Confused about the “meaningful use” component of the American Recovery and Reinvestment Act’s stimulus program? You are not alone.<< MORE >>

I was talking to Jonathan Krasner from Business Engineering, Inc  (BEI) this past week about HIPAA and the need to make sure data is encrypted and that we are dong everything possible to safegauard our clients information.  Following is an articale from BEI that Jonathan sent me that I would like to pass along to all of you that has a lot of great information.

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HITECH Act: Suggested IT Policies & Procedures

Congress passed and President Barack Obama signed the American Recovery & Reinvestment Act (ARRA) in February, 2009. The healthcare IT component of the ARRA is commonly referred to as the HITECH (Health Information Technology for Economic and Clinical Health) Act. The HITECH Act covers a broad range of healthcare IT initiatives including providing over $20 billion in funding towards implementation of healthcare IT. The HITECH Act also includes "Subtitle D" which focuses on privacy and modifies and broadens portions of the HIPAA Privacy and Security laws and regulations.

 

What you need to do

All of our privacy rules and laws (not just in the medical field) need to be updated to reflect the increasingly connected electronic world we live in. The electronic security measures mandated in HITECH are not that much different than what would be recommended for any business that needs to protect proprietary or confidential information. Technologies that render Electronic Protected Health Information (EPHI) unusable and unreadable to unauthorized individuals are necessary for EPHI to be considered secured. Secured EPHI is not subject to fines under the new HIPAA regulations. All of the recommendations below can be implemented with no or low additional cost, and with standard IT systems and services.

Encrypt your data:

 

The new HIPAA regulations frown on unsecured EPHI. EPHI can be unsecured when it is considered "data at rest" (i.e. stored on a hard drive) or "data in motion" (i.e. data moving from one device to another). To solve the "data at rest" issue, all workstations, laptops, servers, flash drives, or any other device that stores data, should utilize data encryption technology. It is easier to encrypt everything (e.g. entire hard drive) as opposed to encrypting selectively (e.g. just certain files/folders). There is no real harm in encrypting data that is not EPHI. Encryption is a capability built into most new operating systems (Windows7, Windows Server 2008), so turning on encryption is just a matter of reconfiguring some settings. Devices using older operating systems (e.g. Windows XP, Windows Server 2003, etc.) can be encrypted with any of several off-the-shelf software products. In the event that an encrypted device is compromised (i.e. a laptop is lost), the data will be inaccessible and therefore no breech of any HIPAA regulations would have occurred. The National Institute of Standards (NIST) provides guidance on storage encryption through their Special Publication 800-111, Guide to Storage Encryption Technologies for End User Devices.

Encrypt your network transmissions:

 

Any time you transmit EPHI between locations (examples: from your PM to a clearinghouse, or from a workstation in an office to a server in another office or datacenter), the transmission should be encrypted. Several technologies are available today and they are commonly used to transmit other secure information such as banking transactions and credit card authorizations over the Internet. The most common technologies used are Secure Sockets Layer (SSL), IPSecurity (IPSec) and Transport Layer Security (TLS). Most people are familiar with SSL since any website session that is accessed with the prefix "https://" is being managed by a security protocol, which is typically SSL, and the transmission is encrypted to and from the Web server. To implement HTTPS you have to purchase a digital certificate from a trusted authority (such as Verisign) and install it on your secure server(s). Your IT vendor should be able to configure any of these secure connections that you may require. NIST also provides guidance in three documents:

Special Publication 800-113,

 

 

Guide to SSL VPNs  

Special Publication 800-77, Guide to IPsec VPNs

Special Publication 800-52, Guidelines for the Selection and Use of Transport Layer Security (TLS)

Utilize encryption on wireless access points:

 

Transmission on a private local area network within the organizational confines of the covered entity (i.e. which does not traverse the public Internet) and that occurs over standard cabling is generally considered protected and these links do not have to be encrypted. However many medical offices use laptops and tablets that communicate through wireless access points (WAPS). Make sure that all your WAPS use encryption, and that a security key is required to access your network. Do not leave your network open – that will allow anyone to logon and potentially access or intercept your data.

