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From HIPAA and ICD-10 to Meaningful Use and the two-midnight rule, government regulations demand a lot from health organizations. But with 80 percent of compliance risk residing in the revenue cycle, providers need to understand how profoundly billing can heighten their risk and find ways to protect themselves.


Gone are the days when it was enough just to keep pace with regulatory changes. As they seek to follow a rising number of ever-more-elaborate rules issued by an expanding pool of regulators, providers must gear up to respond proactively — preparing now for policy modifications and audits yet to come.

But given the complexity of today’s regulatory environment, it’s nearly impossible for health organizations to cope with compliance risk without advanced solutions. Shifting that task to a partner that can manage the intricacies of today’s compliance considerations, keep abreast of changes buried in the legislation and oversee the end-to-end systems that distill thousands of regulations into an automated function is one way to lower the risk.

As regulatory pressures intensify, a strong revenue cycle partnership can prove invaluable in revealing new and better ways to fulfill government and provider mandates. Many hospitals and health systems do not realize the requirements needed for protecting their organization or are unaware of how significantly billing can impact their risk.


Optum360® expert

Daniel Roach, J.D.

Chief Compliance Officer and General Counsel

“In health care’s dynamic regulatory environment, there is a real possibility of an organization getting into trouble for dropping the compliance ball. The key to effective oversight is asking the right questions and knowing where to look for compliance failures. The answers may surprise you.”

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