Identify Your Organization’s Vulnerabilities

Identify Your Organization’s Vulnerabilities

Have you performed and identified your organization’s vulnerabilities with a Security Risk Assessment this year? We understand that achieving and maintaining compliance is a delicate matter as it requires auditing, constant supervision, good staffing, adequate policies, and procedures, along with excellent reporting and investigation of any issues.

The process of assessing and maintaining compliance to any standard is the same, irrespective of the industry but especially when HIPAA compliance is required:

1. Start with a complete understanding of all the rules that you are expected to follow.
2. Establish internal policies and procedures to ensure your organization follows the rules.
3. Regularly check and assess whether or not your organization is following the rules.
4. Address issues whenever you discover the rules are not being followed.
5. Document everything.
6. Perform accurate and thorough Security Risk Assessment(s)

Are you unsure or not clear on what your organization is required to do?

THINGS TO CONSIDER:

● A Security Risk Assessment will target vulnerabilities related to what is potentially exposing Protected Health Information. Correct any potential risks identified within your Technical, Administrative, and Physical deficiencies.

● A Security Risk Assessment should be completed at least twice a year to target vulnerabilities

● Your policies and procedures should be thorough and accurate and reflect the Corrective Action Plan that is determined by the Security Risk Assessment and remediation steps should be taken to correct any deficiencies or vulnerabilities found.

● Workforce training should reflect the organization’s HIPAA Policies and Procedures

Would you like to schedule a compliance team meeting phone conference? If so, please contact support@livecompliance.com or at (980) 999-1585 and one of our compliance support team members will reach out to you.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Full Practice Authority for NPs Continues to Grow

Full Practice Authority for NPs Continues to Grow

With two more states recently joining the list of locations that allow Full Practice Authority, many nurse practitioners are exploring the option of operating independently. As the need for qualified healthcare professionals continues to grow and the ability for NPs to practice independently continues to increase, quickly gaining credentials and navigating compliance challenges becomes more and more important.

Recently, Massachusetts and Delaware became the latest states to enact Full Practice Authority (FPA) for nurse practitioners (NPs), bringing the total number of states to 24. With this new inclusion, nearly half of U.S. states now allow nurse practitioners to operate on their own. Essentially, this means that registered nurses can practice independently from physicians, allowing for more autonomy in their careers and the care they provide.

So why this is significant? This means that registered nurses can practice independently from physicians, allowing for more autonomy in their careers and the care they provide. Nurses are no longer “tied” to physicians, so to speak.

These new laws cannot come at a better time. We know that the amount of practicing medical doctors has dwindled in recent years, due to the pandemic and many providers leaving the field. This has led to a short supply of physicians in the U.S., which has only 2.6 practicing physicians per 1,000 people, compared to 4.3 in Sweden and 3.2 in France. This decrease is driving unprecedented demand for nurse practitioners (NPs), with an expected increase of 52% through 2029.

Traditionally, state practice and licensure laws required NPs to have a career-long collaborating or supervising physician to provide patient care. However, with more and more states allowing Full Practice Authority, now nearly half of U.S. states now allow nurse practitioners to operate on their own. But in order for NPs to move forward with independent practice, credentialing is essential. How can nurse practitioners looking to establish their own practices quickly gain credentials and painlessly navigate the challenges of compliance?

Operating independently means nurses need to establish credentials as a standalone provider to be eligible for in-network status to receive physician-level reimbursements. These tasks, and complying with the Council for Affordable Quality Healthcare’s (CAQH) requirements, can be taxing and time-consuming, even for the most seasoned professional. Creating a new CAQH application is highly manual, and the required quarterly updates for re-attestation can be onerous. Extensive credentials including education, residency, internships, and peer references are also required, which require time to gather information and resources. It’s not an exaggeration to say that many hours must be spent uploading copies of licensing information, board certifications, DEA registration, and insurance certificates.

NPs looking to leave their current situation may need help navigating credentialing challenges. Partnering with a third-party provider to help manage credentialing lightens the load and allows nurses to focus on patient care. TriZetto Provider Solutions (TPS) offers an end-to-end credentialing service that ensures continuous payer follow-up and insight into enrollment status.

