Whether or not you are aware or not the new HIPAA requirements are on the horizon this week.  The new laws are to enforce privacy options and require a form of “business associate” agreement as the laws are changing to where business associates can now be held responsible in many areas including security breaches.

If you are using an outside 3rd party billing service, these now are affected by the new laws and come under the “business associated” provisions, so perhaps a good idea to check out and do a little housekeeping.   The new laws represent some still penalties.

Seattle, WA, February 14, 2010 –(PR.com)– New HIPAA regulations for Business Associates go into effect February 17, 2010 and most chiropractors qualify as covered entities subject to these new rules. This means chiropractors will have to have a new Business Associate agreement in place to be compliant with the recently changed provisions under the privacy and security rules that impact named covered entities and business associates.

“The first question a chiropractor will ask is: “Am I a covered entity?” Put simply, if you conduct transactions in electronic form, you are a covered entity,” said Strategic Chiropractor CEO, Dr. Tom Necela. A practicing chiropractor, Necela now uses his experience both as a chiropractor, a former Insurance Claims Analyst and Certified Professional Medical Auditor to work with chiropractic practices to improve their business and minimize their audit exposure through better documentation, coding, billing and compliance

To comply with the Business Associate Agreement update chiropractors should:

Make a list of current business associates and vendors
Identify entities with whom the practice shares PHI
Draft new legal agreements for business associates to comply with the new rules
Update HIPAA privacy & security policies

http://www.pr.com/press-release/212790

 Here’s a brief summary of what to expect and which codes to use.  There has been no word yet from commercial carriers on what their position will be with the provisions.  This is something to give some consideration if Medicare is the secondary payer on claims as you may end up with a denial on the Medicare portion due to the change of coding.

1. Consultation codes 99241-99245 (outpatient/office) and 99251-99255 (inpatient) have been eliminated. Tele-health consultation G-codes (G0425-G0427) will not be eliminated.

2. Use codes for new (99201-99205) or established (99211-99215) patients to replace consultations in the office/outpatient setting.

3. Codes in the inpatient hospital setting (99221-99223) should be used to replace inpatient consultation codes (99251-99255), and for nursing facility consultations use codes (99304-99306).

4. To distinguish the difference between the admitting physician of record from the consultants for initial hospital inpatient and nursing facility admissions, Medicare will develop a modifier. Check with your local carrier for more information.

5. Payments for all Evaluation and Management codes have been increased in an attempt to offset the fees lost from the elimination of consultation codes.

The full article can be read at the link below.

 http://ezinearticles.com/?Medicare-Eliminates-Consult-Codes—What-Now?&id=3370768

 One big important change is the use of past billing records, this is being done to help combat fraud and errors.  One other item worth mentioning is the fact they now want legible signatures, which might be a challenge to some.  Durable medical equipment must also be properly documented.

A Medicare initiative to better calculate fee-for-service payment error rates will result in new billing procedures for hospitals. The program also is reporting a much higher error rate than in past years.

The Centers for Medicare and Medicaid services has revamped how it reviews Medicare claims for inpatient hospital services and has eliminated the use of past billing records as part of a complex medical review. The result of heightened scrutiny and a more complete accounting of fee-for-service claims is that Medicare’s 2009 FFS error rate was 7.8%, compared with 3.6% in 2008, according to CMS.
More information is available at https://www.cms.hhs.gov/apps/media/press_releases.asp and https://www.cms.hhs.gov/apps/media/fact_sheets.asp.

http://www.healthdatamanagement.com/news/billing-39385-1.html?ET=healthdatamanagement:e1085:120588a:&st=email

Now that we are in full swing with the H1N1, there is a video on YouTube you can watch and easily reference for some coding guidelines.
The video can be viewed at the link below.
http://www.youtube.com/watch?v=DZz7eAeGmhc
A practice can’t charge for the vaccine, but can charge for administering the shot. V04.81 is the Diganosis code. The video has all the
rest of the information and codes you may need.
The current “Medical Billing Minute” focuses on the coding specifications
required by the Centers for Medicare and Medicaid for billing out the
administration of the H1N1 swine flu vaccine.Although the actual vaccine is not
billable, the video clearly explains what can be billed and what healthcare
professionals can expect to be reimbursed.

The series of free videos to follow the current “Medical Billing Minute” are
designed to inform providers of current medical coding and billing
information.In addition to general medical billing procedures and coding updates
some specific topics to be covered are Red Flag Rules, HIPAA compliance and
auditing, along with other government regulations.
http://www.reuters.com/article/pressRelease/idUS98639+23-Oct-2009+BW20091023