HIM/HIPAA

Effective privacy and information security programs start with attention to governance. These eight guidelines will help establish and measure privacy and information security structure and processes.

There is an extensive list of coverage requirements that must be met to furnish outpatient ser­vices to Medicare beneficiaries. Hospitals may find that certain coverage requirements for therapeutic and diagnostic service are more difficult to meet than others, especially in off-campus provider-based departments.

Q: Are county entities such as county counsel, public defenders, patient rights advocates, the courts, correctional facilities, and law enforcement required to comply with HIPAA?

Two misdirected faxes cost a New York City hospital $387,200 in a HIPAA settlement.

Traditionally, the OPPS rulemaking cycle has been the main vehicle for changes to outpatient coding and billing regulations and policy that hospitals need to pay attention to. But increasingly, CMS has been introducing or discussing changes relevant to outpatient hospitals beyond the scope of the OPPS rules. 

It is an unfortunate reality that mood-altering chemical misuse and dependency is rampant throughout the world, especially in the United States.

Kidney disease is a challenging component to inpatient and outpatient care, incurring significant costs and negative outcomes. CMS and other agencies that measure our quality and cost efficiency use ICD-10-CM codes based on provider documentation and billing to ascertain that a patient has a designated kidney anatomic or functional illness in their risk-adjustment methodologies.

This month's Q&A answers our readers' HIPAA questions on returning insurance cards, making appointments for family members, and email encryption.

When it comes to dealing with Medicare Recovery Auditors (RACs), there is never a dull moment for HIM professionals. Any shift in the RAC program quickly emerges as front-page news for HIM leaders.

Reimbursement for provider-based departments (PBD) can be complex, and regulations affecting it have changed frequently over the past year. Section 603 of the Bipartisan Budget Act of 2015, the 2017 outpatient prospective payment system (OPPS) final rule, and the 21st Century Cures Act changed the payment methodology and made multiple adjustments to the definition of excepted (on-campus or grandfathered off-campus) and non-excepted (off-campus) PBDs. Hospitals must know the regulations inside and out and understand how they apply to their PBDs and to avoid denials or noncompliance.