Category: Business
Can Your Employee Handbook Get You In Trouble?
Many healthcare businesses have an employee handbook, but fail to update them on a regular basis.
There have been a large number of changes to employment law, over the past couple of years.
Have Questions About Capturing Telehealth Visits?
Teleheath appears to become increasingly complex on a daily basis.
The following is a list of guidelines provided by MGMA:
Click on the title to follow the link.
Digital Precertification on CignaforHCP.com
- Beginning July 18, 2024, registered users with the Precertification – View and Submit entitlement have access to digital precertification correspondence via the Messaging Center on CignaforHCP.com.
- Digital correspondence notifies users when precertification letters are available, or when action is required to continue processing.
- Designate the following communication preferences by logging into CignaforHCP.com > Settings and Preferences > Communication Settings:
- The type of correspondence you want to receive (e.g., emails and/or alerts) when digital correspondence is available.
- Email notifications and frequency to alert you when new digital correspondence is available.
UHC Major Data Breach
Just four months after the Change Cyberhack, UnitedHealth Care is hit again.
Community Health Centers (CHC), has disclosed a major data breach. CHC has revealed that a “substantial quantity of data” was stolen, impacting a “substantial proportion of people in America.” UnitedHealth’s CEO Andrew Witty estimated one-third of all Americans have been affected by the breach. That is over 111 million people.
“While CHC cannot confirm exactly what data has been affected for each impacted individual, information involved may have included contact information (such as first and last name, address, date of birth, phone number and email.
This means that millions of individuals could be at risk of identity theft and other forms of fraud.
Cigna Denies Claims without Z-Code
Starting July 14th
Cigna Healthcare will deny certain claims that are billed with a Z-code and without documentation. A move that could add to your administrative burden.
Cigna will deny claims when practices bill certain evaluation and management (E/M) codes (99202-99215) with a preventive service code and a supporting Z diagnosis code – but not supplemental medical record documentation.
Physicians will need to refer to multiple policies by the payer to utilize both preventive services and problem-oriented E/M services for new and established patients on the same date of service, which Texas Medical Association billing and code experts caution could add to practices’ workload. Moreover, these services will not be payable by Cigna when billed with a Z diagnosis code alone.
TMA experts recommend including supporting medical record documentation with the diagnosis code for the problem E/M claim to identify why a preventive service – like dietary counseling, for example – was performed.
Physicians can also check Cigna’s preventive services policy for examples of Z codes or refer to Cigna’s E/M Reimbursement Policy for more payment information from the payer.
UHC Network News July 1, 2024
Take Note: Quarterly CPT and HCPCS Code Updates
Effective Jul. 1, 2024, all applicable Medical Policies and Medical Benefit Drug Policies have been updated to reflect the quarterly Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code additions, revisions, and deletions. Refer to the following sources for information on the code updates:
FBI and HHS release Joint Cybersecurity Advisory
The Federal Bureau of Investigation (FBI) and the U.S. Department of Health and Human Services (HHS) have issued a joint cybersecurity advisory (CSA) to share known indicators of compromise (IOCs) and tactics, techniques, and procedures (TTPs) associated with a social engineering campaign. The campaign focuses on healthcare, public health entities, and providers, recognizing healthcare organizations as prime targets for hackers due to their large scale, reliance on technology, access to personal health information, and the significant consequences of disruptions in patient care.. ~Ann Ribeiro, Industrial Cyber News Editor
Physicians Can Delegate Breach Notifications to Change Healthcare
However, this delegation is only allowable if Change Healthcare or UHC are business associates of the covered entity. OCR made clear that the ultimate responsibility for ensuring such notifications occur remains with the covered entity, meaning physicians may still need to provide breach notifications under those circumstances.
FTC Mandates Vendors Notify Patients of Breaches
The Federal Trade Commission (FTC) has amended its Health Breach Notification Rule to require vendors of personal health records (PHR) and related entities not covered by HIPAA to notify individuals, the FTC, and, at times, the media, when a breach in protected health information (PHI) occurs. The change will take effect July 29.
Physicians do not have to notify patients if their PHI is leaked via a PHR vendor that is not a business associate of the physician. That responsibility falls to the vendors themselves.
Smart Edits are Going Away
Smart Edits were introduced in July of 2023 to analyze claim data and will be removed effective June 28th. No action is needed. The removal of these edits will not impact your electronic billing routine. The typical workday using electronic billing will remain the same.
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