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Tag Archives: Compliance
Compliance for Maternal Fetal Medicine Billing Global Delivery
Hello,
My question is if Maternal Fetal Medicine is seeing a patient for all of her prenatal care, delivery and postpartum care, shouldn’t MFM bill out a global delivery charge if the patient meets the criteria with the amount of prenatal visits (approximately 13 rule)? Also if MFM is seeing a pregnant patient as a co-specialty to the patients general OB doctor who is seeing the patient for her prenatal, delivery and postpartum care, wouldn’t MFM bill out their visits separately since MFM isn’t taking on the patients care?
Thanks for your help. It’s greatly appreciated,
Sarita
Avoid the Top 3 Compliance and Auditing Mistakes
Dodging them means your practice will better serve patients, decrease risks, and improve cash flow. In today’s environment of increasing regulatory oversight and ever-changing reimbursement policies, compliance requires concerted effort and plan. Although healthcare organizations are not federally mandated to implement a compliance and auditing program, it’s foolish not to. Done right, a compliance and […]
The post Avoid the Top 3 Compliance and Auditing Mistakes appeared first on AAPC Knowledge Center.
Review of CPAP compliance reports
Can a provider bill for review of CPAP compliance reports? After patient gets CPAP machine Medicare/Medicaid requires report to be reviewed between 30-90 days. It is time consuming for doc to review these reports so wondering if there is a way to bill.
Patty
CMS Begins Compliance Review Program
Beginning this month, nine HIPAA-covered entities — a mix of health plans and clearinghouses — will be randomly selected by the Centers for Medicare & Medicaid Services (CMS) for compliance reviews. Any health plan or clearinghouse — not just those that work with Medicare or Medicaid — may be selected. The CMS Division of National […]
The post CMS Begins Compliance Review Program appeared first on AAPC Knowledge Center.
Prevalent Vendor Assess evaluates third-party vendors’ HIPAA compliance
Product watch
Prevalent Vendor Assess evaluates third-party vendors’ HIPAA compliance
by Chris Apgar, CISSP
Much of today’s healthcare industry is reliant on third-party vendors. If you haven’t asked your vendors whether they are compliant with HIPAA and have implemented sound information privacy and security programs, you are likely facing unknown?and possibly significant?risks. Covered entities (CE) and business associates (BA) are required by HIPAA to exercise due diligence when it comes to their BAs and BA subcontractors. Assessing the risk of those vendors is necessary, especially if those vendors support critical functions in support of CE operations.
Prevalent offers Vendor Assess: a software as a service-based tool that can automate a large part of third-party vendor assessments. Its third-party risk management solution can help CEs and BAs manage the risks associated with BAs and BA subcontractors. And Vendor Assess provides the information and tools necessary to require vendors to address risks that could have an adverse impact on business and clinical operations.
Vendor Assess is a subscription-based service which uses industry best practices to efficiently support CEs and BAs to conduct third-party assessments without the need for additional staff or resources. Prevalent Vendor Assess leverages Prevalent’s Vendor Risk Manager platform to generate focused third-party risk assessments and store the results in an easily accessible web portal. Also, Prevalent’s Vendor Threat Monitor is available to support the collection of real-time vendor threat intelligence information. THe subscription includes a single assessment, threat intelligence monitoring, reporting, and assessment recommendations by Prevalent.
Vendor Assess uses predeveloped third-party security questionnaires to identify CE and BA vendor risks. The questionnaires sent to vendors are customized to address areas of risk that are associated with each vendor versus a static set of questions that are not necessarily suited for each vendor. Because risks vary depending on the vendors and the services provided, the customization is an added bonus?especially when evaluating critical vendor information security risk to CEs and BAs.
The tool can be used to electronically generate questionnaires that can be distributed to vendors and takes a lot less time than manually generating, addressing, and sending questionnaires that are geared to identify risks that vendors pose to their CE and BA clients. The tool creates a centralized repository that can be used to track vendor risk management activities and questionnaire returns and create a baseline of vendor risk that can be used for future Vendor Assess assessments.
In addition to providing a sound solution to assess vendor risk, Prevalent’s offerings include the Prevalent Vendor Risk Maturity Assessment. The Vendor Risk Maturity Assessment was created to help CEs and BAs understand the maturity of their vendor risk management program, review specific actions for maturity improvement, and benchmark overall maturity with other Prevalent clients.
The Vendor Risk Maturity Assessment identifies CEs’ and BAs’ vendor risk management program maturity. The assessment involves a question and answer session with the staff responsible for vendor risk management. A Prevalent analyst reviews the data, identifies areas for improvement, develops a specific action plan for improving maturity across all the CE’s BAs and BA subcontractors and creates an executive presentation to show how an entity’s vendor risk assessment program compares to other Prevalent clients.
Pricing for Prevalent services fits the budget of most small and large CEs and BAs. Pricing is, for the most part, tiered by the number of vendors CEs and BAs will be sending questionnaires out to. Prevalent offers a concierge package of services that has, per Prevalent, appealed to smaller CEs and BAs. More information is available from Prevalent at www.prevalent.net.
Editor’s note
Apgar is president of Apgar & Associates, LLC, in Portland, Oregon. He is also a BOH editorial advisory board member. Opinions expressed are that of the author and do not represent HCPro or ACDIS. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Email your HIPAA questions to Associate Editor Nicole Votta at [email protected].
Concerns about Certified Coding Compliance Officers reponse on an Email
Hello everyone,
I am writing this post for advice on what I should do about an email from our Coding Compliance Officer in response to an email I sent a certified coder in our organization. I am a CPB and work billing Medicare and some Medicaid at my organization. I have sent the email to the CPC coder asking her to review a date of service where the patient was billed in error and had Medicaid. One of the reasons I needed her to look at it was the provider billed a new patient visit and the patient has been well established with our providers for the last year. I received a response from the Coding Compliance officer stating why was I asking the coder to review it when all I had to do was convert the new patient visit code to the "corresponding" established patient visit code. In my years in this industry and working with many facilities we as billers (who are not certified coders) where told to give those types of visits to the CPC personnel to review for correct coding. Am I wrong in this? and Should our Certified Coding Compliance Officer even be suggesting that I as a non certified coder just randomly change the codes? Thank you for your time in answering my question.
Compliance Policies
Hey, could someone direct with where to find compliance policies? I have went to oig.hhs.gov but I am not able to find what I am looking for. Any assistance would be great!
Thanks!
Compliance: NP and Physician E/M Service
Per CMS new patient services must be personally performed by a physician with the exception of history obtained by ancillary staff.
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?
Compliance Issue: NP and Physician E/M Services
Per CMS new patient services must be personally performed by a physician with the exception of history obtained by ancillary staff.
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?