Showing posts with label healthcare compliance. Show all posts
Showing posts with label healthcare compliance. Show all posts

Wednesday, March 21, 2012

WEBINAR: Tactical Solutions Supporting the Challenges of ANOC/EOC Creation-Print-Distribution-Reporting Requirements

Merrill Corporation is hosting a Free Webinar and You're Invited!


Title: Tactical Solutions Supporting the Challenges of ANOC/EOC Creation-Print-Distribution-Reporting Requirements.
Date: Wed, March 28
Time: 1:00pm Central Time
Duration: 1-hour
Cost: FREE!

A streamlined process for the creation, print, distribution and reporting of your ANOC/EOC program is crucial to successfully meeting the regulatory requirements as well as ensuring the integrity of PHI, and minimizing the risk associated with HIPAA violations. 

In this webinar you will:
  • Review current technology and manufacturing workflow innovations and best practices associated with ensuring the final product is produced on time and correctly.  We will examine everything from the latest dynamic document creation technology to effective use of the postal intelligent mail barcode.
  • Learn how our advanced reporting allows you to track delivery at the piece level.  See how the use of a personalized 2D barcode scan during manufacturing translates into member level reporting. 
  • Discover what options are available for a hybrid print and e-fulfillment workflow. 
 
Click below to register for this webinar today!



http://bit.ly/MerrillWebinar328

Thursday, May 12, 2011

HIPAA Regulations and New Technology: May 2011

We have received a lot of feedback on our post about HIPAA and new technology, and because of that, we will continue to share news on this very important issue that will play a major role in how the industry evolves.

It is well documented how doctors and other medical practitioners have been slow to adopt social media, and there is next to no following available for those that do. A recent poll revealed that only 11% of those interviewed would participate in social network interaction with their doctor if it was offered. Unlike the compliance issues that are holding health plans back, the only thing keeping physicians out of social media is a lack of interest. Many argue, however, that a lack of interest does not create a lack of responsibility. More and more patients are turning to social networks for advice on medical treatment, pharmaceuticals, and diagnoses. As a result, it is the responsibility of medical professionals to ensure that the information they find is accurate and up to date.

Obviously, some restraint is necessary. Doctors are just as required to follow HIPAA policies online as they are in any public setting. There should be no harm, however, in presenting generalized and accurate medical information, as long as the required compliance issues are handled responsibly.

HIPAA regulations also come into play with mobile technologies. Thousands of companies, in and out of the medical industry, are turning to mobile devices like smartphones and tablet computers to simplify the logistics of their operations. New advances in mobile tech have lowered the cost and time-consumption of training programs, and eased the transition of work materials from one workplace to the next.

The problem with this ease of access is just that; the access. In the wrong hands, a major company’s mobile technology could provide private data on hundreds, if not thousands, of clients and customers. Mobile devices need to be very well secured in order to meet HIPAA standards. This required level of compliance does not seem to be affecting the devices’ popularity, however.

So how do you take advantage of social networks and mobile technology without worrying about misinformation and HIPAA involvement? By creating your own network, of course. OrthoMind, by orthopedic surgeon Jon Hyman, MD, is a social network open only to other orthopedic surgeons. The exclusive community allows for the simple exchange of thoughts, practices, and techniques without the added downsides of outside influence. Because the network is not marketing toward any consumers, or sharing patient-doctor conversations, there is also no worry of HIPAA reprisal.

Networks like OrthoMind are extremely important for physicians, who may find themselves bombarded when patients that believe they are informed show up with armfuls of inaccurate medical advice. While it is superficially wonderful that patients are being empowered by social media to research things on their own, a doctor needs to be just as informed in order to be capable of separating the good advice from the bad.

Thursday, March 10, 2011

Health Reform Legislation Threatens Mini-Med Plans

If there has been one clear victim of the new health plan regulations, Mini-Med Plans are it. Last year when the new MLR percentages became reality, hundreds of Mini-Meds began seeking alternative measures to survive. HHS has provided a solution for 1,040 such plans. Out of all the Mini-Med Plans that applied, 94% have been granted a waiver, allowing the plans to be considered exempt from the new law. The exemption lasts only for one year, but is renewable until the full weight of the reform falls in 2014.

