HITECH Act Explained

HITECH Act Explained

HITECT Act was created aside from the pre-existing HIPAA laws to strictly implement the patients’ security of information. Nitin Chhoda explains the difference between the two, and how they are connected to each other.

HITECH act explainedHITECH Act Protections for Patients

HITECH Act or the Health Information Technology for Economic and Clinical Health Act expands on the already existing HIPAA regulations protecting patient health information.

The result is that healthcare practice management providers must take certain steps when privacy issues arise.

If sensitive and personal health information has been stolen or possibly viewed, HIPAA covered hospitals or medical facilities must notify their patients within 60 days.

Within the HITECH Act, the term breach is used to mean

“unauthorized acquisition, access, use or disclosure of protected health information which compromises the security or privacy of such information, except where an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information.”

A breach of patient health information not only requires the medical clinic to report to the patients, but also to a major media outlet and to the Secretary of the Dept of Health and Human Services.

The HITECH Act even outlines what must be included in the notice, including the date of the breach as well as the date of discovery of the breach along with a description of what happened. Other information that must be included:

  • Steps that patients can take to avoid potential harm.
  • Description of what was stolen or viewed.
  • Description of what is being done by the medical clinic to minimize damage, investigate what happened, and avoid a similar incident in the future.
  • Contact information so patients can call, email, review, or write to the company for more information or if they have questions.

HITECH Act explainedWhile some of the information in the HITECH Act may be familiar because it relates to pre-existing regulations from HIPAA, the major difference will be enforcement.

HIPAA is thought to provide these protections, but it is also considered to be very poorly enforced.

The HITECH Act puts enforcement as a top priority and includes hefty fines for what has been termed “willful neglect”, a very imprecise term that will be defined by cases in the future.

Additionally, the HITECH Act puts more pressure on “business associates” of healthcare providers. HIPAA allows these business associates to have access to information via contracts.

But now they will be held responsible for breaches in a more comprehensive way. Providers of EMR or EHR systems are considered business associates and will have to consider HIPAA security and privacy rules when designing EHR or EMR systems.

Incentives for Healthcare Providers

The HITECH Act isn’t all focused on procedure, however, and as it is part of the American Recovery and Reinvestment Act (ARRA), there are also some incentives for healthcare providers.

Most of the incentives focus on promoting the use of electronic medical records and electronic health records. Because electronic records cut down on long term costs, but require an initial investment that many clinics don’t want to make, ARRA and the HITECH Act offer financial benefits if you make the switch.

HITECH Act : Economic Stimulus for EMR Adoption

HITECH Act : Economic Stimulus for EMR Adoption

Nitin Chhoda reveals a few ways that the HITECH Act can help a private practice switch to an electronic medical records system using a limited budget.  He also shares the requirements needed so that the practice can qualify with the HITECH Act incentives.

HITECT Act While the HITECH Act may help improve the safety and security of electronic medical records keeping systems, the aspects that clinicians and healthcare providers are excited about is the incentives.

The HITECH Act provides financial encouragement to clinicians, hospitals, and medical practitioners for the “meaningful use” of electronic medical records. A total of $19 billion has been allocated for incentives.

Financial Benefits

There are some great financial benefits to switching to electronic medical records anyway, but the HITECH Act makes things even easier. Physicians could qualify for as much as $44,000 for electronic health record implementation and use over the five years that the Act is funded.

The incentives only apply to the Medicare and Medicaid programs, but they can only get incentives through one program at a time. This means that they can also accrue incentives through one program and then when that runs out, they can accrue the same amount through the other program.

The incentives were also meant to encourage providers to adopt EMR systems for HITECH Act as soon as possible. One deadline was for 2012, and next year the incentives will be lower than they are this year.

And after 2015, medical practices will start to incur penalties if they have not switched to an EMR, starting with a 1% Medicare fee reduction. After 2017, that fee reduction is increased to 3%, an after 2019 the fee reduction will be increased to 5%.

