In April of 2003, HIPAA was mandatory of all covered entities.  Many of us read the guidelines, tried to interpret them and made our manuals….but have you done anything to keep them updated since then?  Is the same manual on your shelf collecting dust?  Do you review the guidelines with your staff?

Quite a few additions to the HIPAA guidelines have been added over the last few years.  The most important has been to the security of all of new devices which is referred to as HITECH.  It is rather an extensive piece of legislation that wants to keep all of our new devices (computers, phones, emails) secure, meaning private that contain PHI.

The security guidelines cover the following:

• Specifically, covered entities must:
  1. Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit;
  2. Identify and protect against reasonably anticipated threats to the security or integrity of the information;
  3. Protect against reasonably anticipated, impermissible uses or disclosures; and
  4. Ensure compliance by their workforce

The Security Rule defines “confidentiality” to mean that e-PHI is not available or disclosed to unauthorized persons. The Security Rule’s confidentiality requirements support the Privacy Rule’s prohibitions against improper uses and disclosures of PHI. The Security rule also promotes the two additional goals of maintaining the integrity and availability of e-PHI. Under the Security Rule, “integrity” means that e-PHI is not altered or destroyed in an unauthorized manner. “Availability” means that e-PHI is accessible and usable on demand by an authorized person.

To get the full summary of this piece of legislation, please go to : http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

If you have not dusted your compliance manual off in a while, now might be the time.

Once you have determined what your position should look like, what duties are involved and what time is necessary to complete the work, then you will need to advertise for the position. A few years ago, people advertised in newspapers and speciality magazines, but now the Internet is where it is at.Various browsers offer this speciality. Google, Indeed, CraigsList, LinkedIN etc. They are out there and they do a great job for all of us.  Ok, the resume’ start to come in.

You review them, and call the applicants.  You think you have two or three that fit the bill, Great!! Now what? How do you know who works and who does not? Have you ever hired someone only to find out their personality did not go well with your other employees.  Or realize after you hired them, that you could not take direction and only insisted on doing it their way? Here at Omega we use the tool of a working interview. We actually pay the perspective employee for the time they take to come here.

We take one of the trainers and go over that persons job description and see if that person can do it. In doing this, we can do a further evaluation of that perspective employee. We have been amazed by what we find out in this short time period of time. It actually is a win-win situation for all of us.  The placing of the employees in your organization is very important and can be very expensive. So take the time to understand what the position is and what kind of person would be best suited for it, will save you money in the long run.

“It’s the Leaders responsibility to place people in the right position to succeed”

Your reply is always….that is a given.   Yet when an opening occurs in your place of employment, do you actually stop and consider all the aspects of a particular position?  I would say that most people don’t, particularly if they have a small business.   Most physicians are this in role and we know that their time is very limited for something like this.  So the answer might be “That is why they hire office managers.”  Yet, how many have a clue as to who, how and what to hire?

What roles all the employees play is vastly important if for no other reason than for your business to succeed.   Hiring and training is very expensive, and yet how much time to we give to figuring out the details of each job?   Do you write what the job entails, or do you fly by the seat of your pants by just saying  “I want a person to work up front and answer the phones”  Is that all?  Will he/she have other responsibilities?  Do they need to have a good voice?  Be bilingual?  Do they have to understand any of the other functions of the company?  What about personality?  How does that dove tail with the position that needs to be filled?  Is working on a computer involved?  What kind of computer skills are need?

Questions and more questions….all lead to making your head spin.   There are solutions.

If you can take some time and just jot down some thoughts about any position and then leave for a while and come back to it.  You can then add or delete as you think this position there.  Run it past another employee and get there thoughts.  The more complete and through the job description, the better chance of  getting an employee that would fit that position that you need filled.  After all, if you don’t know what you are looking for than anyone can do, right?

Next time we will talk about the screening and interviewing process.

Another year to start again or go forward or to renew/reflect!  Or we here at Omega are busy with the 5010 format changes!   Reflecting….starting again…don’t have time.  This new format has us all on the run.   Submit the claims, it comes back….this provider wants it one way and the other wants it another….!!   And this once again gets sold as a better way of submitting claims.   All of us in the medical billing business are having to jump over the various hurdles, but we do this and we do this well!

It is not changing of the format that is the trouble, it is whether your staff is keeping abreast enough to make the changes necessary for all of this to happen.  The industry says this is how we need to submit the claims and so we do.   How much money are you the provider going to lose, because you do not have a staff that is up to the challenge of tweaking your formats for the various carriers.

Can hardly wait for the ICD-10 challenges!  How about you guys?  Are you getting your claims out?   By the time you read this, we should have it pretty much smoothed out and running smoothly!   How is your office doing?

