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The 2015 Workplan of the Office of the Inspector General highlights important areas for providers including medical necessity of services billed, payment review, exclusions, and incentive payments. Determination of the medical necessity of services billed is a primary focus of the Workplan. As stated in the Social Security Act, Medicare will not pay for items […]
Covered entities should be aware of differences between the Privacy and Security Rule requirements regarding protected health information. One major distinction is that the HIPAA Security Rule only applies to electronic protected health information (e-PHI). A covered entity is responsible for maintaining confidentiality, integrity and availability of all e-PHI. Under the HIPAA Security Rule, covered […]
Covered entities have several requirements under the Privacy Rule. The purpose of the rule is to protect and secure individually identifiable patient information and the covered provider has the ultimate responsibility for HIPAA compliance. Compliance with the Privacy Rule was required on April 14, 2003. According to the OCR’s HIPAA Audit Program Protocol for covered […]
The recently released information on physicians’ billing practices with Medicare has sparked some interesting discussion on the data analysis. In 2012, 880,000 healthcare providers billed Medicare for $77B. A rheumatologist listed as a “Medicare Top Biller” describes the potential for the public to misconstrue the data without knowing all of the factors involved in billing […]
The U.S. Dept of Health & Human Services, Office of Civil Rights (OCR), enforces HIPAA and HITECH security regulations. Below are three examples of incidents and fines reported to Congress in 2012. The common denominator is that none of the three practices demonstrated that they had procedures in place to minimize the risk of exposing […]
10 I want to know about a violation of law in my practice before the government and the world know about it. In a world with information readily available at the press of a button, the government and patients have access to lots of data. Knowing your high risk areas allows you to put controls […]
Under the Occupational and Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. According to Robert Kulick, OSHA regional administrator, employers and employees must work together to identify and eliminate potential hazards. A serious OSHA violation occurs when there is substantial probability that death or serious […]
Doctors playing defense The government cites defensive medicine as a factor in the escalation of health care costs. However, a recent study indicates that 73% of physicians engage in some form of defensive medicine. The payers’ perception of defensive medicine is negative, but the providers’ view it as a necessary evil in today’s environment. Medical […]
First Healthcare Compliance provides products and services specifically designed to help physicians achieve a compliance program as required under the Affordable Care Act. Let us help you protect your practice against growing government scrutiny. -HIPAA/HITECH -OSHA -The False Claims Act -Anti-kickback Statute -Stark -Employee screenings -Auditing/monitoring Our simple, comprehensive, online solution narrows the gap […]
The OIG Work Plan for 2013 includes a review which will attempt to determine whether payments for “Incident-to” services had a higher error rate than non-incident to services. Physicians who appear to be providing more services in a 24 hour period than possible could be red-flagged. The consequence could be an audit conducted by CMS. […]
