Q: Our clinical trial claims often hit edits for missing drugs or devices when those are supplied by the trial sponsor and we can't bill for them. We've been manually reviewing these edits. Is there a recommended method for handling these types of edits that's more efficient?
It can be impractical for medical researchers to seek authorization from all the patients whose medical records are sought for a study. That’s why HIPAA allows researchers to use de-identified PHI from records without individual authorization.
Commercial and government payers track chronic conditions using Hierarchical Condition Category (HCC), and providers can track HCCs to better monitor and project reimbursement and compliance.
Hospitals are doing a better job at protecting patients from safety problems leading to deaths from accidents, infections, injuries, and medical errors, but there is still much room for improvement, according to the most recent Leapfrog Hospital Safety Grade report.
Q: We have a patient who received a pancreas transplant for the treatment of diabetes. The patient was later admitted to the hospital for treatment of an unrelated kidney stone. Would I still need to assign the ICD-10-CM code for diabetes as a chronic condition based on the patient’s medical history?
Q: I work for a behavioral health recovery center, and many of our programs fall under 42 CFR Part 2, as we provide substance use services. Sometimes a referring agency follows up to ask if a client has scheduled an appointment. Can we confirm that a patient has made an appointment? Do referral appointments like this fall under PHI?
