This blog article gives you an overview of regulations for healthcare providers and how they can improve compliance processes with specialized AI-driven solutions.
Healthcare, Compliance, Artificial Intelligence
Telehealth compliance challenges
One of the most common challenges that healthcare providers face is the ever-changing regulatory landscape. Healthcare regulations are constantly evolving, with new rules and guidelines being introduced regularly.
Staying up to date with these changes and ensuring compliance can be a daunting task for healthcare providers.
Telehealth has become an important tool for remote medical care. The recent pandemic has accelerated the adoption of digital technologies especially for the healthcare sector. Telemedicine consultations, electronic health records (EHRs), and digital patient portals have become the norm. However, this convenience also leads to challenges in complying with communication regulations. While these advances are improving accessibility and efficiency, they are also raising significant compliance concerns regarding data privacy and security.
Recording and archiving of patient consultations must also follow defined rules. Many unified communication platforms such as Microsoft Teams or Zoom already offer recording options, but their built-in solutions often do not comply with the relevant regulations. This is where specialized apps can help with compliance.
With new technologies and communication channels, educating healthcare professionals about compliance is critical. Regular training on the latest compliance regulations and proper handling of patient data can reduce the risks associated with data breaches and non-compliance. To further complicate matters, these new technologies have the potential to challenge the level of trust that patients place in their healthcare providers.
Legal and regulatory requirements for healthcare providers
While healthcare compliance is vital, it does come with its fair share of challenges. Healthcare providers must ensure that their telehealth platforms are compliant with regulations. Ensuring that communication channels are secure and encrypted is critical to protecting patient information and must be met to comply with the Health Insurance Portability and Accountability Act (HIPAA), a U.S. federal law.
Impending penalties for non-compliance with HIPAA regulations
HIPAA is the U.S. federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. Compliance breaches often result in severe legal and financial consequences for healthcare organizations. From 2020 to 2022, fines and penalties for violating HIPAA totaled up to approximately $21.6 million. In addition, the financial impact of ensuring compliance with privacy laws such as HIPAA is significant, with the American Hospital Association reporting that the healthcare industry spends $39 billion each year on the administrative aspects of compliance. While administrative and functional reforms are on the table for consideration, the reality is that the situation will only become more complex. More importantly, non-compliance can lead to a loss of reputation, which can have a lasting impact on an organization's credibility and ability to provide care.
How emerging regulations affect how we operate
2023 Centers for Medicare and Medicaid Services (CMS) Final Rule
There are always new regulations coming down. Like all regulated industries, the healthcare sector must adapt to these new regulations. This includes understanding the nuances of state, federal, and international laws, especially for organizations that operate in multiple regions. For example, The Centers for Medicare and Medicaid Services (CMS) issued a final rule as a response to complaints of inappropriate marketing practices by Medicare Advantage organizations and Third-Party Marketing Organizations (TPMOs).
The rule requires all TPMOs to adhere to all applicable laws, regulations and CMS guidelines, including the requirements for conducting lead generation, marketing, selling, and enrollment activities with Medicare beneficiaries as outlined within the 2023 CMS Final Rule released May 9, 2022. This meant that insurance companies and Third-Party Marketing Organizations (TPMOs), including healthcare agents and brokers are now all required to record all marketing calls with beneficiaries in their entirety including the enrollment process. This rule applies to both new and existing clients of the organization.
Call recordings must then be stored in a HIPAA-compliant manner for at least 10 years – which almost certainly means higher operational costs for the affected companies. And that’s just one of the over 600 regulations that could potentially update their rules regularly – keeping every compliance officers busy.
- Download CMS Final Rule brochureRed more about compliance requirements for medicare Recordings in our Compliance Primer.
Leveraging technology to enable compliance for healthcare
With the ever-evolving capabilities of technology, and artificial intelligence in particular, ensuring compliance is more important than ever. At the same time, ensuring compliance through technology has never been easier. Automated solutions like Recording Insights that monitor communication and flag potential compliance issues have been proven to help healthcare organizations stay ahead. With Recording Insights e. g. we enable operators in the healthcare sector to adopt Microsoft Teams for external communication so they can use Teams for telehealth and stay compliant with regulations like HIPAA and unlock features such as:
- Omni-channel recording
- Highest security standards with encryption
- Redundant recording and storage
- Flexible recording rules
- Powerful search and easy replay with strong access right control
- Emotion detection and keyword spotting
- Identifying calls that contain personal data
- Identifying customer complaints
- Auto-categorization
- Automated compliance screening and alerting
- Script adherence
Monitoring and detection of compliance violations with AI
Without automated processes and intelligent software, monitoring customer communications is nearly impossible. Without tools, companies in regulated industries monitor no more than 2-3 % of customer communications. Conversely, this means that over 97 % of customer communication remains unmonitored, resulting in a high risk of compliance violations and no further analyses of customer communication for more insights.
By integrating AI into the monitoring process, 100 % of customer communication can be monitored and analyzed.
This minimizes the risk of undetected compliance risks while providing valuable insights into customer needs. Leveraging artificial intelligence for the analysis of customer communication affords a thorough comprehension of these interactions. Facilitated by Recording Insights and the integrated AI Policy Engine, we provide our partners and customers with a range of options, including:
- Validating that all disclaimers have been mentioned
- Auto-categorizing regulated (e. g. HIPAA) vs. non-regulated calls
- Identifying calls that contain personal data
- Auto-categorizing calls with sensitive patient information
- Identifying customer complaints
- Revealing inappropriate consulting
By integrating Azure Open AI into our solution, we can even summarize entire conversations and execute a sentiment analysis. For example, you can ask the AI:
"Was this conversation HIPAA relevant?"
The AI examines the conversation and provides an assessment thus you no longer have to worry about the security of your data. Customer data is stored within the secure Azure infrastructure and patient conversations are never used for training purposes.
- Request a DEMO DEMOGet a live demonstration of our compliance recording solution Recording Insights and we show you how you can get more insights from your customer communication with AI-driven Analytics.
Conclusion: The future of healthcare compliance
Technology plays a significant role in healthcare compliance, enabling healthcare providers to streamline processes, enhance data security, and improve compliance efforts. Electronic health records (EHRs) and other technological solutions help healthcare providers meet regulatory requirements and minimize the risk of non-compliance.
EHRs allow for secure storage and transmission of patient health information, ensuring compliance with HIPAA regulations. These systems also facilitate easier access to patient data, enabling healthcare providers to make informed decisions and deliver personalized care.
Additionally, technology solutions can automate compliance processes, such as monitoring and auditing, reducing the administrative burden on healthcare providers and improving overall efficiency.
