TAHCS Lone Star Conference


REGISTER NOW!   http://www.box.net/shared/5mqkgyr94e Early Bird Pricing Extended 1 week, so hurry!

ALL DAY ONLY $99 INCLUDES LUNCH & free  Happy Hour

I will be participating at the ALL DAY Conference.  We tried to make this a half day conference but there is so much information and so many changes that we just could not fit it into 4 hours.  This conference will include session presented by Thompson Coe, myself and representatives from CIGNA and VGM.  This conference will discuss the many woes that you are facing as health care providers from Competitive Bidding, ZPIC & RAC Audits, Compliance Issues, Effects of the new Healthcare Bill, Reimbursement and Legal Aspects to protect your business.  There will be many vendors that focus on helping health care providers run their businesses more efficiently and save money.

The 2010 LoneStar HME Conference will be held at the Dallas Crown Plaza Market Center Hotel. This one-day event will bring together top professionals in various fields, including numerous lawyers from Thompson Coe, who will present on topics including, but not limited to, the following:
  • Competitive Bidding; the HITECH Act Edward L. Vishnevetsky (Thompson Coe)
  • Medicare’s Latest Changes – Mark Loney (Cigna Health Service)
  • ZPIC/RAC Audits – John G. Browning (Thompson Coe)
  • Governmental Affairs Update – Mark Higley (VGM)
  • DME Manufacturer/Supplier Lawsuits – Jeff Otto (Thompson Coe)
  • Texas Legislative Update in Health Care – Jay Thompson (Thompson Coe)
  • Effective Lobbying of HR 3790 – Barry Johnson (TAHCS)
  • Choice of Business Entity for DME Suppliers – Bruce Bringardner (Thompson Coe)
  • Proactive Chart Documentation – Angela Miller (Medical Auditing Solutions)

You will leave with a great deal of knowledge and only for $99 which includes lunch.  The Free Happy Hour is sponsored by Thompson Coe.  You will have a chance to network and have your questions answered by the best experts in the industry.  Get a double dose of information while enjoying yourself !  Now where can you spend an hour with 3-4 attorneys networking and asking questions for free?

Don’t miss this extraordinary meeting.  Take advantage of our industry experts in a relaxed atmosphere.  Learn how to survive tough times and do not miss the insider information

Early Bird Pricing Extended 1 Week 4/7/10, so hurry!  If you include the following code you can extend the early bird price of $99. 9-52  code- 042610

HME Lone Star Conference

2010 HME Lone Star Conference.
Crowne Plaza – Dallas Market Center
7050 N. Stemmons Freeway
Dallas, TX 75247

April 26, 2010
8:30 to 4:00 pm
Free parking
Lunch included with registration

REGISTER NOW AT:   http://www.box.net/shared/5mqkgyr94e
Make plans to attend this informative
HME meeting featuring nationally
recognized speakers. Presented By: TAHCS & Thompson Coe

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What’s New with HITECH HIPAA Rules?


Are you wandering what in the heck is HITECH and how this impacts your business?  Let’s do a very simple review of the increased accountability and higher penalties.  All existing HIPAA requirements are unchanged; however, if you have not effectively implemented HIPAA policies, training, compliance auditing, and security within your office it is crucial to get busy.  The penalties are as substantial as with penalties associated with billing non-compliance.

With the new HITECH requirements:

  1. The privacy and security requirements and penalties extend to the business associates,
  2. Establish a mandatory reporting requirement for any breach by covered entities and business associates of unencrypted data,
  3. Creates new privacy requirements for covered entities and the business associates which include accounting requirements for the electronic health records, restrictions on marketing and fundraising activities, and others,
  4. Creates new criminal and civil penalties for non-compliance which are substantially more than in the past,
  5. Establishes a federal audit protocol to ensure compliance, it is no longer complaint driven audits.

This means you need to cover your back-side through a proactive HIPAA security & privacy audit.  It will be much cheaper to pay a little up front for protection than be hit with the outrageous penalties plus face criminal and/or civil action.  I have included a short check list for the basics:

  1. Do you have Privacy Notice of Uses and obtain a Signed Acknowledgement for them?
  2. Do you obtain a Authorization to Release information to spouses or any other party prior to sharing information?
  3. Does each employee have a unique username and password to the EMR or billing system?
  4. If you have a patient portal, how often do you require them to change their username and password?
  5. Are patient files stored in a locked file cabinet or locked room at the end of the day?
  6. Do you obtain business associate agreements for vendors that work with your company?
  7. Do you have annual HIPAA training?
  8. Do you have an annual security audit for all systems access and back-end IT fields?
  9. Do you have annual privacy compliance audits, which is more patient “chart” related?
  10. Are all your programs and network encrypted with the latest or highest encryption possible?

This is a short list of areas for HIPAA Compliance but is not all inclusive.  If you have answered no to any of the above questions, it is very important that you improve those areas to prevent costly penalties.   The penalties associated with unauthorized disclosures or breaches of information can be as severe as penalties associated with false/erroneous billing.  We can help you get in compliance.  You may be doing some of these things but don’t have the policies to back it up.  It is important as with any compliance program to have written policies and procedures, implement the program, have on going training, periodic audits to test policies, and options for reporting potential violations or concerns.  All of these actions will show best efforts and mitigate exposure becoming criminal and/or penalties that may be associated with any breach.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back end collections. You can visit our website at Medical Auditing Solutions LLC.

RAC and ZPIC Audits: How to have a Successful Payer Audit?


In the last twelve months, there has been more money than ever before put into fighting fraud and abuse.  Contractors are requesting more charts than ever before to review for fraud and abuse.  How do you have a successful payer audit?  The simple answer is provide the documents requested, but there is more to it.

First, Make a checklist for each chart.  Pull each chart and copy all records requested.  The request period may not include the delivery or start date and copies of initial qualifying test results and/or chart notes, include them if it is pertinent to the determination of ongoing medical necessity for example rentals of equipment.  If you did not obtain the test results or physician chart notes at the time of the start of care, request them now because the physician is not penalized if he does not respond.  Physician failure to respond to a request is an error and results in “overpayment/error” paid by the provider.  It is in your best interest to gather and submit each patient record in an organized manner.  This needs to be top priority because you have limited time frame to produce and failure to respond timely results in overpayment calculations!

Have you seen or heard the “error rates” being published?  The way it sounds, ever provider will have an audit with an error rate, it is just a matter of time.  A error rate published March 1, 2010, by Noridian was over 102 files with 86% error rate.  This is a small sample to create a crisis over.

I would recommend you have an independent third party, whether consultant or your health care attorney,  review the records before you send them off.  You can typically be granted one extension.  Do not wait until the last minute to start this process.  If you have a large number, have someone review a sample then expand based on the determined error rate.

If more than 20-30 charts are requested, I would notify outside counsel.  I am receiving new clients weekly with 200, 300, 400 or more charts being requested.  To produce duplicate copies of these records and obtain physician records in 14-21 days may be difficult and still run your business.

If you haven’t received an audit to this point, be prepared for when it happens.  Any overpayment determination in a payer audit requires payment arrangements prior to the appeal process being completed.  Be proactive, have an audit of your business to be prepared for when that day comes.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller has extensive experience with Medicare and Payer audits.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back end collections. You can visit our website at Medical Auditing Solutions LLC.