3 Keys to Starting Your Medical Billing Practice

medical billing practiceWhether you are a person new to medical billing or someone who’s been in the business for years, launching a new medical billing practice can be hard. Understanding the market, connecting with new clients and knowing how to master your processes are challenges that you often learn as you go. Despite these challenges, it is rewarding to be out on your own growing a new company. Before you jump, let us help you understand some essential keys that you can research upfront and prepare yourself to get one step closer to being successful.

1. ONE BILLING PLATFORM VERSUS MULTIPLE PLATFORMS: First and foremost you must make a conscious decision to either focus on being an expert on an individual medical billing platform, like EZClaim, or tackling multiple platforms.  There are pros and cons of both: being an expert can make you extremely efficient in your use of the software’s billing and, scheduling features, however, it can also limit your client base to only one set of software users. Whereas having a basic understanding of multiple platforms can allow you a larger base of medical offices while limiting your ability to truly understand how best to serve each individual client’s needs.  

Pro tip: Start and master one trusted billing program, and grow your options as your billing business grows.

2. GET CLEAR ON THE CLEARINGHOUSE: A new billing company owner does not want to be held to just one clearinghouse as options are key here. Having the ability to work with any or many would be an essential piece to your billing services, however, you still want to know the best clearinghouses in the business. Understanding which clearinghouses provide the best products and services and being able to recommend those services to your client upfront will make your life easier and their business run smoother. For this very reason, EZClaim has built its software around partnerships and integrations with the best clearinghouses to make working with the one you need easy.

3. COMPLY OR DIE (HIPAA Compliance): The third key to any start-up is first understanding the importance of HIPAA Compliance. Medical billing firms literally can come crashing down with any missteps, mistakes, or misunderstandings of this essential piece of the puzzle. It goes without saying that if you are going to choose a billing software be sure that they have partnerships built around making sure you are protected. You are also responsible to make sure the data is protected so your customer and their patient’s data is safe.

HIPAA Hint: Check out Live Compliance for further details on the topic. 

There are many options available out there for your new medical billing practice, and we recommend doing your research. Within that research, you will find that EZClaim ranks very high in performance and comes in at a great price.

To learn about EZClaim go to our about page, sign up for a demo and/or download a trial for free today!

 

Small Practice Fined $100,000 for Risk Analysis Breach!

Risk Analysis Breach Can Cost Physicians Dearly!An independent physician gastroenterology practice in Utah had to report a breach related to a dispute with a Business Associate to the Office for Civil Rights department of HHS.

After the investigation into the breach, it was determined that the practice of Steven A. Porter, MD “had failed to complete an accurate and thorough risk analysis, and failed to implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level” and therefore, has agreed to pay a $100,000 fine.

In addition to the monetary penalty, the practice is required to implement a Corrective Action Plan (CAP). According to the investigation resolution agreement, the practice agreed to conduct a thorough Risk Analysis, the Practice must develop a complete inventory of all its categories of electronic equipment, data systems, and applications that contain or store ePHI, which will then be incorporated into its Risk Analysis, and must complete a Risk Management plan. They must also revise and implement actionable policies and procedures, all of which should have been in place prior to the breach incident.

Have you ever read such headlines and doubted whether a small Billing Company or independent physician practice actually ever face penalties?

According to the Resolution Agreement, the practice must also completely reinvent their Business Associate process, and implement a strict protocol to ensure it’s Business Associates are HIPAA Compliant. In addition to ensuring their Business Associate relationships are accurate, the entire staff must undergo security and privacy training that stresses the use of Business Associate services and applications, disclosures to Business Associates that require a Business Associates agreement or other reasonable assurances in place to ensure that the Business Associate will and can safeguard the PHI and/or the ePHI. This puts immense pressure on the Business Associates, such as Billing Companies, to ensure that they are HIPAA Compliant, but also independent physician practices to ensure their Business Associates, “down the chain” are also compliant. This is also known as gaining Satisfactory Assurance of vendor HIPAA compliance.

What can you do?

