Q: I’m working with our contracting staff to negotiate with a new payer. Is there any potentially problematic contract language I should take under further review?
A proposed rule that would expand the use of prior authorization and step therapy for Part D and Medicare Advantage beneficiaries has earned criticism from patient advocacy groups and praise from pharmacy groups.
Q: I am an acupuncturist and have a patient who owes me $100. I contacted the patient about the missing payment but received no response. Would it be a HIPAA violation to get in touch with the patient’s emergency contact person about the missing payment? Or should I go to a debt collector?
HHS Office for Civil Rights has issued a request for information seeking input from the public on how the HIPAA Privacy Rule could be modified to meet HHS’s goal of promoting coordinated, value-based care.
Q: Can an ICD-10-CM body mass index (BMI) code be used as a standalone code? If not, what documentation should we look for to justify the use of a BMI code?
Q: I am still not sure whether I need RNs or social workers or both as case managers. Is there any evidence to help me make a decision? I want everyone to be effective, work together well, and be respected as a service.
A recent study in the Journal of the American Medical Informatics Association found that using population health data could help identify patients with a high risk of developing cardiovascular disease who have not been previously identified as high risk due to lack of relevant cholesterol data.
Q: If a patient participating in a clinical trial is allergic to one of the drugs used in the trial, how do we report the drug that is used as a substitute?
On December 4, CMS released additional FAQs regarding the 2019 IPPS final rule requirement that hospitals post a list of their standard charges on the internet.
Pagosa Springs Medical Center (PSMC) in Pagosa Springs, Colorado, has agreed to pay $111,400 to the Office for Civil Rights (OCR) and to adopt a substantial corrective action plan in a settlement over alleged HIPAA violations.
Advanced Care Hospitalists PL in Lakeland, Florida, has agreed to pay $500,000 and undergo a corrective action plan in a settlement with the HHS Office for Civil Rights (OCR) for its alleged violations of HIPAA’s Privacy and Security Rules.
Baylor Scott & White Medical Center-Frisco, in Frisco, Texas, announced a data breach earlier this month affecting 47,000 patients and guarantors. The breach occurred in September when the hospital found an issue with a third-party vendor’s credit card processing system.
Q: Sometimes the emergency department where I work gets so busy we have to evaluate patients before they can be placed in a room. I have seen nurses perform examinations on patients on stretchers in hallways where they can easily be overheard discussing medical histories and treatment options. Would this be considered a HIPAA violation?
Q: My hospital's marketing team is becoming ambitious on social media lately. They like images, of course. What should we know about posting images of patients in social circles as it relates to HIPAA?
Hospitals are allowed to publish a list of charges that contains UB-04 revenue codes when complying with 2019 IPPS final rule requirements requiring the publication of standard charges, the American Hospital Association (AHA) said in a regulatory advisory bulletin
Q: As a case manager, I know about motivational interviewing, especially for patients with mental health or substance abuse disorder, but a colleague recently mentioned the “ask me 3” technique to me. Is it similar to motivational interviewing?
Geisinger Health System’s ProvenRecovery program, a population health initiative to combat opioid use after surgery, reduced the length hospital stays, saved $1.5 million, and contributed to an 18% reduction in opioid use across the organization since its pilot launched in June 2017.
