Mnet Health News delivers the latest news and information articles for the world of healthcare.

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Updating Business Associate Agreements to Comply With New HIPAA Regulations

It may be time for health care providers and their vendor partners to review and refresh their business associate agreements (BA) to ensure compliance with the recent HIPAA omnibus rule and HITECH Act. According to the U.S. Department of Health and Human Services (HHS), BA agreements must include provisions that:

• Establish the permitted/required uses and disclosures of protected health information (PHI) by the BA

• Provide that the BA will not use or further disclose the information, other than as permitted or required by the contract or by law

• Require the BA to implement appropriate safeguards to prevent unauthorized use or disclosure of PHI, including implementing requirements of HIPAA’s Security Rule with regard to electronic PHI

• Require the BA to report to the covered entity (CE) any use/ disclosure of information not provided for by its contract, including incidents that constitute breaches of unsecured PHI

• Require the BA to disclose PHI as specified in its contract to satisfy a CE’s obligation with respect to individuals’ requests for copies of their PHI, as well as make available PHI for amendments and accountings

• To the extent the BA is to carry out a CE’s obligation under the Privacy Rule, require the BA to comply with the requirements applicable to the obligation

• Require the BA to make available to HHS its internal practices, books, and records relating to the use and disclosure of PHI received from, or created or received by the BA on behalf of, the CE for purposes of HHS determining the CE’s compliance with HIPAA’s Privacy Rule

• At termination of the contract, if feasible, require the BA to return or destroy all PHI received from, or created or received by the BA on behalf of, the CE

• Require the BA to ensure that any subcontractors it may engage on its behalf that will have access to PHI agree to the same restrictions and conditions that apply to the BA with respect to such information

• Authorize termination of the contract by the CE if the BA violates a material term of the contract

BA agreements must comply with the new rules by Sept. 23, 2013; however, those that were in place as of Jan. 25, 2013 (and are not renewed or amended thereafter) are granted grandfathered status and deemed in compliance until Sept. 23, 2014.

HHS has also released a new sample BA agreement that reflects the changes made by the HITECH Act and omnibus rule, available at http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/contractprov.html.

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5 Things ASC's Do to Turn the Month from Good to Great

Every ASC wants to have a great month. Let’s define this simply as delivering a service that creates well satisfied patients, maintaining regulatory compliance, and operating efficiently to generate financial profitability and a return to investors. Great results don’t happen by accident and they don’t happen after the month is closed. There are five simple things you can do every day to ensure that your month goes from “good to great”.

  1. Provide every patient, every day with an easy patient satisfaction survey. The best are email/web based and tabulate results instantly as they arrive so you always know what your “customers” are saying about you.
  2. Maintain your quality metrics and your accreditation tasks every day. While this can be a daunting chore, these tasks and measurements ensure that your ASC is operating at standards.
  3. Set a goal for the number of cases you need to perform and bill each month that will generate a profit. Track the number of billed cases each day and quickly solve any bottlenecks (scheduling, dictations, coding). If your goal is to bill 400 cases for the month, be sure you have 100 by the end of the first week, 200 by the 15th, etc.
  4. Set a goal for dollars collected each month. How much do you need to collect to pay all expenses and generate a return on investment – this is your goal. Similar to cases, track it every day so you can take immediate steps to avoid a disappointing month. Resolve claim submission errors, investigate denials, and call any payer that is slow paying. Be diligent on collecting co-pays and deductibles at the time of service. Consider having the front desk report the totals daily.
  5. Know your cash position every day. View this against your budget of expenses for the month. Cash equals actual dollars on hand (in the bank) that are available.
  6. Bonus! Spend at least 5 minutes talking to a different staff member and a different physician each day. Ask the question “how are we doing?” This will take you 10 minutes a day and in a normal month you will reach out to 22 different staff members and 22 physicians.

We have designed AccredAbility and ManageMyASC at www.mmxhealthcare.com to allow you to accomplish #1 – 5 simply, quickly and accurately (which gives you more time to do the bonus activity).

Contributed by:

John Seitz, CEO and Tamar Glaser, RN, President

www.mmxhealthcare.com

info@mmxhealthcare.com

877-578-4484

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Fiscal Cliff Deal Leaves Health Care Industry Anxious

The conflict and subsequent deal concerning the Federal budget has left most people in the health care world feeling somewhat confused, including administrators, doctors, and other professionals who work with Americans covered by Medicaid and Medicare. The deal that came together at the eleventh hour is not a long-term solution. It’s a compromise that prevents steep Medicare payment cuts…for now.