Encrypt your copiers:

 

It may come as a surprise to some people, but digital copiers have hard drives (just like the ones used on PCs) built-in. If you dispose of a copier, by returning it to a leasing company or selling it, the data on the hard drive (i.e. all the copies that were made on the machine) may be unencrypted and therefore, unprotected. Make sure to contact your copier vendor and ask how you can get the hard drive encrypted. This is a feature that is available for free on newer machines from major manufacturers. 

Use secure email or patient portals:

 

Many providers use email to discuss patient cases between themselves or to converse with patients. Email transmissions are generally unencrypted, especially when dealing with a third party who is not a member of your organization. Secure email is an available alternative, as it encrypts all the information in each message. Using secure email is not as straightforward as regular email. It may require additional action on the part of the sender or receiver. An alternative to secure email is the use of a patient portal. When using a patient portal, standard email is used between parties to communicate that a message is available for viewing on the portal. The receiving party logs into the portal to receive (and possibly reply) to the message. Since the EPHI is totally contained within the portal website, and since that information is encrypted, the problem of securing the email is eliminated.

Ensure terminals used for teleworking/remote access are secure:

 

Many covered entities now allow their employees and contractors to conduct work from locations other than the organization's facilities. This is commonly referred to as teleworking. Most teleworkers use remote access, which is the ability of an organization’s users to access its nonpublic computing resources from locations other than the organization’s facilities. Organizations have many options for providing teleworkers remote access, including virtual private networks, remote system control, and individual application access (e.g., Web-based email). In addition, teleworkers use various devices, such as desktop and laptop computers, cell phones, and personal digital assistants (PDAs), to read and send email, access Web sites, review and edit documents, and perform many other tasks. Teleworkers should ensure that all the devices on their wired and wireless home networks are properly secured and protected, as well as the home networks themselves. This includes properly configuring the account control of the PC, utilizing business-class antivirus/antimalware software and using a broadband router or separate firewall device or software. NIST provides guidance for this in Special Publication 800-114, User’s Guide to Securing External Devices for Telework and Remote Access.

Check your firewalls:

 

Any local network that is connected to the Internet should use a device called a firewall to provide external access to the network only to authorized users and processes. Conversely, it should also be configured to guard against and reject unauthorized incoming external traffic (i.e. hackers). It is best practice to make sure that your firewall is properly configured to allow access and transmission for applications and users that you have approved. Improperly configured firewalls will have open ports that could possibly allow unauthorized access to your network. 

Develop and implement a backup/disaster recovery plan:

 

Although not new to HIPAA under HITECH, the HIPAA security rule does require all EPHI to be subject to a backup/disaster recovery plan. Think of all the EPHI that was lost when Katrina struck; what would be the effect on your practice if a disaster occurred? How would you recover? In the past, tape backup was often used. However newer technologies and techniques are now available that are more cost effective and provide better outcomes.

At first glance, all of this would appear to be a tall order to implement for any private practice. In reality, these types of security and privacy measures are commonly implemented for small businesses. Consult your IT support vendor on how to proceed. Also remember that these measures do not insure HIPAA compliance for your practice; rather they are a component of your overall HIPAA plan. 

 

 

        

Group Visits Increase Revenue

Patient expectations are rising and payors and regulators are demanding increased documentation and strict compliance with a rapidly expanding cadre of clinical practice guidelines. If you’re looking for a way to streamline processes, increase revenue  and improve patient care, consider group visits.
 

 

Group visits, sometimes called shared medical appointments, provide an opportunity to increase capacity, and at the same educate patients and empower them to take active roles in the management of their health. Consider group visits for patients who have chronic conditions such as diabetes, tobacco dependence, COPD, arthritis or heart disease.

Group visits, which typically last 90 minutes to two hours, include a group educational session, plus one-on-one medical evaluations conducted by a physician or nurse practitioner. During the evaluations, the provider should clarify the assessment and discuss and document appropriate treatment.

Many providers have found that the most successful strategy for billing for group visits is to code them as individual office visits using CPT codes 99212 to 99214, based on the level of complexity of the individual visits.

 

Group visits are both efficient and effective. Physicians and patients report higher satisfaction, and studies have shown that these shared medical appointments lead to improved health behaviors.

