During these unprecedented times, EZclaim is monitoring Coronavirus (COVID-19) developments, and are working to maintain the safety of our customers and employees. We are doing this by following the guidelines set forth by our state and local governments, and the recommendations from the CDC.
To enhance the safety of our employees, families, and communities, EZClaim is transitioning to a remote workforce to continue to serve our clients during this difficult period. We will remain available, and anticipate no disruption to our service or support.
Feel free to e-mail us or visit the contact page on our website to issue any question or concern.
Thank you for your patience, and please be safe!
Live Compliance – EZClaim’s trusted HIPAA Compliance Experts
It is often, small companies who work in healthcare falsely assume that HIPAA pertains to large organizations and hospitals, when in fact, a Business Associate, is a person or entity that works with Protected Health Information. Many organizations don’t realize that the fundamentals of a compliance program are Business Associate Agreements, and performing Security Risk Assessments.
In fact, an Indiana-based Business Associate, Medical Informatics Engineering, was recently fined $100,000 for “failing to perform a comprehensive risk assessment before its server was hacked in May 2015” resulting in what was concluded to be “one of the largest breaches in recent healthcare history!” According to the Resolution Agreement, MIE must assess whether its existing security measures are sufficient to protect its ePHI, and must revise their Corrective Action Plan, Policies and Procedures, and training materials, as needed.
In May of 2019, 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.
The OCR has made it very clear that even so much as simply “[failing] to comply with the requirements of the Security Rule” can result in immediate penalties as well.
To this end, one of the most important rules also includes information about Business Associate Agreements 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. Because it is so often overlooked, the fact
sheet points out that there would be penalties associated with “Failure to enter into business associate agreements.”
Are you ready when asked by your clients to provide your statement of Satisfactory Assurances?
Checking off your Business Associate requirements, including those listed in the OCR’s fact sheet, is very easy with EZClaim’s trusted HIPAA Compliance Experts, Live Compliance.
First, it is most important that all Business Associates and Vendors have proof of Satisfactory Assurance at least annually, as well as Business Associate Agreement outlining their roles, functions and notification requirements.
Second, Business Associates and Vendors must complete an accurate and thorough Security Risk Assessment. A Security Risk Assessment will target vulnerabilities related to what is potentially exposing Protected Health Information. Failing to do so could also result in a penalty under ‘willful neglect’. This category alone is $50,000 per violation! These fines are huge, but the reputational damage to your billing company and the covered entity is expensive and difficult to overcome. (Live Compliance has a 100% audit pass rate!)
Lastly, employees should be HIPAA trained with relevant course material to their role and your organization. Your workforce is your first line of defense. Completely built into your portal, Live Compliance training is custom, online, and role-based. Training is delivered and monitored within the Live Compliance portal, anytime and from anywhere.
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AMBA 2019 National Conference Summary
Written by Stephanie Cremeans of EZClaim
Acupuncture and chiropractic medicine have faced stigma for some time in the medical field, often considered alternative treatments. As the opioid epidemic continues to grow patients are looking for alternatives and the US is starting to recognize the therapeutic value of both chiropractic and acupuncture treatments. Thanks to the internet, patients can educate themselves on alternatives and as more patients want the treatment, they also approach their self-funded employer plans for coverage of such treatment. As a result, we are seeing more and more insurance plans that will cover the cost of these services.
Requirements for providers vary greatly by state for licensure as well as scope of practice but both acupuncturists and chiropractors can generally bill for Evaluation and Management (E&M) services, and both need to have a very clear understanding of patients benefits. Many insurance plans will combine the number of allowed visits for acupuncture and chiropractic services, and some even include physical therapy visits as well. Unfortunately, both specialties also lack in medical billing training, leaving providers to figure it out as they go.
For providers considering accepting insurance, it is important to familiarize yourself with the guidelines for the specific payers and plans that you would like to contract with as well as the diagnosis and procedure codes that are billable. If you are just getting started, consider working with a consultant to ensure that you are properly enrolled with payers and help you understand the specifics of acupuncture and chiropractic billing for your state.
One recommended consulting firm is RCM Insight.
If you want to go about billing on your own, which we do not usually recommend unless you have the experience, then speak to AMBA so that you can learn the basics. They are a very good organization to get you started.
The EZClaim platform offers its customers a low-cost option that has all the functionality needed to get their claims paid.