As we have stressed before, it is important for you to understand that every complaint or potential breach must be investigated by HHS/OCR. If you, a billing company, or other vendor, suspects 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 there is no Billing Company too small or too large to comply with the Federal HIPAA regulations. Again, if you haven’t completed an accurate and thorough security risk assessment prior to that, you could also be penalized under ‘willful neglect’. This category alone is $50,000 per violation!

What we do is keep this from ever being a worry for you! In fact, we have a 100% audit pass rate! For example, Live Compliance has easy to understand HIPAA breach notification training. We perform your security risk assessment and manage all your requirements, including business associates, in a clean, organized cloud-based portal. Don’t risk your company’s future, especially when we are offering a FREE Organization Assessment to help determine your company’s status. It’s easy, call us at (980) 999-1585, email me jim@LiveCompliance.com or visit LiveCompliance.com

[ Contributed by Jim Johnson, President of Live Compliance ].

Lost Laptop = $65,000 Fine

lost laptopLost laptop = $65,000 fine. Have you ever read such headlines and doubted whether a small billing company or independent physician practice would ever face such seemingly insurmountable penalties? 

What happened? Most recently, an ambulance company out of Georgia paid $65,000 for a lost laptop that happened to be unencrypted. More often, small businesses and practices are taking work outside of the office, so this kind of violation is one that can occur to anyone. 

The laptop contained 500 individual’s Protected Health Information. As a result of the investigation, the ambulance company will undergo a Technical Security Risk Assessment and is required to adopt a Corrective Action Plan. This is a great example of why it is important and mandatory to conduct a Technical and Objective Security Risk Assessment at least annually on all devices. 

Following the investigation, it was uncovered that West Georgia Ambulance never provided a security awareness and training program for its employees! You and your workforce are your first line of defense. This reinforces the importance that both you, and your employees must understand what a breach is and the breach notification requirements! It was later revealed that West Georgia Ambulance failed to implement HIPAA Security Rule policies and procedures as well. 

What can you do? As we have stressed before, it is important for you to understand that every complaint or potential breach must be investigated by HHS/OCR. If you, the Billing Company or independent physician practice, suspects a breach or complaint you must inform the covered entity (your client) and have a breach risk assessment completed to determine key factors and take action. Again, if you haven’t completed an accurate and thorough security risk assessment prior to that, you could also be penalized under ‘willful neglect’. This category alone is $50,000 per violation!

What we do is keep this from ever being a worry for you! In fact, we have a 100% audit pass rate since 2010! For example, Live Compliance has easy to understand HIPAA breach notification training. We perform your security risk assessment and manage all your requirements, including business associates, in a clean, organized cloud-based portal. 

Don’t risk your company’s future, especially when we are offering a FREE Organization Assessment to help determine your company’s status. 

It’s easy, call us at (980) 999-1585, email me or visit LiveCompliance.com 

Keep in mind, a business associate is a ‘person’ or ‘entity’. This means there is no billing company too small or too large to comply with the Federal HIPAA regulations. 

LEARN MORE

If you are enjoyed this article about the lost laptop as well as informative content we’re providing and have a specific topic you would like to see covered, we would love to hear from you! Please feel free to send along your ideas via email to sales@ezclaim.com.

Compliance Plan Breakout

Compliance Plan Breakout

AMBA 2019 National Conference Session Recap

Compliance Plan Breakout – Written by Stephanie Cremeans of EZClaim

Any provider that is treating Medicare or Medicaid patients is required to have a compliance plan for their practice. This is mandated under the Patient Protection and Affordable Care Act of 2010.

The Office of Inspector General (OIG) has established an outline of seven components to help the small or individual provider offices get started. They also understand that small practices don’t typically have extensive resources creating and establishing a plan, and encourage practices to start with one item, making the compliance plan a working document that is updated and added to as necessary. The seven components are as follows:

  • Conduct internal monitoring and auditing
  • Implement compliance and practice standards
  • Designate a compliance officer or contact
  • Conduct appropriate training and education
  • Respond appropriately to detected offenses and develop corrective action
  • Develop open lines of communication with employees
  • Enforce disciplinary standards through well-publicized guidelines

