The laws and regulations that govern healthcare are too numerous to list here. A healthcare compliance officer stays informed of all healthcare laws and regulations, and they provide a valuable service to your organization.
Healthcare compliance officers work for a variety of public, private, and nonprofit organizations. Because healthcare organizations must comply with so many important regulations, positions for healthcare compliance officers are in high demand. If you’re wondering how to become a healthcare compliance officer, here’s a look at how to define a healthcare compliance officer, why hiring someone for the position is so important, and what skills and qualifications are necessary for the role.
What Is a Healthcare Compliance Officer?
Let’s kick things off with a definition of healthcare compliance. Michigan State University defines it this way:
“Healthcare compliance is about a healthcare facility or organization maintaining compliance with a number of government agencies, acts, guidelines, and laws. But the role of compliance goes beyond knowing these laws and regulations to the letter and ensuring a healthcare organization complies with them. A major responsibility of healthcare compliance is to conduct investigations and audits to identify areas of risk, draft a plan for improving compliance practices to address those risks, and monitor to ensure the program is following best practices and standards.”
A healthcare compliance officer is an individual who is responsible for ensuring that everyone working for the organization follows all laws and regulations. In larger organizations, a healthcare compliance officer may lead a team of people to get the job done. One of the duties of a healthcare compliance officer may include setting up a training program to instruct all employees on each person’s role may impact compliance matters.
Something that makes the role of a healthcare compliance officer challenging is that regulations are continually changing and evolving.
Here’s a list of some of the issues that a healthcare compliance officer is responsible for addressing:
- Business ethics
- Billing fraud
- EMTALA (Emergency Medical Treatment and Active Labor Act)
- Code of conduct
- Privacy laws
- Business relationships
A healthcare compliance officer is a little different than a regulatory compliance officer. A regulatory compliance officer is usually responsible for overseeing accreditation and regulatory compliance for several agencies, including healthcare agencies. In the interest of both roles, it’s important for your board to write a clear job description and list of duties and responsibilities.
Why Healthcare Compliance Is Important
While obeying laws and regulations is of primary importance, it’s also highly important to protect patient data, which is just as important as patient care.
A healthcare compliance officer is responsible to ensure that record-keeping, billing practices, and any other source of personal patient information remains confidential. This responsibility extends to electronic records, electronic devices, and transferring records.
A failure to comply with laws and regulations or a breach of personal data could cost a healthcare organization millions of dollars and create undue legal liability.
What Are the Requirements to Become a Healthcare Compliance Officer?
The requirements for how to become a healthcare compliance officer include a combination of education, the right certifications, and experience. It’s not typically an entry-level position.
Let’s start with the educational requirements. Most healthcare compliance officers have at least a bachelor’s degree. It’s also coming to see healthcare compliance officers that have an advanced degree such as a JD or MBA.
Healthcare compliance officers commonly have one or more certifications such as the following:
- Certified in Healthcare Compliance (CHC)
- Certified in Healthcare Privacy Compliance (CHPC)
- Certified in Healthcare Research Compliance (CHRC)
- Certified in Healthcare Compliance – Fellowship (CHC-F)
- Certified Professional Compliance Officer (CPCO™)
The certifications require an exam and retesting every two years to maintain the certification. Certification standards ensure that healthcare compliance officers are able to develop, manage, and direct the duties and responsibilities of a compliance department.
Healthcare organizations that participate in federal healthcare programs are required to have compliance programs as a part of the Affordable Care Act (ACA).
In general, it’s important for healthcare compliance officers to have certain skills and conduct themselves professionally at all times. They need to be analytical and detail-oriented. Also, they should be good researchers, strategists, and decision-makers. Healthcare compliance officers are often called upon to give informative and engaging presentations about healthcare compliance matters.
What Are Some of the Duties and Responsibilities of a Healthcare Compliance Officer?
It’s important for boards to document the many duties and responsibilities of a healthcare compliance officer in writing and monitor their performance annually.
Here is a list of some of the things your healthcare compliance officer should be familiar with:
- Compliance guidance for individual medical practitioners and small group practices, laboratories, and third-party billing firms, as provided by the Office of Inspector General (OIG)
- How to conduct a compliance program and report to the board on it
- False Claims Act
- Stark Laws
- Anti-Kickback Statute
- CLIA (Clinical Laboratory Improvement Amendment)
- Requirements under Corporate Integrity Agreements (CIAs)
- Requirements under Certificate of Compliance Agreements (CCAs)
- How to handle investigations and self-disclosure protocols
- Investigative activities such as Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), Medicaid fraud control units (MFCUs)
Healthcare compliance officers also need to be aware of other basic laws and regulations that govern organizations including compliance regulations around gifts, advance beneficiary notices, physician guidelines, conflicts of interest, and incidental services.
Hiring and monitoring your healthcare compliance officer is an area of oversight for board directors. With unlimited cloud storage, your BoardEffect board portal is the best place to store copies of resumes for potential healthcare compliance officer candidates and documentation around your decision-making for the position. A board management system is also a secure place where you can create a library of all the important state and federal laws and regulations about health care so that the board and healthcare compliance officer can easily access them at any time.
Your board can more easily protect your organization when you hire a qualified individual to serve as your healthcare compliance officer if you document the job description, the employee’s qualifications, and your board’s recruiting and hiring processes.