Chiropractic CBR

According to Safeguard Services, all providers who received the original 2010 CBR are being sent a new, updated report.  This new report shows the original 2009 data and compares in to the providers 2011 data.  It is being used to contrast and compare where you were - to where you are.


The CBR contains the same graphs as the original; Average Number of Services per Beneficiary by CPT andNumber of Beneficiaries by Three Categories of Distinct Diagnoses.  It compares your 2011 data to the whole of the State and National providers.  The differences - and the value - lie in the tables supporting the graphs.


These tables show a comparison of your 2009 services to your 2011 services.  If you received a CBR in 2010, you did so because your practice was statistically different from that of your state and national peers.  This new report gives those providers a glimpse into how their practice has changed since that original report.  You can view an example of the original CBR here.


If your utilization remains substantially higher than that of your state and national peers, it may be an indication of an area of concern.  It may warrant some additional steps.


Consider a Chart Audit to review your billing and coding patterns.  Using published guidelines, a Certified Professional Coder and Medical Compliance Specialist (with Chiropractic Proficiency) will review your notes.  You will receive a detailed, written review of your documentation with areas for improvement clearly identified.  For more information about the process and cost, send a note to terry@cstonemedical.com.

 

 

OIG Reveals HIPAA Audit Results

The Office of Civil Rights has completed the first 20 HIPAA audits.  In this first round of audits were 8 health plans, 10 provider offices and 2 clearinghouses.  As you might expect, smaller entities had more issues than larger entities and providers are the group lagging farthest behind. 


In an effort to learn from those who were lucky enough to experience the first 20 audits, lets look at what OIG discovered about HIPAA compliance.

 

Healthcare provider offices had 81% of the deficiencies noted and contained both privacy and security violations.  The majority of issues identify by the audits related to the security rule.  The most common security issues identified include the lack of:


  • User activity monitoring
  • Contingency planning
  • Risk Assessment
  • Encryption

 

Some common privacy issues include:

  • Missing review process when patients are denied access to records
  • Failing to provide patients appropriate access to records
  • Missing policies and procedures
  • Incorrect use and disclosure of deceased individuals information
  • Missing or invalid business associate agreements
  • Problems with the Notice of Privacy Practice

 

OIG has stated that those entities audited in the first round will not have sanctions imposed.  There are an additional 75 audits planned in 2012 and those selected entities will be given 15 days to respond to the OIG’s request for information.

 

What can you do in your office to prepare? 

 

First step is to conduct a comprehensive review and risk assessment of your environment.  This includes an asset inventory and mapping the movement of protected health information within your organization and to external sources.  This risk analysis should be done “periodically” or at least annually.

 

If you have an existing HIPAA manual, review it and make sure it’s updated with the changes from HITECH.  Make sure that your manual addresses the administrative, physical and technical controls required by HIPAA.

 

If you are without a HIPAA manual, consider purchasing or hiring a consultant to audit your office and prepare a custom manual for you.

 

Train your staff on HIPAA regulations, as well as your internal policies and procedures.

 

For those offices participating in the Medicare EHR Incentive program, part of your attestation includes attesting to having conducted a “security risk analysis in accordance with requirements under 45 CRF 164.308(a)(1)…”.  If your office hasn’t performed a full risk analysis, your attestation may be invalid and your incentive money at risk.

 

Check out our archived articles for more information on HIPAA related regulations.  For assistance with any compliance related need, contact us.  We’re happy to help.

False Claims Act

Are Bad Mules to Blame for the False Claims Act? 

The False Claims Act (FCA) was passed by Congress in 1863.  Some historians say it was in response to a man who sold the Union Army decrepit mules, horses and provisions, another says it originated from a man who sold uniforms, yet never delivered.  In 1986 this law was amended adding civil penalties.  The False Claims Act is one of the cornerstones of the government anti-fraud and abuse prosecutions.

Recent changes to the law under the Patient Protection and Affordable Care Act (PPACA) and the Fraud Enforcement Recovery Act (FERA) have provided additional funding for investigations, strengthened the current criminal and civil statues, make the failure to return overpayments a violation, and clarified that any claim found to be in violation of the anti-kickback status is also in violation of the FCA.

It is under the Qui Tam provision of the law that “whistleblowers” can receive a portion of the civil penalties levied against an organization.  The phrase Qui Tam is an abbreviation of the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur”, meaning "[he] who sues in this matter for the king as [well as] for himself." 

A major factor in the government’s success has been the whistleblower.  The person or person(s) who bring forth the suit can share in the government's recovery. When private whistleblowers bring frauds to the attention of the government, they can receive bounties in the millions of dollars. Publicity concerning these awards motivates otherwise reluctant informants to bring additional fraud to light, and increases public awareness.

Examples of healthcare related prosecutions under FCA include:  up-coding, unbundling, ghost billing, double billing, and billing for medical unnecessary services.  This is not an exhaustive list; there are many other instances that can land physicians in the courtroom.

Protecting yourself against Qui Tam suits begins with a thorough understanding of your current compliance situation, creating policies and procedures to deal with suspected improper claims before they become “false” and being prepared to internally investigate and correct any situations that are reported to you.  


 

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