HIPAA Compliance Reminder: Windows 7 End of Life

Windows 7 End of LifeAs 2020 comes to an end, the last thing on anyone’s mind is what operating system is installed on their computers. However, many are unaware that Windows 7 end of life happened over 10 months ago, and according to Microsoft, “If you are still using Windows 7, your PC may become more vulnerable to security risks.

When an operating system reaches the end of its lifecycle, servicing and support is no longer available for the product. This means, Microsoft no longer releases important security updates or technical support for any issues! In addition to that, the antivirus software, “Microsoft Security Essentials,” is also unavailable, and they are warning that, “Windows 7 users will be at greater risk for viruses and malware.”

As a result, possibilities of exploitation of private and sensitive data and information is increased, which makes it even more easily accessible to lurking hackers. The Windows 10 update is a safer solution for the common user, but there are still some steps that both Covered Entities and Business Associates should take in order to remain in compliance with privacy settings and HIPAA Rules and Regulations after making the upgrade.

 

One of EZClaim’s partners, Live Compliance, is an expert in determining compliance, and have offered to help. In addition to upgrading your machine to the latest version, the Live Compliance  team of HIPAA and HITECH experts will also ensure that your computer meets all other important compliance requirements, and is safe from other common vulnerabilities.

So, if you have questions regarding your organization’s compliance, Windows 7 end of life, or even assistance in setting up Windows 10, contact Live Compliance at 980.999.1585, or e-mail Jim Johnson.

[ Article contributed by Jim Johnson of Live Compliance ]

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ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

Life Cycle of a Medical Bill (Revenue Cycle 101)

Life Cycle of a Medical BillThere are five ‘phases’ in the life cycle of a medical bill: Pre-appointment; Point of care; Claim submission; Insurance payment or denial; and Patient payment. This post will overview each of these phases, and could even be considered to be a “101-level” course on Revenue Cycle Management.

With high deductible health plans on the rise, the recent explosion of telehealth appointments due to COVID-19, and many other factors in play, it’s more important than ever for everyone to understand the life cycle of a medical bill, and how the process works. The healthcare revenue cycle is relevant not only to those who work in healthcare, but to the patient, too.

The revenue cycle is the series of processes around healthcare payments—from the time a patient makes an appointment to the time a provider is paid—and everything in between. One way to think of it is in terms of the life cycle of a medical bill. Although there are many ways this process can play out, this post will lay out a common example below:

1. Pre-appointment
For most general care, the first stage of the revenue cycle begins when a patient contacts a provider to set up their appointment. Generally this is when relevant patient information will begin to be collected for the eventual bill, referred to on the financial side of healthcare as a claim.

At this point a provider will determine whether the appointment and procedure will need prior authorization from an insurance company (referred to as the payer). Also, the electronic health record (EHR) used to help generate the claim is created, and will begin to accumulate further detail as the provider sends an eligibility inquiry to check into the patient’s insurance coverage.

2. Point of care
The next step in the process begins when the patient arrives for their appointment. This could include when a patient arrives for an initial consultation, an outpatient procedure, or for a follow-up exam. This could also include a Telehealth appointment.

At any of these events, the provider may charge an up-front cost. One example of this is a co-pay, which is the set amount patients pay after their deductible (if they are insured), however, there are other kinds of payments that fall into this category, too.

3. Claim submission
After the point of care, the provider completes and submits a claim with the appropriate codes to the payer. In order to accomplish that, billing staff must collect all necessary documentation and attach it to the claim. After submitting the claim to the payer, the provider’s team will monitor whether a claim has been been accepted, rejected, or denied.

[ Note: Medical coding refers to the clerical process of translating steps in the patient experience with reference numbers. The codes are normally based on medical documentation, such as a doctor’s notes or laboratory results. These explain to a payer how a patient was diagnosed and treated, and why. This information helps the payer decide how much of an encounter is covered under any given insurance plan, and therefore how much the payer will pay. ]

4. Insurance payment or denial
Once the payer receives the claim, they ensure it contains complete information and agrees with provider and patient records. If there is an error, the claim will be rejected outright and the provider will have to submit a corrected claim.

The payer then begins the review process, referred to as adjudication. Payers evaluate claims for accurate coding and documentation, medical necessity, appropriate authorization, and more. Through this process, the payer decides their financial obligation. Any factor could cause the payer to deny the claim.

