We live in an exciting time. New advances in science and technology are offering healthcare professionals new tools to improve the health of their patients, and more people than ever have access to high-quality healthcare.
At the same time, we’re facing new challenges that will require us to use our creativity and knowledge to find effective solutions. Join me as I explore some of the trends healthcare regulatory professionals can expect to see over the next decade.
Information Blocking Regulations
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits a covered entity to summarize ePHI if disclosed for treatment, payment, or healthcare operations. So if you are on a health plan and you receive a summary of an individual’s mental health history from a provider, you can include that information in your claims data without violating HIPAA.
In some cases, individuals will still have a right to view and request corrections of their ePHI held by HIPAA-covered entities. For example, suppose you receive an individual’s mental health history from a provider who has summarized it without his or her permission. In that case, you may have to provide him or her with access to that information.
Telehealth (or telemedicine) is an umbrella term that encompasses all types of healthcare services delivered via telecommunications technology. It allows medical professionals to provide care remotely and has become increasingly common as telecommunication technology improves and becomes more affordable. In 2021, many insurance companies began offering telehealth coverage as a standard benefit.
Televisit is a great example of how Telemedicine works. According to experts at Medable, “Televisit connects your patients to their physician, using a single 21CFR Part 11 compliant solution that’s fully integrated with your clinical studies’ clinical workflows.” This type of service provides the perfect platform for consultations between doctors and patients.
Electronic Prescribing of Controlled Substance (EPCS)
The Centers for Medicare and Medicaid Services (CMS) announced that it would be implementing an electronic prescribing of controlled substances (EPCS) requirement for Medicare Part D beneficiaries. The EPCS requirement went into effect on January 1, 2021. In addition, CMS requires all pharmacies to have systems in place that allow them to accept e-prescriptions from prescribers by January 1, 2021.
No Surprises Act
Effective January 1, 2022, this bill is a response to recent news stories of patients receiving bills from out-of-network providers for thousands of dollars after being treated by an in-network provider. The law requires insurers to cover most out-of-network claims if a patient receives care from an in-network provider who accepts responsibility for payment.
On January 1, 2023, CMS will launch a real-time benefit comparison tool that will allow people to see what their plan covers at any given time. This should help people make better choices about which plan best suits their needs.
The healthcare industry is constantly growing, evolving, and changing. There are always new regulations to be aware of and new standards to meet. So professionals in all aspects of healthcare need to stay up-to-date on these trends to provide patients with safe care.