ZPIC Audits What We’ve Learned from 2011 and other Audit Risks Webinar


Edward Vishnevetsky, healthcare attorney with Munsch Hardt has asked Angela Miller to join him as a guest speaker during his presentation next Thursday, February 9, noon-1pm CST.  Audits are inevitable at this point, so better be prepared and proactive for the audits that are coming.  Join us as we discuss ZPIC audits and other audits you can expect in 2012, such as HIPAA, OCR, Medicaid RAC, Commercial audit expansion. Also learn how best to prepare and prevent  adverse outcomes.

You are Invited to Join our Complimentary Medicare ZPIC Audit Webinar

Featuring Topics on:

Changes to Medicare ZPIC and RAC Audits
The Office of the Inspector General’s (OIG) take on Audits in 2012 based on the 2012 OIG Work Plan
Which HCPCS codes may be most vulnerable and subject to scrutiny
How DME suppliers can work with physicians, hospitals and manufacturers to assist in responding to audits
Tips on how to effectively respond to audits (based on lessons learned in 2011)
Other Audit Risk and Prevention

Presentation Given By:

Edward Vishnevetsky

Attorney at Munsch Hardt Kopf & Harr, P.C.

Featuring Guest Speaker:

Angela Miller

President of Medical Auditing Solutions LLC

Date: Thursday, February 9th, 2012

Time: 12:00-1:00 PM CST

Cost: Complimentary

To reserve your Webinar seat, please click here.

After registering you will receive a confirmation email containing information about joining the Webinar.

If you have any questions, please contact Ashley Thomas.

Edward Vishnevetsky has successful defends over 40 physicians, DME providers and HHAs against ZPIC, CERT, MAC and RAC Audits; achieved 100% success rate in removing providers from pre-payment audit.  Successfully defended over 100 providers through all stages of Medicare appeals, including the Administrative Law Judge (ALJ) level.  Read more at Munsch-Vishnevetsky

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 through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  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.

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15 Minute Thoughts “Conflict of Interest” & “Role of Compliance Officer”


UPDATE:

September 8, 2010      Conflict of Interest: Pay Attention or Write a Big Check – CANCELED

There will be no live program this Wednesday.

Reminder, Tune back on next Wednesday

September 15, 2010    Compliance Officer:  Who? What? …Really?

We will discuss who can be the compliance officer.  We will discuss the roll of the compliance officer as well as who should be the “supervisor” of the compliance officer.  With the requirement for all health care providers to have a compliance program fully implemented as part of the health care reform bill, this program is for physicians, DME, HME, home health, hospice, pharmacies and other health care providers that bill Medicare and Medicare.

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 through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  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.

HIPAA Privacy Settlement – $1 Million


With all the new enforcement efforts for privacy violations, better read this and take note.  If you are not sure you are HIPAA compliant MAS can provide security as well as chart and process assessment to help you.  This article is so important, I couldn’t find the short link so recopied exact with all Ms. Stamers contact information as well.

Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As Office of Civil Rights Proposes Tighter HIPAA Privacy & Security Regulations

August 4, 2010 <!–Cynthia Marcotte Stamer–>

Stay Tuned To Solutions Law Press For More Details

One of the nation’s largest drug store chains, Rite Aid Corporation and its 40 affiliated entities (Rite Aid) will pay $1 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule.  The U.S. Department of Health and Human Services (HHS) Office of Civil Rights announcement of the HIPAA resolution agreement with Rite Aid and the concurrent negotiation of a separate consent order of potential FTC Act violations between Rite Aid and the Federal Trade Commission (FTC) follows HHS’ announcement of proposed changes to its HIPAA Privacy Rules and associated penalties in response to changes enacted under the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act).  The Rite Aid settlement and the proposed Privacy Rule changes illustrate the growing penalty risks that health care providers, health plans, healthcare clearinghouses and their business associates (Covered Entities) face for violating the Privacy Rules.

Rite Aid Resolution Agreement

The Rite Aid resolution agreements settle charges that Rite Aid failed to appropriately safeguard the privacy of its customers when disposing of identifying information on pill bottle labels and other health information. The settlements apply to all of Rite Aid’s nearly 4,800 retail pharmacies and follow an extensive joint investigation by the HHS Office for Civil Rights (OCR) and the FTC.