If the claim is approved, the payer submits payment to the provider with information explaining details of their decision. If the claim is denied, the provider will need to determine if the original needs to be corrected, or if it makes more sense to appeal the payer’s decision.

Following adjudication, the payer will send an explanation of benefits (EOB) to the patient. This EOB will provide a breakdown of how the patient’s coverage matched up to the charges attached to their care. It is not a billing statement, but it does show what the provider charged the payer, what portion insurance covers, and how much the patient is responsible for.

5. Patient payment
The next phase occurs when the provider sends the patient a statement for their portion of financial responsibility. This stage occurs once the provider and payer have agreed on the details of the claim, what has been paid, and what is still owed.

The last step occurs when a patient pays the balance that they owe the provider for their care. Depending on the amount, the patient may be able pay it all at once, or they might need to work with the provider on a payment plan.

 

The above example represents one way the lie cycle of a medical bill can play out. Some of the ‘phases’ are often repeated. Because of the complexity of healthcare payments and the parties involved, there is not always a ‘straight line’ from patient care to complete payment. That’s why we call it the revenue cycle, and there are companies that provide systems for its management.

One of EZClaim’s partners, Waystar, aims to simplify and unify healthcare payments. Their technology automates many parts of the billing process laid out above, so it takes less time and energy for providers and their teams, and is more transparent for patients (Click here to learn more about how Waystar automates manual tasks and streamlines workflows.) When the revenue cycle is operating at its most efficient, providers can focus their resources on improving patient care—and that’s a better way forward for everyone!

For more information of how Waystar works together with EZClaim, click here.

[ Article and image provided by Waystar ]

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ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

Latest Best Practices for Medical Offices During COVID-19

Best Practices for Medical PracticesTo adjust to the ‘new normal’, here are some of the latest best practices for medical offices to implement.

In the current state of the world, filled with struggles brought on by COVID-19, many providers and practices are attempting to weave new procedures and workflows into their daily activities—to adjust to the ‘new normal’. This includes implementing virtual visits, exploring automation and paperless options, streamlining eligibility verifications, and strategizing on denials management.

An EZClaim partner, TriZetto Provider Solutions, has provided information about the latest best practices for medical offices. Their in-house experts offer some creative ways of how your practice can become more efficient and navigate through the pandemic with the following articles:

Eligibility Woes: The Impact of COVID-19 on Insurance Coverage
Adapting denials management to protect and retain revenue
Healthcare Huddle: How to Manage Telemedicine & New Challenges during the New Normal

 

EZClaim’s medical billing software can ensure that you are equipped with the right solutions to manage costs and maximize revenue flow. Want to learn more? Well, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

Noncompliance of HIPAA Security Rules Has Huge Consequences

HIPAA security rulesThe noncompliance of HIPAA security rules has had huge consequences for an IT and health information management company.

CHSPSC LLC, (“CHSPSC”) has agreed to pay over $2 million to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), for the breach of Protected Health Information (PHI). The Business Associate was notified by the Federal Bureau of Investigation (FBI) that it had traced a cyber-hacking group’s advanced persistent threat into CHSPSC’s information system.

After OCR ‘s investigation, it was found that CHSPSC had “longstanding, systemic noncompliance with the HIPAA Security Rule including failure to conduct a risk analysis, and failures to implement information system activity review, security incident procedures, and access controls.” The large health system provided various Business Associate services, including IT and health information management, to hospitals and physician clinics. These violations could have easily been avoided! OCR Director Roger Severino said, “The healthcare industry is a known target for hackers and cyber-thieves. The failure to implement the security protections required by the HIPAA Rules, especially after being notified by the FBI of a potential breach, is inexcusable.”

 

In addition to the monetary penalty, the Business Associate will be required to complete a “robust” Corrective Action Plan (CAP) with monitoring activity for at least the next two years. CHSPSC will also be required to do the following:

Implement technical policies and procedures to allow access only to those persons or software programs that have been granted access rights to information systems maintained
Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports
Conduct accurate and thorough assessments of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI

All this shows that ANYONE can face HUGE penalties, and they would most likely bankrupt a small billing company or an independent physician practice.

 

So, based on this specific example, it is VERY important to understand that every complaint or potential breach must be investigated by HHS/OCR. If you, a billing company, or other vendor, suspect a breach, you must inform the covered entity (your client) and have a breach risk assessment completed to determine key factors and take action.