Regional Extension Centers

In addition to financial incentives for adoption of EMR, the HITECH Act also funded 70 regional extension centers that can provide administrative help and guidance for health care providers attempting to make the switch to EMR.

Specifically, these regional extension centers will help “providers select the highest-value option, defined as that which offers the most favorable cost of ownership and operation, including both the initial acquisition of technology, cost and implementation, and ongoing maintenance and predictable needed upgrades over time.”

However, there is no requirement that health care providers use the regional extension centers unless they need help implementing an EMR.

HITECH Act stimulusQualifying for HITECT Act Incentives

The most important requirements for qualifying for HITECH Act incentives for EMR adoption are the proper selection of an EMR system and understanding “meaningful use”.

There are a total of 25 meaningful use criteria, and health care providers must demonstrate 20 out of those 25. Fifteen criteria are pre-determined by the HITECH Act, and out of the final ten, you must choose five. The criteria are measured in three stages over five years.

The first stage of HITECH Act requires that you use a certified EMR system and document set percentages of criteria electronically.

You will also be required to use the reminders and warnings systems that certified EMR systems have, share patient information, and report public health information and quality measures.

The second state of HITECH Act requires that you also send and receive lab results and other information using the EMR.

The third stage of HITECH Act requires that you also enroll patients using public health records, access patient data, improve population health, and report on national high priority conditions. Other criteria may be added in the future.

Medical Management: Defined

Medical Management: Defined

Medical management in today’s world is not as simple as it was decades ago. Many practitioners believe they need to extend their education in order to properly manage their clinic. Nitin Chhoda defines medical management practice in the 21st century.

medical management definitionClinicians and other healthcare practice management professionals spend a lot of time getting a thorough education. Unfortunately, their medical knowledge is not supplemented with quite enough business and medical management study.

Private Practice Trends

Some clinicians opt to get an additional degree in business or medical management so they can comfortably run a private practice. However, that is the exception and not the rule.

There has been a recent trend in private practices where clinicians are finding themselves in financial trouble due to mismanagement of expenses, billing, and health insurance companies refusing to pay for the provided care.

In some ways, the problems of private practice physicians in medical management are not their own fault at all. Insurance companies change their policies frequently, and what was billable one week may not be billable the next.

Additional Education

In response, new degrees and a new career path have been forged so clinicians or their staff can be educated about dealing with the particular challenges of running a medical practice. A medical manager is also often called the healthcare administrator, health services manager, or healthcare executive.

For those interested in medical management careers, you must complete at least a bachelor’s degree in business or a related field, and a master’s degree is highly recommended. The Bureau of Labor Statistics estimates that medical management is growing more rapidly than many other fields due to projections of an increase in demand for medical services over the next decade.

Medical management combines strategy, information management, and leadership for building and managing a successful health care practice.

Components

One of the major components of being able to manage a medical practice is having an understanding of the laws and requirements that health care providers must adhere to, such as HIPAA and the HITECH Act.

medical management definedClinicians are usually concerned with being able to do their job and take care of their patients as best they can.

What a medical management professional can bring to a private practice should include everything else, from understanding how to implement an EMR and EHR system to reporting to government agencies and ensuring that the practice is eligible for tax breaks and HITECH Act incentives.

The health care industry is changing rapidly and clinicians who run a private practice are starting to pay for inattention to administrative and management duties which they do not really have the time to handle.

There are medical management systems that attempt to streamline the way that medical clinics handle administrative tasks, such as billing, scheduling, and health insurance filing.

In fact, most EMR systems are equipped to handle medical management tasks as well as medical records. EMR and EHR systems will include scheduling and billing organization and reminders so that the clinic can be more efficient.

They can also ensure that the proper paperwork is filed for Medicare, Medicaid, and health insurance companies. Claims are often rejected due to illegibility or errors in the paperwork, and EMRs attempt to do away with those kinds of mistakes and rejections.

