OCR Offers Advice in Advance of Upcoming Audits

By M. Thomas Langan II.

A senior advisor for the Office for Civil Rights (OCR) recently gave health care providers advice on how to prepare for an OCR audit.  Speaking at a HIPAA conference, the advisor said that a provider’s top obligation when audited is to prove that its facility has the proper privacy and security systems in place.  The main way to show this is by previously conducting a comprehensive risk analysis and correcting any shortcomings the analysis might find. The advisor did not provide any updates on when the audits will begin.

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Posted in HIPAA

AMA Proposes Medicare Billing Codes for End of Life Consultations

By Mary E. Vandenack.

Continued efforts by the American Medical Association (“AMA”)  are being made to get physicians paid for consultations related to end of life and advanced care discussions. The Centers of Medicare and Medicaid Services (“CMS”) will review proposed codes submitted by the AMA to determine whether the codes will be included in the 2015 physician fee schedule, expected to be released in November. Various legislation has been  introduced in Congress seeking to get physicians paid for end of life discussions. If CMS includes the codes in its fee schedule, such legislation will become unnecessary.

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Posted in Coding Issues, Medical Coding

HHS Issues Temporary and Proposed Rules on Contraceptive Coverage

The Department of Health and Human Services (“HHS”) has recently issued rules to address the Supreme Court’s recent Hobby Lobby ruling. Under a temporary final rule, religious nonprofit organizations can notify the government of their objection to providing contraceptive coverage for employees, rather than having to authorize the coverage themselves. The government will then arrange for contraceptive coverage. HHS also issued a proposed rule that would extend similar accommodations to closely-held, for-profit religious employers.

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Posted in Affordable Care Act, Rulings

Weak Passwords Put Patients’ EHR at Risk

By M. Thomas Langan II.

A recent government report criticized the current electronic health record certification process for failing to require strong passwords.  These vulnerabilities make it easier for hackers to penetrate electronic health record (“EHR”) systems and access patient records.  The report comes amid a study that many patients are reluctant to divulge their information when their physician uses EHR out of fear of their data’s security.  Despite the current lax requirements, it is recommended that all passwords be at least 8 characters long and contain 3 of the following: capital letters, lowercase letters, numbers and special characters and are changed at least monthly.

The government’s report can be found here: http://oig.hhs.gov/oas/reports/region6/61100063.asp

The study can be found here:  http://jamia.bmj.com/content/early/2014/07/24/amiajnl-2014-002804.abstract

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Posted in Electronic Health Care, Electronic Health Care Records

HHS Confirms October 2015 Deadline for ICD-10

By M. Thomas Langan II.

The deadline to implement ICD-10 has been confirmed to be October 1, 2015.  The implementation date was most recently postponed from October 1, 2014 to an undetermined date.  In its statement announcing the new deadline, CMS explained that the delay will give the healthcare industry “ample time” to prepare for the change.

The notice from CMS can be found here: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-31.html.

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Posted in Coding Issues, Medical Coding

Medicare and Medicaid Requesting Comment on Proposed Changes to Home Health Regulations

A proposed rule issued July 1 by the Center for Medicare and Medicaid Services (CMS) (CMS-1611-P) looks to change payment rates for home health agencies and simplify the  face-to-face encounter regulatory requirements. The decrease in payments to the home health agencies will begin in 2015 and reduce the overall budget .30 percent, equivalent to $58 million dollars.

The Affordable Care Act mandates that individuals shifting from hospital care to home health meet with a physician to certify that the home health services are medically necessary. Current regulation requires that the meeting occur within 90 days prior or 30 days after services begin. Regulations also require documentation with a narrative explaining why the patient requires home services. The proposed rule eliminates the narrative requirement, reduces the CMS review to only the certifying physician’s medical records for initial eligibility, while the physician’s visit to patient’s home for certification would not be covered if the overall claim was not approved.

CMS is requesting comment by September 2, 2014.

Other proposed changes include:  changes to the home health quality reporting program requirements, rebasing of the 60-day payment rate, and simplifying the certification regulatory requirements.

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Posted in Affordable Care Act, Medicare/Medicaid

CMS Expands Proposed Five-Star Rating System for Providers

The Centers for Medicare and Medicaid Services have announced another expansion to their planned five-star rating system for various medical facilities. At present, CMS uses star ratings to allow consumers to compare Medicare Advantage plans and nursing homes on its website.

Over the past six months, CMS has stated that it would include star ratings on its Physician Compare website. Now, CMS will also include star rankings for hospitals, home health agencies, and dialysis providers. CMS plans on rolling out the new star ranking system in late 2014 to early 2015.

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Posted in Medicare/Medicaid

Latest Healthcare Premium Costs Within the Nebraska Exchange

The Congressional Research Service recently published the latest costs for a healthcare plan within the Nebraska Exchange. Every plan has variables that may affect the costs associated with securing health insurance. The Nebraska exchange costs follow the basic balancing of monthly premiums paid, coverage, and potential out of pocket costs. The average cost of a plan premium in the highest category of coverage within the Nebraska exchange is $443, with a range of $862 to $236. The $236 premium is for single adults age 21, while the $862 premium is for a single adult age 60. A basic summary of costs is provided below.

Congressional Research Service Summary Cost Data for Health Plans in Nebraska

 

Source: May 16, 2014, Congressional Research Service Summary Cost Data for Health Plans in Nebraska

 

A full copy of the report can be obtained at http://www.fas.org/sgp//crs/misc/R43549.pdf

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Posted in Affordable Care Act

HHS Proposes New Rules on Civil Monetary Penalties

HHS’s Office of the Inspector General (OIG) has issued a new proposed rule that makes a number of changes to its civil monetary penalty authority. Among other changes, this rule would increase the maximum reduction of penalties when providers can show mitigating circumstances. It also makes providers who cause more than $15,000 of losses to Medicare/Medicaid subject to increased penalties.

The rule also explains the factors that OIG will consider in determining how much in penalties it will assess. These include the provider’s history and whether other wrongful conduct was involved. OIG will also consider whether the provider followed self-disclosure protocols and took corrective action. Providers should review their self-disclosure policies to determine whether they reflect the new factors.

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Posted in Affordable Care Act, Ambulatory Surgery Centers, Billing, Business of Practice of Medicine, Health Care Clinics, Medicare/Medicaid, Practice Management

Nebraska Passes Bill Expanding Telehealth Coverage

The Unicameral has passed a bill that expands the definition of telehealth, which will presumably expand Medicaid coverage for these services. Under the new law, telehealth includes all usage of medical information electronically exchanged between sites to aid providers in diagnosing or treating patients. The bill explicitly includes telemonitoring and “store-and-forward” technology in the definition of telehealth. It also removes language from the prior statute that excluded telephone conversations, e-mails, and faxes from the definition of telehealth consultations.

The bill makes a number of other minor changes to the state’s telehealth laws. Specifically, it prohibits changes in reimbursement rates that depend on the distance between a patient and her healthcare provider. Thus, as a result of this bill, Nebraska providers may be able to claim reimbursement for new services, and are protected from changing reimbursement rates based on distance.

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Posted in Electronic Health Care, Legislation, Medicare/Medicaid, Telemedicine
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