Medical Billing Minute

Senate Approves 30-Day Postponement of 21% Medicare Cuts

Manny Oliverez Capture Billing — Wed, 03 Mar 2010 04:35:00 GMT

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.

Medicare Cuts Payments by 21%

Manny Oliverez Capture Billing — Tue, 02 Mar 2010 14:53:00 GMT

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.

HITECH Act Privacy and Security

Manny Oliverez Capture Billing — Mon, 15 Feb 2010 15:46:00 GMT

Changes to Current HIPAA Laws and Regulations

My colleague Jonathan Krasner at Business Engineering, Inc. in Reston, Virginia sent me the following information about HIPAA changes that take effect this week. His information pertains to physician offices, medical billing companies, hospitals and a host of other healthcare facilities and vendors.

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. The following is a high level overview of how the HITECH Act impacts current HIPAA laws and regulations. This first section is an overview of the changes that will go into effect on February 17, 2010; changes that were or will be effective on other dates are summarized on the second page of this document.

Application of Security/ Privacy Rules to Business Associates

Business Associates (BA’s – generally defined as those who do not work for a covered entity (CE) but handle protected health information (PHI))[mj1] will now be required to directly comply with the Administrative Safeguards, Physical Safeguards, Technical Safeguards and Policies and Procedures provisions of the existing HIPAA Security Rule. Similarly, BA’s are now directly bound by the privacy rules in the existing HIPAA regulations. They are also now directly subject to civil and criminal penalties for violations. Previously BA’s were only indirectly regulated through BA agreements with CE’s.

Restrictions on Certain Disclosures

CE’s are required to grant a request from an individual to restrict disclosure of their PHI if the disclosure is to a health plan for purposes of either payment or health care operations and the PHI pertains to a service for which the individual paid in-full, out-of-pocket. CE’s were not previously required to grant requests for restriction of any disclosure for payment or healthcare operations.

Disclosures Limited to the "Minimum Necessary"

CE’s are currently required to limit requests, use or disclosure of PHI to the “minimum necessary”. The HITECH Act clarifies that the “minimum necessary” will only be satisfied if a CE or BA uses a “limited data set” which is defined in HIPAA as PHI that excludes a specific set of direct identifiers of the individual. However, if using a “limited data set” is not practical then the “minimum necessary” guidance still applies. This HITECH Act also clarifies that it is the CE or BA disclosing the PHI that determines the “minimum necessary”.

Access to PHI in Electronic Format

CE’s that use an EHR must provide individuals the option to receive an electronic copy of their PHI. Any associated fee charged by the CE can only cover its labor costs for providing the electronic copy. Previously there was no requirement that an electronic copy had to be made available to individuals.

Marketing

Under HIPAA a CE generally must obtain authorization for any use or disclosure of PHI for marketing purposes except if the communication is for “health care operations”. This has been revised under HITECH. If a CE has received payment for making a communication, the communications for “health care operations” is allowed if (1) it relates to a drug or biologic that is currently being prescribed or (2) individual authorization has been obtained and or (3) a BA makes the communication on behalf of a CE that is within the framework of the BA agreement.

Fundraising

The requirement that a CE must, in any fundraising materials it sends to an individual, allow that individual to opt out of receiving any future fundraising communications is unchanged except that it is now a statutory requirement of the HITECH Act and not just a regulatory requirement.

Other HIPAA Changes in the HITECH Act

Clarification of Criminal Penalties (effective 2/17/2009)

The Department of Justice declared in a June 1, 2005 position paper that only CE’s could be directly liable for HIPAA criminal violations. The HITECH Act clarifies this to include that individuals, whether or not they are employees of a CE, can now be criminally liable for violations of HIPAA. BA’s are also now directly liable for violations of HIPAA or the HITECH Act. A new set of tiered, significant civil monetary penalties have also been established. Fines start at $100 per violation (max. $25K[mj1] per year) and go to $50K per violation ($1.5M per year), depending upon the violation type.

Improved Enforcement (effective 2/17/2009)

The HITECH Act now requires that HHS must investigate any complaint that may have resulted from “willful neglect” by a CE or BA. Also, a methodology must be developed by which victims of privacy violations may receive a share of the collected penalties. Finally, states’ attorneys general are also now permitted to bring a federal civil action on behalf of the residents of their states whom they believe have been adversely affected by a HIPAA violation.

