Mastering Compliance Amid Healthcare Regulatory Changes

AdobeStock_531067660-1The last few years have been quite active with healthcare regulatory changes, and 2024 will have a large impact on payers due to the changes implemented in previous years going into effect. Staying compliant with the recent changes and updated on future ones is essential, so we’re digging into what these changes mean and how you can stay informed and compliant.

Why Is Compliance Important?

Before we explore some key strategies you can implement, let’s first get into the whys. We know compliance isn’t easy, so it can be helpful to remember why we’re doing this. 

It all starts with members having access to true cost and quality information about the care they need. This can lead them to make more informed decisions about their care, improving their health and helping them save money. In turn, this ability also impacts costs for their employers. 

Understanding the true cost and quality of care before receiving it can also cut down on hospital readmissions. Additionally, when members feel confident in their healthcare choices, they will seek necessary care rather than putting it off due to costs or confusion with navigating complex healthcare systems.

Top Strategies for Keeping Up with Healthcare Regulatory Changes

Now let’s explore some top strategies you can implement to keep up with healthcare regulatory changes.

Stay Informed

One of the best ways to keep up with healthcare regulatory changes is to stay informed on new regulations, updates to existing regulations, and how these developments impact you. One of the largest healthcare regulatory changes is Transparency in Coverage—specifically the Final Rules that went into effect on January 1, 2024.

Transparency in Coverage implements legislative mandates under section 1311(e)(3) of the Patient Protection and Affordable Care Act (ACA) and section 2715A of the Public Health Service (PHS) Act. The final stage of these rules requires pricing information for all covered services and items to be made available through internet-based cost comparison tools. 

Part of the final rules is the requirement to provide machine-readable files (MRFs) with in-network rates for all covered items and services and the allowed amount file, which states the allowed amounts for out-of-network providers.

On September 27, 2023, the US Centers for Medicare and Medicaid Services (CMS) clarified the MRF requirements in the final rules. It was determined that Rx MRFs wouldn’t conflict with the reporting requirements as outlined in the Consolidated Appropriations Act (CAA) because the act requires different information to be disclosed than what is required in the Transparency in Coverage rules.

Conduct Internal Audits

Internal audits are essential for determining areas of noncompliance and evaluating potential consequences and risks. By performing a regularly scheduled audit of your documentation, processes, and adherence to regulations, you can proactively identify and address areas for improvement in your organization’s compliance before they become a significant problem.

Who knew compliance could become a business strategy? We break it down for you  in an infographic here.

Utilize Technology 

One of the best ways to ensure you’re compliant with healthcare regulatory changes is to utilize technology solutions, such as Bluebook Comply™.

Healthcare Bluebook has been in the transparency and compliance space for more than 20 years. As such, we keep on top of any healthcare regulatory changes and ensure our tools meet these needs.

Bluebook Comply is a comprehensive solution that’s solely focused on ensuring deadlines are met and organizations stay compliant with critical regulations, including the Transparency in Coverage rules and the No Surprises Act. Our solution addresses essential requirements, including price comparison tools, MRFs, and advanced explanations of benefits.

Ready to Get Started with a Comprehensive Compliance Strategy?

Compliance regulations aren’t going anywhere. It’s time to think of them as a business strategy and use them to your advantage. Discover how by reading our guide, Compliance as a Business Strategy.

Cover of Compliance as a Business Strategy