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(e.g., height of the apex of the fibular head from the floor) as well as the proximal trim line height of the device ordered.
The revised set of federal privacy rules is expected to have a significant impact on the way physicians run their practices.
For more information, read the posts from DME MAC Jurisdiction B, Jurisdiction C, and Jurisdiction D. APMA will provide additional information as it is available.
Revised privacy notices will need to be displayed in prominent areas of doctors’ offices and on practices’ websites. Patients will be able to ask for copies of their electronic health records or restrict the information given to health plans if they self-pay for services. And perhaps most important, practices might be subject to serious fines if any of their business associates cause security breaches.
(Source; APMA 2/7/2013)
Providers Now Required to Formally Notify Patients Before Referring Out-of-Network Effective March 1, Blue Cross contracting doctors will be required to formally notify patients in writing before making out of network referrals. Anthem Blue Cross notified physicians in November that it would begin requiring use of a payor-provided form any time they are referring a patient out of network. The new policy does not apply to emergencies. While Blue Cross has included language in its contracts since 2008 requiring physicians to disclose to patients and document the same type of information included in the APN form, it was not often enforced. According to Blue Cross, it frequently receives complaints from patients who were unaware that they were being referred to out-of-network providers. The payor says that its new policy is not intended to deter patients from using their out-of-network benefits. Rather, it is intended to help patients make informed decisions about their coverage and options. The form can be downloaded from the Blue Cross website at www.anthem.com/ca/home-providers.html. Click on “Advance Patient Notice for Use of a Non-Participating Provider” under Providers > Spotlight. Providers with questions or concerns are encouraged to contact Blue Cross Network Management at (855) 238-0095. (Source; CMA 2/25/2013)
New, Greatly Expanded HIPAA Rules and Regs Much Tougher on Docs New privacy regulations mean practices face more legal scrutiny and higher fines in case of an information breach. The rules -- called for under the 2009 federal economic stimulus package’s HITECH Act and the Genetic Information Nondiscrimination Act -- implement tougher privacy and security provisions. The rules: • Clarify when breaches must be reported to HHS’ Office for Civil Rights; • Establish new standards for the use of patient-identifiable information for fundraising and marketing; • Expand liability to “business associates” of hospitals and other “HIPAA-covered entities,” such as data miners and health information technology service providers); and
Under the new privacy rules, doctors now must assume the worst-case scenario in the event of a possible privacy breach. Previous regulations had required a practice to notify affected patients and the federal government only if it determined that a breach involving patient records had occurred and that it carried a significant risk of financial or reputational harm to patients. The new rules eliminate that standard and replace it with a stricter one. Now any incident involving patient records is assumed to be a breach, and unless a practice conducts a risk assessment that proves a low probability that any protected information was compromised, the breach must be reported. HIPAA Rules; Final Rule,” Dept. of Health and Human Services, Federal Register, Jan. 25 (www.gpo.gov/fdsys/pkg/FR-2013-0125/pdf/2013-01073.pdf) (Sources; California Healthline 1/18/2013; AMA 2/4/2013)
California Implements New Workers’ Comp Changes Beginning January 1, 2013, new provisions of California’s workers’ compensation insurance system reform bill (SB 863) were implemented by the Department of Industrial Relations (DOI) and Division of Workers Compensation (DWC). The new provisions, approved on an interim basis, are effective for 180 days while DWC initiates formal rulemaking procedures to adopt permanent regulations. Details of the newly implement regulations include:
Utilization review, independent medical review For injuries on or after Jan. 1, 2013, and effective July 1, 2013 for all dates of injury, medical treatment disputes will be resolved through an independent medical review (IMR) process. Injured workers who receive denials, delays or modifications to a physician’s request for medical treatment because the treatment is deemed not medically necessary by the workers’ comp carrier can request an independent review of that decision through the IMR process.
Independent bill review For dates of service on or after January 1, 2013, billing disputes involving payment for medical services may be submitted through a process known as independent bill review (IBR). Medical providers disagreeing with the amount paid by a claims administrator and seeking an independent determination on payment may submit a request for IBR providing details and/or supporting documentation along with the non-refundable IBR fee of $335.
• Raise the maximum penalty for noncompliance to $1.5 million per violation. 28 |
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