Category: Business
Network Adequacy Waiver Hearings
TDI will hold virtual public hearings to consider insurers' requests to waive network adequacy standards. Health care providers and consumers can share information for TDI's consideration.
Digital Claim Correspondence for Cigna
Beginning today, registered users with the Claim Search entitlement have access to digital claim correspondence via the Messaging Center on CignaforHCP.com.
Cigna Provider Newsroom
WEBINAR SCHEDULE FOR DIGITAL SOLUTIONS: You’re invited to join interactive, web-based demonstrations of the Cigna for Health Care Professionals website (CignaforHCP.com). Learn how to navigate the site and perform time-saving […] Read more >
CLINICAL, REIMBURSEMENT, AND ADMINISTRATIVE POLICY UPDATES: To support access to quality, cost-effective care for your patients with a medical plan administered by Cigna Healthcare, we routinely review clinical, reimbursement, and administrative […] Read more >
COORDINATION OF CARE: Coordination of care is the process by which a patient’s team of providers cooperatively help coordinate care management and ensure access to quality, cost-effective care. […] Read more >
New Option to Report Violations of the Emergency Medical Treatment and Labor Act
“Health and Human Services (HHS) is committed to protecting access to emergency medical care for everyone in America.”
“We will continue to uphold the law and the right to emergency care, to inform people of their rights under EMTALA, and to make it easier for someone denied care to file a complaint.”
For more information, please visit: https://www.cms.gov/priorities/your-patient-rights/emergency-room-rights.
UHC Responsible for Breach Notifications
The Health and Human Services (HHS) Department announced Friday (May 31, 2024), United HealthCare must take responsibility for informing people about privacy breaches resulting for the the Change Healthcare cyberattack.
UnitedHealth Group previously disclosed that the ransomware attack exposed personal information of a “substantial portion” of Americans.
That “substantial portion” turns out to be 1 in 3 Americans.
“OCR must affirm its position that the breach was perpetrated upon Change Healthcare, whose status as a healthcare clearinghouse makes them a covered entity under HIPAA and thus responsible for the breach of any [protected health information] which it processes or facilitates the processing of,”
Under HIPAA, UnitedHealth Group must provide affected individuals with descriptions of the incident, what data were compromised, how the company responded to the attack, how the company can be reached and what individuals can do to protect themselves.
Congratulations are in Order
POET and all it’s staff are very proud of our Credentialing Coordinator, Kelly Scroggins.
Kelly’s hard work, study, and perseverance has helped her achieve an outstanding goal in her skills and knowledge as a medical service professional. Kelly now holds certification from The National Association Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS).
There are only a little over 500 Certified Provider Credentialing Specialist in the state of Texas.
Virtual Vigilance
“The Change outage was disruptive to the business of my practice, but most importantly it was disruptive to my patients,” Dr. Bruggeman testified. “Every minute my staff spent trying to reconcile [electronic remittance advice] with received payments, assessing which patients received incorrect bills, [and] resubmitting prior authorizations is time taken away from patient care.”
Robust Cybersecurity Can Safeguard Practices
By Alisa Pierce Texas Medicine June 2024
Data held hostage
. . . cautions that ransomware attacks can be delivered via multiple platforms, such as in email attachments or links within an email. Malicious attachments can include documents, zip files, and executable applications, and suspicious email links can bring users directly to websites that are used to place malware on a system.
Similarly, “phishing” email scams can give hackers access to internal business systems that could reveal confidential information like credit card numbers, personal identity data, and passwords. Often these emails appear to come from real companies or trusted individuals.
From there, hackers steal electronic patient data, even encrypted information; block the practice from accessing it; and demand a ransom for its return, much like “a hostage situation,” according to Shannon Vogel, TMA’s associate vice president of health information technology.
If that data aren’t backed up, practices don’t have much leeway. At that point, they can either hope the data can be retrieved by law enforcement or move forward without patient records.
“It’s vital that practices talk to their [electronic health record] and other vendors about redundant systems so that all is not lost,” Ms. Vogel said. “Otherwise, it would be like starting from scratch.”
Cigna and Zelis
If you have accidently signed up to receive virtual credit card (VCC) payments, and would like to change back to Automated Clearinghouse (ACH), please call Zelis.
Zelis Customer Service:(877) 828-8770
If you have questions regarding claim payments, please contact Cigna Healthcare Provider Service Line (800) 882-4462.
UHC Notably Absent from Congressional Hearing
Quotes from Texas Medicine 4/19/2024, Emma Freer Article
“The attack has exposed the vulnerability in our health care system and the disproportionate burden placed on physician practices by insurers, government payers, and third-party vendors,” Dr. Bruggeman told lawmakers.
“The Change outage was disruptive to the business of my practice, but most importantly it was disruptive to my patients,” he said. “Every minute my staff spent trying to reconcile [electronic remittance advice] with received payments, assessing which patients received incorrect bills, [and] resubmitting prior authorizations is time taken away from patient care.”
“To add insult to injury, some of these practices were purchased by Optum during the crisis,” he said. “There were even reports of Optum using the financial emergency caused by the cyberattack on its own subsidiary as legal justification to expedite its acquisition of physician practices.”
In the meantime, Dr. Bruggeman called on Congress to pass legislation that would insulate physician practices from industry consolidation and other existential threats.
“Allowing physicians to practice in the setting that is best for them, their patients, and the broader community should be the hallmark of our United States health care system,” he said. “Instead, the increase in administrative burden, including the new threat of potential cyberattacks, makes such events catastrophic for many providers.”
For the full very interesting article: https://www.texmed.org/TexasMedicineDetail.aspx?id=64062&utm_campaign=TMT&utm_medium=email&_hsenc=p2ANqtz-9E4jpFAqBr1fYThi6pjc3ECIrkJtF4-urerPcLF78JmZ4BixUPkxoA-ngiRvbPx06ORd5U2bsbiOEFK-CaqUP6-URb8jMZ6SEHyZL-aPXwfFmCQ9w&_hsmi=303492305&utm_content=303492305&utm_source=hs_email
POET Emergency Number
Here of late, POET has experienced our phone lines going down, more often than usual.
We do not like this one little bit. We always want to be there when you need us.
We have set up an emergency line, separate from our regular phone service.
If ever you call and can not get through, please keep this emergency number handy.
1-888-803-3871
We are sorry for any inconvenience this may have caused.
Recent Comments