7 Recommendations to Avoid Audits

On Part II of HIPAA Risks Webinar by Liles and Parker, Atty's at law presented by AMBA, they offered some practical tips to avoid being audited and fined. Not many can afford the steep fines that are assessed by being found guilty of an offense because of carelessness or fraud!





7 recommended  Questions to ask yourself.




1.  Does the claim meet the Medical Necessity requirement for payment? This is the most important question to ask before submitting the claim. If it is not medically necessary to perform the procedure and if it does not meet this criteria, the claim will be denied. 

2.  Did you provide the service?  In order for you to get paid for what you did, you have to be the one to do the service.  The nurse practitioner cannot perform the service and you get the credit for it. If there is an audit, this can be a serious offense.

3.  Coverage Requirement  If you do not know what is covered, look it up in your contract. The service you provide could be medically necessary, but if it is not covered, you will not get paid. That is a waste of your time and resources, neither of which you can afford to squander away on uncovered services. Coverages will invariably differ from carrier to carrier. Make sure you and your staff know what is covered and what isn't. 

4.  Documentation  Know what documentation is required for which carrier. This can be another area in which  insurance carriers will quickly deny claims. Properly document!

5.  Proper coding Was it coded to the highest degree of specificity?  Was it the correct code for the procedure?  Were the modifiers correct? All of these coding issues can cause claim denials...which  can mean a decrease in your income if it continues regularly.

6.  Was it billed properly?   Was it bundled when it should not have been? 

7.  Was the claim legible?  Legibility is key!   Handwriting must be legible or claims will be denied.  If a carrier cannot quickly read the claim, it will be denied. If there is an error on a record, the best way to correct it is to draw a single line through the erroneous word(s) and put the correct word above it. Date and initial your changes. Do not try to make changes on someone else't entry.  That is a red flag for fraud alert!

If there is a pattern of incorrect claims submissions, audits are more likely to happen. This could lead to the loss of your practice, bankruptcy, or other disastrous effects.

Be Audit Free! Submit claims properly by using these recommendations.
Attorneys recommended the tips, after all.

Thanks for reading.

Donna McHugh, CMRS

7 Practical Ways to Avoid a HIPAA Breach

Because I am a certified medical reimbursement specialist, I must do 15 CEU hours every year in order to maintain  my certification with AMBA. Some of the CEU's that I am doing are on the subject of HIPAA Compliance and how serious it is to maintain it. In the webinar by Liles and Parker Law Offices, there were a number of warnings that I had not even thought about. Maybe you haven't, either.  I would like to pass along some insights that I learned.

One warning that was given is to have a compliance plan in place and make sure that you and your staff follow it. Because of the changes and the effects of the economy on states and federal programs, they are looking for an income source to fill in those gaps that were left by cuts in their budgets. Breaches are easier than before and may be considered fraud, so we all must be careful!

 Whistle-blowing is encouraged and is being paid handsomely from huge fines that are being meted out for non-compliance. This headline from today's post from AMBA says:

2012 Record Year for qui tam (whistle-blower) suits. $2.5 billion recovered of $3 billion total in fraud recoveries. 

                                                                  That is a lot of money!!!

As technology advances, there are a lot of ways to make our live easier, but technology does pose problems for security of personal information that must be protected.  It is much easier to commit a breach, sometimes unknowingly. One of the biggest areas of concern with HIPAA is protection of personal medical data.

Here are a few practical tips that I learned from the webinar.

1.  Don't store patient information on laptops. They can be stolen easily and a lot of

     information  compromised. If you do put information on a laptop, password and encrypt the 

     information. Even if the laptop is not stolen and you are very careful, you can still be 

     considered non-compliant and charged with huge fines if the information leak is traced back 

     to your computer.

2.  Do not use flash drives unless they are encrypted. Even then, they are easily lost, 

     slipped in a pocket or briefcase, and the information is gone!

3. Do not allow shredding companies to shred your documents  unless you 

    are present to make sure they are shredded properly and not just tossed into the landfill, 

    thereby unintentionally allowing access to information.  Your office can be fined for the 

    actions of a careless third party . 

4. Cellphone usage in the office should be limited. Nowadays, with the use of cameras on 

    cellphones, information can be quickly compromised and data sent over the web in a matter 

    of seconds. Be careful who has access to your records. Make sure the person is trustworthy. 

    You cannot be too careful with information.

5, Have a plan in place for social networking. ie. Facebook, LinkedIn,etc. Although they are 

    wonderful  communication and advertising tools, here is some advice concerning them.

                           a.  Never friend patients on Facebook. That is a breach of their privacy and

                                patient-doctor confidentiality.

                            b. Don't let patients "like" you on Facebook.

                            c. Never talk about your patients on the social network sites.

 6. Copy machines have hard drives in them and they store the information which is 

     scanned. Make sure to turn off those settings so that it does not save your information when 

      you scan them on the copier.

7.  Completely erase old phones and destroy. Do not recycle. There are ways to restore 

     data on phones...and if the phone is traced back to you, your messages, although deleted, 

     may be used in a breach case. The best way is to totally destroy the phone so that there is 

     no way that the information can be restored or retrieved. 

There is so much more that could be shared on this subject, however this is only the tip of the iceberg. We as healthcare workers have to be so diligent to protect information. The more you educate yourself, the better  your chances are of staying away from non-compliance problems.

Protect yourself from a fine or lawsuit. Be informed. Know the laws and comply.

Thanks for reading.

Donna McHugh, CMRS