Analyzing Regulatory Rules for Privacy and Security Requirements
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Quality-driven architecture development using architectural tactics
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HIPAA and QMS Based Architectural Requirements to Cope with the OCR Audit Program
MUSIC '12 Proceedings of the 2012 Third FTRA International Conference on Mobile, Ubiquitous, and Intelligent Computing
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The United States Office of Inspector General (OIG) has issued a number of compliance guidelines including third-party medical billing guidelines for healthcare companies in the United States to reduce errors and fraud in the field of medical billing. OIG strongly suggests that medical companies should ensure compliance of these guidelines by incorporating OIG requirements within their processes. Compliance of OIG guidelines will ultimately support medical companies to reduce the consequences and penalties of legal actions in case of non-compliance/government audit. This research has suggested that medical companies can adopt an ISO 9001 framework to ensure compliance with OIG billing guidelines. The authors compared ISO 9001 standard with OIG third-party medical billing guidelines by mapping their components. The comparison reveals that the requirements mentioned in the ISO 9001 guideline meet or exceed the OIG third-party medical billing guideline by more than 70 percent. The authors also emphasize the importance of creating additional patterns, named as compliance patterns for the healthcare industry. A few billing compliance patterns are also devised to ensure billing compliance. The United States based third-party Medical Billing Company (MBC) with a backup office in Pakistan was used as a case study to evaluate the effectiveness of this proposed framework. MBC was able to increase customer satisfaction from 72 percent to 84 percent by implementing the proposed framework and compliance pattern approach. Two internal audits were also carried out to evaluate the effectiveness of the proposed framework. It was also clear from the evidence that with a prior implementation and tailoring of the framework approach customer satisfaction tremendously increased.