Posted and filed under Compliance.

Compliance Corner – October

If a patient is deceased, may a covered entity disclose to a family member who was involved in the patient’s care or payment for healthcare prior to the death, PHI of the deceased? Answer: Yes, unless there is an expressed statement to the contrary. (45CR 164.510)

Posted and filed under Compliance, Healthcare.

What to Watch Out For With Credit Balance

In May 2014, the Department of Health and Human Services, Office of Inspector General (OIG) published a proposed rule updating its regulations. The proposed rule will authorize civil monetary penalties for “failure to report and return a known overpayment,” among other issues.   The rule has outlined the penalty for failure to report and return overpayments…

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Posted and filed under Compliance.

Compliance Corner: September

What are the 3 core health activities where a covered entity could disclose a patient’s PHI? Answer: The core health care activities of “Treatment,” “Payment,” and “Health Care Operations” are defined in the Privacy Rule at 45 CFR 164.501.

Posted and filed under Coding, Compliance.

Medicare Guidance for Mid-Level Providers

Taking the Guesswork out of Correct Billing More and more health organizations are hiring midlevel providers to perform services that were formerly thought to be appropriate exclusively for medical physicians. While it is less costly to hire Physician Assistants, Nurse Practioners, and Certified Nurse Midwives, it’s imperative that institutions familiarize themselves with the rules regarding…

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Posted and filed under Coding, Compliance, Medical Record Auditing.

Vaccine Administration Counseling

Vaccine administration coding and documentation is often confused by many providers, billers, coders, and even auditors.  One misunderstanding is what exactly is a toxoid component? And what documentation is necessary to support billing vaccine administration with counseling?  Here’s a quick look at the codes we are talking about. A toxoid component according to CPT refers…

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Posted and filed under Compliance.

Compliance Corner: August

Define the principle of “minimum necessary”? Answer: a covered entity must make reasonable efforts to use, disclose and request only the minimum amount of PHI needed to accomplish the intended purpose of it’s use

Posted and filed under Coding, Compliance, Healthcare.

How ICD-10 is Like Trying to Eat an Elephant in One Bite

This past week, one of our auditors, Robert Blizzard, presented to the Central Florida Physician’s Alliance in Lakeland.  There were 7 practices represented at this particular presentation.  He was asked “ICD-10 is like trying to eat an elephant in one bite.  If you were to make 3 recommendations for practices to enact right now, what…

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Posted and filed under Coding, Compliance, Healthcare.

How to Code Transitional Care Management

Transitional Care Management (TCM) codes are used to report patients who are transitioning from inpatient hospital, observation, skilled nursing/nursing facility, or rehabilitation to the patients’ normal community settings such as their home, domiciliary, rest home or assisted living settings. The patient’s transition to a normal community setting is not the only requirement of the TCM…

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Posted and filed under Compliance, Healthcare.
Norma Panther and Maria Candia

Is Anyone Truly HIPAA Compliant in Healthcare?

Advize Health presented “Is Anyone Truly HIPAA Compliant in Healthcare?” to ISACA West Florida Chapter’s Tampa Governance Risk and Compliance (GRC) Conference. Highlights included: Understanding HIPAA Breach / Violation Statistics Breach Examples Why We Should Care? As Seen At Our Clients: Providers Payers Where is HIPAA Heading? Compliance issues investigated most (in order of frequency)…

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Posted and filed under Compliance, Payers.
physician arms crossed

Quality Measuring Tools for Payers

How important is quality to you? For most people, quality – which equates to a measure of excellence and meeting strict standards – is one of the most important factors in most decision-making related to consumer goods and products. Take the automobile industry; businessdictionary.com uses the example that “if an automobile company finds a defect…

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