Medical Management Streamlined with EMR

Medical Management Streamlined with EMR

Streamlining medical management is now possible with the use of EMR. Nitin Chhoda enumerates the benefits of EMR including the efficiency of billing, scheduling and managing productivity reports.

medical management EMRClinicians, practitioners, and other private practice owners that use medical management are being forced to take certain steps toward efficiency.

The financial pressures of an increasingly hostile and uncooperative health insurance industry, combined with the fact that more and more patients are unable to pay their bills, has put clinicians in an uncomfortable bind.

How can you provide the best medical care possible if you are restricted by financial considerations? The transition may be a bit rough, but it looks as though private practices are going to get some major help by adopting electronic medical records.

Electronic medical records cut down on administrative costs, making it just a bit less expensive to run the clinic. But more importantly, they can streamline medical management and help the practice to run more efficiently.

Billing and Scheduling: Efficiency Traps

It turns out that much of an clinic’s efficiency is decreased because of errors and delays in billing and scheduling. The ways that EMRs can streamline the billing aspects of medical management may be obvious to some.

A billing system that tracks unpaid bills and sets reminders for the medical management personnel responsible for billing will increase the likelihood that bills will not be forgotten.

This is true for patients as well as health insurance companies. Most medical management and health insurance companies have very particular requirements for the filing of claims. These forms can be time intensive and frustrating to complete. EMRs that are designed to streamline medical management will include options for filing the appropriate paperwork and will include reminders so the paperwork is filed in the required timeframe.

Increased efficiency in scheduling is less obvious at first, but the benefits are certainly easy to understand. When a patient cancels an appointment, that time slot is easily lost and left empty. Scheduling components of EMR programs will ensure that all empty slots are filled when possible. They also allow for re-scheduling with a few clicks of the mouse.

medical management streamlineReporting and Medical Management

On the other hand, medical management professionals will tell you that one of the biggest challenges to improving efficiency is the lack of useful data.

On paper, it is overwhelming to attempt to compile reports that detail how many appointments have been missed, how many bills are left unpaid or the collection percentage, and productivity as measured by the number of patients scheduled for each medical professional.

EMRs offer reporting tools and instruments for medical management systems that make evaluation of the practice quick and efficient. Imagine if you could print a referrals report with a few clicks or figure out how many visits each patient typically schedules.

More Productive and Efficient

Medical management can be more productive and more efficient if these kinds of figures can be analyzed. Without EMR and reporting capabilities, this kind of analysis is overwhelmingly challenging and presents time barriers that are insurmountable.

Rather than relying on the business to continue as usual, medical management professionals and EMR systems learn what is working at your practice and what is not working. Once you know how things are actually going, you can take action to change it for the better.

Medical Billing Basics

Medical Billing Basics

The basics of medical billing and its role in the physical therapy business are shared by the licensed physical therapist, Nitin Chhoda. He emphasizes the difference between medical billing and regular businesse billing.

medical billing basicsClosely followed by the process of medical coding is the medical billing step. These two important parts of any practice are closely related and intertwined.

They work together like the contract administrator and the biller who must base billing on the details of the contract.

In small practices, the medical coding staff member is the same person as the medical biller. It is likely that this trend will continue as medical coding and medical billing systems become more efficient and more integrated.

What is medical billing and why is it different from other forms of billing?

The primary difference between medical billing and any other billing is that medical billing requires an incredible amount of attention to detail and specific codes for each procedure. Naturally, there are other billing processes that are similar, but medical billing seems to be one of the most complex of them all.

Medical billing is what health care providers and health insurance companies go through to get medical expenses paid to the health care provider. The first step is the visit of a patient to the health care provider. The clinician will attempt to diagnose the problem the patient is having in an attempt to classify the exchange for the health insurance company.

