Does your IT person or IT company understand how Health IT differs drastically from IT in general corporate environments?
Posted on | August 24, 2010 | No Comments
Most competent IT providers are going to understand how to administer/support PC’s, printers, firewalls, servers, applications, etc. This is fine for most corporations and small businesses but for your practice these skills are not enough.
In addition to strong “general” IT knowledge a competent IT provider for your practice MUST:
• Know what sets Health IT apart.
• Understand how your practices IT system is regulated under HIPAA/HITECH.
• Understand the nuances specific to medical technology (i.e. EMR integration/implementation, EMR complications, data backup/recovery/security, transcription systems, imaging systems, HL7 interfacing, etc)
• Grasp the concept of “meaningful use” for your EMR system and how your EMR actually works
• Know what HIPAA “red flags” to look for and avoid
• Perform periodic HIPAA IT security audits using the same standards and scrutinizing as Health and Human Services auditors.
• Have experience specific to Health IT
• Know the steps that must be taken on each PC to bring into compliance
• Have a plan for disaster recovery
If your practice is looking for a change or is currently in need of IT assistance let me know.
MAG Mutual Healthcare Solutions Inc. now provides affordable “contract free” Health IT services to the greater Atlanta/Athens area.
Contact Brian for more info.
Disturbing findings – Business Associate Agreements
Posted on | August 20, 2010 | No Comments
While performing HIPAA IT Security audits (especially for smaller practices) I have noticed a disturbing trend. Many practices are not aware that third parties who come in contact with PHI (Private Health Information) are required to sign a Business Associate Agreement (BAA). In many cases I have noticed that practices do not even have a BAA! This is absolutely critical for HIPAA compliance and lack of one is a major “red flag”. I cannot stress the importance of this. Templates can be downloaded from the HHS Web site. However, it is advised that legal counsel review any BAA.
Who are potential Business Associates? Lawyers, external auditors, accountants, answering services, consultants, accreditation agencies, shredding companies, transcription services and any other entity in contact with PHI.
By the way, if you are in the Atlanta area and would like a free HIPAA IT Security Audit for your practice, please contact me.
Brian L Tuttle, CPHIT
Health IT Services Consultant
MAG Mutual Healthcare Solutions, Inc.
btuttle@magmutual.com
404-842-5463
Click Here For Link regarding ZPIC reviews
Posted on | August 18, 2010 | Comments Off
It’s on like Donkey Kong.
For all of you worried about RACs let me introduce you to the real scarry auditors: ZPICs
If you don’t know what a ZPIC is make sure you take a second to “google it.” These guys are going after Part B physicians and will be coming to a carrier near you very soon. This is from the carrier in North Carolina.
Don’t say I didn’t warn you about proper coding and documenation.
Effective September 1, 2010, if your claims are impacted by prepayment review by AdvanceMed Corporation, LLC (The Zone 5 Zone Program Integrity Contractor) all prepayment review response documentation will be sent to the following address:
AdvanceMed
Zone 5
1530 E. Parham Road
Henrico, VA 23228
The prepayment review response documents will not be sent directly to CIGNA Government Services (CGS). (All AdvanceMed prepayment reviews will continue regardless of the address changes.) In addition, AdvanceMed will notify each provider on prepayment review of the address change as well.
Please send all requests for appeals of prepayment claim denials to CGS.
New ICD-9 Code Summary Tables
Posted on | August 18, 2010 | No Comments
Hey Guys,
Here is a link to a web site that allows you to take a look at the new, deleted and revised ICD-9 codes that go into effect October 1, 2010.
You can see the new, revised, and discontinued ICD-9-CM diagnosis codes on the Centers for Medicare & Medicaid Services (CMS) website at
http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp#TopOfPage
or at the National Center for Health Statistics (NCHS) website at
http://www.cdc.gov/nchs/icd9.htm
You are also encouraged to purchase a new ICD-9-CM book or CD-ROM on an annual basis.
If you need any books at all visit us at www.coderscentral.com
Steve Adams
Link to latest news on 21% cut and 2% raise click here
Posted on | June 29, 2010 | No Comments
ISSUED: 6/28/2010 @ 2:50 PM – Medicare Physician Fee Schedule – Update
As Highmark Medicare Services (HMS) reported on June 25, 2010, as a result of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, the Medicare Physician Fee Schedule was updated to apply a 2.2% increase for dates of service June 1, 2010 and after. CMS required contractors to start processing claims with the new rates by no later than July 1, 2010. Please see the bulletin dated 06/25/2010 for more information.
