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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Code Moderna COVID-19 Vaccine for Patients 6 Months to 5 Years

Pair admin code 0111A or 0112A with supply code 91311. Moderna’s COVID-19 vaccine for pediatric patients 6 months to 5 years old has been granted emergency use authorization (EUA) by the Food and Drug Administration (FDA). The effective date is June 17, 2022. Assign the Correct Code Pair The CPT® codes for administration of Moderna’s pediatric […]

The post Code Moderna COVID-19 Vaccine for Patients 6 Months to 5 Years appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Tips from this month’s issue

Tips from this month’s issue

Small breaches could become a big problem (p. 1)

1.Regional offices were advised to increase investigations of breaches affecting fewer than 500 individuals. Investigators will look for evidence of systemic noncompliance, such as multiple small breaches and common root causes.

2.Implementing OCR’s directive may be a tall order for resource-strapped regional offices, and it’s difficult to predict what the outcome will be.

3.Because small breaches weren’t investigated on the same scale as large breaches, OCR has much less data on them. Stepping up small breach investigations will mitigate that and may lead to improved guidance on key HIPAA pain points.

4.Although large breaches grab attention, they’re statistically less likely than small breaches.

5.But even a breach involving a single patient’s records can have serious consequences for the individual and even impact his or her safety if the medical record becomes compromised as a result.

6.Large health systems may lose sight of the details and brush off small breaches, but it’s the duty of privacy and security officers to take every breach, no matter how large or small, seriously and ensure the organization does so as well.

 

The cost of a data breach (p. 4)

7.Data breach costs vary between industries but healthcare, a highly regulated industry, sees especially high data breach costs.

8.Direct costs include remediation efforts and possible fines, but indirect costs are sometimes more difficult to identify and quantify.

9.Breach notification costs are the highest in the U.S.?first class postage adds up fast.

10.The more quickly a breach is identified and contained, the lower the cost. A well-prepared security incident response team is a smart investment that will pay off.

11.Participating in threat sharing may also be linked to lower data breach costs, but executive leaders may be concerned that sharing information on cybersecurity threats will put confidential information at risk. But no sensitive business information needs to be disclosed to participate.

12.Direct breach costs may be significant on their own but may not stack up against other risks an organization faces. Remember that one of the indirect costs of a data breach can be bad debt via medical identity theft. Bad debt is a top financial risk, and any measures that can bring that risk down are worth investing in.

 

Is HIPAA enough? (p. 8)

13.The rise of ransomware and other threats has led some stakeholders and lawmakers to question whether HIPAA is robust enough to provide even a reasonable bare minimum of security.

14.OCR has pointed fingers at executives for failing to support strong security programs, but the agency has no power to hold those executives accountable.

15.OCR recommends that CEs and BAs follow NIST’s cybersecurity framework, but that standard is only optional?not required?and many organizations may choose to not spend more resources on security than required.

16.Failure to complete an organizationwide risk analysis will land a CE or BA in hot water if a breach happens, but other federal agencies are critical of OCR’s risk analysis guidance, calling it inadequate.

17.HIPAA is designed to work with state laws. CEs and BAs must follow all applicable state privacy and security laws. In some cases, state laws may be stricter than HIPAA and provide stronger security requirements or clearer guidance.

HCPro.com – Briefings on HIPAA

Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $3.8 Million Health Care Fraud Scheme

A LA, California-based dental practitioner was sentenced to forty months in jail last week for his role during a $ 3.8 million health care fraud scheme during which he charged various dental insurance carriers for crowns and fillings that were not ever actually provided to patients. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. attorney Nicola T. Hanna of the Central District of CA, Acting Assistant Director responsible for John P. Selleck of the FBI’s Washington, D.C. Field workplace and Assistant Director accountable for Paul D. Delacourt of the FBI’s LA Field workplace generated the announcement.

Read the Full Article Here!

The post Los Angeles Dental Practitioner Sentenced to Forty Months in Jail for Role in $ 3.8 Million Health Care Fraud Scheme appeared first on The Coding Network.

