2010 Benchmark Study

1.
2010 Healthcare Compliance
Benchmark Study
Presented By:
1185 Sanctuary Parkway, Suite 250, Alpharetta, Georgia 30004 I Phone: 678.992.0262 I www.compliance360.com

2. Executive Summary
Beginning on November 30th, 2009, Compliance 360 conducted a benchmark study among
compliance professionals in the Healthcare Provider industry lasting over a 7 week period.
Respondents were asked questions relating to budget and priority areas for their compliance
departments in 2010. In all, 1,420 healthcare compliance professionals responded to this
benchmark study, representing organizations from all 50 states, and ranging in size from larger
healthcare systems with over 5000 beds to critical access hospitals and assisted living facilities
with less than 25 beds.
Benchmark Findings
2010 Compliance Program Budget Expectations
2009 brought a slew of new regulations and audit challenges for healthcare providers to
contend with ranging from claims audits including RAC and MIC to the new HIPPA/HITECH
security and privacy provisions. Additionally, there has been plenty of editorial commentary
discussing the impact of the Healthcare Reform Bill and how it will impact healthcare providers;
the opinion believed by most is that healthcare providers can expect greater oversight. While
there still is some uncertainty with respect to healthcare reform, the data in the graph below
suggests that many healthcare providers are expecting greater regulatory scrutiny in 2010 and
have increased their budgets accordingly. Overall, 88% of respondents expect to increase or
hold their compliance budgets steady for 2010.
1185 Sanctuary Parkway, Suite 250, Alpharetta, Georgia 30004 I Phone: 678.992.0262 I www.compliance360.com

3.
2010 Compliance Program Priorities
We asked respondents to select the top priority areas for their compliance programs in 2010.
As evident by the chart below, HIPAA/HITECH Privacy regulation is the leading priority area for
healthcare providers in 2010. The HITECH provisions of the Economic Stimulus Act significantly
expand HIPAA regulations to include mandatory data breach notifications, heightened
enforcement, expanded patient rights, and increased penalties of up to $50,000 for each
violation and up to $1,500,000 per calendar year.
1185 Sanctuary Parkway, Suite 250, Alpharetta, Georgia 30004 I Phone: 678.992.0262 I www.compliance360.com

4. Claims Audit Preparedness
Despite all of the publicity and uncertainty surrounding claims audits including RAC and MIC in
2009, “Managing Claims Denials and CMS Recoupment Audits” only came in at number 9 on the
list of top priority areas. This may be due to the fact that over 40% indicated in the benchmark
that they are fully prepared for managing RAC audits and nearly 30% indicating they are fully
prepared for managing MIC audits. Despite the fact that many healthcare providers indicated
that they are full prepared to manage claims denials and CMS recoupment audits, doing so will
still pose some challenges in 2010. Because of the complexity of the audit process, the very
strict timeframes, and the potentially negative impact to their bottom lines, over 40% of
respondents indicated that “Holding everyone accountable for their part of the (audit and
appeals) process” was a challenge for them.
1185 Sanctuary Parkway, Suite 250, Alpharetta, Georgia 30004 I Phone: 678.992.0262 I www.compliance360.com

5. Conclusion
Compliance 360 would like to thank all of the healthcare compliance professionals that
provided their valuable input to this benchmark study. With many healthcare providers
receiving their first RAC letters, privacy regulations significantly expanded by the HITECH
provisions, and the possibility of healthcare reform in some form yet to be determined, the vast
majority of healthcare providers are expecting to contend with additional regulatory oversight
in 2010. As evident by the findings of this benchmark, many healthcare providers have
increased their compliance budgets to address these new challenges. Compliance 360
recommends that healthcare providers consider using software applications specifically
designed for Risk Management, Regulatory Compliance, Claims Audit Management and Privacy
Breach Management to automate and streamline their governance efforts. By leveraging
proven applications as many are already doing, healthcare providers will have the visibility
necessary to identify gaps, remediate issues and demonstrate proof of compliance. For more
information, please visit www.compliance360.com.
1185 Sanctuary Parkway, Suite 250, Alpharetta, Georgia 30004 I Phone: 678.992.0262 I www.compliance360.com