Skip to main content

Regulatory Compliance in Hospital Revenue Cycle Management

September 6, 2023

Regulatory compliance refers to a healthcare organization’s extensive efforts to ensure they have the appropriate measures and hospital billing processes that enable them to meet all legal and professional obligations. 

Maintaining regulatory compliance while managing hospital staff, caring for patients, and ensuring the highest standards of medical treatment is a complex and demanding endeavor that requires meticulous attention to detail, comprehensive training, and effective communication across all levels.

Identifying Key Regulations Impacting Revenue Cycle Management

Revenue cycle management is an essential aspect of healthcare operations that is subject to various legal and regulatory compliance requirements. These are the key regulations all healthcare organizations are likely to be subject to:

  • HIPAA – the Health Insurance Portability and Accountability Act of 1996 is a federal law that protects the privacy of certain health information. The HIPAA Privacy Rule sets the standards for using and disclosing individuals’ health information (known as protected health information, or PHI), while the Security Rule establishes security standards that protect certain health information that is held or transferred electronically.
  • The HITECH Act – the Health Information Technology for Economic and Clinical Health Act of 2009 ensures healthcare providers use Electronic Health Records (EHR) and support healthcare information technology. The Act sets the standard for information security, provides financial security and penalties for healthcare providers and associated businesses, and encourages them to proactively protect patient information.
hospital medical billers having a meeting and looking at graphs
  • EMTALA – the Emergency Medical Treatment and Labor Act of 1986 ensures greater public access to emergency services regardless of their insurance status and ability to pay.
  • AKBS and Stark Laws – the Anti-Kickback Statute prohibits the abuse of the healthcare system for financial gain. The AKBS ensures that no healthcare professional or organization offers or receives any reward or financial incentive for an award or the referral of patients. 
hospital medical biller working at computer in office

The Stark Law is a set of fraud and abuse laws that prohibit physicians from referring patients to other medical entities from which the referring physician or their family could receive financial gain.

  • PSQIA – the Patient Safety and Quality Improvement Act of 2005 is a voluntary reporting system that enhances the data available to resolve patient safety and health issues and protects healthcare workers who report unsafe conditions at their organization. The Act allows individuals to report medical errors while maintaining patient confidentiality.

Compliance Challenges in Hospital Revenue Cycle Management

To remain compliant, hospitals must address the following challenges:

Cybersecurity threats

Hospitals store confidential patient data that is worth a lot of money to hackers who sell it, making the healthcare industry a vulnerable target. It is crucial to update security systems and strengthen digital infrastructures at all levels – from hospital billing and coding to data entry and other components of the revenue cycle. Taking this for granted can put patient safety at risk and damage an organization’s integrity.

infographic showing compliance challenges in hospital

The rise of telemedicine

The pandemic has highlighted the relevance and usefulness of telemedicine in delivering patient care, but regulating telehealth remains a controversial issue because it is relatively new.

Still, hospitals must prepare to adopt telehealth services and, in turn, prioritize cybersecurity to protect sensitive patient information.

Hiring ethical and compliant professionals

The first step to maintaining compliance is hiring the right people. Organizations must strengthen their screening process to find the most ethical and compliant individuals to join their team. Having knowledgeable and experienced members will make it easier to keep up with the healthcare industry’s ever-changing regulations.

Promoting compliance may also mean placing the responsibility in the hands of trusted and experienced professionals who know best.

At Coronis Health, we never underestimate the importance of compliance in revenue cycle management. Our collaboration with the best of the best in revenue cycle management ensures we understand your facility’s competitive landscape while keeping abreast of the latest regulations.

If you’d like to learn more about how you can remain compliant and keep your hospital billing optimized, contact Coronis Health to see how we can improve your revenue today.

Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch