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.
Regulatory compliance reforms have forced CMS to set the bar high for meeting evaluation and management (E/M) standards. This is especially true for clinical documentation improvement (CDI) performance for coding and billing level four and five patient visits in outpatient settings.
Overcoming barriers to care for LGBT individuals can require a culture shift at an organization, but it can be as simple as adding additional options to forms. It’s up to organizations to close the gap, and HIM plays a central role in identifying barriers, implementing change, and fostering a culturally competent environment.
Q: The parents of a child at our pediatric clinic are divorced and the child is a beneficiary of one parent’s insurance. That parent wishes to restrict information the other has access to. However, because the parents have joint custody, the child may be brought in by either parent. Is there anything in HIPAA that could support denying the request or that would require us to comply?
An authorization generally applies when an organization wishes to use or disclose a patient’s protected health information for a purpose other than treatment, payment, or healthcare operations, or for legally required purposes. In this case, a patient must sign a HIPAA-compliant authorization form that specifically grants permission to the organization.
The use of electronic health records (EHR) should be guided by ethical principles that put patient care at the forefront, according to a position paper published by the American College of Physicians (ACP). EHRs can be an asset in delivery quality care, but may have unintended ethical consequences, the ACP said in a March 21 statement.
Q: Can we ask patients to submit a signed document stating who their personal representative(s) is/are? Can a patient have more than one personal representative?
The 2017 calendar year marks the beginning of a new approach to physician payment through the Quality Payment Program (QPP), an initiative created by the Medicare Access and CHIP Reauthorization Act to revise the physician payment system previously updated through the Sustainable Growth Rate.
The Office for Civil Rights (OCR) is planning to implement a regulation that would share HIPAA settlements and monetary penalties with individuals affected by breaches.