HMS Current Status: The new 2.2% Medicare Physician Fee Schedule was loaded to production for both Part A and Part B services on Friday night, June 25th. The production files were validated by HMS staff on Saturday, June 26th. As of Monday night, June 28th, HMS began releasing previously held claims with June dates of service for payment using the new fee schedule. HMS will process claims first in, first out, processing the oldest claims first. As a reminder, claims received for services rendered prior to June 1st, will continue to be processed using the previously established 0% Medicare Physician Fee Schedule.
As reported previously, prior to the passage of the new law, CMS required contractors to begin paying claims at the negative 21% Medicare Physician Fee Schedule update. HMS processed Part A and Part B claims with June 1st and after dates of service, received on June 1st, 2nd and 3rd at the negative 21% fee schedule. At CMS direction, HMS will automatically reprocess these claims using the new 2.2% fee schedule. We expect to initiate these adjustment claims by no later than July 9th. Providers do not need to take any action to have these claims reprocessed.
We will publish additional updates as we work through the release of the held claims and the reprocessing of the claims paid at the negative 21% fee schedule.
Link to Info on CMS Pay Cut and Raise
Posted on | June 25, 2010 | No Comments
Most of you might know this, but the president and congress have put in a short-term fix for the CMS cut this year.
The President Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010—2.2 Percent Medicare Physician Fee Schedule Update for June 1, 2010 Through November 30, 2010.
On June 25, 2010, President Obama signed into law the “Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010.” This law establishes a 2.2 percent update to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems. Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.
Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed. Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.
Link – Hot off the press – CMS will continue to hold claims for one more week
Posted on | June 14, 2010 | 1 Comment
Well, still no fix on the 21.2% cut, so CMS is going to continue holding claims till Thursday. See article below.
Steve Adams, MCS, CPC, CPC-H, CPC-I, PCS, FCS, COA
Dear Medicare Part A, Part B Providers,and Partners,
The 2010 Medicare Physician Fee Schedule
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.
This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.
We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.
Thank you,
Provider Outreach & Education (POE)
Cahaba GBA- J10 A/B MAC
Cahaba GBA- Title XVIII Part B Carrier for Mississippi
HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud
Posted on | June 8, 2010 | No Comments
This letter to all state attorneys general outlines a meeting that they had with HHS and our Attorney General. It is interesting again to see the emphasis the current administration is putting on stoping fraud and abuse in the Medicare System.
Steve Adams, MCS, CPC, CPC-H, CPC-I, PCS, FCS, COA
Dear Attorney General: It was a pleasure to have the opportunity to speak with you and your staff a few weeks ago. We wanted to send you a letter summarizing our discussions and following up with some suggestions of ways we can work together to protect the American people from health care fraud.
In the two months since the Affordable Care Act was signed into law, we have made substantial progress on providing better choices for consumers, tackling health care costs, and holding insurance companies accountable. But while we have been hard at work, scam artists and criminals continue to profit from misinformation about the Affordable Care Act.
Since early April, we have heard increasing reports about seniors being asked to provide their Social Security numbers in order to receive a “donut hole” check under the new law, raising concerns about potential identity theft scams. We have fielded consumer complaints about phony insurance policies, and our Senior Medicare Patrols have been receiving a growing number of calls from people across the country reporting potential fraud schemes.
We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it.
The President has asked us to reach out to you and to other federal, state, and local law enforcement officials across the country to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud. Some important components of these outreach and education efforts, where you and your staff could make a big difference, are described below.
First, the President has directed the Department of Health and Human Services (HHS) to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012.
Second, following on the National Health Care Fraud Summit we co-hosted in Washington earlier this year, the President has asked both our Departments to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia. These summits will bring together top federal and state officials; representatives of federal, state, and local law enforcement; representatives of our agencies; the health care provider community, such as hospitals and doctors; local businesses; the Senior Medicare Patrol; caregivers; and seniors, for a day of panels and training sessions. Your expertise and experience will be instrumental to the success of these events.
