Social media is everywhere—even inside the walls of hospitals. Staff may log into personal accounts during lunch breaks, and many organizations maintain official social media accounts; plus, of course, patients and visitors often rely on social media to keep in touch with friends and family. For many, social media is so much a part of their everyday routine that the benefits are almost too obvious to list. Yet the risks—including potential HIPAA violations—are often not as clear, and privacy and security officers need to stay aware of them.
As OCR's auditors wrap up the final desk audit reports for phase two of the HIPAA audit program, many covered entities (CE) are breathing a little easier. Only 167 CEs were selected for desk audits in July. Audited CEs can expect to wait several months to see the final audit reports, although they will have the opportunity to review a draft version and submit comments that will be attached to the final report.
But phase two is far from over. Business associates (BA) will be selected for desk audits this fall—the first time these entities will be subject to OCR's HIPAA audits. And early next year, OCR will launch comprehensive on-site audits of both CEs and BAs.
One of the topics raising the most questions in case management today is related to the MOON notification requirement. Hospitals were struggling this summer to comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which was signed by President Barack Obama August 6, requiring hospitals to provide a verbal and written notice of outpatient status to any patient in observation who has been in the hospital for more than 24 hours. Just prior to the August 6 implementation date, hospitals received word that the notification requirement would be delayed pending approval of modifications made to the government's notification form.
When CMS decided to postpone the MOON notification requirement a few days before the scheduled implementation date of August 6, it provided a welcome reprieve for many hospital staff members who were scrambling to get ready.
"We were almost ready to go, however, plans are actually now on hold until the final draft is approved, in probably January," says Frantzie Firmin, MS, RN, director, utilization management and care coordination of Brigham & Women's Hospital in Boston.
The hospital's preparations included development of a process to deliver the notification to patients who needed it.
"Our organization, Partners Healthcare System, has decided to address the MOON implementation systemwide. As a result, we set up a case management expert panel, which is a collaborative practice committee that meets regularly to address and develop a plan that will ensure regulatory compliance across the system," she says.
The group worked with the electronic medical system team to develop an automated workflow directly within the system. "Each hospital has its own work queue set up," says Firmin. "The Medicare patients in the work queue are only those in observation status that have been there 12 hours or more."
Care coordinators and insurance support nurses have access to the work queue, which allows them to identify their observation patients. "Furthermore, we have also added functionality in [our electronic system] to document that the notice has been given," she says. Staff members are able to check off the status and date of receipt for each patient, and then the patient's name moves out of the work queue.
The system also allows the insurance support nurse or care coordinator to print the form and provide a copy to the patient before discharge.
Other organizations had taken similar steps.
RWJ Barnabas Health in Toms River, New Jersey, also formed a small task force to ensure compliance with MOON, says Shawna Grossman Kates, MSW, MBA, LSW, CMA, the organization's case and bed management director. But while MOON is new to them, this type of observation notification requirement is not. New Jersey hospitals have already been subject to an even more restrictive patient notification requirement for several years, she says.
In the outpatient setting, we have a different set of rules to follow in regard to the ICD-10-CM Official Guidelines for Coding and Reporting compared to those that follow the guidelines for inpatient care. The ICD-10-CM guidelines for outpatient coding are used by hospitals and providers for coding and reporting hospital-based outpatient services and provider-based office visits.
Billing correctly for observation hours is a challenge for many organizations. Getting it right requires knowing how to calculate observation hours for each patient, which is far from straightforward.
