BILLING UPDATES – SEPTEMBER 2016

Blue Cross News

Blue Cross has entered into a partnership with Amerigroup Partnership Plan, LLC to administer services to Medicaid Managed Care (MMC) and Child Health Plus (CHP) members. They are targeting an October 1, 2016 effective date and will notify the provider community of any changes to this effective date.

Changes to anticipate:

  • New member identification cards, ID numbers and prefixes
    • The prefix for Medicaid Managed Care will be WNH
    • The prefix for Child Health Plus will be WNB
  • Claims submission process
  • Online provider website/portal
  • Preauthorization information and look-up tool
  • EFT and ERA capability
  • Provider service contact info
  • Medicaid and CHP-specific provider manual
  • HealtheNet will no longer be used to verify eligibility and benefits after 10/1/16 for MMC and CHP members only

Additional information is forthcoming from Blue Cross with detailed information about this transition.

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

THE SMARTPHONE – POSSIBLE RISK TO YOUR PRACTICE?

By Emilie DiChristina for PracticeFirst

Almost everyone has a smartphone now, but even the old style flip phone can be a risk to your practice.

Patient phones can present a HIPAA problem, a customer service nightmare and a medico-legal/malpractice issue. This shouldn’t be a surprise to you, but may be overlooked due to the ubiquitous nature of the technology. We are used to seeing a cell phone in everyone’s hand, no big deal right?

It can be a big deal from a medico-legal standpoint as the presence of a cell phone in the examination room can mean:

  • Your interaction, or your staff member’s interaction is being recorded – even if the phone is not out in the open, it may be recording the conversation. This could be a positive in that the patient is hoping to not miss any vital instruction. It could also be a negative in that any interaction the patient is unhappy with can wind up on social media, or in the hands of a lawyer.
  • When a second person is in the exam room with the patient, they may appear to be playing a game on this phone but may instead by video- taping the interaction. Now you have the same issues of the interaction ending up on social media, or in the hands of a lawyer, or being a civil rights/HIPAA violation.
  • Also, whether it is an old style flip phone or smart phone, pictures can be taken of charts, records, dirt in the corner of an exam room, over-flowing sharps containers…you get where this is going.

Staff and provider phones can also present HIPAA, customer service and medico-legal/malpractice issues as well as Human Resource issues.

  • Customer service can be impacted when employees or providers are perceived as being too involved with their phones. You may be looking up a PDR notation, but to the patient, you are not looking at them. When phones are seen on the desks of staff, patients will assume the worst as well.
  • Of course, recording or video-taping can also be an issue with employees. There are many stories of HIPAA violations when employees have taken pics of a special tattoo, or piercing and posted them on social media for example. Staff can also take a pic of a patient demographic sheet or computer screen as well, allowing PHI or ID information to leave the practice quit easily.
  • Other examples of HIPAA risk include providers and staff texting any information about a patient without using proper encryption software, losing a phone that has any PHI on it, and…
  • An often forgotten risk – the employee plugging their phone into a computer via USB to recharge. Unless your computers are hardened against intrusion, when the phone is plugged in, it becomes a storage device potentially allowing the download of PHI or ID information such as Social Security #’s, DOB, addresses, etc. directly on to the phone. One requirement of HIPAA/OCR is that you have a plan in place to prevent this because the risk is so significant.
  • For people with access to the financial records of the practice or providers, downloading this data to the phone can be a nice safeguard for potential termination.
  • When phones (and other devices) are plugged into computers used for patient care or practice issues there is also the risk of a virus or malware transferring into the computer and/or network. If insurers and governments can get hacked or be held hostage to data breach, your practice is at risk as well.

And there are HR risks as well. Allowing your staff to have a cell phone readily available to them during hours of operation reduces productivity. Practice costs are high enough, but hearing there is not enough time for your staff to get their work done, when you have seen them with their phone in hand should trigger an alert.

Human resources professionals often recommend that employee phones not be allowed in personnel meetings whether it is a positive or negative meeting. You may be aware of the trend for employees to post reviews of former employers, but if they have audio or video to go with their claims, the problems rises to a recruitment nightmare and possible Labor Board investigation should the recorded meeting be juicy enough.

So what do you do?

  • All phones that are used for texting/emailing PHI need to be owned by the practice, be password protected, be able to be wiped immediately if lost or stolen, and should use proper encryption software. These phones should also not be used for personal purposes by staff.
  • Non-provider staff members should not be allowed to use their personal phones at that work station, nor should they be carrying them on their person (e.g. keep them in locker or purse), and use should; be restricted to break time only, and only in a non-patient care area like a break room. Staff members should also be prohibited from charging their personal devices on a practice computer.
  • Providers using their phones in front of patients should explain why/what they are doing so the patient understands that they are not being ignored.
  • Practices should consider requesting that no cell phones be used in examination rooms, even by an accompanying visitor. To make this more palatable, it should be explained that the medical experience is improved when all parties are paying attention to the patient.<