Doctors have a hard enough time treating patients and dealing with basic business operations on a day-to-day basis. It’s a difficult task to ask them to be aware of and in compliance with every section of health care regulatory laws and other standards in addition to their daily provision of care to patients. Simply stated, doctors and other health care professionals and providers face an enormous challenge trying to be aware of, understand, and comply with applicable state and federal health care regulatory laws.
Consequently, health care professionals and providers are often completely in the dark on what it takes to spot compliance issues and prevent them from happening before they become serious issues. This level of awareness (or lack of it) can be summed up in one simple statement. You don’t know what you don’t know. And not having this knowledge can lead to devastating consequences.
That’s where Halos4Health (Halos) comes in.
At Halos4Health, we focus on helping health care professionals and providers identify, assess, and address their compliance risks. Halos has developed a first-of-its-kind set of compliance risk assessment tools to help health care professionals and providers understand basic and niche laws and regulations, as well as identify and target potential compliance exposures and gaps in their businesses or practices.
Why is a compliance risk assessment important for your business or practice?
Being able to identify gaps and your practice’s or business’s compliance is critical to preventing unforeseen and devastating investigations, lawsuits, penalties, and other ramifications. Being able to assess and address these gaps is even more critical.
But why is a compliance risk assessment more important than ever? Why complete one now?
A new year is always a good time to assess where your business or practice stands and effect changes/additions to its compliance awareness and structure. With change and innovation comes great responsibility - especially in today’s age. It is important to understand health care is more than just providing great care and that compliance is multifaceted. The ending of one calendar or fiscal year and the start of another is the perfect time for health care professionals and providers to take stock of their compliance risk profile and perform an assessment.
The upcoming changes in the federal Executive Branch - including in HHS, CMS, OIG, FDA, and DOGE - will have a significant impact on health care professionals and providers. President-elect Trump’s nomination of Robert F. Kennedy, Jr., for Secretary of HHS and Dr. Marty Makary as Commisioner of the FDA, as well as Elon Musk and Vivek Ramaswamy to run DOGE, promises to bring sweeping and intense changes to the federal health care regulatory apparatus. While we can expect to see a cut in regulations, the remaining regulations will most likely be enforced more heavily - especially the Stark Law and Anti-Kickback Statute. Preparing for more heavily enforced regulations now will help ensure that your business or practice doesn't face investigations, severe fines, and/or punishment in the future.
Additionally, the OIG and CMS have been very active in issuing new compliance guidance, coverage, and regulations over the past 2+ years. Again, health care professionals and providers often don’t know what they don’t know. Performing a compliance risk assessment helps them raise their level of knowledge and awareness, which in turn helps identify and correct gaps in compliance.
Halos4Health’s comprehensive compliance risk assessment tool does just that. Understanding what laws and standards apply to your business or practice can help you become more confident in your compliance and gap analysis.
Our process begins with a comprehensive compliance risk assessment, which asks questions from multiple compliance risk categories. It contains more than 120 questions which allow us to assess and stratify the customer’s compliance risk profile. Each of the questions requires a simple “yes or no” answer, and the risk assessment only takes about 60-90 minutes to complete while being easy to use and user-friendly. Halos4Health’s algorithmic system then scores your answers to each question and stratifies your overall risk in ten compliance risk categories to help you identify your most concerning compliance risk areas.
We can then recommend one or more submodules to help address identified compliance risks and gaps in the following categories: APPs (APRNs and Physician Assistants), HIPAA and Privacy, HIPAA and Security, Medicare Billing/Coding, AI, Managed Care Contracting, Medical Malpractice, Medical Records Release, Medical Record Documentation, Employment and Medical Director Agreements, and General Compliance.
TLD Systems has a very strong HIPAA program and has elected to partner with Halos to assess and assist with compliance of Federal Regulations. TLD members receive discounted, preferential pricing including bundled pricing arrangements from Halos. Please visit Halos’ website for more information on this discounted and preferential pricing.
Completing a compliance risk assessment for your business or practice cannot only help you identify and address gaps, but also sleep better at night. We are also in the process of building both chiropractic-specific and podiatric-specific submodules, and they should both be available by early January 2025. If you are interested, you can visit our website at halos4health.com or email us at info@halos4health.com. Authors: Michael R. Lowe is a board-certified health care attorney with 28 years of experience in health care law/litigation, medical malpractice, and compliance. Brian Evander is a health care attorney with 15 years of experience in health care law, medical malpractice, civil litigation, and complex business litigation. Jacob Lowe is a programming specialist for Halos who helped program and design the comprehensive module and submodules.
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