2019 MIPS Reporting
2019 MIPS Reporting – Guest Author: Sarah Reiter of Health eFilings
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law on April 16, 2015, and is driving the transition in healthcare from a volume to a value-based care model. CMS programs such as MIPS require providers to transition to a value-based care model or else face significant financial risks and even reputational harm. The stakes have been raised every year and it is even more complex than it has been in the past, further increasing the stress, burden and financial risk to providers. For a provider, it is critical to understand the impact that the reporting methodology has on one’s MIPS score and to choose the best methodology and reporting partner.
Within this new framework of the MIPS program, all healthcare practices regardless of size or specialty must evolve their approach to reporting to assure their financial viability. However, most do not understand or have awareness of, the different reporting methods available to them. Many providers erroneously still 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 covers their reporting obligation. This misperception and general lack of awareness of the other reporting methodology is detrimental to the financial interests of any practice. And, furthermore, for the 2019 Reporting Period, it is likely the first time that traditional, legacy reporting systems (registry or EHR) may be unable to fulfill enough of the reporting criteria to avoid the minimum score penalty.
The other reporting methodology, known as a Certified EHR Technology or CEHRT, has emerged as the superior reporting methodology. Reporting through a CEHRT dramatically improves the efficiency and effectiveness of the MIPS reporting process especially when done using ONC certified software. Also, a CEHRT utilizes eCQMs (electronic Clinical Quality Measures), which are a better way to optimize the points that can be earned. When the process utilizes ONC certified software and is, therefore, an end-to-end electronic solution, CMS awards significant bonus points toward the provider’s MIPS score.
Health eFilings, a CEHRT, is the best choice for a reporting partner. Our cloud-based ONC certified software fully automates the process and does all the work with no IT resources, administrative support, and workflow changes. Health eFilings’ service is an end to end electronic solution that will save significant time, be a turn-key submission process and maximize the financial upside for providers.
And, finally, an important and timely addendum: While the 2019 reporting period is quickly coming to a close, Health eFilings can support you with reporting for 2019 so that you will avoid the automatic 7% penalty for not complying. But, time is of the essence, reach out NOW to connect with Health eFilings.
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AMBA National Conference Overview – Written by Stephanie Cremeans and Dan Loch of EZClaim
EZClaim, represented by Stephanie Cremeans and Dan Loch, was proud to exhibit at the American Medical Billing Association’s AMBA National Conference last week in Las Vegas at Planet Hollywood. The AMBA team had things ready to go when we got there and made sure we had what we needed throughout the event.
The AMBA National Conference attendees seemed to have fun and were fully engaged with the exhibitors. Many thanked us for our support of the event as well. The attendees supplied the vendors with good traffic from start to finish. Stephanie and Dan were able to spend some quality time with the attendees speaking about their struggles, needs, and ideal functionality to help improve their billing service.
During slower times EZClaim was able to interact with some of the other exhibitors and sponsors of the event for an added benefit. This is a conference that EZClaim will be returning to in October of 2020 at Caesars Palace in Las Vegas.
Stephanie was able to attend a few of the sessions as well. There was a wide variety of topics covered including specialty-specific information for Acupuncture and Chiropractic billing, coding and billing compliance and the importance of conducting internal coding audits. These topics were informative and presented by dynamic speakers that made the information relatable. Stay tuned as we bring you our key takeaways from these very informative sessions.
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MMBA Chapter Meetings
It’s nearly time for the Michigan Medical Billers Association (MMBA) Southeast and Mid-Michigan Chapter Meetings. We hope you will join the great people at MMBA Southeast to hear speakers Jill Young and Lori Ann Rickard provide information-based sessions focused on documentation, reporting requirements, and Medicare denial appeals. The Mid-Michigan Chapter has IT Security Analyst JJ Strieff to discuss the roles we all need to play in securing our connected environments and Jane White, Executive Director of the Michigan Human Trafficking Task Force, to provide information related to identifying victims of human trafficking. We look forward to seeing you at our MMBA Chapter Meetings!
MMBA Southeast Chapter Meeting | December 11, 2019 | 8:30-11:45 AM
Ukrainian Cultural Center | 26601 Ryan Road | Warren, MI 48091
Register today at the MMBA website
Mid Michigan Chapter Meeting | December 18, 2019 | 8:00AM-12:00PM
MSU FCU Community Room | 4825 E. Mount Hope Road | East Lansing, MI 48823
Register today at the MMBA website
Can’t make it to one or more of the MMBA Chapter Meetings? Get an EZClaim demo at any time. We have pre-recorded demos or you can schedule a one-on-one demo to meet your needs.