Would the Government Say Your Compliance Program Is Adequately Resourced?

Every practice—not just large organizations—needs a compliance program that works. Here’s what that really means and why it matters.

When you hear the words “compliance program,” you might think of large healthcare organizations and hospitals with entire departments dedicated to oversight. However, compliance is critical for every healthcare practice, regardless of its size. A well-resourced program protects your practice, your patients, and your team. It can also make the difference if a regulator comes knocking.

What Does It Mean to Have a Well-Resourced Compliance Program?

Having a well-resourced compliance program doesn’t mean hiring hundreds of compliance officers. It means having the right policies, tools, and accountability structures in place to regularly check your licensure, privacy practices, billing, and treatment procedures. It also means spotting issues before a government authority does and correcting them with minimal disruption to your operations.

Licensure: Keep an Eye on Renewals and Good Standing

If your practice provides services that require a professional license, you must carefully track licensure and continuing education requirements. A simple spreadsheet listing each employee’s license number, renewal date, and continuing education deadlines—reviewed monthly—can help you avoid costly mistakes.

You should also have a clear policy for what happens if an employee’s license lapses. While termination may not always be necessary, a licensed healthcare professional should not treat patients until their license is active again.

Privacy Practices: HIPAA Compliance Is Only the Beginning

Most practices know not to share protected health information improperly. But HIPAA compliance also includes securing stored information, responding to security breaches, controlling internal access, and informing patients of their rights and responsibilities.

State privacy laws often add more requirements. A strong compliance program will include written policies covering HIPAA and state-specific rules, annual staff training for all employees, and clear procedures for handling breaches, even for those who do not directly manage patient information.

See our related articles:

• “Does HIPAA Apply to You? You Might Not Be Compliant.”
• “Your HIPAA Policy and Notice of Privacy Practices: How Do They Relate?”
• “HIPAA Right of Access: Six Reasons That Practices Get Busted” 

Billing Practices: Stay Ahead of Audits

If you bill patients, insurers, Medicare, or Medicaid, your compliance program must address billing accuracy. For self-pay patients, this includes providing Good Faith Estimates as required by the No Surprises Act.

If you bill third parties, your practice should run regular audits to catch issues early. Document all claims thoroughly, including date of service, consent to treatment, and services provided. If you discover a billing error, your policies should guide you through prompt corrective action, such as refunding overpayments within required timeframes.

See our related articles:

• “The No Surprises Act: A Primer for Independent Healthcare Practices”
• “The No Surprises Act: What Out-of-Network Healthcare Practice Owners Need to Know”

Patient Intake: Get Consent and Disclosures Right

A well-resourced compliance program ensures that intake forms are complete, up to date, and legally compliant. This includes gathering informed consent, collecting required medical history, and meeting state-specific disclosure requirements, such as California’s notice to consumers.

If you provide telehealth services, remember that patients must consent to both the treatment and the telehealth delivery itself. Using generic templates can create dangerous gaps that lead to legal risks.

See our related video, “Template Intake Forms: Are They Putting Your Practice At Risk?”