PRACTICEFIRST’S HIPAA & HITECH UPDATE

By Emilie DiChristina

The rules of HIPAA have changed! The rules of HIPAA have expanded! Now, you also have HITECH to comply with!

Where are you in all of this? If you are reading this and saying, “Now What?” you really have to get up to speed quickly and we have provided a link below to let you do just that, but first let’s see where you stand.

  • When was the last time you gave your staff training on HIPAA?
  • If you do have training, has it  been updated to include all of the electronic security rules?
  • Do you know the electronic security rules under HIPAA and HITECH?
  • Do you know if your staff is downloading patient info or personal data unto a thumb drive?
  • Have you down the Security Audit that you should have done by August 31 of this year?
  • Do you even know what to look for in the audit?
  • Are you sure no one is sending PHI via cell phone, email or other unencrypted formats?
  • Do you have a social media and cell phone policy?
  • Do you enforce it?
  • Do you have Business Associate Agreements with all applicable entities?
  • How about your IT or EMR vendor?
  • When was your BAA last updated and have you had all applicable parties re-sign it?
  • Do you Business Associates and  Vendors know about the changes to the laws and have they made their company changes?
  • Have you updated your Privacy Notices to patients to comply with the electronic age?

The rules are tough, the penalties for non-compliance are tougher! There is no safe haven for not knowing, or for thinking your practice size is too small, or that your staff are already doing things correctly!

Get to know the law.  CLICK HERE TO READ THE RULES

PRACTICEFIRST’S BILLING UPDATES – AUGUST 2013

By Becky Amann

UNIVERA NEWS

GOING PAPERLESS

As a reminder, effective August 1, 2013, Univera will cease mail delivery of many important communications and will begin to provide these bulletins through postings on their website.

To continue to receive these communications from Univera, it will be necessary for providers to access Univera’s “opt-in” process and complete their form which is located at:  http://pages.email.univerahealthcare.com/provider/email/

Univera has indicated that it will still be necessary to distribute some communications by traditional mail and fax. Please note: This “opt-in” process is not the same as the access to their secure portion of their website.

MVP NEWS

MVP has launched their first mobile application. The MyMVP mobile app allows members to use a smart phone or other mobile device to display the front and back of their current MVP Member ID card.

What MVP wants health care providers to know:

  • If an MVP patient shows you an ID card  on a mobile device, you should treat it the same as you would an actual “hard copy” ID card.
  • Members have the ability to send you a copy of the ID card shown on their mobile device via email or fax, if you require a copy of the card.
  • What will the ID card look like? Since the ID card that members can display and forward from their mobile device comes from the same system that MVP uses, when they print and mail ID cards, a member’s electronic ID card will look the same as their hard copy ID card.
  • At this time, MVP will promote the MyMVP mobile app only to MVP employees and employees of General Electric (GE) who are covered by an MVP-administered health plan. The app will be promoted to the entirety of their membership this fall.

For Billing questions, please contact Becky Amann at 716-348-3902 or beckya@pracfirst.com

PRACTICEFIRST COMPLIANCE UPDATES – AUGUST 2013

By Becky Amann 

CENTERS FOR MEDICARE & MEDICAID (CMS)

SIGNATURE REQUIREMENTS

Railroad Medicare issued guidance regarding Signature Requirements as follows:

CMS requires that service provided/ordered be authenticated by the author. The signature for each entry must be legible and should include the practitioner’s first and last name. For clarification purposes, CMS recommends that you include your applicable credentials (eg. M.D., D.O., P.A.)

The purpose of a rendering/treating/ordering practitioner’s signature in patients’ medical records, operative reports, orders, test findings, etc., is to demonstrate that services submitted to Medicare have been accurately and fully documented, reviewed and authenticated. Furthermore, it confirms the provider has certified the medical necessity and reasonableness for the service(s) submitted to the Medicare program for payment consideration.

