Patient Access » Latest News

House approves healthcare reform bill

PARC Editor — Wed, 18 Nov 2009 18:48:00 +0000

The U.S. House of Representatives recently passed the healthcare reform bill (HR 3962) by a narrow margin (220–215). The bill's estimated cost is more than $1 trillion over the next 10 years.

The Senate is working on its own version of the bill. If that version passes, then a congressional conference committee will meet to compromise on the two versions. If the committee reaches a compromise, it will send that bill would to both the House and Senate for another vote. If it passes both houses, the next step is President Obama’s desk for his signature.

Preliminary drafts of the Senate bill differ from the House version with respect to funding, how many individuals will be covered, and the availability of a public option.

Source: CNN

Q&A: Red Flags Rule

PARC Editor — Sun, 15 Nov 2009 18:42:00 +0000

Q. How does the HIPAA privacy rule coincide with the new Red Flags Rule, which requires providers with covered accounts to contact law enforcement if the provider suspects identity theft? May providers release PHI or discuss the patient’s case with law enforcement officials?

A. The Red Flags Rule does not require you to notify law enforcement officials of suspected identify theft. Instead, the rule permits you to do so. Most states' identity theft protection laws allow this as well. Informing law enforcement officials about a PHI breach and its nature does not violate HIPAA. Patient authorization is necessary before you disclose any specific identifiable information to law enforcement officials. Absent specific authorization, release of PHI to law enforcement would violate the HIPAA privacy rule.

Advising patients to contact law enforcement is the best course of action. If warranted, notify law enforcement of the breach and provide the perpetrator’s name if known, but don’t provide a list of affected patients.

Editor’s note: Chris Apgar, CISSP, answered this question. This is not legal advice. Consult your attorney regarding legal matters.

Red Flags Rule enforcement delayed to June 1

PARC Editor — Wed, 11 Nov 2009 18:32:00 +0000

The Federal Trade Commission is delaying enforcement of its identity theft Red Flags Rule for a fourth time, pushing back the November 1 deadline to June 1, 2010.

The latest delay comes at the request from Congress, which is considering exempting entities with fewer than 20 employees from the identity theft rule.

The House of Representatives passed the bill late last month. The Senate is now considering the bill.

The previous delay announcement—from August 1 enforcement to November 1—came in July. The House Appropriations Committee requested the additional three months to educate small businesses about Red Flags Rule compliance. The delay also allowed financial institutions and creditors more time to implement written identity theft prevention programs, according to the FTC.

Red Flags requires creditors and financial institutions to have in place identify theft prevention, detection, and response systems. The rule is mandated by the Fair and Accurate Credit Transactions Act of 2003.

Red Flags was initially supposed to go into effect November 1, 2008, but was pushed back to May 1, 2009, then to August 1, 2009, then to November 1, 2009, and now to June 1, 2010.

Benchmarking in patient access

PARC Editor — Wed, 28 Oct 2009 18:26:00 +0000

We presented an audio conference, “Use Patient Access Benchmarks to Improve Registration Accuracy,” September 22.

These days, it seems all patient access departments are ramping up efforts to be accurate, considering the economic climate.

Take a look at some of the tools we offered during the show:

Audit tool for consistent education
Training checklist
Manual monitoring tool
Outline of Albany Medical Center's training program
Productivity standards
Dashboards
Audit QA
Standard set of elements of scorecard

Learn more about the audio conference.

AHA RAC Program Update answers provider questions

PARC Editor — Wed, 21 Oct 2009 16:12:00 +0000

As of September 18, all four RACs were conducting automated audits, according to an October 6 American Hospital Association (AHA) RAC program update. But only 16 of the 23 audits underway were on hospital outpatient claims, according to the AHA. (The others were therefore on physician and durable medical equipment claims.)

So unless your hospital is so very unlucky to have been selected as one of the first for an audit, chances are you still have time to make a few necessary tweaks and run a few tests on your RAC processes to help ensure you're ready when RACs do begin auditing your facility.

The AHA also updated providers on the arrival of additional types of RAC audits (e.g., DRG validation and medical necessity). RACs have already requested the ability to audit for more than 100 different issues, according to the AHA. Some of these include code and DRG validation reviews, which CMS has not yet approved, choosing instead to begin solely with automated audits involving no need for medical record review.

And while DRG and coding reviews could begin as soon as November, the AHA says CMS may delay the onset of medical necessity reviews so it can first establish a process that would give providers the ability to re-bill all eligible outpatient claims. CMS previously announced medical necessity reviews would begin in January 2010.