Discover the most painless way to gain credentials. Visit our TPS partner page to get started.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

 

How to Choose the Right Reporting Partner

How to Choose the Right Reporting Partner

MIPS Strategic Guide – How to Choose the Right Reporting Partner

Given the way the MIPS program has evolved, all healthcare practices regardless of size or specialty must evolve their approach to MIPS reporting to assure their success with the program. However, most clinicians do not understand or don’t have awareness of, the different reporting methods available to them and the impact the reporting method can have on their success with MIPS. With what is at stake financially, it is critical that you understand and select the right methodology and partner to maximize your MIPS points and protect your bottom line.

Many clinicians erroneously think that a registry is the only reporting option available to them or that they are required to use a registry. Or, they think that their EHR handles reporting for them. These misperceptions and general lack of awareness of the other reporting methodology will be detrimental to your ability to be successful with MIPS. And, given that 50% of all clinicians will be penalized annually by next year, the legacy reporting methods (registry or EHR) will not be able to fulfill enough of the reporting criteria to earn the minimum MIPS points needed to avoid the 9% reduction in Medicare reimbursements.

To help you determine if you are choosing the right reporting method and partner, we’ve identified the five most important factors to consider in order to increase your probability of avoiding the 9% penalty.

  1. Reporting Classification – is the reporting partner a CEHRT?
  2. Service Approach — Does the reporting partner use ONC certified software to do all the work with no IT resources, administrative support, or workflow changes?
  3. Quality Measures — Is the reporting partner certified by CMS to calculate all eCQMs, which earn significantly more points than registry measures?
  4. Benchmarking — Are proprietary algorithms used to assess the 9 million possible combinations of Quality measures to maximize earning MIPS points?
  5. Submission Method — Does the reporting partner submit a comprehensive electronic file directly to CMS to comply with reporting for all MIPS categories?

If you answer “no” to any of these questions, then the reporting partner you are working with will not be able to maximize the MIPS points you can earn. Given every MIPS point matters, because MIPS points determine your reimbursements and impact your bottom line, it’s time to consider a new strategy with a new reporting partner.

Health eFilings, a CEHRT, is the national leader in automated MIPS reporting.  They utilize ONC-certified software to handle 100% of the tracking and reporting of the required data to CMS.  And because their service is classified as an end-to-end electronic solution, you’ll also earn additional bonus points toward your MIPS score even though they are doing all the work.  Health eFilings as your partner is the more effective and efficient reporting method so you will earn more points and, ultimately, receive higher reimbursements.

Learn more about how Health eFilings can help your practice here: https://healthefilings.com/ezclaim.  Contact Sarah Reiter, sreiter@healthefilings.com, or 608.841.1866 to find out how to maximize your Medicare reimbursements and protect your bottom line.

About Health eFilings:

Health eFilings, a CEHRT, is the national leader in automated MIPS compliance and quality data analytics.  Its services drive improved patient outcomes, optimized quality measures, and stronger financial results for healthcare practices. Their proprietary cloud-based ONC certified software is significantly more efficient and effective than any registry as it does all the work to extract, calculate, benchmark, format, and electronically submit MIPS data to CMS so clients avoid significant penalties and earn maximum reimbursements. And, you can have peace of mind knowing you are working with the best partner because CMS has accepted 100% of Health eFilings’ submissions. Learn more here: https://healthefilings.com/ezclaim


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

 

HIPAA Training Standards Everyone Needs to Know

HIPAA Training Standards Everyone Needs to Know

HIPAA Training Standards Every Business Associate Needs to Know

Per the HIPAA Privacy Rule and HIPAA Security Rule, both Covered Entities and Business Associates, must require HIPAA training for all workforce members that access protected health information (PHI) or electronically protected health information (e-PHI) in any of its forms and should be provided “as necessary and appropriate for the members of the workforce to carry out their functions within the [organization].”

According to the Rule, training must be provided “to each new member of the workforce within a reasonable period of time after the person joins the [organization’s] workforce.” Along with all other annual compliance requirements, HIPAA training is arguably the most important. Your workforce members are your first line of defense in the event of a Breach and must be able to identify your organization’s designated HIPAA Security Officer, and have a firm understanding of the HIPAA Privacy and Security Rule. Training should also highlight the organization’s Technical, Administrative, and Physical Safeguard objective security requirements. It is best practice to provide ongoing security awareness training and, in addition to the mandatory annual training, the Privacy Rule also highlights what’s known as “periodic” training. The goal is to ensure workforce members’ knowledge of HIPAA compliance is not forgotten.