Keep in mind, a Business Associate is a ‘person’ or ‘entity’. This means that ALL billing companies—large or small—need to comply with the Federal HIPAA security rules and regulations. So, if your company has not completed an accurate and thorough security risk assessment, there is a possibility that you could be penalized under ‘willful neglect’. (This category alone gas a fine of $50,000 per violation!)

 

So then, what can be done to ensure this doesn’t happen to my billing company or my organization? Well, one of EZClaim’s partners, Live Compliance, can make determining your compliance requirements extremely simple:

Completely online, Life Compliance’s role-based courses make training easy for remote or in-office employees
Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location.
Policies and procedures are curated to fit your organization, ensuring employees are updated on all workstation use and security safeguards in or out of the office. Update is in real time.
Electronic, prepared document sending and signing to employees and business associates

 

So, don’t risk your company’s future, especially when Life Compliance is offering a FREE Organization Assessment to help determine your company’s status. Either call Life Compliance at 980.999.1585, visit LiveCompliance.com to schedule an assessment, or e-mail Jim Johnson.

[ Article contributed by Jim Johnson of Live Compliance ]

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ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

How to Improve Medical Billing Revenues

Improving Medical Billing RevenuesIt IS POSSIBLE to improve medical billing revenues, and here are a few ways to do just that.

Healthcare practitioners, whether established or just starting out, have many overwhelming tasks: Managing a practice; Seeing patients; Working to staying up-to-date on administrative tasks; The whole host of compliance at the federal, state, and local level; and Overseeing the billing.

One of these that can lead to loss of revenue is not properly managing the medical billing, which can also lead to HIPAA fines and rejected claims. However, there is a solution: a medical billing system that balances the budget and optimizes revenues of medical practice.

EZClaim, an expert in the medical billing software market since 1997, provides a solution that improves the efficiency of an office’s billing process in many ways. The following are the primary reasons.

Reduce Coding Errors
Medical procedures become codes, codes become claims, and claims become revenue. Any error in this process can make claims to be denied, your workload can be increased, and revenue can be lost. To help in avoiding errors, it is essential to use billing software that offers the easiest implementation and access to descriptive diagnosis and treatment codes. EZClaim’s medical billing solution offers ease-of-use in coding, billing, and strong partnerships with Clearinghouses which act as an additional ‘safety net’ for catching errors.

Administrative Support
Most medical practices are a small team of people tackling a wide range of tasks, so when one cannot understand the function of the billing software, accessing reliable support is very important. EZClaim prides itself on having dedicated support experts available, and that was how the company was established. Founder and President Al Nagy has said, since day one, “We are a support company that happens to sell medical billing software.”

Maintain Industry Compliance
It is important to recognize that industry compliance and a practice’s revenue go hand-in-hand. Filing and batching inaccurate and non-HIPAA compliant claims can often be traced back to an outdated healthcare revenue management system. Conquering these tasks requires a focus on multiple fronts: A properly trained billing team, clear office procedures, patient payment policies, and a reliable medical billing company. These are all ways to help buttress against non-compliance and rejected claims.

Streamline Workflow
Recently, a study was done that showed almost 80% of medical bills contain errors. These incorrect medical claims often end up as lost revenue originally, not to mention the additional cost of resubmissions and collections. One of the best ways to resolve this problem for your practice is to make use of both well-trained, experienced billers and coders, combined with a competent medical billing solution that aids in catching these errors. EZClaim software features a library of standard validation, the ability to add custom validation, and integrates with Alpha II for full claim scrubbing.

Follow up
Errors will and do occur, so establishing a system for follow-up on all denials will close the loop and protect against lost revenue. Being consistent with the follow-up process, and having a medical billing solution that tracks these things will help close that gap.

Collections
Finally, probably the most important aspect that optimizes a practice’s revenue is to get paid. Portals and payment collection systems definitely help with this, but having collections integrated into the medical billing system is, of course, the best. EZClaim has pain-free payment processing integrated into their solution, called EZClaimPay. It solves all the problems associated with payment processing: Bank deposits, reconciliation, statements, changing fees, and ‘finger-pointing’ when there is a problem. EZClaimPay’s robust platform will greatly increase a practice’s collections success, and improve their revenue.

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ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

[ Photo credit: Studioarz ]

Medicare Reimbursements Webinar (MIPS)

Medicare Reimbursements WebinarThis FREE Medicare reimbursements webinar will help healthcare providers with the financial challenges they are facing this year, and it’s critical not to ignore the impact MIPS compliance has on their bottom line.