The Impact on Medicare and Medicaid

There can be no doubt that those within the industry who work with Medicaid and Medicare patients are encouraged that the compromise has, yet again, averted the “automatic” 26.5 percent cut in payments that was put in place by a poorly-designed formula included in a bill passed by Congress in 1997. The deal to avert the fiscal cliff will postpone automatic cuts for one more year. The cost of this postponement is estimated to be $30 billion; approximately half of this amount will be mitigated through cuts in payments to hospitals over the course of the next decade.

The amount of money on the line is staggering. It affects both medical centers and hospitals, as about half of the nation’s healthcare costs are borne by the government, with Federal funds providing the majority of this. The fiscal cliff bill that was passed will save $10.5 billion over the course of the next 10 years by reducing the base payment increase for Medicare, and an additional $4.2 billion over the next 10 years by reducing Medicaid payments.

CLASS Act & Co-Ops

Another health care change brought about by the fiscal cliff deal is the repeal of the Community Living Assistance Services and Supports (CLASS) Act. This Act was originally intended to create a voluntary and government-run long-term care insurance program for the public. Although the White House announced in 2011 that it would suspend that portion of the new health reform law because it was not sustainable, this move simply placed the CLASS Act on hold. The fiscal cliff deal brings the CLASS Act to its end completely.

The deal also cuts funding for health insurance co-ops. During health care reform negotiations, the public option was struck down and the Senate replaced it with funding for loans to start nonprofit health insurance co-ops. There was $3.8 billion for this included in the Affordable Care Act, and, at this point, Health and Human Services has already loaned out about half of this money to 24 nonprofits nationwide. While the new deal doesn’t take back money already loaned out, it does cut out all but about 10% of the money that has not yet been spent, about $1.9 billion. The 10% that remains will be used for administrative costs that are associated with the plans that have already been created.

With so many changes being made at one time, it’s no wonder so many in the health care field are anxious about how all of this will eventually play out. The fiscal cliff deal did not even address the debt ceiling issue, which will become apparent in the very near future. In the meantime, by waiting until the last possible moment to create a fix for Medicaid and Medicare, Congress is leaving many patients and healthcare professionals with the impression that these programs might not be reliable any longer.

Written by Mnet Financial

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Encrypted Emails Prevent Million Dollar Penalties

Sending and receiving email is a common part of life in the 21st century; most people don’t think twice when sending emails to family, friends, business connections, or even clients. Regardless of the content of the email, they never stop to consider what could happen if the information in the email were to fall into the wrong hands. When it comes to email, most people tend to think that the information they’re passing along is just not that important or confidential. But is this the case?

In 2010, an amendment known as the HITECH Act was made to the HIPAA Privacy and Security Rules. One noteworthy change that this Act brought about is the creation of stronger penalties for breaches of patient information. Previously, the maximum penalty for this type of HIPAA violation was $250,000; this amendment increased the maximum penalty to $1.5 million. In the short time since this Act went into effect there have been several penalties levied against healthcare institutions in excess of $1 million per violation. Because each incident often results in multiple violations, a breach of patient information could result in fines of several million dollars – and in some cases it already has.

Encrypted Email is Key

Sometimes it is necessary to send sensitive personal information, such as Social Security numbers, credit card numbers or passport information, or birthdates, to someone. When faced with this situation on a personal level, many people will avoid transferring the data via email, since email can easily be hacked by a person who has the right knowledge and the wrong motives. However, within the arena of business, particularly in the field of healthcare, it is frequently necessary to transfer many sensitive pieces of information. Email is typically the information transfer method of choice, due to its simplicity and lightning-fast transferal speed. To avoid security breaches, healthcare organizations are therefore advised to use encrypted email whenever they use email to transfer sensitive information.

Encrypting email is the best way to keep all but the most vigilant of hackers out of your private communications. There are several services available for both personal and professional use. These services require a personal email certificate, which allows you to digitally sign your email so that the recipient of the email can verify that it is truly from you. It also encrypts your messages so that each message can only be viewed by its intended recipient.

Basically, the way that email encryption works is that when you sign up for the service you’re given a public key and a private key for encryption. Only you will have access to your private key; your public key is given out to anyone that you may choose. If a person would like to send you a message that is only intended for you, they would first encrypt the message using the public key that they have been given.

Upon receipt of the message, your private key would be required so that the message can be decrypted. Because of this process, even if someone were to intercept the message that is being sent out, it would be unintelligible and thus useless to them. When you send out a message using your private key to digitally verify that you are the sender, the recipient can rest assured that the message is indeed coming from you.

