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Healthcare Compliance

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A fundamental aspect of the healthcare industry is ensuring that organizations comply with all relevant federal, state and industry regulations.

healthcare compliancePolicies and procedures related to protected patient health information (PHI), patient safety, security, and billing practices are compliance-related matters most subject to scrutiny and regulation.

LexisNexis Risk Solutions provides a variety of data-centric solutions to ensure compliance across organizational workflows. By leveraging data and analytics, healthcare organizations can mitigate exposure and risk while not compromising customer experience, patient engagement or due diligence.

Our compliance solutions are used across the healthcare spectrum, to validate prescribing authority, conduct vendor due diligence and verify providers and prescribers.

Conduct Vendor Due Diligence to Ensure Regulatory Compliance

Today's healthcare organizations operate in a highly regulated environment, with exercising control over third party vendors, suppliers and subcontractors being one of the major challenges.

Compliance programs that allow healthcare organizations to stay on top of evolving laws, global and domestic watch lists, and sanctions can be difficult to effectively implement, yet they are essential because the penalties for non-compliance are too severe to ignore both in terms of financial penalties as well as potential safety risks to patients.

healthcare complianceRegulatory agencies expect all healthcare organizations, including pharmacies, hospitals, pharmaceuticals and medical device companies to take responsibility for every entity and individual conducting business on their behalf.

Watchlist screening is a critical component of vendor due diligence. Thorough watchlist screening processes can help healthcare organizations determine if any relationships pose a security risk. It helps healthcare companies ensure compliance with domestic and international sanctions, reducing the likelihood of disruption when onboarding legitimate third party vendors and subcontractors.

To meet these due diligence requirements, Bridger Insight XG for Healthcare offers a streamlined regulatory review to transform business compliance processes. This compliance solution can help businesses identify areas of risk, while adhering to federal and global regulations.

By performing real-time checks in sub-seconds, Bridger Insight XG for Healthcare reduces manual reviews and decreases false positive rates while also reducing operational costs through its advanced audit and reporting capabilities. From the initial scan, where potentially troublesome individuals and companies will be identified, to the regular checks against an ever-updating database, Bridger Insight XG for Healthcare provides an end-to-end solution to meet due diligence requirements.

Prevent Potential Life Sciences
Corruption and Fraud

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Real-Time Prescriber Authority Compliance Checks

Pharmacies need a prescribing authority verification solution. Retail, chain, specialty pharmacies and pharmacy benefits managers (PBMs) need a solution that addresses audit challenges, workflow efficiencies and pharmacy ROI. LexisNexis VerifyRx solution helps pharmacies:

Mitigate Risk and Exposure

Log all transactions data in real-time. Monitoring and reporting compliance performance is available at the click of a button, fulfilling auditing requirements. 

Enable Focus on Compliance

Benefit from a tailored solution that is adaptable to suit legal requirements and compliance program needs — a single point of control allows compliance and legal experts to set a company-wide policy for each state, covering in- and out-of-state prescriptions.

VerifyRx delivers daily updates to DEA and state data as opposed to the industry standard weekly NTIS file. These more frequent updates allow a greater insight into the way the organization operates.

Reduce Cost

Lower risk of fines, lower impact to workflow and filing claims, lower rollout costs and IT investment, reduce research time.sanction data, enabling compliance with dispensing guidelines.

Support Current Pharmacy Operations

Build a solid, reliable framework that integrates industry-leading technology and data while delivering advanced analytics.

VerifyRx can integrate seamlessly into existing workflows, ensuring quick processing and dispensing to patients.

Verify Healthcare Providers and Prescribers Seamlessly

healthcare complianceIndependent and community pharmacies need to be able to quickly validate prescribers before dispensing medications. In order to stay compliant, these smaller pharmacies need access to real-time provider information to assist with credentialing and provider data maintenance.

Pharmacists can get access to the richest, most reliable source of healthcare provider information available through Provider Data Validation from LexisNexis Risk Solutions. This platform offers a convenient, agnostic online portal with zero development cost. Access to provider data allows pharmacies to validate licensures, group and hospital affiliation, and sanction data, enabling compliance with dispensing guidelines.

To find out more about LexisNexis Health Care's compliance solutions and how they can be integrated into your healthcare compliance program, please contact us today.


Healthcare Markets We Serve

Payer

Data solutions help plans ensure the right people receive the right care by the right providers at the right costs.

Provider

Data management and intelligence solutions improve market share, reduce risk and safeguard patient identities.

Pharmacy

Data, analytics and prescriber verification solutions help pharmacies identify ways to reduce fraud and expand market penetration.

Life Sciences

Data management and market intelligence solutions offer life sciences organizations a healthy market advantage.
White Paper

Managing Regulatory and Financial Compliance Risk

White Paper

Specialty Pharmacy Compliance Challenges Can Be Mitigated with Real-time Checks

Infographic

CMS 455 Regulatory Compliance: Pharmacy Credentialing for Government Programs

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