Compliance is either a state of being in accordance with established guidelines, specifications, or legislation or the process of becoming so. Healthcare compliance is required by law throughout the United States. This regulates billing and coding compliance for treatments, risk assessment, practice ethics, referral laws, and patient rights legislation.
Proper documentation and itemization of charges for treatments and services are important to provide proof of service during an audit or adjustment by integrity contractors. The compliance of healthcare providers also prevents improper treatments, lawsuits and various problems which occur between patients and insurance claims. Protection of the organization of healthcare providers can only be done by following the strict laws and regulations set for compliance.
To prevent audits and inquiries, healthcare organizations must analyze and correct all factors which could lead to such audits and adjustments. Proper compliance also leads to less conflicts with insurance claims and offers efficient processing for healthcare providers.
Physician practices must keep up-to date on an increasing number of deadlines required by the different rules and regulations. The TMA Compliance Calendar will help physician practices keep track of existing and future deadlines.
This section contains free posters that must be posted in the physician's office for employees and/or patients.
The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of health information needed for patient care and other important purposes.
The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates to use to assure the confidentiality, integrity, and availability of electronic protected health information.
This webpage will have additional information, deadlines, resources, and toolkits to help practices with HIPAA compliance.
Because Health System Reform (HSR) rules and regulations are continuously being published, The Harris County Medical Society (HCMS) created a new health system reform (HSR) webpage for HCMS physicians and their staff. This page:
Focuses on issues that have an immediate impact on, or require immediate action from physician practices;
Provides clear directions on what these actions involve and helpful tools; and
Provides pertinent resources, reports and websites on health system reform.
For information on medical records, including retention requirements, please see the Medical Records webpage under Practice Resource-Ethics.
The National Provider Identifier (NPI) is a standard unique health identifier for health care providers. The Administrative Simplification provisions of the Health Insurance Portability & Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers, as well as for health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. All physicians will have to move to the NPI number to file claims for Medicare, Medicaid and commercial insurance. Once enumerated, a physician's NPI will not change.