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What is “Risk Management” in the Healthcare Setting?

The healthcare field is concerned with more than just treating patients when they become sick. Unfortunately, there are a number of fraud cases and compliance issues that must be addressed. A trusted attorney can use his or her experience to help various organizations face difficult audits, to avoid criminal charges, and to remain in business.

What Types of Risks Must be Managed in the World of Healthcare?

In healthcare, there are many risks that are linked to treating patients, including storing confidential records, maintaining a safe working atmosphere, and upkeeping emergency response capabilities. Although each organization must form a unique management solution, a solid program must encompasses all aspects of legal compliance and patient care.

To a healthcare provider, each patient is a top priority. When discussing patient care, risk management must include various aspects of a practice. For example, it must deal with proper sanitation, proper prescription administration, diagnostic procedures, secure recordkeeping, and follow-up care.

Besides patient safety, a major risk that faces a medical institution is a malpractice claim. To be sure, no one is perfect, and mistakes may be made at any time. Therefore, each practice must make sure to have enough insurance. It is wise to purchase insurance that caters to specific needs of the entity. It must be renewed annually as well. Also, it is important to implement an asset protection plan. This deals with the risks of facing liability when a negligence-based claim is filed.

Legal and Regulatory Compliance

Many times, the legal side of healthcare is forgotten. In fact, there are countless compliance issues that must be addressed. Developing and following through with an effective legal and regulatory compliance program is vital. Even one oversight can bring severe problems.

Billing and Coding Compliance

In the healthcare industry, there are strict billing and coding requirements. Besides private insurance, federal programs come with their unique rules. Also, insurance providers have standard practices and billing codes, but each brings special requirements. Third-party billing is completed as well. Under federal laws, violations may bring a number of penalties. Therefore, it is essential to work with a lawyer who understands how to help.

Prescription Drug Compliance

Prescription drug compliance is an essential part of risk management. Hospitals, doctors offices, and all medical facilities must maintain strict compliance. As more and more people are ordering drugs online, these rules must be followed in these cases as well.

Anti-Kickback Statute

Even though the anti-kickback statute is often pushed to the wayside, it is illegal to offer, pay, or accept bribes in exchange for referrals or other advantages. Although there are exceptions, it is vital not to cross the line so that liability is avoided.

Data Security Compliance

HIPAA was introduced to protect a person’s private information. When data security is breached, a healthcare entity may be subject to negative consequences. Each practice must fulfill obligations and must make sure that all safety protocols are met. Patients’ privacy must be protected at all times. This includes employee data as well.

Telehealth Compliance

Thanks to advanced technology, it is possible to visit a doctor through the power of online communication. Like with electronic prescriptions, telehealth is subject to a multitude of legal responsibilities, including billing, documentation, out-of-state procedures, and other items.

Avoiding Risks

The healthcare industry is filled with contracts and protocols that aim to minimize liability and other risks.

  • Patient waivers
  • Employee relationships and contracts
  • Contracts with other healthcare facilities
  • Third-party service providers

Ways to Effectively Manage Risk in a Healthcare Setting

Indeed, there should be great concern when it comes to risk management in a healthcare setting. A solid plan should include risk assessments so that problem areas can be identified. Also, periodic audits should be conducted to assess new risks. To be sure, having a qualified law team is helpful as well. Experienced attorneys can draft and negotiate contracts, advise facilities about federal laws and regulations, and offer representation during investigations.

Obviously, risk management is a key part of a healthcare organization. It is possible to develop a solid program that deals with all the principles and practices of federal law. In this manner, it is possible to stay safe and to stay out of legal trouble.

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