Click here to read more.

Establish a relationship with patient financial services staff

PARC Editor — Wed, 21 Oct 2009 16:10:00 +0000

The crossover between patient access and case management is natural. Share this tip with your ED case managers:

Patient financial services (PFS) counselors offer various assistance to patients. They:

Speak with patients about insurance coverage or the lack thereof
Offer to assist with originating a Medicaid or free/charity care application
Try to answer any questions related to the financial obligations resulting from the patient’s ED visit/hospitalization

The ED case managers in your organization also can inquire about other funding opportunities available through:

Workers’ compensation
No-fault motor vehicle insurance
State crime victims’ insurance funds
Charity care, such as professional home visits, durable medical equipment, or free transportation
Individual state public health resources
Individual hospital funded programs for post acute needs

Establishing a relationship with PFS counselors can help case managers in their role as patient advocates.

This tip was adapted from the HCPro publication Emergency Department Case Management. For more information or to order your copy visit the HCMarketplace.

Another Medicaid reduction possible when stimulus funds are gone

PARC Editor — Wed, 21 Oct 2009 16:08:00 +0000

The decline in tax revenue and increase in Medicaid enrollment combined to put the squeeze on the Medicaid budget for many states.

As a result, 13 states will reduce Medicaid pay for physicians in fiscal year 2010. They include: Georgia, Louisiana, Minnesota, North Carolina, Vermont, Wyoming, California, Utah, Washington, Colorado, Hawaii, Maryland, and Ohio..

In fiscal year 2009, Medicaid enrollment grew by 5.4% and total program spending increased by 7.9%, the fastest pace in five years. Without the federal stimulus bill, the current economic climate would have forced states to cut Medicaid funding even more drastically. That additional federal funding for Medicaid runs out December 31, 2010. This has Medicaid directors worried about cuts that may be in store for fiscal year 2011.

Source: American Medical Association

CMS releases new RAC FAQ

PARC Editor — Wed, 14 Oct 2009 16:19:00 +0000

CMS released the following new RAC FAQ September 25:

Q: How long is the RAC discussion period?

A: The discussion period begins with the time of notification (demand letter for automated reviews and the review results letter for complex reviews) through the time recoupment occurs. The discussion period normally requires written notification to the RAC. The discussion period does not extend the provider's appeal time frames.

Click here to read the FAQ on the CMS Web site.

Health coverage does not protect against incurring medical debt

PARC Editor — Mon, 28 Sep 2009 04:00:00 +0000

Health insurance does not safeguard people against medical debt in California, where one in seven non-elderly adults is trying to pay off healthcare bills in excess of $2,000. Of those with debt, 1.4 million, or two-thirds, have health coverage.

"More than 2.2 million Californians, or 13% of nonelderly adults, reported having medical debt," according to the survey, "The State of Health Insurance in California." Among those 2.2 million, 17% had debts from $2,000 to $4,000; 9.4% were paying debts between $4,000 and $8,000, and 8.7% had debt about $8,000.

The nation's largest state health survey was conducted by the UCLA Center for Health Policy Research, which conducted telephone surveys of 50,000 California residents between June 2007 and early March 2008. The survey is part of a biennial project, but its release sends a message to those trying to craft health reform proposals, the authors said.

Source: HealthLeaders Media.

Patient deportation case highlights issues with illegal alien healthcare

PARC Editor — Mon, 28 Sep 2009 04:00:00 +0000

A medical ethicist says people who are angry at a South Florida hospital for repatriating a brain-damaged patient to his native Guatemala should instead push Congress to expand emergency healthcare coverage to illegal aliens.

Arthur Caplan, a professor of bioethics at the University of Pennsylvania Center for Bioethics, says Martin Memorial Medical Center was unfairly criticized after the Stuart, FL hospital chartered an airplane and returned Luis Jimenez, 37, to his native Guatemala in 2003.

The hospital had been providing unreimbursed long-term care for the uninsured day laborer ever since he suffered severe head injuries in a 2000 automobile accident that left him partially paralyzed. The hospital placed the value of the uncompensated care at around $1.5 million.

"Those who are outraged over sending him home should try to push for illegal aliens to be covered. Good luck with that," Caplan says. "You can yell at the hospital all you want, but if he was in a public plan they probably would have kept him here because he would have had coverage. In a way, each one of us decided to send him home."

Source: HealthLeaders Media