        

Medical Billing Fan Page

Capture Billing has setup a Facebook Fan Page to help medical practices come together, ask questions and help each other. Over the past decade or so, healthcare has become a highly regulated field. There is a maze of Medicare and Medicaid regulations along with patient privacy laws that must be followed.  Don't adhere to them and risk allegations of fraud, civil penalties and possibly even jail time.  Now add Healthcare reform to the mix with all its new regulations, most of which are still being figured out, and you can begin to imagine how confusing and frustrating it is for your local medical practice and physicians to make sense of it all.   

"We just started but already have hundreds of physicians, medical office managers, practice administrators, nurses and other healthcare providers on our Facebook Fan Page that have become our friends", states Manny Oliverez, Director of Operations at Capture Billing. "People are looking for answers to their medical billing issues."

Capture Billing hopes to facilitate the conversation on its Facebook page for such topics as healthcare reform, medical billing and coding, the difference between ICD-9 and ICD-10 coding, electronic health records, dealing with health insurance companies, practice management, patient billing and more.

Join the medical billing conversation at Capture's Medical Billing Fan Page on Facebook.

        

How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient's medical information with confidence?<< MORE >>

CPC Exam Preparation Classes at Northern Virginia Community College

Several of our staff members have gotten together and are teaching a class to prepare medical billers for the 5 1/2 hour Certified Professional Coder (CPC) certification exam  from The American Accademy of Professional Coders .  If anyone happens to be in the Washington DC area and would like to take the classes, I have included the course description and contact information at the college for you to sign up.
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CPC (Certified Professional Coder) Exam Preparation

The CPC preparation course will take you through the principles and purpose of the CPT, ICD-9 CM and HCPCS coding manuals. This prep course will make you a better coder and enable you to assign procedures and diagnosis codes to the highest level of specificity. The CPC prep course uses instructional methods that include practice exercises, discussions, assignments, module review tests and much more to get you prepared for the exam. An important aspect of the prep course is that you gain access to the latest updates to be able to code with more accuracy. You have so much to gain and nothing to lose! The course is intensive and uses the best course materials available along with solutions from knowledgeable and experienced instructors. The class will also present specialty coders from different areas of medicine. Get valuable test taking tips from the pros! You'll learn what the test expects you to know, what format you can expect, and what you can skip. Everyday, you'll tackle and review practice questions so that you're prepared for the real thing.

· Test taking skills you'll gain: Make the most of "open book." Our expert instructor shows you her unique way to tag and highlight your coding reference books so that you can move quickly from question to question.

· Is that anatomy or medical terminology question a
stumper? Master these prefixes and suffixes and it will be a snap.

· Time management skills that help you pass. You've got 5 hours - but should you tackle that heart cath coding scenario or skip it? Here's how to know for sure.
· ICD-9's neoplasm table and why it's an aspiring CPC's best friend.

· When you shouldn't code like you do in your office. Hint: Savvy test takers know how to use the multiple-choice format to save loads of time.

· Work with your instructor and peers to discover the test-taking strategies that work for you - and where you're most likely to mess up. Successful test takers reveal where the test tries to trip you up. Hint: Here's when ICD-9's index is your worst enemy.

· Signs and symptoms coding rules that you must understand to ace diagnosis coding questions. Diagnosis coding tricks for diabetes, hypertension, the neoplasm table, burns, V codes and other ICD-9 challenges.

· 4th and 5th digits: Here's what examiners want to make sure you understand.

· HCPCS: Do you know how to use the book?

Mandatory book requirements:
The CPC-P (R) Study Guide, CPT 2010 (AMA standard or professional edition only), your choice of ICD-9-CM 2010 (expert editions are allowed), your choice of HCPCS Level II 2010 (expert editions are allowed). These books will not be available in the campus bookstore, but they may be purchased online at www.aapc.com. These books will be used for the CPC open book exam and you may write in them.

