Compliance
HIPAA & ISO 27001
Compliance Program
Elico Healthcare Services' well-conceived compliance program makes your institution operate with greater efficiency leading to superior quality patient care and reduced errors. Our Commitment to Healthcare Compliance is much more than a defense. It is a critical component of modern risk management and a new approach to Quality of Patient Care.
Our Main Compliances
For the industry standards
Healthcare compliance programs across the Healthcare industry are a systematic & documented approach to Standardize and Protect the confidentiality and integrity of Patient Health Data while mitigating the risk of Healthcare errors, fraud, or abuse. Our Organization is staffed with a certified expert compliance team that will create customized compliance programs for the various stakeholders across the Healthcare Industry.
Objectives of our Organization’s Comprehensive Compliance Program
- Confidentiality & Integrity of Patient Health Data.
- Meet or Exceed the legal, ethical & professional standards applicable to a particular Healthcare organization or provider as per Federal guidelines.
- Find & Correct potential vulnerabilities and errors so that there is a reduction in the chance of an audit.
- Optimize compliance standards and protocols leading to minimizing billing mistakes, increasing payment of claims, reducing the chance of fraud & abuse, and promoting safe & quality care.
The above core elements are the foundation for our compliance program.
Elico Healthcare Services’ Compliance Model
Understanding the challenges and strategies associated with patient data protection and proactive reporting is the key to amend the compliance protocol effectively. Our model is based upon the seven compliance standards recommended by the OIG.
Our Compliance program is differentiated in 7 different stages:
HIPAA
Health Insurance Portability and Accountability Act
Introduction
Health Insurance Portability and Accountability Act (HIPAA), a US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals, and other health care providers.
Following HIPAA
Elico Healthcare Services adheres to the rules, in compliance with Federal & State Laws and Regulations guiding the Healthcare Industry sector. Our organization has a robust framework that determines the accessibility & availability of specific patient health data. As an ISO 27001 ISMS certified organization, we ensure relevant physical, cyber & process security measures are in place to safeguard patient health information
The act was conceived to guarantee that health insurance coverage follows
Available to workers and their families when they change or lose their jobs
Standardizing the data content and format for electronic transactions (administrative simplification)
Privacy of confidential personal health care information
Secure physical access to records, and national identifiers for providers, employers, and health plans
The Federal and State laws, including HCFA regulations were formulated to prevent fraud and abuse in the health insurance industry, especially in the Federal programs such as Medicare, and Medicaid.
There are established laws, rules and regulations that govern medical billing. Disregard or breach of these laws and regulations, in the course of our billing operations, can result in one or more of the following:
- Rejection of claims
- Delay in reimbursement
- Reduction in reimbursement
ISO 27001
Information Security Management
Introduction
ISO 27001, titled "Information Security Management - Specification With Guidance for Use", is the replacement for BS7799-2. It is intended to provide the foundation for third party audit, and is 'harmonized' with other management standards, such as ISO 9001 and ISO 14001.
ISO 27001
The ISO 27001 standard was published in October 2005, essentially replacing the old BS7799-2 standard. It is the specification for an ISMS, an Information Security Management System. BS7799 itself was a long standing standard, first published in the nineties as a code of practice. As this matured, a second part emerged to cover management systems. It is this against which certification is granted. Today in excess of a thousand certificates are in place, across the world.
The upgrade
ISO 27001 enhanced the content of BS7799-2 and harmonized it with other standards. A scheme has been introduced by various certification bodies for conversion from BS7799 certification to ISO27001 certification.
The objective of the standard itself is to
"Provide a model for establishing, implementing, operating, monitoring, reviewing, maintaining, and improving an Information Security Management System”
Regarding its adoption, this should be a strategic decision. Further, “The design and implementation of an organization’s ISMS is influenced by their needs and objectives, security requirements, the process employed and the size and structure of the organization”.
The standard defines its ‘process approach’ as “The application of a system of processes within an organization, together with the identification and interactions of these processes, and their management”. It employs the PDCA, Plan-Do-Check-Act model to structure the processes, and reflects the principles set out in the OECG guidelines.
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