By Frost & Sullivan
The health care industry is heavily regulated at the federal, state, and local levels. The challenge to professionals involved in the regulatory and compliance process is that the element of change is always present; yet in today’s environment the stakes have risen, given the combination of internal and external factors driving change for most health care providers. A large segment of the regulatory maze involves the submission of specific information that is crucial to successful reimbursement by the payer to the provider for medical services that have been delivered to patients, some of whom have limited coverage.
Meanwhile, all stakeholders, including payers, physicians, and patients, have financial interests that must be protected. To be successful, payers and providers must also be aware of the latest rules and guidelines that pertain to information security. However, the health care industry must remain functional while enduring a major upheaval, based on as-yet undetermined impacts of policy changes on insurance markets, value-based care reimbursement structures, and other possible policy and regulatory shifts. The potential for massive disruption to the regulatory and compliance process is intense and uncertain. For all stakeholders, having access to a best-of-breed source of targeted information and alerts is a critical success factor.
Managing regulatory and compliance risk in the face of constantly evolving rules and guidelines is a significant challenge for both payers and providers, creating a pressing need for a best-in-class system to consistently support regulatory, reimbursement and compliance professionals in health care.
© 2017 Frost & Sullivan Reprinted with permission.
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