Head Off Most of Your Claim Rejections With 2 Simple 5010 Tips

More than half of claims submitted in 5010 testing batches are rejecting for 2 reasons…

Make sure your billing provider and service facility addresses are street (physical) addresses.

These addresses MUST have the zip+4 zip code and CANNOT be a P.O. Box; hence, the physical address.

The primary identifier for your practices and your physicians MUST be the NPI# NOT a tax id# or SS#.

Good Luck and from all of us at Omega Billing Service

The End is Coming! 

Yes, the end of version 4010 is December 31, 2011 and the commencement of version 5010 begins!  Are you ready?  Have you checked and tested with your clearing houses and/or payers?  With all the hustle and bustle of December upon us this is just another process that must be done in order for you to maintain a constant cash flow.  So, contact your clearing houses NOW and be sure you are not left behind!

General description: Responsible for general oversight of the day to day medical billing operations.  Must have at least 10 years of experience in coding, medical billing, sending of claims and collections.  Must have experience is supervising employees. Accountable for efficiency, completeness of work, and prevention of backlogs. Knowledge of Healthpac software is a plus, but not necessary. Salary is dependent on experience.

Did you know you could increase your bottom line by $62,500.00 a year?

It’s true and you can do it by stepping up efforts in your office by collecting patient copays.  It’s that simple, so why are you not doing this?  On average, a physician can see approximately 10 patients per day.  Say each patient has a minimum copay of $25 (which is on the low side), these fees are collected up front rather than after the fact, think of the time, and money spent sending out statements, phone calls, etc., trying to collect.  Time passed results in increased cost and decreased revenue.

This is also true for patients with balances after insurance.  Collect coinsurance up-front as well.  After all, you cannot leave the grocery store without paying for your groceries.  At the very least make payment arrangements before the patient leaves the office and stick to it. 

There are many psychological barriers in asking for money.  Seventy percent of Americans live paycheck to paycheck.  Most patients believe they either do not owe and/or cannot pay.  You have to change the patient’s beliefs.  You have to develop a strategy for decision – making about accounts based on sound business reality – not emotion.

Improve your front-end training.  Set goals.  Put the money in your pocket!

GETTING READY FOR 5010

There really are benefits for you, the physician, in Version 5010.  It all seems like just another way to make the lives of the electronic medical world chaotic.  I mean face it, 4010 came around some 10 years ago and we are pretty comfortable with it, right?  However, there are some improvements…

System wide improvements within CMS simultaneously and implementing standard acknowledgement and rejection transactions across all jurisdictions.  Improving claims receipt, increasing consistency of claims editing and error handling and returning claims needing correction earlier rather than later.  Assigning claim numbers closer to the time of receipt is also an improvement.  These are just a few of the benefits to be improved upon in the electronic world related to your claims, remittances, eligibility and claims status requests and responses.

A few tips you may or may not know about yet…

• A billing provider must be a provider of health care services not a billing service or clearinghouse.
• Billing providers are entities that perform services and are reimbursed by health plans.
• Make sure you are using the correct NPI for the organization.
• The tax ID must be sent for the Billing Provider on the claim.
• For health plans that assign a unique identifier per member, the individual must be listed as the subscriber.
• The patient is not listed on the transaction.

For health plans that assign a number to the entire family, follow these rules:

• The policyholder is always listed as the subscriber.
• If the policyholder is the patient, the patient is not listed on the transaction.
• If the dependent is the patient, they are listed as the patient in the transaction.

For professional claim transactions, 5010 requires total anesthesia minutes be reported.  In 4010, payers could require the anesthesia time be reported as the total number of minutes OR as units.  Units are no longer accepted for reporting anesthesia time.  Any requirements by a payer to submit anesthesia start and stop times in the 5010 transaction will be non compliant with the TR3.

Medicare as well as most insurance companies requires physicians and/or providers that order services for patients prove medical necessity in documentation.  The #1 error related to this requirement is not being able to identify the health care provider that ordered the service, through lack of either documentation or where the signature is illegible.

Did you know there are two acceptable forms to authenticate the health care provider’s signature?

Yes, Medicare/CMS accepts, and recommends a signature log or attestation statement alongside a requested submission of medical records should the charges be audited.  This can save the office as well as the auditing entity valuable time and money.  And we are all about saving time and making money, right?

Physician offices may want to create a signature log to help identify the health care provider associated with either initials or signatures that are not legible.  Face it; most physician signatures are not legible.  Having a sheet similar to a ’key’ to a map or a ‘glossary’ of definitions can be used/submitted to an auditing entity alongside medical records for authentication/verification of physician/health care provider signatures.  This can be done as simple as creating a signed and dated document.

An Attestation Statement is also an acceptable form of authenticity where the medical record is lacking or is illegible.  An example of an attestation statement can be found at http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14440