Stark Law compliance is now more than just a compliance issue. It has grown to become an Enterprise Risk Management matter, if the substantial awards and settlements in recent enforcement actions are anything to go by. For healthcare organizations that develop and implement provider contracts; managing their…Continue
Added by Roger Steven on July 18, 2017 at 7:52am — No Comments
The fact of about 120 million individuals being affected by HIPAA breaches in 2015 highlights two important points:
Added by Roger Steven on July 14, 2017 at 8:07am — No Comments
When people with autism spectrum disorder (ASD) –called just autism –enter college, they are up against challenges that are unique and peculiar to the group. They need to be understood for their special needs, because they enter college at a sensitive age. There is an onus on the part of…Continue
Added by Roger Steven on July 12, 2017 at 7:48am — No Comments
It goes without saying that preparing for HIPAA enforcement is of crucial importance to organizations. The reason: Last year saw a spike in the settlement payments ordered by HIPAA. There were as many as seven settlements of a value of over $1 million each. Of these seven, one was for $5.5 million, another was for $3.9 million, and yet another for $2.75 million. These constituted a part of a dozen or so overall resolutions settlements. These results point to the fact that HIPAA is continuing…Continue
Added by Roger Steven on July 10, 2017 at 8:41am — No Comments
Electronic Health Records (EHR) or electronic medical records (EMR), as they are called, are of enormous use in the fields of healthcare and medical sciences. They have a number of features that enable the patient; the medical professional and the healthcare provider have complete and unimaginably easy access to all important records that relate to the patient.
A direct result of the…Continue
Added by Roger Steven on June 29, 2017 at 7:50am — No Comments
The American healthcare industry is a curious mélange. On the one hand, it is the world’s largest industry, with an estimated size of around $ three trillion. It is a system in which any treatment option that one can think of is available to the patient. Yet, it is characterized by a high degree of inefficiency and exorbitant costs. Many treatment options are out of reach of a large number of patients. It also suffers from non-implementation of many best practices that would have ensured a…Continue
Added by Roger Steven on June 13, 2017 at 8:24am — No Comments
It is not commonly known that a Covered Entity or its Business Associate have to comply with HIPAA regulations that relate to their organization’s human resources function. While HIPAA requirements for departments that deal with IT security and risk management are commonly known; HIPAA for the human resources department is also important.
HIPAA lays down a number of requirements that the HR…Continue
Added by Roger Steven on June 12, 2017 at 8:40am — No Comments
When structuring and auditing medical director and administrative agreements; the provisions of the Stark Law need to be taken into careful and full consideration. This is because the Stark Law is the operative law for this kind of arrangement.
Implementation of best practices for negotiating and drafting administrative arrangements on behalf of health systems, hospitals, medical groups and…Continue
Added by Roger Steven on May 30, 2017 at 7:31am — No Comments
In this age of outsourcing and globalization, and with it, the emerging potential phenomenon of the Internet of Things (IoT); it is quite a tempting proposition for HIPAA Business Associates or Covered Entities to think of outsourcing their processes relating to Protected Health Information (PHI).…Continue
Added by Roger Steven on May 26, 2017 at 8:30am — No Comments
MentorHealth webinars are designed to offer professionals in the healthcare industry the knowledge they need in all the areas of the healthcare industry that enables them to excel in their professions. MentorHealth’s trainings bring experts from all the core areas of healthcare and impart learning to help professionals understand and implement all the important issues that matter to their professions. To keep updating your knowledge of regulatory compliance in the healthcare industry, all…Continue
Added by Roger Steven on May 23, 2017 at 9:05am — No Comments
A Claim Adjustment Reason Code (CARC) is a code used in medical billing to communicate a change or an adjustment in payment. CARCs have to be used to communicate why there was a difference between the amount paid in a claim or service line and the amount that was billed against it. CARCS are to be mentioned only if there is an adjustment of this kind. If there is no adjustment to a claim or…Continue