The waivers are required because the Mini-Med Plans, which provide care for over 2.6 million people, do not meet the minimum annual dollar limit on essential benefits as outlined in the reform legislation. This limit starts at $750,000 in 2011, increasing to $2 million in 2013. By 2014, the law states that there is to be no annual limit on essential benefits.

Mini-Med Plans cater to low-income or part-time workers, who often do not qualify for more expensive plans. Unless the reform legislation is re-written to account for these smaller providers, 2014 will see the end of Mini-Meds, and those employees will be forcefully folded into the government-created health exchange planned for 2014.

-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Wednesday, February 23, 2011

Cignet Fined for HIPAA Violation.

The first civil money penalty of $4.3 million has been imposed by HHS on Cignet Health of Prince George’s County, Maryland. HHS and CMS have been very firm that violations will no longer be tolerated. With the enactment of HITECH, this type of penalty seemed inevitable.  An individual’s rights to the privacy of their personal information and access to their own medical records is of utmost importance and while beneficiary protection is a main theme of CMS, it appears HHS is a strong advocate of this as well.

OCR has issued a Notice of Final Determination finding that Cignet violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.  The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

“Ensuring that Americans’ health information privacy is protected is vital to our health care system and a priority of this Administration. The U.S. Department of Health and Human Services is serious about enforcing individual rights guaranteed by the HIPAA Privacy Rule,” said HHS Secretary Kathleen Sebelius.

In a Notice of Proposed Determination issued Oct. 20, 2010, OCR found that Cignet violated 41 patients’ rights by denying them access to their medical records when requested between September 2008 and October 2009. These patients individually filed complaints with OCR, initiating investigations of each complaint. The HIPAA Privacy Rule requires that a covered entity provide a patient with a copy of their medical records within 30 (and no later than 60) days of the patient’s request. The CMP for these violations is $1.3 million.  

During the investigations, Cignet refused to respond to OCR’s demands to produce the records. Additionally, Cignet failed to cooperate with OCR’s investigations of the complaints and produce the records in response to OCR’s subpoena. OCR filed a petition to enforce its subpoena in United States District Court and obtained a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet produced the medical records to OCR, but otherwise made no efforts to resolve the complaints through informal means.

OCR also found that Cignet failed to cooperate with OCR’s investigations on a continuing daily basis from March 17, 2009, to April 7, 2010, and that the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule. Covered entities are required under law to cooperate with the Department’s investigations. The CMP for these violations is $3 million.

“Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA’s requirements,” said OCR Director Georgina Verdugo.  “The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules.”
-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.

Friday, January 7, 2011

Mandated Member Communications: A Case Study

At the end of 2010, we discussed in abstract the resource-draining, time-consuming process that is the preparation, distributing and reporting of CMS mandated member communications, highlighting how the enactment of the Affordable Care Act and tightening regulatory guidelines have only compounded this already trying process and how the penalties for non-compliance include monitoring, fines, and the risk of contract non-renewal.

We wanted to start 2011 off with a scenario, and while this is a true case study, we believe that there are aspects of this specific issue that are relatable to a number of organizations that are part of the healthcare marketing space:

THE CHALLENGE:

A nationally-known insurance company was having difficulty managing the creation and distribution of mandated letters for their Medicare members. They lacked an in-house solution and their current production vendors could not manage the growing volume, facilitate mass template changes nor provide adequate reporting. This resulted in inaccurate mailings, missed deadlines, and poor CMS audit results. 

Additionally, the organization realized that in an effort to improve their CMS Five-STAR Rating, they needed to reduce the amount of appeals and grievances filed with CMS as a result of non-compliant communications.

Next week, we will discuss the solution that was developed that helped both reduce costs and improve workflow.

-------------------------------------------------------------------------------------------

Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at Pamela.Argeris@merrillcorp.com.