The Republican staff of the Senate investigations subcommittee recently reported that HHS failed to act on clear warning signs that the co-op health insurance plans created under the Affordable Care Act were failing. The subcommittee said that the HHS ignored the warnings signs and continued to give loans to the unstable programs. More than half of the co-op plans under the ACA have failed so far and the remaining plans are facing serious financial problems. See the full article from Modern Healthcare below: Published by: Modern Healthcare: Shannon Muchmore, March 10, 2016 Republican report says HHS ignored warning signs of co-op…
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When talking to family about Patient Care, can I report an E/M code that includes that time in the visit?
The answer to this question is YES. The E/M CPT’s are defined as “face-to-face time spent with the patient and/or family”. Because of this verbiage, the Physician can bill for time spent with a patient’s family member discussing the patient’s treatment, condition(s), and plan of care. Medicare makes this a bit more complicated. Read the full article from SuperCoder.com below: Published by: The Coding Institute: SuperCoder.com February 29, 2016 As long as the patient is present, CMS allows you to bill an E/M code based on time. It happens frequently in Part B practices—a patient presents with her family members, who…
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ACA EXCHANGE WARNING SOUNDED OFF BY AETNA
Every fall, ACA Exchange consumers have the opportunity to buy coverage for the following year. Aetna, and other major health insurers are struggling with consumers who sign up outside of the ACA’s annual enrollment window. What problems are the insurance companies facing as a result? Modern Healthcare Article Published by: Modern Healthcare: Associated Press: February 1, 2016
Medicare FFS Sequestration Payment Reductions Continue
In an article from Palmetto GBA on February 25, 2016, they announced that Medicare FFS sequestration payment reductions of 2% “Continue until further notice”. This shouldn’t come as a surprise to Providers that have been hit with these payment reductions since 2013. To read the full publication, click on this link: Sequestration Article Article published by: Palmetto GBA: February 25, 2016
What Can a Failed IRS Audit Do to Your Practice?
There are two reasons why the IRS might choose to audit your business. Either you have been randomly selected for this joyous experience or you’ve managed to raise some red flags. Unfortunately, even reputable medical practices that are on the up and up could end up failing an IRS audit. Not only is business taxation incredibly complicated and mistakes prevalent, but most business owners don’t have the faintest idea how to prepare for an audit. It’s imperative that you keep neat, meticulous records documenting all income and expenses, that you’re careful to keep write-offs legitimate, and that you seek the…
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Commentary on ACA Exchanges: Are they Unraveling?
In November of 2015, UnitedHealth Group, Aetna, Anthem, and Humana reported larger than expected financial losses on ACA exchanges. Some of these insurance companies believe “the ACA is unraveling”. Click on the following link to read a commentary published in Modern Healthcare by Paul von Ebers that addresses this topic. Link to Commentary Published by: Modern Healthcare: February 11, 2016
PATIENT FIRST STOPS ACCEPTING NEW ANTHEM PATIENTS
Patient First, one of Virginia’s largest providers of primary and urgent health care, announced that effective Feb. 2, they have stopped accepting new Anthem patients. This also includes patients with Anthem’s Medicaid plan, Healthkeepers Plus. According to the full article printed on the WTVR.com website, this decision was made based on Anthems continued reduction in reimbursements. Click to read full article. Article by: Capital News Service: Published at WTVR.com, February 10, 2015
Hard work outs might not shed weight? Studies show this may not be true.
In a Medscape article by Peter Russell, he explains that although exercise is important for keeping our bodies and minds healthy, it may not be the main “tool” we should use for keeping our weight in check. See the full article below: Published by: Medscape: by Peter Russell, January 29, 2016: New research casts doubt on the commonly held belief that taking more exercise always helps you lose weight. A study in the journal Current Biology suggests that if you jog for longer or work up a bigger sweat at the gym, your body will adapt to the higher activity level and…
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MEDICARE OVERPAYMENTS: CONTROVERSIAL RULE FINALIZED
According to a Modern Healthcare article published on February 11, 2016, CMS finalized a controversial rule regarding the return of Medicare overpayments. The Affordable Care Act requires providers to return overpayments within 60 days of identifying the overpayment. A previous ruling held Providers liable for returning payments going back 10 years. The new ruling changed this liability to 6 years. Read Article Published by: Modern Healthcare: By Virgil Dickson: February 11, 2016
HIPAA QUIZ : ANSWERS TO THIS MONTH’S NEWSLETTER
(ANSWERS BOLD-UNDERLINED BELOW) 1.) The minimum fine for a minor HIPAA violation is $100; the maximum fine for a serious HIPAA violation is $50,000. What is the maximum of total violation fines per year? (a) $500,000 (b) $750,000 (c) $1,500,000 (d) $2,500,000 2.) The Privacy Rule requires an “Authorization” form to be completed for: (a) use and disclosure of PHI for specified purposes other than treatment, payment, or health care operations. (b) use and disclosure of PHI for research purposes. (c) disclosure to a third party specified by the individual. (d) all of the above 3.) For PHI disclosures where there is personal gain…
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