Added by Roger Steven on May 19, 2017 at 8:44am — No Comments
One of the major fallouts of the passage of the Affordable Care Act (ACA) or Obamacare is the phenomenal rise in the number of physician practice acquisitions. These are some of the reasons for this rise:
- Because of physician practice acquisitions, healthcare providers can consolidate and integrate their business better, since acquisition brings about alignment between the business prospects of the referral networks with the hospital’s strategic goals
Added by Roger Steven on May 17, 2017 at 7:00am — No Comments
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a federal Act that determines the way in which physicians need to be paid when they treat patients who come to them under Medicare. It substantially alters and replaces the earlier Act in this regard, namely the Balanced Budget Act, which was in force from 1997. Signed into law by then president Barack Obama; MACRA is hailed as his biggest step at reforming the healthcare system in the US since the Affordable Care Act or…Continue
Added by Roger Steven on May 15, 2017 at 8:08am — No Comments
The Comprehensive Error Rate Testing (CERT) is a program used by the Centers for Medicare & Medicaid Services (CMS) for calculating the rate or extent of improper payments of Medicare Fee-for-Service (FFS). The method used by the CMS under CERT is to pick up a stratified random sample of some 40,000 claims that are statistically valid and calculate and audit it to determine if the payments were made in accordance with the rules relevant to items such as coding, Medicare coverage, and…Continue
Added by Roger Steven on May 10, 2017 at 8:27am — No Comments
In many years that it has been in existence, one of the noticeable changes that HIPAA has undergone is in its attitude. The earlier phase of advice and counseling has now given way to hardboiled and unforgiving enforcement. The Office of Civil Rights (OCR) no longer uses the cajoling and persuasive method. It wants to impose super harsh penalties on healthcare organizations which violate its rules.
For starters, healthcare organizations have to reckon with new, ominously higher fines,…Continue
Added by Roger Steven on May 10, 2017 at 8:24am — No Comments
In July 2010, the Obama administration chalked out new Electronic Health Record Standards. These Electronic Health Record Standards were a major improvisation on the standards…
Added by Roger Steven on January 4, 2017 at 7:02am — No Comments
A HIPAA audit is very important for service providing organizations, because the penalties for violations can bring their business down. It is important to understand the nuances of a HIPAA audit if one has to be successful.
A HIPAA audit is, for many service providing organizations, a make or break situation. This is because HIPAA audits are considered stringent. Violations can attract huge penalties, which is why getting it right the first time is extremely…Continue
Added by Roger Steven on December 9, 2016 at 4:20am — No Comments
For many professionals, writing skills are learned while they are on the job. In many cases, they would go by a preferred style or other documents or style guides that help to put a certain style in place. Editing, however, is rarely taught. Worse, the perception most people have of editing is that it is revising or rewriting a work. But the truth is different. Editing gives shape to a document. It helps to perfect and sculpt it. The big question most editors face…Continue
Added by Roger Steven on November 29, 2016 at 6:10am — No Comments
Nanotechnology, a part of Quantum Physics (QP), is growing fast and has myriad uses. Nanotechnology is all about size and self-assembly. While QP deals with subatomic particles and waves; Nano relates to the atomic and molecular level. Atomic behavior and properties get dramatically changed at the Nano level. Of note are properties such as color change due to refraction of light. Gold, packaging and chemistry are some of the well-known areas into which…Continue
Added by Roger Steven on November 25, 2016 at 4:50am — No Comments
The importance of conducting a risk analysis updating it can be gauged from the fact that failure to conduct a written risk analysis qualifies as “willful neglect”, which carries the highest Civil Money Penalty (“CMP”). This cannot be waived by the DHHS unlike violations that happen due to a reasonable cause.
Since risk analysis is a required implementation specification under the Security Rule, failure to do one amounts to willful neglect. If the civil…Continue
Added by Roger Steven on November 15, 2016 at 5:23am — No Comments