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Set your business up for success by focusing on these key concerns. In an era of resource scarcity for many, it’s imperative for organizations to strategically identify areas of concern unique to them and on a broader spectrum. Healthcare business professionals and clinicians from entry-level departments to the C-suite should have at minimum a risk […]
The post 10 Areas That Will Impact Your Healthcare Organization in 2023 appeared first on AAPC Knowledge Center.
Have you refreshed your office space this year? 2022 is in full swing. We have all updated our code sets and finished the annual financial reporting that comes with closing out the previous year, but have you taken the time to refresh your office space? Where to Begin? In-office and remote workforce members alike have […]
The post Add Office Organization to Your Yearly To-do List appeared first on AAPC Knowledge Center.
As many know, professionalism is a key theme of my term as your National Advisory Board (NAB) President. I hope to motivate all members to “Achieve a Higher Standard” as it is my belief that the value of our credentials is directly related to how we are perceived by the entities that seek to employ […]
The post The Value of Membership in a Professional Organization appeared first on AAPC Knowledge Center.
The Healthcare Facilities Accreditation Program—also commonly known as HFAP—will be keeping its name. The longtime accrediting organization had originally planned to take the name of the Accreditation Association for Hospitals/Health Systems (AAHHS), which acquired HFAP in 2015 from the American Osteopathic Association (AOA).
It is being set up as a lab however he states a "full service tissue/blood bank that works in the areas of stem cell collection, process, preservation and delivery of products to hospitals and physicians.
I am not familiar, at all, with NON-pharmacy set ups and health insurance companies.
My main issue is keeping my certification and leading this guy in the right direction. He informed me the prior billing company could not obtain a BC/BS provider number just to submit claims because his company wasn’t required by the state to have a Laboratory license since blood was not being mixed or manipulated etc. and the product is not considered a DME therefore BC/BS did not have a classification for his entity. He was told to obtain a CLIA/CLIA waiver and CAP certificate,to set up a lab. A blood bank does not fall under any of BC/BS categories and an independent lab was the closest category they could associate his services with. He provided BC/BS the documentation from the state clearly showing there is no equivalent license for a blood/tissue bank as FDA requires therefore no CAP certificate or CLIA/CLIA waiver could be issued. The Chief Compliance Officer of the State clearly wrote "Since your organization is not manipulating the cells collected to make a pharmaceutical drug nor supplying the patient or doctor with a medical device, no drug or device distributor or manufacturer license is required! He had no problems previously with Cigna or UHC so I’m not sure what to do.
I have done some investigation and I have seen where companies have registered as NON Pharmacy, DME and also Lab? I’m curious because the prior company he worked with, same scenario, BC/BS would not pay because he couldn’t obtain a provider number with BC/BS. The reason was BC/BS states your a clinic or lab. He wrote to the state as he would purchase it from another company and sell it to the surgeon therefore since he wasn’t officially manipulating blood products, he wasn’t classified as a lab and this type of product is also not considered DME.
If you have any knowledge, please let me know as I’d like to get this contract but do not want to mislead him. Thanks s
Freedom Health Inc., a Tampa, Florida-based provider of managed care services, and its related corporate entities (collectively “Freedom Health”), agreed to pay $ 31,695,593 to resolve allegations that they violated the False Claims Act by engaging in illegal schemes to maximize their payment from the government in connection with their Medicare Advantage plans, the Justice Department announced today. In addition, the former Chief Operating Officer (COO) of Freedom Health Siddhartha Pagidipati, has agreed to pay $ 750,000 to resolve his alleged role in one of these schemes. You can read the full update on the justice.gov website – here.
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In a $ 750,000 HIPAA Settlement, the University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations. UWM is an affiliated covered entity, which includes designated health care components and other entities under the control of the University of Washington, including University of Washington Medical Center, the primary teaching hospital of the University of Washington School of Medicine. Affiliated covered entities must have in place appropriate policies and processes to assure HIPAA compliance with respect to each of the entities that are part of the affiliated group. The settlement includes a monetary payment of $ 750,000, a corrective action plan, and annual reports on the organization’s compliance efforts.
You can review the complete notice on the HHS.gov website.
The post $ 750,000 HIPAA SETTLEMENT CAUSES OCR TO UNDERSCORE NEED FOR ORGANIZATION WIDE RISK ANALYSIS appeared first on The Coding Network.