Third, at the Attorney General’s request, the Acting Deputy Attorney General has sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud efforts. Most of these meetings will be held quarterly, with some exceptions for smaller districts. All 93 U.S. Attorneys have been asked to put a plan into place and schedule their first meeting by August 16, 2010. We hope that you and your office will take part in these regular exchanges on effective fraud fighting strategies.
Fourth, HHS will be doubling the size of the Senior Medicare Patrol and putting more boots on the ground in the fight against Medicare fraud. Since 1997, HHS and its Administration on Aging have funded Senior Medicare Patrol projects to recruit and train retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to three million Medicare beneficiaries have been educated since the start of the program, and more than one million one-on-one counseling sessions have taken place with seniors or their caregivers. Currently, the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.
Fifth, the Centers for Medicare & Medicaid Services, in conjunction with the Administration on Aging, will be launching an educational media campaign this summer to educate Medicare beneficiaries about the importance of staying vigilant with their personal Medicare information and getting the facts out about the new law so that scam artists are not able to prey on seniors. The more we can educate the American people about fraud prevention, the better chance we have to protect taxpayer dollars and the Medicare trust fund. The Affordable Care Act also contains some important new tools and resources that will directly help law enforcement officials crack down on fraud. As you are well aware, fraud schemes have plagued public and private health care plans for decades. Fraudsters have been stealing billions of dollars a year from Medicare, Medicaid, and private health insurers.
A year ago, our Departments joined forces to combat fraud in federal health programs. Through the establishment of the Health Care Fraud Prevention Enforcement Action Team (HEAT), we have expanded special anti-fraud Medicare Fraud Strike Forces into seven cities, developed sophisticated new techniques of fraud prevention data analysis, and redirected program integrity resources to fraud hot spots. Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.
These include new criminal and civil penalties, enhanced information technology to track and prevent fraud in the first place, and new authorities to prevent bad actors from billing Medicare and Medicaid. HHS has already issued the first set of fraud prevention regulations required under the new health law. These regulations strengthen provider enrollment requirements to ensure we have the ability to better identify, screen, and audit providers and claims. As we do our part in Washington, we want to work closely with you and other state officials to fight fraud. In that vein, the Affordable Care Act also strengthens state officials’ ability to detect and root out Medicaid fraud.
For example, the law provides new access to Medicaid data for the Secretary of HHS that will help both states and the Administration to coordinate anti-fraud activities and gives states greater incentives and flexibility in identifying and collecting Medicaid overpayments. It also helps to promote enhanced information technology to track and prevent fraud, including predictive modeling techniques that can identify abusive or fraudulent billing patterns, audits, and a shared provider database for pre-enrollment screening and post-enrollment anomaly monitoring. Securing health care coverage, affordability, and choices for Americans requires hard work and vigilance. We stand ready to serve as a resource and partner for you as we work together to fight fraud, implement the provisions of the new health reform law, and strengthen our health care system.
Sincerely, Eric Holder Attorney General
Kathleen Sebelius Secretary of Health and Human Services
AMA Link – Call, Write, or Meet with Your Senators Today.
Posted on | June 8, 2010 | No Comments
Hi,
No fix on the “doc fix” for the 21.2% pay cut. The AAFP has published their link so that physicians can contact their representatives to express concerns pertaining to the Medicare SGR.
Click below to find out how to contact your local representative:
Steve Adams, MCS, CPC, CPC-H, CPC-I, FCS, PCS, COA
http://capitol.aafp.org/aafp/home/
LINK – HHS, CMS LAUNCH FRAUD PREVENTION EDUCATION CAMPAIGN
Posted on | June 8, 2010 | 1 Comment
Wow, your tax dollars hard at work – click the link below to go to the CMS web site so you can see how HHS will educate Americans on ways to battle fraud and abuse.
This link will have the text and audio files for the 30 and 60 second commercials in different languages.
Steve Adams, MCS, CPC, CPC-H, CPC-I, PCS, FCS, COA
keep looking »
Recent Posts
- Does your IT person or IT company understand how Health IT differs drastically from IT in general corporate environments?
- Disturbing findings – Business Associate Agreements
- Click Here For Link regarding ZPIC reviews
- New ICD-9 Code Summary Tables
- Link to latest news on 21% cut and 2% raise click here
- Link to Info on CMS Pay Cut and Raise
- Link – Hot off the press – CMS will continue to hold claims for one more week
- HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud
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