Notification in Case of Breach of Confidentiality (effective 9/24/2009)

CE’s must now notify individuals whose unsecured protected health information (PHI) has been accessed or disclosed as a result of a breach. BA’s must similarly notify CE’s who must then notify affected individuals. Notification must be in writing within 60 days of discovery of the breach. If more than 500 individuals are affected Health and Human Services (HHS) and prominent media outlets must also be notified.

Prohibition on Sale of PHI (regulations due by 8/16/2010, effective 6 months later)

CE’s and BA’s may only receive payment in exchange for PHI if the individual has signed an authorization that discloses that payment will be made to the CE or BA. There are some exceptions including disclosures for public health, research, treatment, sales or mergers, payments to a BA for services performed for the CE or payments by an individual to obtain a copy of that individual’s record. Previously, only sales of PHI for marketing purposes required an authorization that disclosed payment was involved.

Accounting of Disclosures (effective date varies by date CE implements EHR)

The HITECH Act will require that CE’s follow a detailed accounting practice not previously in place under HIPAA. If an individual requests an accounting of electronic health records (EHRs), CE’s must be able to provide to the individual disclosure information for the prior three years, if the disclosures were made for "treatment, payment or health care operations." This will be phased in between 2011 and 2014.

We have seen some of these changes already being enforced. For instance, in January 2010, Connecticut Attorney General Richard Blumenthal sued Health Net for multiple HIPAA violations. Protected private medical records and financial information on almost a half million Health Net enrollees in Connecticut were exposed for at least six months before Health Net notified appropriate authorities and consumers.

Note: The foregoing is intended solely for informational purposes and should not be construed as legal advice. Providers should consult with independent legal and accounting counsel before making any decisions.

What Does it Take to Qualify for the EHR Stimulus Funds?

Manny Oliverez Capture Billing — Tue, 19 Jan 2010 15:51:00 GMT

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 .

Capture Billing Now Podcasts on iTunes with its Medical Billing Minute

Manny Oliverez Capture Billing — Tue, 05 Jan 2010 19:11:00 GMT

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/ .

Medical Billing Minute: Consultation Codes

Manny Oliverez Capture Billing — Sat, 02 Jan 2010 19:36:00 GMT

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

Now Podcasting!- The Medical Billing Minute: H1N1

Manny Oliverez Capture Billing — Sat, 02 Jan 2010 04:24:00 GMT

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

Medicare Eliminates Consultation Codes

Manny Oliverez Capture Billing — Thu, 10 Dec 2009 17:35:00 GMT

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.

http://blog.capturebilling.com/2009/12/10/medicare-eliminates-consultation-codes.aspx

Video Released to Help Physicians Bill Insurance for the H1N1 Swine Flu

Manny Oliverez Capture Billing — Thu, 22 Oct 2009 16:44:00 GMT

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.

Medical Billing Minute - Billing for the H1N1 Swine Flu Vaccine

Manny Oliverez Capture Billing — Thu, 22 Oct 2009 16:40:00 GMT

This episode of the Medical Billing Minute helps physicians and medical billing on how to bill and code for the H1N1 Swine Flu Vaccine.
http://blog.capturebilling.com/2009/10/22/medical-billing-minute--billing-for-the-h1n1-swine-flu-vaccine.aspx

Coders Elected President and Treasurer of Local American Academy of Professional Coders Chapter

Manny Oliverez Capture Billing — Fri, 09 Oct 2009 02:12:00 GMT

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.

Doctors Should Run Their Practices Like a Business

Manny Oliverez Capture Billing — Thu, 01 Oct 2009 14:24:00 GMT

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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Manny Oliverez Capture Billing — Tue, 15 Sep 2009 04:07:00 GMT

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The HITECH Act and 300 BAUD Modems

Manny Oliverez Capture Billing — Tue, 15 Sep 2009 03:35:00 GMT

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 on the planet can also access your PC now too.

This is why the Federal government has come up with HIPAA, Red Flag Rules and the HITECH Act for healthcare providers so they will secure patients data, both physically and technically. There are penalties ranging from $10,000 to $250,000 per breach of patient data, even if it was unintentional or just an accidental discloser. It doesn’t matter to the feds or the trial lawyers.

From what I hear in my dealings with medical practices, most are not aware of the compliance requirements and their computer systems are vulnerable. Hopefully within the next year the word gets out more and medical practices really start to take computer security seriously.

Welcome

Manny Oliverez Capture Billing — Fri, 04 Sep 2009 20:38:01 GMT

Welcome to my blog. Please check back soon for new entries.