“I suggest” states Stacy Eaton, Collection Manager of Mnet Financial, “that instead of just encrypting the messages that contain sensitive information; you should encrypt all of your email communications. If you only encrypt some of your emails, a hacker who intercepts email communications will be able to easily tell which messages contain sensitive information. They would then be able to focus their efforts on hacking those specific messages. Encrypting all messages makes it much more difficult for a hacker to identify the messages that contain information that would be useful to them.”

In the fast-paced world of healthcare, it is wise to consider making use of an email encryption service to ensure compliance with law. Even though encryption solutions may appear to be complex, the implementation and use of an encryption service can be affordable and effortless. Violations to HIPAA Privacy and Security Rules can result in harsh fines and other penalties such as criminal sentencing and disciplinary action by licensing boards. Such extreme measures should serve as a wake-up call to everyone involved in the field of healthcare today.

Written by Mnet Financial

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Health Care Consumers Equate Higher Costs with Better Quality

When asked to choose a healthcare provider based only on cost, consumers choose the more expensive option, according to a new study funded by HHS' Agency for Healthcare Research and Quality (AHRQ).

The study found that consumers equate cost with quality and worry that lower cost means lower quality care. But higher costs may indicate unnecessary services or inefficiencies, so cost information alone does not help consumers get the best value for their health care dollar, according to the study.

The study found that when consumers were shown the right mix of cost and quality information, they were better able to choose high-value health care providers - defined as those who deliver high-quality care at a lower cost.

Health care consumers want to visit high-quality doctors and hospitals, and many public report cards are available to help them compare providers. However, few report cards include information on cost, and there has been little scientific evidence to guide the presentation of that information to help consumers choose high value providers.

The study's findings have implications for the design of public report cards that offer consumers information on the quality and cost of health care providers. Although report producers have been adopting strategies to help consumers process and use comparative information on quality and cost, many reporting websites still use overly technical information or present other barriers to easy comprehension, according to the study.

Written by Pulse

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4 Pre-Collection Tools Released at ASCA 2012

Last month the Ambulatory Surgery Center Association (ASCA) met at the Gaylord Texan resort in Grapevine Texas, a suburban community that is part of the larger Dallas/Fort Worth "Metroplex."

In tandem with the kickoff of the ASCA convention, Mnet Financial released their newly refined Pre-Collection Suite for healthcare providers. Surgery Center managers were excited to learn that Mnet's Pre-Collection Suite now seamlessly integrates a variety of new technologies, including:

- SMS (Short Message Service) or Text Messaging
- Email Communication
- Voice Messaging
- Multilingual Auto-Dialer

Medical receivables can quickly become devalued. These new technologies help surgery centers to improve their receivables, and, in turn, improve their bottom lines. The Pre-Collection Suite is HIPAA-compliant and gives healthcare providers the option of either utilizing the services independently or using them in conjunction with Mnet Financial's Collections Services and Payment Solutions.

Mnet Financial's Pre-Collection Services can be accessed online and are available to all healthcare providers. Whether it is being used by an individual healthcare provider or a large healthcare system, Mnet Financial's Pre-Collection Service package "evens the playing field" for all, by offering a premium set of services at an affordable price.

Written by Mnet Financial

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New Rules Could Save $9 Billion Over Ten Years

Health and Human Services (HHS) announced the release of a new rule on Aug. 7, 2012 that aims to cut red tape for doctors, hospitals and health plans. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.

Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician's office, two-thirds of a fulltime employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems. By receiving payments electronically and automating the posting of the payments, a physician practice and hospital's administrative time and costs can be decreased.

The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules are projected to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.


Written by Pulse

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Growth in Family Health Premiums Outpaces Growth in Wages and Inflation

Annual premiums for employer-sponsored family health coverage reached $15,745 this year, with workers on average paying $4,316 toward the cost of their coverage, according to a recent survey from the Kaiser Family Foundation/Health Research & Educational Trust. This reflects a 4-percent increase in premiums from last year.

Although this year's rise in premiums is low compared with other years, it has outpaced the growth in workers' wages (1.7 percent) and general inflation (2.3 percent).

The survey also revealed significant differences in the benefits and premium contribution of workers in lower-wage firms (at least 35 percent of workers earn $24,000 or less per year) versus higher-wage firms (at least 35 percent of workers earn $55,000 or more per year).

According to the survey, workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,997 and $3,968, respectively), despite the fact that lower wage firms pay less on average in total premiums.

In addition, the survey found that workers at lower-wage firms are more likely to face high deductibles than those at higher-wage firms. Specifically, 44 percent of covered workers at lower-wage firms face an annual deductible of $1,000 or greater, compared with 29 percent of workers at higher-wage firms.


Written by Pulse

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