OCR opened its investigation of Rite Aid after television media videotaped incidents in which pharmacies were shown to have disposed of prescriptions and labeled pill bottles containing individuals’ identifiable information in industrial trash containers that were accessible to the public in a variety of Rite Aid locations in cities across the United States.  OCR and FTC previously settled a similar case involving the national drug store chain CVS in February 2009.

The HIPAA Privacy Rule requires covered entities to safeguard the privacy of patient information and other “protected health information” including during its disposal.  In addition to the detailed requirements for protection and safeguarding of protected health information and electronic protected health information under the Privacy Rules, breach notification rules added to HIPAA under the HITECH Act also generally require that Covered Entities investigate and provide timely notification of breach to patients, OCR and in some cases the media when “unsecured protected heath information” is breached.  Meanwhile, the FTC Act and associated regulations require those retailers and certain other parties receiving personal financial information to comply with certain requirements for the protection and use of that information and to provide certain notifications of their privacy polices for protecting personal financial information.

The joint OCR and the FTC investigations raised concerns that:

  • Rite Aid failed to implement adequate policies and procedures to appropriately safeguard patient information during the disposal process;
  • Rite Aid failed to adequately train employees on how to dispose of such information properly; and
  • Rite Aid did not maintain a sanctions policy for members of its workforce who failed to properly dispose of patient information.

Under the HHS resolution agreement, Rite Aid agreed to pay a $1 million resolution amount to HHS and must implement a strong corrective action program under which Rite Aid agreed to:

  • Revise and distribute its policies and procedures regarding disposal of protected health information and sanctioning workers who do not follow them;
  • Train workforce members on these new requirements;
  • Conduct internal monitoring; and
  • Engage a qualified, independent third-party assessor to conduct compliance reviews and render reports to HHS.

In addition, under its FTC consent order, Rite Aid separately agreed to external, independent assessments of its pharmacy stores’ compliance with the FTC consent order.

The HHS corrective action plan will be in place for three years; the FTC order will be in place for 20 years.

Proposed Privacy Rule Changes

The Rite Aid resolution agreement and consent order follows the July 8, 2010 publication by OCR of proposed changes to its existing HIPAA Privacy, Security, and Enforcement Rules in response to amendments enacted under the HITECH Act. Because of the lead time required to implement needed changes in policies, technology and training, Covered Entities need to begin preparations to adjust their health information privacy and data security policies and practices in anticipation of the finalization and implementation of these rules as well as to act quickly to submit their comments about the proposed changes.  .

The more than 220 page Notice of Proposed Rulemaking (NPRM) proposes to revise the existing Standards for Privacy of Individually Identifiable Health Information (Privacy Rule); the Security Standards for the Protection of Electronic Protected Health Information (Security Rule); and the rules pertaining to Compliance and Investigations, Imposition of Civil Money Penalties, and Procedures for Hearings (Enforcement Rule) issued under HIPAA.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with HIPAA and other privacy and data security, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also is regularly conducts training on HIPAA and other health industry compliance, management and operations matters.  You can get more information about her health industry experience here.  If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872  or via e-mail here.  You may link to her on Plaxo and Linkedin as well where she posts she articles.

Social Media Security and Privacy


Social Media sites are becoming a way of communicating with the world.  Remember, no matter what social media site you are using whether it is an instant message, website profile, social network or skype or similar sites, your communication can be viewed or intercepted.  If you have any of these social media profiles, do not publish your address, DOB, or any other information that could be used to steal your identity, break into your home, stalk you or your children.  Use the incorporation date of your business or a combination of information and chose not to publish your address and DOB.  Ensure you obtain your free annual credit report to review for accuracy.  There are also programs that will monitor your credit activity for potential theft.

Publishing any personal information can lead to not only credit or financial fraud but health care fraud also.  Protect your information.

Remember, this method to communicate with patients is not with HIPAA, HITECH and Red Flag rules if you are exchanging any credit, financial or other personally identifiable information whether health or otherwise.

As a note, you can find us on all Social Media sites: Facebook, Myspace, Linkedin, Plaxo, Twitter.  We do submit blogs through these sites and occasional other notes so you can stay updated through status notifications.

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 ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  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.

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.