 

 

Class Dates (10 Sessions):

Fri., May 21, Thurs., May 27, and Fri., Jun. 4, 7:00 - 10:00 p.m.; Sat., Jun. 12, 10:00 a.m. - 1:00 p.m.; Fri., Jun. 18, 7:00 - 10:00 p.m.; Sat., Jun. 26, 10:00 a.m. - 1:00 p.m.; Fri., Jul. 9, Thurs., Jul. 15, and Fri., Jul. 23, 7:00 - 10:00 p.m.; and Sat., Jul. 31, 10:00 a.m. - 1:00 p.m.

NVCC Loudoun Campus

 

For More Information Contact:

Lisa or Clair
Workforce Development & Continuing Education at the Loudoun Campus

703.450.2551

        

As of April 1, 2010 Medicare has changed the way you need to report that a Medicare patient signed an Advanced Beneficiary Notice (ABN).  Medicare has revised the GA modifier and added a new GX modifier you must consider when doing medical billing.

Medicare GA Modifier

Prior to April 1st he GA modifier read "waiver of liability on file".  The new revised description is "waiver of liability statement issued, as required by payer policy."  Use this modifier when the patient has signed an ABN and you expect Medicare to deny the claim due to the medical necessity of the diagnosis or frequency. By having the signed ABN you will be able to collect from the patient.

Medicare GX Modifier

The new GX modifier reads "notice of liability issued, voluntary under policy." Use this when you know the service is considered non-covered by Medicare. Since the service is non-covered you technically do not have to give an ABN to a patient to sign, hence "voluntary", but it is a good idea to inform the patient that they are financially responsible.  Plus you may still want to bill Medicare to get the denial to forward to the secondary payer.

So you are not sure when the GX modifier applies? On the Medicare fee schedule under the status code if there is an "N' or "X" the code is non-covered and you would append the GX modifier to the CPT code if you had the patient sign an ABN. The Medicare Physician Fee Schedule can be downloaded off the CMS website. Our billing and coding staff likes to use  from DecisionHealth because it is easy to use and gives us a wealth of information.

You are not required to give the patient an ABN for non-covered procedures.  If you do not give the patient an ABN then you can use the GY modifier to indicate "Item or service statutorily excluded, does not meet the definition of any Medicare benefit, for non-Medicare insurers, is not a contract benefit."

Please make sure the ABN is filled out properly.  Without a properly competed ABN it is considered invalid by Medicare and you will not be able to hold the patient responsible.  We come across this all the time at our medical billing company  and we will go back and reeducate the providers, clinical and front desk staff to make sure they are filled out correctly.

 

 

        

Deciding if and when to outsource your medical billing tasks to a third-party is one of the most important choices that a provider will ever make. Choose wisely, and revenues will be more and headaches will be less. Choose foolishly, and the provider will have more work cut out for them after outsourcing their medical billing.
 

 

Chris Thorman, who blogs at Software Advice, recently wrote an article pointing out some of the major points that a provider will need to evaluate when deciding whether or not to outsource their medical billing services. In the article, he evaluated costs and other qualitative factors that goes into this important decision.

 

Chris' came to the conclusion that hiring a medical billing service resulted in a higher net income than doing it in-house. Chris was also quick to point out that only quality, efficient services, are able to earn this extra income for their clients. Not all billing services are the same. To read the rest of Chris' article, click here. 

        

        

The Senate passed the jobs bill late Tuesday night that includes the postponing of the 21% cut in Medicare reimbursement.  Doctors get another 30 days before the Medicare cuts take effect.  Hopefully Congress will act and rescind the cuts because doctors are already getting there reimbursements cut by commercial insurance companies.

        

With the failing of the Senate to repeal a bill that reduces reimbursements for Medicare, a 21% cut on payments to physicians went into effect March 1, 2010.  Medicare is notifying their contractors to hold Medicare claims for 10 business days effective today.  Claims will begin processing on March 15^th with the reduced rates.  There is still a chance that Congress may reverse this decision. Stay tuned.

        

        

I came across a webinar that explains qualifying for the federal governments stimulus funds for Electronic Health Records under the HITECH Act in the American Recovery and Reinvestment Act (ARRA).  The audio seminar covers:

How the stimulus money will be paid out

What it takes to qualify for funding

Which specialties qualify for funding

How “meaningful use” is defined

What constitutes a “qualified EHR”

The webinar last about an hour and is well worth the listen to learn how your practice can take advantage of the government incentives.

