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"We have attained the peace of mind that comes with knowing that our operations comply with
national standards, and that our services are compensated accordingly. BSA Healthcare
is a must for longstanding and newer practices that want to maximize their revenue with the reassurance
of complying with federal guidelines."
Jorge Lopez, MD, FACEP
Florida Emergency Physicians
Maitland, FL
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ComplianceThe adherence to government rules and regulations particular to
the reporting and documentation of services provided by health care professionals is
known as compliance. The Centers for Medicare and Medicaid Services (CMS), the federal
agency that creates these rules and directs the Medicare program, has estimated that
billions of dollars annually are wasted due to fraudulent billings. Medicare believes
these lost funds are related to incorrect billing and coding practices. To decrease
the amount of non-compliant billing and coding practices, the Office of Inspector
General (OIG) has developed compliance plans for both billing operations and physician
practices.
To assure continued adherence to these regulations, BSA Healthcare can assist
you in the creation of compliance plans specific to your practice, or we can review an existing
plan for completeness. Creation of a new plan is accomplished primarily by on-site visits with
your physician group, selected leadership, and billing and coding vendors. We address common
OIG areas of investigation with special emphasis on the most prevalent compliance pitfalls including:
- Physician at teaching hospitals (PATH) audits
- Physician extenders, including physician assistants and nurse practitioners
- Documentation guidelines
- Independent contractor status
- Improper upcoding and unbundling of codes
- Credentialing issues
- Duplicate claims
- Poor coding and billing educational programs and quality assurance methodologies
Compliance Plan Development
Much of the compliance plan is created on-site and focuses on:
- Formation of a Compliance Committee, and construction of the committee's responsibilities
- Creation of a compliance educational program for coders that addresses proper billing procedures
- Implementation of a plan focused to meet the requirements of any entity, whether a hospital or a proprietary billing firm, that does physician coding and/or billing
- Development of an effective communication process that protects the employee who reports an aberrant activity
- Establishment of a discipline program that can lead to termination for those employees who continue to perform non-compliant activities
- Creation of a reporting mechanism for compliance errors to appropriate federal and state organizations
Once completed, the compliance plan integrates the physician group with its billing and coding entity. After
the plan has been implemented, we will continue to update areas of the plan that become obsolete or require
revisions due to new billing and coding rules promulgated by state and federal agencies.
Compliance Plan Templates
BSA Healthcare is currently developing standard compliance plans in template form to be
completed by select leaders of the physician group, or the billing and coding vendor. The compliance plan
templates currently under development include:
- Physician groups
- Physician group billing and coding divisions
- Private billing vendors
- Private coding vendors
- Hospitals performing billing and coding in-house
- Hospitals performing billing in-house
HIPAA Questions & Answers
About This Service
HIPAA has probably changed your practice and you may already be implementing changes to
comply with the Health Insurance Portability and Accountability Act (HIPAA). If so, then
you probably know that the act includes three areas of significant concern: the first,
commonly referred to as the Administrative Simplification Rules, second the Privacy Rule,
and third the recently finalized Security Rules. The Administrative Simplification Rules
created a single standard for electronic data interchange and data sets for forms such as
the 1500 claim. The Privacy and Security Rules require providers to implement protections
when using or disclosing individually identifiable health information. Given these new
requirements you probably have many questions regarding HIPAA and its affect on your
organization.
In order to assist our clients in finding the answers they need, BSA Healthcare is
introducing a new HIPAA Q & A service. Simply, send us your questions via email to bsainfo@bsanda.com,
and receive a general answer and, if you would like, an estimate of fees to develop a specific policy,
procedure, or guideline related to your chosen issue of concern. Our compliance experts include
Certified Compliance Professionals who are available to provide you with in-depth answers to your
most difficult compliance questions regarding issues from coding compliance to HIPAA Privacy.
BSA Healthcare can answer your questions regarding:
- HIPAA training issues
- Privacy Notices
- Basic Compliance Plan design
- Ideas to mitigate damages given a hypothetical HIPAA violation
- Basic Privacy Policies for the Medical Billing Office
- The development of coding and documentation policies for specific issues where the industry guidelines are ambiguous, unclear, or non-existent
About HIPAA
What is HIPAA? HIPAA (Health Insurance Portability and Accountability Act) is a set of federal regulations
intended to protect and simplify the exchange of health care data. Compliance with HIPAA requires that covered
health care companies understand the threats and liabilities to protected health information and that they
implement a wide variety of safeguards and security practices.
Who is Affected? HIPAA affects every company that transmits protected health information in electronic
form, which includes health care providers, health plans and health care clearinghouses. These organizations
are referred to as covered entities.
What is Covered? Patients' medical records and other personal health care information known as electronic
protected health information are covered under HIPAA.
BSA Healthcare Services
EMERGENCY MEDICINE & PHYSICIAN SPECIALTY SERVICES
| HOSPITAL SERVICES
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