The Coding Network

Tips from this month’s issue

Tips from this month’s issue

Conducting a phase two audit self-review (p. 1)

1.Although CE desk audits are complete, BA desk audits and comprehensive on-site audits of both CEs and BAs are coming up. Audited entities will have only a limited amount of time to submit documentation, and those that don’t prepare in advance might miss the deadline.

2.The audit protocols are useful beyond simply checking boxes for auditors. By reviewing the audit protocols, CEs and BAs can match their compliance efforts exactly against OCR’s expectations and rules.

3.Some organizations may put audits and other evaluations aside in favor of competing compliance demands. But as OCR increases enforcement and audit activity, and the number and cost of breaches rises, now is the time to review HIPAA compliance.

4.Conducting a self-review can help a BA identify what documents it is missing before an audit letter arrives. After that letter lands in a BA’s inbox, it’s too late to create missing policies or enforce them.

5.A self-review can usually be conducted by the staff who handle HIPAA compliance as part of their regular duties. Other staff, such as human resources, may need to be pulled in to provide additional documentation.

6.The self-review should look beyond policies and procedures on paper: Auditors will want to know if they’re actually followed, and an unenforced ­policy won’t be a defense if a breach occurs. Take a look at how policies and procedures are followed and whether they should be updated to reflect the actual working environment.

 

Staying HIPAA compliant on social media (p. 5)

7.Many people use social media for personal purposes, but it’s also a powerful part of many organizations’ marketing campaigns and is invaluable for professional networking and recruitment.

8.A social media’s security policies and terms of use should be carefully reviewed by the security officer before an organization opens an official account.

9.A social media policy is a must, whether an organization operates official social media profiles or if its staff just use social media for personal reasons. The policy should be specific about when and how staff can access social media sites and who is allowed to access the organization’s official social media profile, if applicable.

10.Social media best practices should be part of basic HIPAA training.

11.Staff should not post anything that contains patient names, pictures, or other identifiable information without explicit, HIPAA-compliant permission from the patient.

HCPro.com – Briefings on HIPAA

Fraud Lands Biller in Slammer for 50 Months

A Detroit-area medical biller was recently sentenced to 50 months in prison for helping with a $ 7.3 million Medicare and Medicaid fraud scheme where services were billed but not rendered. Dawn Bentley, 56, of Oakland County, Michigan, was also ordered $ 3,253, 107 in restitution with her co-defendants for one count of conspiracy to commit healthcare […]
AAPC Knowledge Center

AWV Billing after initial eligibility months

Hi,
Can anyone advise on how you which CPT code should be used to bill AWV for Medicare Fee for Service for the following situation?

CPT code G0439 is used for Subsequent AWV after 12 months of Initial AWV. However, what if the patient comes 36 months after their initial AWV, which CPT code should be used for billing, G0438 or G0439?

Any advise is appreciate it.
Thank you.

Medical Billing and Coding Forum

Detroit Area Home HealthCare Agency Co-owner Sentenced to 96 Months

The co-owner of a Detroit home health care company was sentenced today to 96 months in prison for his role in a Medicare fraud scheme that caused approximately $ 33 million in losses.

See the full story here: https://www.justice.gov/opa/pr/detroit-area-home-health-care-agency-co-owner-sentenced-96-months-prison-33-million-medicare

The post Detroit Area Home HealthCare Agency Co-owner Sentenced to 96 Months appeared first on The Coding Network.

The Coding Network

HCC Coding – Seasonal? When are the busy and slow months?

I have heard that HCC work is "seasonal." For anyone knowledgeable about this, can you describe which months are the busy ones and which ones are the slow ones? Do you get temporarily laid off during the slow periods and/or have to look for other work during that time? Are HCC coders usually "independent contractors?" Is the pay decent while you are working? How do you manage your schedule and situation as an HCC coder? Anyone have insight on this? Thanks…..!!

Medical Billing and Coding | AAPC Forum