It’s advisable that HIPAA training is given to all employees as new hires during the new employee orientation period, and before new employees are exposed to or work with individually identifiable health information. This includes officers, agents, employees, temporary employees; like students, interns, volunteers, and salespeople. At a minimum, training should cover the basics of HIPAA, the basics of privacy and security requirements and restrictions, and policies and procedures. All new hires need to be provided HIPAA training and a post-test on the material covered within the training course to ensure comprehension of relevant and appropriate HIPAA policies and procedures.  Security Officers should be trained on the Breach Notification Rule, Minimum Necessary Rule, and the Organization’s policies and procedures.

The HIPAA Privacy Rule states that “An [organization] must document that the training as described [in the HIPAA Text] has been provided.” Failing to do so will be seen as “willful neglect” and will result in HIPAA violations including monetary penalties as high as $1.5 million dollars. A minor violation may only result in a corrective action plan requirement, whereas a significant data breach attributable to a lack of training will be viewed more seriously.

For more information about HIPAA Training, join Kellie Morse on October 5, at 1 pm EST for a webinar where she will review the HIPAA training requirements for employees and designated HIPAA Security Officers. This webinar will have a strong focus on the HIPAA Security Rule requirements that every Business Associate and Covered Entity needs to be aware of in order to ensure your workforce has a fundamental understanding of the HIPAA Privacy and Security Rule. This webinar will highlight important training requirements and what you must cover to properly train your workforce, and why HIPAA training is more than just a requirement to remain compliant; it could keep your company from being part of a breach.

At Live Compliance, we make checking off your compliance requirements extremely simple.

      • Completely online, our role-based courses make training easy for remote or in-office employees.
      • Short informative video training to meet periodic training requirements
      • Depending on the size of your organization training may start as low as $79

Call us at (980) 999-1585 or visit us online at www.LiveCompliance.com/ezclaim


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

No Surprise Act Tackles Unexpected Medical Bills

No Surprise Act Tackles Unexpected Medical Bills

New No Surprise Act Tackles Unexpected Medical Bills

Two-thirds of bankruptcies filed in the United States are a result of medical expenses. It’s an alarming statistic, but probably not surprising. It’s no secret that many people have trouble paying out-of-pocket medical costs, so much so that a recent survey from The Commonwealth Fund found that 72 million Americans have some sort of trouble with medical debt.

It’s a common problem, but why? Let’s say a person visits a hospital, perhaps an emergency room, and receives a myriad of services. Maybe they arrived via ambulance or required treatment from an anesthesiologist. Although they may inquire about an estimate at the time of service or have an idea of their coverage, the exact financial responsibility is often a mystery. But what’s a person to do? They need medical assistance, and they need it at that moment. Then a surprise arrives in the mail in the form of an outrageously high medical bill. It’s something many of us have likely experienced.

What’s the cause of such an expense? Often the charge stems from using an out-of-network provider. Basically, this means that the hospital may have been in-network, but the physicians were not. Additionally, patients are often confused about medical coverage. Even with a good understanding of their benefits, situations may arise that are out of their control, and there may be unintended outcomes. Patients may (falsely) believe that all services rendered will be considered in-network when they go to an in-network facility. However, this isn’t always the case. In some instances, even though their physician is in-network, patients referred to specialists (such as a pathologist or radiologist) may discover the ancillary services were out of network. It is only after the patient receives a bill that they discover the issue. In the case of an emergency visit, patients don’t have the luxury of researching for in-network hospitals and typically go to the nearest hospitals. Patients may also be taken to out-of-network hospitals by ambulance. Researchers estimate that 1 in 6 emergency room visits and inpatient stays involve care from at least one out-of-network provider. The cost of out-of-network visits can have devastating financial consequences for the patient.

2019 study by the Government Accountability Office (GAO) found that the cost for air ambulance services clocked in at approximately $40,000. A large portion of this cost (over 70 percent) often fell out-of-network, meaning that the balance usually was placed on the consumer. When such a service is needed, it’s understandable to not have the option to “shop around” for a cheaper, in-network alternative.

Thankfully, help is on the way. Leaders and policymakers at the federal level have taken steps to tackle the issue. On July 1, 2021, the Biden Administration announced a new rule aimed at protecting consumers from surprise medical bills. In conjunction with the Department of Health and Human Services (HHS), together with the Departments of Labor and Treasury and the Office of Personnel Management, debuted “Requirements Related to Surprise Billing; Part I.”

