Top 10 major regulatory changes in US healthcare in 2022
It's no surprise that the US healthcare system is constantly changing. With new regulations and practices being put in place to improve health outcomes each year, it can be hard to keep up with all of the changes. In 2023, there will be a significant shift in how many aspects of the industry are managed, which could have far-reaching implications for you as a care provider or beneficiary. To help make sense of this transition and prepare yourself for what's to come, we've compiled our list of the top 10 regulatory changes to take effect this year. Whether you work in an insurance company, a hospital setting, or as an independent practitioner – understanding these shifts will be critical.
1. Fabricated Claims or Whistleblower Activities
Recently, the healthcare sector has had issues, including baseless claims and whistleblower lawsuits. Medicare and Medicaid are only two examples of federally financed programs and contracts that are within the purview of the False Claims Act. If a healthcare professional does an act that causes a false claim to be made, they may face criminal charges under this law. Deliberately submitting a fraudulent request for reimbursement to the federal government or intentionally utilizing a misleading claim or statement to induce the federal state to pay a claim are both key acts constituting a breach of this statute. Whistleblowers' status has also improved as a consequence of recent reform attempts. For example, whistleblowers may now file false claims cases using evidence obtained in legal, judicial, or administrative procedures accessible to the public. In addition, whistleblowers may now bring cases against healthcare institutions without having to be the entire truth.
2. Labor Market and the Employment Culture
There has been a rise in cases alleging age discrimination in hospital discharge policies. Hospitals must also deal with increased demands to accommodate disabled staff members. To protect themselves from potential lawsuits, hospitals should be transparent in their job postings and have clear, documented procedures for firing employees. For example, in the U.S. Department of Labor's final rule on workplace accommodations, employers must provide reasonable accommodation for employees who need it. The government also requires employers (healthcare companies) to keep an open dialogue with employees about disability-related issues, including reasonable accommodation requests.
3. Telemedicine Expansion
The coronavirus pandemic has made it clear that telemedicine is here to stay. The Centers for Medicare & Medicaid Services (CMS) have taken several steps toward expanding the use of telemedicine. For example, CMS created a temporary waiver that allowed Medicare Advantage plans to provide telemedicine services without requiring beneficiaries to use their home broadband or wireless connection. CMS also expanded the list of telemedicine services that qualified for reimbursement and allowed providers to bill for remote patient monitoring services. In 2023, these changes are expected to continue, with telemedicine healthcare services becoming increasingly available.
4. Regulations for Tax-Exempt Medical Facilities
The Patient Protection and Affordable Care Act lays forth strict criteria that hospitals must meet to qualify for and keep their tax-exempt status. The evaluation of the need for health care in society and the development of written regulations for emergency treatment and financial aid are examples of such mandates. Further, there are restrictions on fees and regulations governing the collecting process.
5. Influence of Stark Law on Physician-Hospital Interactions
The purpose of the Stark Law was to ensure that physicians and other referral providers did not improperly benefit from patient recommendations. In accordance with this legislation, any healthcare provider is prohibited from directing patients needing treatments covered by federal healthcare services to any entity in which they have a financial or another conflict of interest. The complexity of this rule necessitates great caution on the part of healthcare institutions when negotiating remuneration packages for doctors. Because of the absence of a need to establish intent, infractions of this law often occur.
6. Privacy Laws and Data Security
The Health Insurance Portability and Accountability Act (HIPAA) is an example of a privacy law that affects hospitals. HIPAA requires all healthcare facilities to protect patient information and keep it confidential. It also imposes penalties for noncompliance, including fines and jail time. To ensure compliance with this law, hospitals must regularly audit their systems and ensure that data is secure. Furthermore, they should develop policies for sharing, storing, and deleting information. Additionally, hospitals should invest in security systems that are constantly monitored for any potential breaches.
7. Changes to Medical Coding Systems
Hospitals must adhere to various medical coding systems, including ICD-10 and CPT. These codes help standardize medical services and procedures, making them easier to document, track, and monitor. As the healthcare industry evolves, so do these coding systems. In recent years, ICD-11 and CPT-11 have been proposed as replacements for their predecessors. These new codes emphasize greater specificity and accuracy, allowing hospitals to document more precise information.
8. Co-Management System
Co-management contracts are agreements between a hospital and its medical staff in which the institution agrees to pay the staff for completing certain tasks and achieving predetermined goals. Conflicts with anti-kickback, antitrust, professional self-referral restrictions, civil financial penalties, and Medicare standards and guidelines are possible outcomes of such systems.
9. Health Information Technology
Health information technology (HIT) is a growing field revolutionizing how hospitals store and manage patient data. HIT systems allow for the secure transfer, storage, and retrieval of medical records in an efficient manner. In addition, these systems can track patient outcomes, monitor drug, and equipment usage, and supply real-time patient data for better decision-making. 2023 is the deadline for all hospitals to adopt an EHR system, as mandated by the HITECH Act.
10. Payment and Reimbursement Reforms
The healthcare industry has seen numerous changes to payment and reimbursement policies in recent years. These reforms are designed to reduce costs and make it simpler for hospitals to get reimbursed for healthcare services rendered. Some of the reforms include changes to Medicare payment policies, such as bundling services, reducing reimbursement for specific procedures, and increasing patient cost-sharing. In addition, the Patient Protection and Affordable Care Act (PPACA) has altered reimbursement rates, significantly decreasing payments to certain healthcare providers while boosting revenues to others.
Healthcare data provider companies, healthcare providers, and hospitals must all be aware of the ever-changing landscape of healthcare laws and regulations. These ten significant regulatory changes in US healthcare in 2022 are just a few of the many changes that hospitals and healthcare institutions must keep up with to ensure compliance.