols, you can protect patient data and keep it secure.

Prepare for a Career in Healthcare at Bryant & Stratton College

In most health professions, there are healthcare compliance responsibilities that have to be managed with accuracy and precision. The healthcare degree programs at Bryant & Stratton College provide industry-aligned coursework that covers key topics, including how workers impact healthcare compliance. Students also learn about nurses’ roles in healthcare compliance through our nursing degree programs, including the Nursing Associate Degree and the RN to BSN programs.

Request more information about our healthcare degree programs today.