Please refer to the following table for Unique Signature Situations:

Situation:

Performed by:

Signature Requirement:

Incident to

Ancillary Staff

Must be signed by supervising provider (billing)

NPP (Non-Physician Practitioner)

May be signed by the NPP or the supervising physician

Split/Shared:

Office/Clinic Setting

NPP and Physician

May be signed by the NPP or the supervising physician

Split/Shared:

Hospital Inpatient/ Outpatient/Emergency Department   Setting

NPP and Physician

Must be signed by billing provider

Surgery

Assistant at Surgery

Must be signed by the surgeon and the operative report   must reference the surgical assistant

Co-Surgeon

Each co-surgeon must sign his/her operative report

Scribe

Ancillary Staff

The signature of the scribe is not required; however, the   billing provider must sign

For further information, please access Palmetto GBA at:

http://www.palmettogba.com/Palmetto/Providers.nsf/docsCat/Jurisdiction%2011%20Part%20B~Browse%20by%20Topic~General~Medicare%20Medical%20Records%20Signature%20Requirements%20Acceptable%20and%20Unacceptable%20Practices?open&Expand=1

For Compliance questions, please contact Becky Amann at 716-348-3902 or beckya@pracfirst.com

PRACTICEFIRST CODING CORNER… AUGUST 2013

By Lisa Kropp

As we prepare for ICD-10-CM, Practicefirst will begin to provide tips & tools to help your practice transition to ICD10!

Benefits to ICD-10-CM

The new, up-to-date classification system will provide much better data needed to:•

  • Measure the quality, safety, and efficacy of care
  • Reduce the need for attachments to explain the patient’s condition
  • Design payment systems and process claims for reimbursement
  • Conduct research, epidemiological studies, and clinical trials
  • Set health policy
  • Support operational and strategic planning
  • Design health care delivery systems
  • Monitor resource utilization
  • Improve clinical, financial, and administrative performance
  • Prevent and detect health care fraud and abuse
  • Track public health and risks

Structure of ICD-10-CM

  • 3–7 digits;
  • Digit 1 is alpha; Digit 2 is numeric;
  • Digits 3–7 are alpha or numeric (alpha characters are not case sensitive); and
  • Decimal is used after third character.

Examples:

  1. A78 – Q fever;
  2. A69.21 – Meningitis due to Lyme disease; and
  3. S52.131A – Displaced fracture of neck of right radius, initial encounter for closed fracture.

Some New Features Found in ICD-10-CM

  1. Laterality (left, right, bilateral).
    1. Example:  C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast
  2. Combination  Codes for certain conditions and common associated      symptoms and manifestations.
    1. Example: I25.110 – Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
  3. Combination  codes for poisonings and their associated external cause
    1. Example: T42.3x2S – Poisoning by barbiturates, intentional self-harm, sequel
  4. Obstetric codes identify trimester instead of episode of care
    1. Example: O26.02 – Excessive weight gain in pregnancy, second trimester
  5. Inclusion of clinical concepts that do not exist in ICD-9-CM (e.g., underdosing, blood type, blood alcohol level)
    1. Example: T45.526D – Underdosing of antithrombotic drugs, subsequent encounter
  6. Significantly expanded codes (e.g., injuries, diabetes, substance abuse, postoperative complications)
    1. Example: E10.610 – Type 1 diabetes mellitus with diabetic neuropathic arthropathy
    2. Example: F10.182 – Alcohol abuse with alcohol-induced sleep disorder
    3. Example: T82.02xA –  Displacement of heart valve prosthesis, initial encounter
  7. Codes for postoperative complications have been expanded and a distinction made between intraoperative complications and postprocedural disorders
    1. Example: D78.01 –  Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen
    2. Example: D78.21 – Postprocedural hemorrhage and hematoma of spleen following a procedure on the spleen.

 With 15 months until implementation, how are you preparing for ICD10? 

Contact Lisa at 716.348.3904 or lisak@pracfirst.com for more information on how our coding service can partner with your practice!

 

&nbs