To listen to the webinar go to http://bit.ly/6tvLWX .

        

We are excited to have our Medical Billing Minute as a podcast on iTunes.  We are hoping more people will be able to access our videos that contain tips on medical billing and practice management.  Through our videos we hope to educate physicians, healthcare mangers and medical billers on various topics that are relevant and help healthcare providers run their medical practices' more efficiently.

To subscribe to our podcast and have it downloaded automatically to your PC or phone, just visit iTunes and search for Medical Billing Minute or Capture Billing.  Don’t have iTunes?  Download it at http://www.apple.com/itunes/download/  .

        

To subscribe to the Medical Billing Minute Podcast, click on the RSS feed on the left or visit us on iTunes.

Download | Duration: 00:02:24

        

To subscribe to the Medical Billing Minute Podcast, click on the RSS feed on the left or visit us on iTunes.

Download | Duration: 00:01:25

        

Medical Billing Video Helps explain the New Way to Code Consultations
Specialty physicians code lots of consultations  but as of January 1, 2010 Medicare is eliminating all inpatient and outpatient consultation codes. This will make medical billing for consults more complicated. So how are physicians suppose to bill for their services and get paid?  Lets take a look at how by playing the video.

        

With Healthcare Reform just around the corner and all the new regulations already placed on physicians in the American Recovery and Reinvestment Act (ARRA), Capture Billing & Consulting, Inc., is helping doctors and medical billers wade thorough and sort out information with its new Medical Billing Minute videos.  The one minute long videos will cover a multitude of topics relevant for today’s physicians to help them through the maze of coding, billing and compliance regulations. The first video walks physicians through how to properly bill for the H1N1 Swine Flu Vaccine.

Capture will produce videos to help doctors code and document properly and tell them of governmental regulations that will affect their practice. Some episodes will give tips to medical billers on how to deal with insurance companies that stall or deny coverage for patients and how to overcome the obstacles they put up.  The company plans to produce ove 60 Medical Billing Minute videos.

Healthcare professionals can subscribe to the Medical Billing Minute by going to the Capture Billing website or blog, to  YouTube.com or finding Capture on  Twitter.

Click here to see our H1N1 Video.

        

This episode of the Medical Billing Minute helps physicians and medical billing on how to bill and code for the H1N1 Swine Flu Vaccine.

        

Capture Billing is pleased to announce that two of its associates, Jackie Penna, CPC, and Nikki Hendrix, CPC, have been elected officers of the Leesburg Virginia Chapter of the American Academy of Professional Coders (AAPC).  Jackie is currently the President-Elect and Nikki the Treasurer-Elect. They will take their offices on January 1st. The AAPC provides certified credentials to medical coders in healthcare facilities including physician offices, hospitals and medical billing companies. The Certified Professional Coder (CPC) credential is the gold standard certification for medical coding. Congratulations to our great staff members.

        

I was reading a blog post entitled 'Doctor: Why I decided to join and insurance-free practice' about a primary care physician joining a practice that does not take insurance because he was not making any money at his current practice. I help run a large physician’s practice and medical billing and consulting firm.  I hear doctors complaining about insurance reimbursements and requirements all the time.  In almost all cases the real reason for their complaining, after asking the right questions, has to do with how they run their business and not so much with the insurance companies. But the insurance companies are easy to blame. Make no mistake, I have no love for insurance companies, I battle with those shysters everyday trying not to pay but you have to assess the practice and find the real reason doctors are stressed. Remember, doctors are trained in healthcare, not in business and workflow management or medical billing. I have heard of doctor’s offices that have lost hundreds of thousands, if not millions of dollars over the years due to poor business practices.  A good management team would take the administrative burden off of them so they can practice medicine. I feel bad for those docs and their staffs.  

        

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I remember back in 1984 when I got my first modem for my computer.  It was a 300 BAUD modem. In today’s terms think 186 times slower than dial-up. But WOW it opened up the world.  No longer was my IBM compatible confined to my desk.  My computer could now go anywhere in the world.  Of course there weren’t too many anywheres to go.  Now I can access almost any computer on the planet.  Well you know what?  Anyone ...<< MORE >>