Overcoming Lab Compliance Issues: A Closer Look

A caregiver enters a room, smiling warmly at an elderly woman who is sitting up in her bed

Each year, over 14 billion lab tests are ordered by healthcare providers. As the demand for tests increases, healthcare compliance is paramount to ensuring patient safety and the integrity of healthcare systems. However, small and large-scale labs struggle with the complexities of regulations in the rapidly evolving field of healthcare. Unable to keep up, they lose dollars to denials, putting patient privacy, data, and quality of care at risk.

In this article, learn more about how to overcome challenges in compliance for labs and master the interplay of healthcare regulation and practice success.

Why compliance and regulation in healthcare matters

According to the University of Phoenix, healthcare compliance is “the practice of adhering to local, state and federal healthcare laws and regulations, which prohibit and prevent fraud, abuse and waste in the healthcare industry.” Compliance in healthcare is not merely about one’s legal and moral obligation but the foundation of a reliable, safe, and well-regulated community. Adhering to laws and regulations shows you care for your practice and patients.

However, it’s not as simple as following a set of rules. Various stakeholders, including healthcare providers, administrators, regulatory bodies, legal experts, policymakers, and patients, are actively engaged and collaborate to ensure the integrity and security of healthcare systems.

Understanding healthcare regulations and lab compliance

Labs, on the other hand, need to understand stringent protocols that govern patient data privacy, cybersecurity measures, test standards for optimal patient care, healthcare ethics, and more.

These include the following major regulations every healthcare organization must adhere to:

  • Health Insurance Portability and Accountability Act (HIPAA): this involves national standards for the protection of patient health information.
  • Health Information Technology for Economic and Clinical Health (HITECH) Act: this allows the adoption and meaningful use of healthcare information technology.
  • Emergency Medical Treatment & Labor Act (EMTALA): this ensures the public can access emergency services regardless of their ability to pay for them.
  • Patient Safety and Quality Improvement Act of 2005 (PSQIA): this helps patient safety organizations (PSOs) to collect and review patient safety information.
  • Anti-Kickback Statute: this does not allow providers and organizations to receive financial incentives for a patient referral.
  • False Claims Act (FCA): this ensures no one can file a false claim for federal program funds illegally.

Remember, these changes come from complex processes, and if you’re not well-equipped to handle them, you can get lost in the whirlwind of compliance. That’s why laboratories all over America must make strategic strides to handle the fast-paced changes in healthcare compliance.

How Synapse can help with overcoming compliance challenges

By nature, the amalgam of laws involving healthcare is diverse. You need to understand different strands of data privacy, tax obligations, and hiring mandates. The best way to overcome these challenges is to consult with experts in regulations like Synapse. Invest in a lab billing team that can help you accomplish the following benefits with proven results:

  • Reduce your operating costs and improve cash flow
  • Eliminate your billing and coding errors
  • Quicken processing and payment

Are you ready to maximize your lab’s revenue and operations? Visit our Contacts or call (844) 384-7532 to schedule a FREE consultation.

Sources:

Strengthening Clinical Laboratories. (2018). Centers for Disease Control and Prevention. Retrieved from: https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html 

Feder, M. (2024). Exploring healthcare compliance as a career. Retrieved from:  https://www.phoenix.edu/blog/exploring-healthcare-compliance-as-a-career.html