Let’s dig in a bit to the first component, conducting internal monitoring and auditing. Starting with this step will help a practice lay the groundwork of its compliance plan and shed light on areas that need additional work. There is no set number of records that are required to be audited, rather a suggestion of 5 (or more) per provider annually for a small or solo practice. You can start your compliance plan by simply documenting that no less than 5 charts per provider will be audited annually. Keep track of the results and use them to start implementing other components. For instance, you have the audit results, but what is considered passing? What are you going to do if a provider isn’t compliant? Document the answers and you are building your plan. Did the audit show specific areas for improvement? Find applicable training or host training for those that need it, document it in your plan. Did you find overpayments? Document how these are to be handled, resolve it quickly and put policies in place to prevent a bigger problem.

By taking steps to create a compliance plan and show a good-faith effort to improve on risk areas your practice will reap the benefits of clean claims with a reduction in denials, fewer billing errors and the assurance that your records are ready for an audit. This will also reduce your risk exposure to fines.

For help getting started with that first audit, setting benchmarks and improvement plans or for education on problem areas contact RCM Insight. For additional assistance with building your HIPAA compliance plans contact Live Compliance.

If you are enjoying the informative content we’re providing and have a specific topic you would like to see covered, we would love to hear from you! Please feel free to send along your ideas via email to sales@ezclaim.com.

ONE Patient Complaint

ONE patient complaint leads to $2.175 Million fine! AND 2 Years of OCR Monitoring.

Contributed by Jim Johnson, President of Live Compliance

One patient complaint, that’s all it takes. Have you ever read such headlines and doubted whether a small billing company or independent physician practice would ever face such seemingly insurmountable penalties? Actually, there should be no doubt! The Sentara Hospital violations are violations that every small billing company or independent physician practice would face, not just because Sentara is a hospital.

So what happened? In short, a complaint from an individual came from a person receiving a bill containing another individual’s billing statement. As a result of Sentara investigating this breach, Sentara reported a breach affecting 8 individuals, when in actuality, Sentara mailed 577 patient’s statements to the wrong addresses. This is an example of why you must perform and document a breach risk analysis as soon as you become aware of a potential incident. It is important that you understand what a breach is and the breach notification requirements.

The second issue discovered during the investigation revealed Sentara failed to have a business associate agreement in place with an entity that performed business associate services for Sentara. This reinforces the importance of having business associate agreements in place and your understanding that BAA’s are contracts that outline timeframes and provide your attestation to a satisfactory assurance of your ability to safeguard PHI among other things.

Maybe most importantly, you should know every complaint must be investigated by HHS/OCR. What that means is, if you improperly disclose protected health information, like sending a statement to the wrong patient, you, a billing company, must inform the covered entity (your client) and have a breach risk assessment completed to determine several key factors. Then the covered entity must take action based on these findings. If you haven’t completed an accurate and thorough security risk assessment prior to that, you could also be penalized under ‘willful neglect’. This category alone is $50,000 per violation! 

In fact, Texas Health received a $1.6 million fine for improperly disclosing ePHI. Texas Health failed to comply with several HIPAA requirements including failure to perform the HIPAA Security Risk Assessment.

The fines are huge, but the reputational damage to your billing company and the covered entity is expensive and difficult to overcome.

What we do is keep this from ever being a worry for you! In fact, we have a 100% audit pass rate since 2010! For example, Live Compliance has easy to understand HIPAA breach notification training. We perform your security risk assessment and manage all your requirements, including business associates, in a clean, organized cloud-based portal.

Don’t risk your company’s future, especially when we are offering a FREE Organization Assessment to help determine your company’s status. 

It’s easy, call us at (980) 999-1585, email me jim@LiveCompliance.com or visit LiveCompliance.com

Keep in mind, a business associate is a ‘person’ or ‘entity’. This means there is no billing company too small or too large to comply with the Federal HIPAA regulations.

LEARN MORE

Click here to read more informative articles from EZClaim and our partners.

CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON


CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON


CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON


CONTACT INFO

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON


SALES

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

CUSTOMER SUPPORT

337 S. Main Street
Ste 200
Rochester, MI 48307

877.650.0904

FOLLOW US ON