Thorough RCM processes address a myriad of compliance issues that can cost an organization money, business freedom, and even exit opportunities. Compliance requirements are continually changing, and any misstep could result in lost revenue, fines, and even extreme penalties such as debarment, corporate integrity agreements, and criminal consequences for the company and responsible individuals.
The federal government continues to aggressively enforce compliance requirements and state-by-state legislation and commercial payor contracts can also have restrictions on compliance violations. It is difficult for any single laboratory or other diagnostic provider to keep up with the changes.
- Standards and Procedures
- Due Diligence
- Communication, Training & Education
- Internal Monitoring and Auditing
- Enforcing Standards
- Responding to Issues
If you are moving toward a comprehensive RCM solution, the supplier you choose should have compliance capabilities built into the logic and workflow, enable an audit trail, have a highly secure system and communications, and have a strong business continuity plan.
Outsourcing all or a portion of your RCM activities can assist with maintaining compliance. When your own employees manage the entire billing process, decisions on coding, write-offs, and other billing matters can increase the risk of fraud, waste, and abuse. Your compensation and management policies may create unintentional incentives for bad or careless behavior.
To learn more about how XIFIN helps customers reduce their compliance risk, click here: