By Emilie DiChristina, MBA for PracticeFirst

Notice of Privacy Practices

As covered entities, provider practices must have an updated Notice of Privacy Practice posted in their facilities, and must be offering and receiving signatures for any new patient (new after 9/23/2103) on their receipt of the new NPP.

Not only are you, as covered entities required to post and give the new version of the NPP, the notice must be provided in a clear, user-friendly fashion. As healthcare providers, we become used to acronyms and “special” language, but many of our patients and their families are only able to read and comprehend at somewhere between a 3rd. and 7th. grade reading level.

Further, if your practice has a significant number of patients who have a primary language other than English, you must also provide the NPP in that language or Languages as well.

You also have to be sure that your updated Notice of Privacy Practices is on your website, posted in your waiting areas and available for distribution

The Notice of Privacy Practices must also list all regulatory changes and your wording must provide that information to the patient.

Obviously, the NPP must still provide information to the patient on how you will use and disclose the patient information as well as the responsibility you have to protect the information gathered and used.

Uses and Responsibilities of the Practice: We have the right and approval to use    information to:

  • Run our business
  • Treat and bill for your treatment
  • To do research
  • For designated public safety, emergency and legal disclosures
  • When required for response to organ and tissue donation requests
  • At the request of a medical examiner or funeral director
  • When required by workers’ compensation, law enforcement, and other government requests
  • When required to respond to lawsuits and legal actions

Practice Responsibilities

  • Our practice is required by law to maintain the privacy and security of your protected health information.
  • Our practice will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • Our practice must follow the duties and privacy practices described in this notice and give you a copy of the notice.
  • Our practice will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by notifying us in writing.

The most significant changes are in the Patient Rights and Patient Choices.

Patient Rights (You have the right to…):

  • Get a copy of your medical record whether it is in paper or electronic format
  • Correct your paper or electronic medical record
  • Request confidential communication (in other words request that notices, bills, or PHI be sent to an address other than that listed in the medical record
  • Request limits on the information we share
  • Get a list of those with whom we’ve shared your information (a disclosure record)
  • Receive a copy of this privacy notice (and any updates or revisions to it)
  • Designate someone to act for you in regard to your records
  • File a complaint if you believe your privacy rights have been violated

Patient Choices:

  • Patients have choices in the way that information is shared and used:
  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds




IHA has begun the implementation process of their new CORE system. During the initial implementation phase, IHA has issued checks with no corresponding remittance. These checks are for those members who are employees of IHA. Employee claims were the first claims processed in their new system. We have been in contact with IHA and have received information on obtaining the remits for these checks. If you receive a check with no remittance, please contact IHA at 631-3282. When prompted for your provider number, enter your NPI.  Once connected to a provider rep, please tell them you have received a check from their new CORE system for IHA employees. They will transfer you to a Supervisor who will fax you the remittances.


As a reminder, effective August 1, 2013, Blue Cross began Phase One in updating their Medicare Advantage Fee Schedule as follows:

  • In the aggregate, the fee schedule is 109 percent of the 2012 Medicare rates.
  • Evaluation and Management codes increased.
  • Some specialty-treatment procedure codes were changed to be consistent with decreases implemented by CMS from 2012 to 2013.



Univera will be launching a Patient Reviews tool in the fall for their members. The online survey tool will allow their members to visit their website to rate the care they received during their medical appointments. Providers are given an opportunity to post a reply in response to the patient’s comments. Univera believes that this transparency tool will help your patients become better informed consumers and more engaged participants in their own care. Univera believes providers’ partnership in this endeavor will be invaluable. More information will become available in upcoming issues of their “Examiner” newsletter.


When key parts of the Affordable Care Act go into effect in 2014, a three-month grace period will be implemented before the patient’s policy is canceled. If a patient who obtains subsidized coverage through the Exchange fails to pay their premium he or she has a three-month grace period before the policy can be canceled. In accordance with this regulation, health plans must pay claims during the first month only of the grace period. During the subsequent two months, if the individual does not pay his/her premium in full, claims with dates of service during this time will suspend and may not be reimbursed. Univera is required to notify providers that the claims are suspended. Providers will be allowed to seek payment from the member if coverage is terminated for non-payment.



For those providers who qualified and attested to the PCRI by the August 1, 2013 deadline, beginning in September, eMedNY will reprocess claims to the increased rate for dates of service on or after January 1, 2013.


Providers must be enrolled in Medicaid in order to continue to order or refer services reimbursed by the fee-for-service Medicaid program. Effective for dates of service October 1, 2013 and after, claims will be denied if they include an NPI of a non-enrolled ordering, prescribing or referring provide


TABLE 1.   Influenza Vaccines — United States, 2013–14 Influenza Season*
Vaccine Trade name Manufacturer Presentation Mercury   content (μg Hg/0.5 mL) Ovalbulmin   content (μg/0.5 mL) Age   indications Route
Inactivated Influenza Vaccine,   Trivalent (IIV3), Standard Dose Afluria® CSL Limited 0.5 mL   single-dose prefilled syringe


≤ 1 ≥9 yrs.††† IM
5.0 mL   multi-dose vial


≤ 1
Fluarix® GlaxoSmithKline 0.5 mL   single-dose prefilled syringe


≤0.05 ≥3 yrs. IM
Flucelvax® Novartis   Vaccines 0.5 mL   single-dose prefilled syringe


§§§ ≥18 yrs. IM
FluLaval® ID Biomedical   Corporation of Quebec (distributed by GlaxoSmithKline) 5.0 mL multi-dose   vial <25.0 ≤0.3 ≥3 yrs IM
Fluvirin® Novartis   Vaccines 0.5 mL   single-dose prefilled syringe ≤1 ≤1 ≥4 yrs. IM
5.0 mL   multi-dose vial


Fluzone® Sanofi Pasteur 0.25 mL   single-dose prefilled syringe


**** 6-35 mos. IM
0.5 mL single-dose   prefilled syringe


**** ≥36 mos. IM
0.5 mL   single-dose vial


**** ≥36 mos. IM
5.0 mL   multi-dose vial


**** ≥6 mos. IM
Fluzone®   Intradermal†† Sanofi Pasteur 0.1 mL   prefilled microinjection system


**** 18-64 yrs. ID§
Inactivated Influenza Vaccine,   Trivalent (IIV3), High Dose** Fluzone®   High-Dose Sanofi Pasteur 0.5 mL   single-dose prefilled syringe


**** ≥65 yrs. IM
Inactivated Influenza Vaccine,   Quadrivalent (IIV4), Standard Dose Fluarix®   Quadrivalent GlaxoSmithKline 0.5 mL single-dose   prefilled syringe


≤0.05 ≥3 yrs. IM
FluLaval®   Quadrivalent ID Biomedical   Corporation of Quebec (distributed by GlaxoSmithKline) 5.0 mL   multi-dose vial <25.0 ≤0.03 ≥3 yrs. IM
Fluzone®   Quadrivalent Sanofi Pasteur 0.25 mL   single-dose prefilled syringe


**** 6-35 mos. IM
0.5 mL   single-dose prefilled syringe


**** ≥36 mos. IM
0.5 mL   single-dose vial


**** ≥36 mos. IM
Recombinant Influenza Vaccine,   Trivalent (RIV3) FluBlok® Protein   Sciences 0.5 mL   single-dose vial



18-49 yrs. IM
Live-attenuated Influenza   Vaccine, Quadrivalent (LAIV4) FluMist®   Quadrivalent§§ MedImmune 0.2 mL   prefilled intranasal sprayer 0.0 (per 0.2   mL) <0.24 (per   0.2 mL) 2-49 yrs.*** IN
IIV=Inactivated   Influenza Vaccine; IIV3=Inactivated Influenza Vaccine, Trivalent;   IIV4=Inactivated Influenza Vaccine, Quadrivalent; RIV=Recombinant Influenza   Vaccine LAIV=Live-Attenuated Influenza Vaccine; IM=intramuscular;   ID=intradermal; IN=intranasal.
* Immunization providers should check Food and Drug   Administration–approved prescribing information for 2013–14 influenza   vaccines for the most complete and updated information, including (but not   limited to) indications, contraindications, and precautions. Package inserts   for US-licensed vaccines are available at