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Tag Archives: risks

Offshore Coding: HIPAA Risks

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From a compliance exposure perspective, we believe that the HIPAA risk associated with sending PHI abroad is simply untenable.  HIPAA is an American law that does not extend beyond our borders.  The only way to ensure HIPAA protection abroad is to do so contractually via a BAA.  There is no regulatory authority abroad for the US Government to prosecute for violations of HIPAA.

Having a BAA in place with an offshore entity may afford you the appearance of contractual protections for the disposition of PHI, however this can prove illusory.  If an offshore entity breaches their BAA with a healthcare provider, the only option for the Covered Entity to attain protection is to point to the Business Associates’ contractual guarantees.  However, if the offshore entity does not have US assets they can simply refuse to comply and the only recourse left to the Covered Entity is to try and sue a foreign company.  This process is typically unsuccessful and at the very least costly and time consuming.  The OIG will hold the Covered Entity responsible for the HIPAA breach.  On top of all of this, the countries for which offshore coding predominantly takes place are some of the world leaders in identity theft.

If your goal is to get cheaper offshore coding, that means the coders abroad are being paid low wages and will therefore have an incentive to appropriate PHI, which is far more valuable than their pay.  All of these factors provide a greater risk than the possible savings afforded by cheap offshore coding.

 

The post Offshore Coding: HIPAA Risks appeared first on The Coding Network.

The Coding Network

SNF therapy contracts: Your risks and what you need to know

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SNF therapy contracts: Your risks and what you need to know

Q: How long does the SNF need to retain background and licensing documentation of the therapist working for a contract company?

 

A: The SNF needs to retain background and licensing documentation of the therapist for a contract company for the same amount of time as it does for its employees. You should follow whatever your record retention requirement is for your employees, and there should be a statute of limitation within your state. Usually if the therapist was there, involved in the care and treatment of patients, and anything comes up, there’s no statute of limitation you should know.

With billing fraud, there’s no statute of limitation. On any kind of care fraud, or any kind of abuse and neglect, if those issues arise, I typically suggest that if you’ve got a seven-year statute of limitation, you maintain records for seven years.

 

Q: Do you recommend shared risk or indemnification clauses for Medicare consultants who come in and make recommendations on RUG levels?

A: Yes, I recommend shared risk clauses for consultants who come in, especially if they’re going to come in on a preemptory basis and decide the RUG levels you should bill. I do expect shared risk. Anybody who’s involved in that Medicare billing process is going to have input into what we bill. That is a contractor separate from the SNF. The SNF can’t essentially indemnify itself. But if the SNF is using somebody to do any of that work and be part of the coding, part of the auditing, and ultimately part of the RUGs, you need to be part of that process of indemnification.

SNF providers need to be part of that process of shared risk?the only way I could make sure that I can indemnify the SNF for the activities of its contractors and anybody who is part of that process is to say, “If you’re going to give me advice and you’re going to be part of this and you’re going to say, ‘Yeah, I’m an expert, I know what ought to be billed, etc.’ and I have to rely on that, my answer is, ‘Okay, I’m happy to do that, but here’s the deal. If in fact you’re wrong and this turns out to be incorrect, you’re going to be responsible for the losses. And at least a portion or a portion thereof, and we’re going to have some shared risk and indemnification as well.’ ”

HCPro.com – Billing Alert for Long-Term Care

Check(list) your ER for suicide risks

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 With the renewed focus on ligature and self-harm, facilities need to undergo a complete reassessment of the physical environment where patients with behavioral or mental health problems are cared for. That goes especially for emergency departments. Annually, 460,000 emergency department visits occur following cases of self-harm, and those patients are six times more likely to make another suicide attempt in the future. 

HCPro.com – Briefings on Accreditation and Quality

Medical Tourism – Know the Risks and Protect Yourself Before You Go

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People regularly go overseas for healthcare to save themselves money and cut waiting times. However, there are some dangers inherent in having surgery carried out overseas and it’s worth investigating them before taking the plunge.

Things like organ operations can be secured for as much as 50% of the cost of the same procedure back in the west, and minus the long and annoying waiting lists intrinsic to the majority of western countries.

Research shows that many American citizens go overseas every year for kidney transplants. However, surveys show that people who go overseas for this kind of operation can risk greater chances of complications like infection or acute rejection, and the level of these complications is accentuated by being a medical tourist.

A piece of research from the University of California, Los Angeles (UCLA) showed that kidney rejection happens in up to 30% of medical tourists who undergo transplant operations abroad while just 12% of people who had operations at UCLA had kidney rejection.

The Clinical Journal of the American Society of Nephrology reports that the most common destinations for kidney transplants via medical tourism are China (18%), Iran (12%), the Philippines (9%), India, Pakistan, Peru, Egypt, Turkey, Mexico and Thailand (3%).

However, with that in mind, the motives for becoming a medical tourist or a transplant tourist are pretty convincing. The USA has just 10,000 kidney transplant operations carried out per year, but the country has around 70,000 patients who need a new kidney. The average waiting list is around five years. Remaining on dialysis for this period is something most patients would do anything to avoid.

Some people consider it simpler and undoubtedly cheaper to seek out a transplant overseas, risking the possibility that the donor was a prisoner, deceased or otherwise.