There are many commonly misunderstood aspects of MIPS (Merit-based Incentive Payment System), and many nuances of how and when actions need to be taken to be able to earn points—and points significantly impact reimbursements!

 

To help bring clarity to MIPS, Health eFilings is holding a FREE 30-minute Medicare reimbursements webinar to help you understand key deadlines for this reporting period, what reporting methods will optimize your MIPS score, and how to increase the financial payouts from the MIPS program.

• Date: TUESDAY, DECEMBER 8, 2020, 1:00 – 1:30 pm EST
• Presenter: SARAH REITER, SVP Strategic Partnership of Health eFilings
• Register Here: https://healthefilings.com/ezclaim

 

The 2020 reporting period is quickly coming to a close, but there is still time to comply and avoid penalties. However, you must act quickly, so Health eFilings is here to help: https://healthefilings.com/ezclaim

 

Health eFilings is a ‘partner’ of EZClaim, a medical billing and scheduling software solution. For more details about their software, visit their website: ezclaim.com/features-pricing/

Revenue Cycle Management Process Webinar

Revenue Cycle Management ProcessFeeling overwhelmed by the complexity of the revenue cycle management process? This webinar will help you identify the most important measures affecting practice revenue, will explain how to make improvements to improve cash flow, as well as how to save your staff time.

PRESENTED BYStephanie Cremeans, CPC, CPMA, CPPM, Founder of RCM Insight

Wednesday, November 4th at 11am MT/ 1pm ET

You Will Learn The Following:

  • Creating scorecards to eliminate issues that are preventing payments
  • Identifying and improving processes that improve revenue
  • Organizing staff to monitor and improve the financial process
  • Avoiding the pitfalls of uncompensated care
  • Teaching & training to get results

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About Stephanie Cremeans:
Stephanie has served in various roles in the medical billing and coding field including Revenue Cycle Manager, Consultant, Auditor, Biller and Coder.  Stephanie has a passion for educating providers, coders, and billers how to maximize revenue through proper documentation and effective workflows. She has worked with several specialties including family medicine, cardiology, physiatry, urgent care, GI, pediatrics, OB/GYN, and behavioral health.

Click here to register for the BillFlash Webinar, “Simple Tips to Improve Your Practice’s Cash Flow Process

New HIPAA Compliance Requirements Coming!

HIPAA ComplianceNew HIPAA compliance requirements are coming!

In an effort to make the HIPAA Privacy Rule as easy to understand as possible, the Office for Civil Rights (OCR) has come up with a list of rules that clearly explain what Business Associates are now “directly liable” for. As OCR Director Roger Severino explains, “We want to make it as easy as possible for regulated entities to understand, and comply with, their obligations under the law.”  The list consists of ten rules that, if failed to follow, can result in penalties and monetary fines.
[ Note: Check out our previous post to access this list ].

 

Immediate Requirements:
As we enter the fourth quarter of the year, you may be wondering what immediate requirements should a Business Associate complete before the end of the year?

One of the most important rules also includes information about Business Associates, and their need for proof of satisfactory assurance when the covered entity requests this of them. Satisfactory assurance is crucial, because it ensures the Business Associate is HIPAA compliant, and therefore, must also be in the form of a contract.

The Satisfactory Assurance contract is oftentimes outlined in the form of a questionnaire, and requires the Business Associate to disclose the date of completion for various compliance requirements.

These include distribution and completion of workforce HIPAA training, implementation and distribution of policies and procedures, Business Associate documentation, and completion of an annual HIPAA Security Risk Assessment.

 

Are You Prepared?:
If a Covered Entity requests this proof from your organization, would you be able to successfully complete it without outdated completion?

If you are uncertain that your organization would be able to easily and efficiently provide that documentation, you may be facing thousands of dollars in fines for each vulnerability!

 

HIPAA Compliance Myths: 

False: The security risk analysis is optional for small providers: All providers who are “Covered Entities” under HIPAA are required to perform a risk analysis. In addition, all providers who want to receive MU, and MIPS incentive payments must conduct a risk analysis.

False: Our office uses the Cloud, so we don’t need a risk assessment: Even if you have a fully HIPAA compliant cloud vendor, your patient data (ePHI and PII) still must go through all your systems to get to the cloud. So, you are still required to perform technical, administrative, and physical security risk analyses.

False: Our EHR makes us compliant, so we’re fine: While your EHR may provide excellent privacy and security features, it definitely doesn’t exempt you from the HIPAA security requirements.

