Patient Access

32 large patient data breaches since september, says OCR

PARC Editor — Wed, 03 Mar 2010 05:00:00 +0000

OCR posted on its Web site a list of covered entities this week that have reported breaches of unsecured PHI affecting more than 500 individuals, fulfilling its obligation under HITECH.

The HHS organization, which oversees enforcement and compliance of the HIPAA privacy and security rules, reports that since September 22, 2009, 32 covered entities have reported breaches that affected at least 500 individuals.

In the cases where a business associate (BA) is involved, OCR lists those organizations as well. OCR reports that among the 32 breaches of 500 or more, seven included BAs.

Read the full report on HealthLeaders Media.

OIG report examines RAC fraud referrals

PARC Editor — Mon, 01 Mar 2010 05:00:00 +0000

Recovery Audit Contractors (RACs) referred only two cases of potential fraud to CMS during the RAC demonstration period (March 2005 to March 2008), according to the Department of Health and Human Services (HHS) Office of Inspector General (OIG).

On February 19, the OIG released “Recovery Audit Contractors' Fraud Referrals” which examined to what extent the RACs referred fraud cases to CMS and how much training CMS provided to the RACs during the demonstration period.

Identifying overpayments and underpayments and recouping any overpayments are RACs’ primary responsibilities, but they also refer cases of suspected fraud to CMS. However, the report concludes that not receiving a contingency fee based on referred cases could create a directive for RACs to report such abuses.

The OIG found that CMS gave no fraud and abuse training to the RACs in the demonstration project. CMS did give a presentation about fraud to the permanent RACs. CMS plans to provide further training on the identification and referral of potential fraud, no date or agenda has been determined.

To improve the RACs ability to identify fraud the OIG recommends CMS:

determine the outcomes of the two referrals made during the demonstration project,
implement a system to track fraud referrals, and
require RACs to receive mandatory training on the identification and referral of fraud.

Source: OIG

Medicaid Integrity Contractors: We want to hear from you

PARC Editor — Wed, 24 Feb 2010 18:32:00 +0000

Has your organization undergone a Medicaid Integrity Contractor (MIC) audit? If so, we want to hear about your experience. Let us know about your interactions with the MICs and how you’ve managed the process by e-mailing Mike Iarrobino at miarrobino@hcpro.com.

Pre-registering on all surgeries/procedures

jmagdits — Tue, 23 Feb 2010 19:56:25 +0000

Our facility is looking into pre-registering 100% of our patients scheduled for surgeries/procedures. I am interested in whether any other facilities are successful in doing this, and, if so, how do you streamline the process to make it easiest on the patient yet ensure the hospital gets all the necessary information/consent forms signed, prior to [...]

Your physicians and RACs

PARC Editor — Fri, 19 Feb 2010 05:00:00 +0000

Tanja M. Twist, director of patient financial services at Methodist Hospital in Arcadia, CA, offers this tip on the role patient access managers play in a hospital's RAC process:

Educate the physicians. The best thing in terms of working with physicians is to go back and show them what happened. “Physicians need to work with office staff to make sure all the necessary data gets over there,” Twist says. "You should be trying to educate physicians on medical necessity.”

Registration paperwork for recurring visitors

cstaske — Wed, 17 Feb 2010 05:00:44 +0000

Wanting to know how other facilites handle patient paperwork (consent? patient rights? insurance form?) for “recurring” visits (therapy). Do you only review the required registration paperwork the first time no matter how many visits they have? Or do you complete new paperwork for each new billing episode? Cheryl Staske Editor’s note: To respond, please click the title of [...]

Centralized patient transport

jwinchester — Tue, 16 Feb 2010 05:00:49 +0000

Does anyone have a centralized patient transport department? If so, which department do they fall under? Thank you. Jennifer Winchester

AHA urges Congress to remove Medicaid RAC provision

PARC Editor — Mon, 15 Feb 2010 05:00:00 +0000

In a January letter to Congress that addresses several concerns and comments on current healthcare reform legislation, the American Hospital Association (AHA) took issue with a Medicaid RAC provision currently included in the Senate bill.

The bill as it currently stands would extend RAC activity to Medicare Parts C and D and to the Medicaid program, despite the fact that state Medicaid agencies already have the authority to implement RACs for their Medicaid programs. Two-thirds of the Medicaid agencies have rolled out a RAC program.

The AHA also notes that CMS is also implementing the national Medicaid Integrity Program to audit the accuracy of state Medicaid programs, furthering the need to reconsider the current bill.

To read the letter, visit www.aha.org/aha/letter/2010/100107-let-aha-conferees.pdf.

Denial to an appeal letter

kfortney — Fri, 12 Feb 2010 05:00:14 +0000

Does anyone have an effective denial to an appeal letter that they are willing to share? (To be used when a patient does not qualify for assistance and appeals that denial, and the denial stands upon a higher review) Thank you. Kim Fortney

Registering lab/radiology outpatients

aharvey — Thu, 11 Feb 2010 21:05:24 +0000

When registering outpatient patients for Laboratory or Radiology, do you leave the discharge date open and then have to go in and discharge each patient? Or does your system automatically discharge them during the registration? Arlene Harvey-Ferrer