HIPAA compliance, with its many strict regulatory requirements, is a daunting task for any health professional or facility to manage. Proposed by the Department of Health and Human Services (HHS) and enacted by Congress in 1996, the Health Insurance Portability and Accountability Act or HIPAA sets the standard in the health-care industry for the handling of patient health information (PHI). It applies not only to health-care professionals such as doctors, nurses, pharmacists, dentists, medical technicians, and other providers of health-care services, but to administrative staff and any third parties that come into contact with PHI. Designed to protect patient privacy, those who do not adhere to HIPAA standards for storing, sharing, and using patient information risk serious legal consequences. Continue reading
With health-care tides shifting and a renewed focus on managed care, Americans have a choice when it comes to choosing a health insurance plan. The following is a review of managed-care basics.
Managed care is a general term describing methods that aim to reduce the cost of providing health benefits while improving quality of care. Although the nature of different managed-care delivery systems varies, the goals of managed-care organizations (MCOs) are largely the same. Some of the techniques designed to reduce health-care expenses include: incentives for patients and doctors to select less costly means of care; more cost sharing; controls on hospital admissions and lengths of stay; assessment of medical services and their necessity; ability to choose health-care providers, and more. Continue reading
Hospital risk management is a tricky business, whether the facility is preparing for a Medicare audit, working to comply with laws passed by the National Institutes of Health (NIH), being investigated for overpayments by a program safeguard contractor (PSC), or conducting its own yearly internal assessment. In fact, hospitals are scrutinized by numerous regulatory boards and must adhere to a seemingly endless barrage of protocols and rules. Some of the other bodies responsible for laws in hospital settings include Congress, the Food and Drug Administration (FDA), the Centers for Medicare and Medicaid Services (CMS), and more. Continue reading
In an era where electronic health records (EHRs) and value-based treatment are at the core of the health-care system, meticulous documentation and big data management are fundamental to patient care and to physician reimbursement. Yet while EHRs have greatly contributed to patient demand for improved coordinated care and have enhanced the exchange of clinical information, digitized records still fall short of the mark, according to health-care professionals.
At issue are the large chunks of “unstructured data” in electronic health records and the difficulty of extracting what is important from amidst the “text blob,” as it is referred to in the industry. This means the most valuable or pertinent information—that which may improve patient care or which may be essential to make an informed clinical decision—is often buried in copious amounts of text. Moreover, medical statistics indicate that up to 80 percent of clinical documentation is unstructured. Continue reading
Signed into effect on March 23, 2010, the Affordable Care Act (ACA) (aka “Obamacare”) is the first significant health-care reform plan since 1965. The legislation aims to make health care more affordable for Americans through regulations for the insurance industry as well as federal subsidies for needy families and individuals.
Key Points of the Affordable Care Act
An attempt to provide American citizens with an affordable health-care plan, the main points of the ACA are: Continue reading
On March 23, 2010, President Obama signed the Affordable Care Act (ACA). Introducing sweeping health-insurance reforms, the law intends to put consumers back in charge of their health care. According to the US Department of Health and Human Services (HSS): “The Affordable Care Act is working to make health care more affordable, accessible and of a higher quality, for families, seniors, businesses, and taxpayers alike. This includes previously uninsured Americans, and Americans who had insurance that didn’t provide them adequate coverage and security.”
With thirty states already expanding Medicaid under the Affordable Care Act, some of the law’s goals and benefits include: Continue reading
Medical billing is more complex than ever, with health-care organizations facing constant updates in compliance and coding regulations, big data management, increased administrative tasks, and a change from fee-for-service to value-based reimbursement. To reduce costs, get paid faster, eliminate payer denials, and improve revenue management, a growing number of hospitals and doctors are outsourcing medical billing, allowing them to focus on practicing medicine instead of administrative operations.
Although the efficiency of a medical practice’s billing operation has become pivotal for reimbursement, most physicians are trained to treat patients, not to run a business or be the gatekeepers of a financial system. With these topics not covered in medical school, many health-care providers who are not proficient at revenue cycle management (RCM) are discovering the benefits of outsourcing these labor-intensive tasks to an outside medical billing service. Continue reading