Glossary of Healthcare Operations Terms

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What is Compliance?

Compliance in healthcare refers to the adherence to laws, rules, regulations, policies, or standards used to safeguard patient safety and privacy.

In what context is Compliance applicable?

Compliance is essential in the healthcare industry to mitigate operational and financial risk.

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Frequently asked questions

Why is compliance important in the healthcare industry?
Compliance is of utmost importance in healthcare operations to maintain data security, patient privacy, and adherence to regulatory standards. Organization-wide healthcare compliance ensures that everyone follows proper procedures and understands expectations—all with the goal of providing high-quality and safe patient care.
What laws and regulations govern healthcare compliance?

Healthcare compliance is governed by various laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and regulations from the Centers for Medicare & Medicaid Services (CMS), and Occupational Safety and Health Administration (OSHA) standards). There also are accreditation standards (e.g., The Joint Commission). And healthcare organizations follow their own internal policies and procedures (e.g., the bylaws). These standards aim to ensure data security, patient privacy, and ethical conduct in healthcare operations.

What are the consequences of non-compliance in healthcare?

Compliance in the healthcare industry requires fast and full adherence to changes in this highly regulated space. Aside from poor outcomes, regulatory noncompliance can result in financial penalties, lower reimbursements, unwanted oversight, and negative media attention.

How do healthcare organizations ensure ongoing Compliance?
Healthcare organizations ensure ongoing compliance by implementing written compliance policies, procedures, and standards, conducting regular audits, providing staff training, and staying updated on regulatory changes. Continuous auditing and monitoring are essential for maintaining a culture of compliance in healthcare operations. And, enforcing compliance standards in healthcare through well-publicized disciplinary guidelines is equally as important.