Posted and filed under Business, Compliance.

The Consequences of HIPAA Violations

 The below tiered civil penalty structure was established from the American Recovery and Reinvestment Act of 2009. The Secretary of HHS still has discretion in determining the penalty amount based on the nature and extent of the violation as well as the nature and extent of harm resulting from the violation.  The Secretary is prohibited…

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Posted and filed under Compliance, Healthcare.

2016 Update: OIG/OCR Audit Process

OCR’s Privacy, Security, and Breach Notification Audit Program: Although the ever-expanding use of health information technology in health care provides many benefits, in turn it poses new risks to consumer privacy. To ensure HIPAA compliance, HITECH requires HHS to perform periodic audits of covered entities and business associates. In 2011 and 2012, OCR conducted a…

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Posted and filed under Compliance, Healthcare.

The Hopeful Future of Sharing Behavioral Health Data

The Colorado Regional Health Information Organization (CORHIO) is launching a pilot program to improve patient information exchange between providers and caregivers. This program is designed in a way that once consent is given by patients, their Behavioral Healthcare Information will be shared with long term care providers and hospitals. The newly accessible documents will summarize…

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

Advize Health Meaningful Use and Security Risk Analysis Webinar Recap

On March 10, Advize Health held our fifth monthly webinar on Meaningful Use and Security Risk Analysis. For this webinar, Advize Health’s auditor Melissa Jewett presented with Don Waechter from Compliance and Remediation Services, LLC. Both Melissa and Don are highly qualified to deliver such an informative webinar; as Melissa is a Certified Professional Coder…

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Posted and filed under Coding, Compliance.

ER Upcoding Rules & Regulations To Be Aware Of

Does documentation of more than 50% of time spent counseling or coordinating care suffice for time documentation, and therefore E/M code level selection? Many will answer: YES Let’s take a peek at an often forgotten CMS rule “In general, to bill an E/M code, the physician must complete at least 2 out of 3 criteria…

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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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