What are the key compliance and regulatory considerations that practitioners should be aware of in revenue cycle management for post-acute long-term care, and how can they ensure adherence to these regulations?

Practitioners in post-acute and long-term care settings must know several critical compliance and regulatory considerations in revenue cycle management. Adherence to these post-acute care regulations is crucial to maintain compliance, avoid penalties, and ensure ethical and transparent financial practices. Here are some important considerations and steps to ensure compliance:

  1. HIPAA Compliance: The Health Insurance Portability and Accountability Act (HIPAA) sets standards for protecting patients’ privacy and the security of their health information. Practitioners must implement measures to safeguard patient data, including electronic health records (EHRs), billing information, and any other sensitive information. This involves training staff, implementing security controls, and regularly assessing and auditing compliance.
  2. Fraud and Abuse Laws: There are various federal and state laws to prevent fraud and abuse in healthcare, such as the False Claims Act (FCA) and the Anti-Kickback Statute (AKS). Practitioners should have robust compliance programs to prevent fraudulent activities, including billing for services not provided, improper coding, and illegal referral arrangements. Regular internal audits and monitoring can help identify and address potential compliance issues.
  3. Medicare and Medicaid Regulations: It is crucial for practitioners serving Medicare and Medicaid beneficiaries to comply with these programs’ specific regulations and guidelines. This includes proper coding, documentation, billing practices, and adhering to coverage and reimbursement policies. Staying up to date with changes and updates from the Centers for Medicare & Medicaid Services (CMS) is essential to ensure compliance.

Complying with these standards plays a crucial role in revenue management for post-acute long-term care practices. Not only could ignoring these compliances harm your practice’s credibility and reputation, but it can also disrupt your entire revenue flow. For his second interview, David Lane covers these compliances and regulations and how they can affect a practice’s revenue management. 

For more interviews focused on RCM challenges in post-acute long-term care, fill out the form below for our all-new E-book featuring never-before-seen interviews with Saisystems’ very own David Lane and Mikell Clayton.

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