Things to think about when considering overseas surgery:

Pick a reputable hospital or clinic
Investigate the surgeon’s qualifications and experience
Investigate the credentials of the medical board which certified the surgeon
Find out if the surgeon can speak English
Request an in-person consultation with the surgeon ahead of the operation
See what post-op care is offered
Be informed of what to in the event of complications on return home
Don’t judge on just price

Seek Advice First

Before you go ahead and book an operation overseas it’s worth speaking to a surgeon in your own country. A domestic doctor might well advise you against a procedure. If you find you require a procedure then you must talk about any likely risks and dangers inherent in the process.

If you do plump for overseas operations, it’s worth meeting your surgeon in person before you go ahead with the procedure. Check that you accept his post-op plan, and ask him about his training, experience and credentials to give yourself peace of mind.

Results

You might end up not getting what you really wanted. If you find that the operation you have abroad leaves you dissatisfied, then the surgeon won’t be there to talk to when you get back home.

People who have cosmetic surgery overseas can find that the results are not up to the level they hoped for. This means that they could then have to fork out additional money to have the work put right.

Safety

This should be one additional main worry for potential medical tourism patients – picking a facility which is regulated and subject to scrutiny is a definite. Being a medical tourist, you’ll most likely not see the hospital ahead of your surgery, and by then it might be too late to turn back.

Price

In thinking about how much the procedure will cost it’s worth considering what you get for your money. Surgery overseas might be cheap but people can risk missing out on vital aftercare, making the trip not cost-effective. Don’t forget your health is invaluable.

Post-Op Care

A major worry for people who want surgery overseas is post-op care. For example, anyone having a gastric band fitted in the UK will get years of post-op care which medical tourism cannot offer.

People who have operations privately around the world don’t get much by way of aftercare or post-op looking after, even though this is an important part of the procedure. There are lots of examples of people heading home only to find that they then experience complications that require further care.

Having no aftercare or post-op support can mean long-term problems so it’s worth checking out what kind of post-op care you actually need to make the best possible recovery.

Discover Medical Tourism is a free information site for patients to research and learn about medical tourism and dental tourism. Covering most of the major countries specializing in medical, health and dental tourism.

Risks of Breast Implants by Medical Malpractice

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According to a recently released report by the American Society for Aesthetic Plastic Surgery, about 355,671 women had undergone cosmetic breast surgery in 2008only. Breast surgery is now the most common type of cosmetic surgery performed in the USA with the result of success depending on the medical practice of the surgeon.

The number one reason women chose to have breast implants is to feel better about themselves and boost their self-image. Reconstruction of breast material lost due to mastectomy or genetic deformities also falls into this category. Regardless of the personal basis for a breast implant, all breast implant surgeries are considered cosmetic.

 

Women most likely to choose breast implants have certain characteristics: a slender build; under the height of 5’4″; and below the age of 40 (86%).

 

The four influential purposes for breast implants are:

· Primary reconstruction to replace breast tissue destroyed by cancer, trauma or severe breast abnormality
· Revision-reconstruction to correct or improve a prior reconstruction surgery
· Primary augmentation to enlarge the breast size
· Revision-augmentation to correct or improve a prior augmentation surgery

 

Of the three types of breast implants currently on the market, saline and silicone implants are most frequently chosen, while breast implants of alternate material are rarely used. There are options where the incision for the breast implants is located. A transaxillary incision is under the arm, a periareolar incision is around the nipple and an inframammary incision is along the fold underneath the breast. The transaxillary and inframammary incisions are less concealed than the periareolar, but considered to have a higher likelihood of successful breast feeding. In addition, breast implants can be placed either on top of the muscle or underneath.

 

Breast implants have a history dating back to 1895, albeit not always with desirable results. Unfortunately, that trend continues today. There are dangers associated with breast implants. A list of the common risks includes:

– Infection
– Wound healing delay
– Hematoma
– Bleeding
– Excessive scarring
– Capsular contracture
– Calcium deposits
– Asymmetry
– Visible wrinkling
– Breast tissue thinning
– Disruption of the natural flat surface between the breasts
– Neuroma
– Nipple sensation changes
– Breast sensation changes
– Deflation
– Rupture
– Leakage
– Swelling
– Burning
– Tenderness
– Increased difficulty in detecting breast cancer
– Additional surgeries to replace or remove breast implants
– Anesthesia reaction

 

Some of the above perils may be the result of the plastic surgeon inserting too large an implant into the breast capsule, damaging the skin’s outer layers or his or her inexperience. Breast implant medical errors can leave a women suffering years of pain, emotional trauma and repeated surgeries to attempt to reverse the medical error. Some women never recover a “normal” appearance and are left with horrendous scarring.

 

If you have concerns about your breast implant surgery, it is advisable to seek an experienced medical malpractice attorney’s opinion as soon as possible.

 

Attorney Richard Hastings, for the past two and one half decades, has been helping injured clients and families collect millions of dollars in losses ranging from motor vehicle accidents to wrongful death, to medical malpractice. He is the founder of Selectcounsel, LLC, a free service that helps you find one of the best lawyers in your area and is the author of the books “How To Find A Great Lawyer” and “Understanding And Improving The Value Of Your Personal Injury Case.”

Joint Commission elaborates on accreditation reports, suicide risks, and toilet seats

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The 2017 Chicago session of The Joint Commission’s annual Executive Briefings saw a far-ranging discussion on the future of accreditation. Attendees from around the country came and listened to the latest news on risk assessments, the SAFER Matrix, documentation, and suicide prevention.

HCPro.com – Briefings on Accreditation and Quality