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    2010HealthcareCompliance
         BenchmarkStudy
                                                         
                                                         
                                         PresentedBy:

                                                                                   







      

      

      

      

      

      

      



    1185SanctuaryParkway,Suite250,Alpharetta,Georgia30004IPhone:678.992.0262Iwww.compliance360.com
ExecutiveSummary
BeginningonNovember30th,2009,Compliance360conductedabenchmarkstudyamong
complianceprofessionalsintheHealthcareProviderindustrylastingovera7weekperiod.
Respondentswereaskedquestionsrelatingtobudgetandpriorityareasfortheircompliance
departmentsin2010.Inall,1,420healthcarecomplianceprofessionalsrespondedtothis
benchmarkstudy,representingorganizationsfromall50states,andranginginsizefromlarger
healthcaresystemswithover5000bedstocriticalaccesshospitalsandassistedlivingfacilities
withlessthan25beds.

BenchmarkFindings
2010ComplianceProgramBudgetExpectations

2009broughtaslewofnewregulationsandauditchallengesforhealthcareprovidersto
contendwithrangingfromclaimsauditsincludingRACandMICtothenewHIPPA/HITECH
securityandprivacyprovisions.Additionally,therehasbeenplentyofeditorialcommentary
discussingtheimpactoftheHealthcareReformBillandhowitwillimpacthealthcareproviders;
theopinionbelievedbymostisthathealthcareproviderscanexpectgreateroversight.While
therestillissomeuncertaintywithrespecttohealthcarereform,thedatainthegraphbelow
suggeststhatmanyhealthcareprovidersareexpectinggreaterregulatoryscrutinyin2010and
haveincreasedtheirbudgetsaccordingly.Overall,88%ofrespondentsexpecttoincreaseor
holdtheircompliancebudgetssteadyfor2010.




                                                                                                               


     1185SanctuaryParkway,Suite250,Alpharetta,Georgia30004IPhone:678.992.0262Iwww.compliance360.com


2010ComplianceProgramPriorities

Weaskedrespondentstoselectthetoppriorityareasfortheircomplianceprogramsin2010.
Asevidentbythechartbelow,HIPAA/HITECHPrivacyregulationistheleadingpriorityareafor
healthcareprovidersin2010.TheHITECHprovisionsoftheEconomicStimulusActsignificantly
expandHIPAAregulationstoincludemandatorydatabreachnotifications,heightened
enforcement,expandedpatientrights,andincreasedpenaltiesofupto$50,000foreach
violationandupto$1,500,000percalendaryear.






                                                                                                                   
                                  




     1185SanctuaryParkway,Suite250,Alpharetta,Georgia30004IPhone:678.992.0262Iwww.compliance360.com
ClaimsAuditPreparedness

DespiteallofthepublicityanduncertaintysurroundingclaimsauditsincludingRACandMICin
2009,“ManagingClaimsDenialsandCMSRecoupmentAudits”onlycameinatnumber9onthe
listoftoppriorityareas.Thismaybeduetothefactthatover40%indicatedinthebenchmark
thattheyarefullypreparedformanagingRACauditsandnearly30%indicatingtheyarefully
preparedformanagingMICaudits.Despitethefactthatmanyhealthcareprovidersindicated
thattheyarefullpreparedtomanageclaimsdenialsandCMSrecoupmentaudits,doingsowill
stillposesomechallengesin2010.Becauseofthecomplexityoftheauditprocess,thevery
stricttimeframes,andthepotentiallynegativeimpacttotheirbottomlines,over40%of
respondentsindicatedthat“Holdingeveryoneaccountablefortheirpartofthe(auditand
appeals)process”wasachallengeforthem.






                                                                                                                   






     1185SanctuaryParkway,Suite250,Alpharetta,Georgia30004IPhone:678.992.0262Iwww.compliance360.com
Conclusion

Compliance360wouldliketothankallofthehealthcarecomplianceprofessionalsthat
providedtheirvaluableinputtothisbenchmarkstudy.Withmanyhealthcareproviders
receivingtheirfirstRACletters,privacyregulationssignificantlyexpandedbytheHITECH
provisions,andthepossibilityofhealthcarereforminsomeformyettobedetermined,thevast
majorityofhealthcareprovidersareexpectingtocontendwithadditionalregulatoryoversight
in2010.Asevidentbythefindingsofthisbenchmark,manyhealthcareprovidershave
increasedtheircompliancebudgetstoaddressthesenewchallenges.Compliance360
recommendsthathealthcareprovidersconsiderusingsoftwareapplicationsspecifically
designedforRiskManagement,RegulatoryCompliance,ClaimsAuditManagementandPrivacy
BreachManagementtoautomateandstreamlinetheirgovernanceefforts.Byleveraging
provenapplicationsasmanyarealreadydoing,healthcareproviderswillhavethevisibility
necessarytoidentifygaps,remediateissuesanddemonstrateproofofcompliance.Formore
information,pleasevisitwww.compliance360.com.










         1185SanctuaryParkway,Suite250,Alpharetta,Georgia30004IPhone:678.992.0262Iwww.compliance360.com

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