Medical Coding and Billing

The billable services are then coded by the medical coding staff member and those codes are used for medical billing to the health insurance company. The rates for services are pre-set by the insurance company and the clinic, which is why clinics only take certain types of health insurance.

They have to negotiate prices with each company they work with. If there are any mistakes in the medical billing service and process, the insurance company will reject or deny the claim.

A rejected claim is a bill that has some clerical, invalid codes, or any other minor detail that can be a cause for rejection. Rejected claims must be researched by the medical biller and re-submitted correctly.

medical billing basicsDenied claims have been processed but the insurance company has deemed them unpayable. A denied claim can be re-submitted or appealed if the medical biller believed the denial was unfounded.

Medical Billers and EMR

Medical billers have to deal with about a 50% rejection and denial rate. There are so many opportunities to make mistakes and insurers are much quicker to deny or reject a claim than they are to pay one.

The back and forth can be frustrating and exhausting. But more importantly, this paperwork headache is incredibly time consuming. Medical billing has turned into a very inefficient process and medical billers can start to feel that they are wasting incredible amounts of time just because of a tiny mistake. Medical billing can be a tough job.

Electronic medical records are attempting to streamline the process, however, and the job of the medical biller may get easier in the very near future. Many EMR systems are actively marketed as easy-to-use for medical billing. They can decrease the occurrence of mistakes and speed up the corrections process.

Medical Billing — 5 Mistakes You Must Avoid

Medical Billing — 5 Mistakes You Must Avoid

Nitin Chhoda reveals the 5 mistakes that a practice owner should avoid when it comes to medical billing. In order to have a successful practice, time management and prioritization are crucial to the billing process.

medical billing mistakesMedical billing mistakes are easy enough to make, and unfortunately even the smallest mistake can cost a practice a lot of time and money.

While there are some mistakes that simply cannot be avoided, there are some basic rules for avoiding the major mistakes that most medical billers and medical clinics make.

#5: Understand the Explanation of Benefits

The explanation of benefits, or EOB, is going to sound like the final word from the insurance company every time. But the EOB should be used as a tracking tool and should be carefully read and understood each time your practice receives a payment.

Insurance companies take any opportunity to point out the medical billing mistakes being made, which can make it feel like they are detail oriented to an unimaginable degree. But the truth is that they make mistakes, too. And it will be up to you to catch them.

#4: Follow Up on Every Submitted Claim

In the medical billing world, once a claim is submitted, there is often the sense that it has been dealt with and now it’s time to wait and see what happens. Medical billing is hard enough and takes a lot of time, so once the paperwork is in the hands of the insurance company, billers are unlikely to want to spend any more time thinking about the claim.

But time and again insurance companies let things go or don’t receive claims, and the practice suffers the consequences. Large sums of money are lost every year because nobody has run an aging report and reviewed unpaid claims.

#3: Create a System that Works 

This may seem obvious, but every practice needs system for photocopying IDs and insurance cards, planning time for regular billing, and ensuring that claims are filed and checked on in a reasonable amount of time.

Delays that medical billing claims experience cost the practice money. Set aside time for each task and make sure that a procedure is followed for every patient and ever visit.

#2: Know Medical Coding Practices

medical billing mistakes to avoidA medical biller may or may not the be the same person as the medical coder, but either way the biller should understand the basics of medical coding.

The medical billing mistakes that cause claims to be denied or rejected often have to do with incorrect codes or insufficient medical coding.

#1: Billing is the Biller’s Top Priority

Especially in smaller practices, the staff member who handles medical billing service may have a whole host of jobs to do. They could also be the medical coder, the receptionist, and the scheduler. The problems arise when the medical billing is not given high enough priority in the list of things to do.

Without efficient and timely medical billing, the practice will suffer. Unfortunately we cannot rely on goodwill and good medicine to ensure that patients and clinicians experience a mutually beneficial outcome. Medical billing has to be a high priority, including the previous four ways to avoid mistakes.

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