1. To satisfy federal mandates under the Health Insurance Portability and Accountability Act (HIPAA) by ensuring the physician or facility provides and bills for services according to the laws, regulations, and guidelines that govern it. 2. Degree to which a patient follows a treatment program directed by a physician or health care provider.
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UK: The process of following agreed or regulated procedures such as those laid down by the FSA concerning authorisations, regulated activities, conduct of business, etc. At Lloyd’s, the managing and members’ agents must comply with the requirements imposed upon them by Lloyd’s and supervised by the FSA (www.fsa.gov.uk).
Insurance Encyclopedia
Compliance audit
1. An audit instigated by the IR to ensure that the pension scheme has complied with IR requirements. 2. An audit to ensure that an authorised party has complied with FSA requirements under powers granted under FSMA.
Compliance audits
Formal, methodical examination or review done to ensure compliance with all laws, HIPAA regulations, and guidelines. This is accomplished by inspecting, analyzing, and scrutinizing the way something is being done (e.g., bookkeeping practices, medical record documentation, insurance claim filing, diagnostic and procedural code selection).
Compliance committee
Under HIPAA, those individuals in a facility or in a physician’s medical practice that are assigned to help the compliance officer teach and comply with all laws, regulations, and guidelines related to health care.
Compliance date
Under HIPAA, the date a covered entity must comply with a standard, an implementation specification, a requirement, or a modification. This is usually 24 months after the effective date of the associated final rule for most entities, but 36 months after the effective date for small health plans. For future changes in the standards, the compliance date would be at least 180 days after the effective date but can be longer for small health plans and for complex changes.
Compliance deadline
Target date when a final rule developed by the Secretary of Health and Human Services to meet a specific law under the Health Insurance Portability and Accountability Act (HIPAA) becomes mandatory and is strictly enforced.
Compliance guidance
Document published by the Office of the Inspector General (OIG) to enable hospitals, home health care, nursing homes, third-party billing companies, and physician medical practices to establish compliance programs.
Compliance monitoring
Under the Health Insurance Portability and Accountability Act (HIPAA), to check provider and insurance company responsibilities in regard to the accuracy of procedure codes and verification of medical services provided to patients to prevent fraud and abuse.
Compliance officer
Individual overseeing a facility’s or medical practice’s compliance program who plans, implements, and monitors the program with a staff trained to perform activities that comply with the Health Insurance Portability and Accountability Act (HIPAA) rules.
Compliance oversight officer
The approved person, having significant influence and acting in the capacity of director or senior manager, who is allocated the compliance oversight function. He or she must ensure that the firm acts in accordance with FSA rules. He or she needs unfettered access to all individuals and information in order to further the sound and prudent management of the firm.