Regulations and Standards

Compliance activity for the physician office practice covers a wide range of issues. Federal and state laws and regulations intended to prevent fraud and abuse, discrimination against individuals with disabilities, and loss of privacy and security of patient health information—as well as mandatory-reporting laws to protect the public—are among the major compliance issues that must be addressed. For practices seeking to attain or maintain accreditation, compliance also entails having a program in place to ensure that accreditation standards are met.

The information in this chapter will help physicians and staff be able to do the following:

In the United States, mandatory-reporting laws were introduced a century ago as preventive public health initiatives to track and control the spread of communicable diseases such as cholera and smallpox. Today, reporting laws address surveillance reporting of certain diseases and genetic conditions for statistical analysis, planning, budgeting, research, and tracking. To promote public safety, state laws may require physicians to report confirmed or suspected cases of certain conditions to state or local authorities for investigation or other action.

State mandatory-reporting laws vary in terms of which conditions must be reported and by whom they must be reported. State laws may require physicians to report...