This announcement, the first in a series, will go into effect on January 1, 2022, and protect patients from those all-too-common surprise medical bills. It’s an important step forward in protecting patients.

“No patient should forgo care for fear of surprise billing,” stated HHS Secretary Xavier Becerra. “With this rule, Americans will get the assurance of no surprises.”

Let’s dive into the new regulation. Among other provisions, the rule:

    • Protects patients from surprise billing in emergency services. These provisions will safeguard patients in emergency care situations from unknowingly accepting out-of-network care and incurring unexpected expenses.
    • Limits out-of-network cost-sharing. Patient cost-sharing for emergency and non-emergency services, such as a deductible, cannot be higher than if provided by an in-network provider. Simply put, co-insurance or deductibles must be based on in-network rates.
    • Bans out-of-network charges for ancillary care. Previously, out-of-network providers like anesthesiologists could have been assigned, even though the facility or physician was in-network.
    • Requires that providers and facilities provide patients with accurate cost information and advance notice of any out-of-network charges for non-emergency services. A consumer notice must explain that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
    • Allows providers and insurers access to a dispute resolution process should reimbursement issues arise around reimbursement.

With the increase in high deductible health plans and increased out-of-pocket costs, finances are top of mind. From the consumer’s standpoint, gaining healthcare services will be less stressful. On the simplest level, this ruling will hopefully eliminate those hefty surprise bills, which can only be seen as a positive. Moving forward, patients can rest assured that they will be more aware of expenses and will avoid out-of-network charges for emergency care.

So can consumers finally say goodbye to surprise medical bills? Hopefully, they become a thing of the past. And how will this bill affect the future of the industry? Advocates are hoping these regulations and newfound transparency will eventually lower costs, for one. More importantly, it shines a light on the need to improve the overall patient experience. It’s a step in the right direction and has the potential to improve healthcare policies going forward for years to come.

For more information on solutions that equip you to have informed conversations about financial responsibility and eligibility, contact a TriZetto Provider Solutions representative today.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

 

4 Strategies to Simplify Patient Payments

4 Strategies to Simplify Patient Payments

With healthcare costs on the rise and an increasing segment of uninsured consumers, the patient payment landscape is changing rapidly. How can medical offices evolve and optimize collections while keeping patient satisfaction high? Thankfully advancing technologies are making it easy to simplify collection processes to increase revenue.

1) Communicate responsibility

How many times have you purchased a good or service without knowing the cost beforehand? Probably not many. Healthcare should not be any different. By providing cost expectations, care providers can give patients the opportunity to not only understand their fiscal responsibility but to also take a proactive, involved approach. Communication allows patients to determine if the value of the service they are receiving is worth the cost. When finances and choices are transparent, patient satisfaction rises.

2) Collect upfront

It’s said that medical providers collect only 25 percent, on average, of available co-pays and deductibles at the time of service. If the patient departs after the initial visit without making a payment, the likelihood of receiving the co-pay drops significantly. Consumers are used to paying for a product at service at the time of use, so why should medical care be different? Capitalize on patients that are willing to pay at the time of service by collecting upfront. Processing payment during the appointment is a step toward helping the patient to be invested in their care, which increases the chance of gaining future payments.

3) Empower patients

We know that patients are taking a more active role in their care and like to be in control of costs. Knowledge is power, and giving patients the information and tools needed is critical to empowering patients to pay. An effective strategy engages the patient early to learn their payment and communication preferences, then proving the proper options.

4) Build awareness

When adding payment options or considering changes to your payment workflow, increasing awareness is key. Be sure to engage your staff and provide the most accurate information on your website and within advertising tools (such as posters in the waiting room). If time and budget allow, conduct a survey to gain patient feedback. A small sampling of users will give insight into the likelihood that patients will adopt new tools and practices. It’s critical to explain the value in an informative, yet simple to understand the way that will resonate with your audience.

Thinking your practice may not have the staff or means to optimize payment processes? Consider tools from TriZetto Provider Solutions that can enable patients to conveniently pay by utilizing a variety of methods, including easy-to-understand statements. Learn how our partnership can help you streamline your workflow, improve efficiencies, and get paid faster.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.