 

Live Compliance helps their clients meet the ever changing and complex HIPAA State and Federal regulations. They protect the information they are entrusted with, and ensure their clients pass any Health and Human Services audits. If you are unsure or need assistance, call Jim Johnson with Live Compliance at (980) 999-1585.

Live Compliance is a partner of EZClaim, a medical billing software company. For more details about their solutions, visit their website at ezclaim.com.

Medical Billing Verification Strategy

Medical Billing Verification StrategyReserve your place for a webinar that will inform you on how to increase your revenue with a proper medical billing verification strategy.

With increased patient financial responsibility, it’s extremely important to proactively check your patients’ benefits coverage and provide payment estimates to avoid any unexpected costs. By enhancing your medical billing verification strategy and providing patient financial transparency upfront, it increases the likelihood that you’ll rake in more revenue this season.

Join EZClaim and TriZetto Provider Solutions, a Cognizant Company, for a webinar on Thursday, October 29, 2020 at 1 p.m. ET, to discover strategies your practice can catch falling revenue through seamless integration and automation.

During This Webinar We Will Discuss:

• Patient Responsibility Estimation: Quickly obtain patient financial estimates at the point of service to help increase patient revenue, decrease billing costs, and improve patient satisfaction through price transparency.

• Integrated Eligibility: Connect to payers through a single application to get the most up-to-date information on patient coverage, co-pays, deductibles, and more. Proactively verify patient eligibility, for up to 50 patients at a time directly from your EZClaim Premier program.

• Insurance Eligibility Discovery: Submit a real-time eligibility request using minimal data and identify a patient’s insurance carrier in a matter of seconds. Maintain groups of your common payers and easily locate active patients and full eligibility benefits on our website.

RESERVE YOUR PLACE NOW!

ABOUT THE PRESENTERS:

EZCLAIM: EZClaim is a medical billing and scheduling software company that provides best-in-class customer service and support. To learn more, e-mail them at sales@ezclaim.com or call a representative today at 877.650.0904.

TRIZETTO: TriZetto combines innovative, proven products with an exacting commitment to serving our customers, in order to provide you with the tools you need to effectively manage your reimbursement cycle.

Get the Most Out of Your Analytics

Today’s healthcare landscape faces truly unprecedented challenges, which means it’s more important to get the most out of your analytics to develop more informed, strategic decisions. There’s a deep well of data that each revenue cycle feeds into, which if properly analyzed, can help organizations operate at their most efficient and effective. Here are the four stages of data analytics workflows that are key to developing those actionable insights: A “Trigger,” or the point in your revenue cycle that sets up the call for deeper analysis; “Interpretation” of data to determine root causes and identify appropriate next steps; “Intervention” to improve specific metrics; and “Tracking” of said metrics to chart success in achieving desired outcomes.

 

So, let’s examine what a successful version of each stage looks like:

Trigger:
The trigger occurs when you notice something that needs further investigation. With the right analytics tool you can easily access all of your key performance indicators, financial goals and more, providing the visibility you need into your rev cycle. When something looks amiss or needs improving, you can drill down to the level that shows what’s really going on.

Interpretation:
Even a wealth of data amounts to nothing without an efficient way to process and communicate key takeaways. You’ll need to equip your team with access to concise reports, smart visualizations and relevant historical data in order to get them to the insights that drive action.

Intervention:
Now is the time to take action. Intervention is ultimately tied directly to your ability to drill down into the data underlying problematic areas of your revenue cycle and clearly communicate takeaways with your team. Success at this stage depends on designing a plan based on your best understanding of underlying issues and the most effective way to address them.

Tracking:
Your intervention plan is built on KPIs that naturally intertwine with the way you measure success across your revenue cycle. With proper implementation and tracking, running with the analytics cycle can become a simple addition to your everyday workflow. More than delivering on your initial goals, the true power of analytics is the ability to deliver repeat value on your initial investment.

 

Wrap Up
A strong analytics solution does more than deliver a more fully developed picture of your revenue cycle performance. It provides actionable business intelligence, cuts down on time between analysis and action, and lessens the strain on your IT department.

 

Waystar is a ‘partner’ of EZClaim, and provides analytics for a practice using their medical billing software. For more details about EZClaim’s products and services, visit their website: https://ezclaim.com/

To learn more about how Waystar can help you harness the power of your data, call their main office at 844-4WAYSTAR, or call sales at 844-6WAYSTAR.

Get the Most Out of Your Analytics

[ Contributed by Waystar ]