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Implement 6 HIPAA security compliance tips for a strong 2023

05/15/2023

HIPAA security remains a hot topic for medical groups, and federal agencies are warning of elevated threats to security. Pay attention to emerging practices that can help keep your data safe — and your money away from regulators.

Report the right E/M level for ED patient with exacerbated chronic illness

05/15/2023

by: Savannah Schmidt

Question: A 19-year-old male with asthma who experienced wheezing and shortness of breath for the past two weeks presented to the emergency department (ED). Inhaler use 10-14 times daily offered temporary relief. Physical exams were normal except for tachycardia, scattered wheezing breath sounds, and elevated respiration. The physician completed three tests (complete blood count; complete metabolic panel; influenza A/B, respiratory syncytial virus, and COVID-19 polymerase chain reaction panel), gave the patient a nebulizer treatment and steroids, released him with MDI and steroid burst, and referred him for a follow-up visit with his doctor of primary medicine. Which CPT code would be reported for this visit?

A year of HIPAA breach data highlights the current threats to PHI

05/15/2023

by: Julia Kyles, CPC

Outside attempts to steal protected health information (PHI), such as ransomware attacks, dominate the headlines, but internal mistakes continue to trigger breaches involving at least 500 patients. Any provider who experiences a breach of that size must file a report with HHS that will be posted on the so-called HIPAA “wall of shame,” notify the affected patients, make a public announcement, take steps to mitigate harm to the patients and, often, weather the bad press that follows.

NPPs get hired without licenses, despite exclusion; keep your guard up

05/08/2023

by: Roy Edroso

A no-longer-licensed physician assistant (PA) was hired by a practice and worked as a PA on thousands of cases before being found out, leading to a prison sentence for her and a potential loss of thousands in billings for the practice. The case is a reminder that you have to make sure not only that your clinical workers meet specific licensing requirements, but also that you don’t let them veer out of compliance and put you and your patients at risk.

Proposed HIPAA rule would protect PHI related to reproductive health care

05/08/2023

by: Julia Kyles, CPC

Prepare to update your HIPAA compliance plan. A proposed rule issued by the HHS Office for Civil Rights (OCR) on April 12 would require stronger guards on protected health information (PHI) related to reproductive health care.

OCR seeks public input on reproductive health definition

05/08/2023

by: Julia Kyles, CPC

The HHS Office for Civil Rights (OCR) intends to create a specific definition for reproductive health to clarify the types of protected health information (PHI) that are covered by the proposed update to the privacy rule..

Modifier 25 decision tree can prevent denials, claims errors

05/08/2023

by: Julia Kyles, CPC

Use this decision tree to improve your staff’s accuracy when turning to modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Find expert tips to dodge real-time CPT coding and billing errors

05/08/2023

by: Thea Sinclair

Thea Sinclair, content writer at Medcare MSO, provides a roadmap for avoiding common coding and billing snafus that can lead to revenue loss.

Total ABN modifier use up in 2021, but three of four fell hard

05/08/2023

by: Roy Edroso

Practices’ use of the four modifiers related to advance beneficiary notices of non-coverage (ABN) was steady overall between 2020 and 2021. But gains and losses in 2021 were differently distributed than they had been the previous year, with three modifiers taking a nosedive.

Create a plan to defend modifier 25 claims ahead of new Cigna policy

05/01/2023

by: Julia Kyles, CPC

Your practice should stand firm on compliance and reimbursement when it submits E/M claims with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

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