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MiraMed’s eAlerts are distributed via email every Wednesday, and contains the latest industry information regarding business process outsourcing solutions, helpful coding news, or any number of relevant topics in the fast-paced, ever-evolving world of healthcare. To subscribe, simply complete the form below. Below the subscription form, you will find the archived eAlerts available.

HIPAA –The Countdown is On to September 23

August 28, 2013

We have issued numerous alerts about compliance with the new Health Insurance Portability and Accountability Act of 1996 (HIPAA) omnibus regulations that were released on January 25 of this year (Omnibus Rule).  Although much has been released about them, many are still behind in ensuring compliance with the new provisions of the rule.  In a little over four weeks from now, covered entities must ensure they are complying with these new provisions or they could be leaving themselves exposed to potential liabilities of up to $1,500,000.  This is a friendly reminder that there is much to do between now and September 23.

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CERT A/B Contractor Task Force: Will it Streamline Coding and Billing?

August 21, 2013

United with a shared goal, all Medicare Administrative Contractors (MACs) joined forces in an August 20, 2013 national conference call to announce the formation of a new combined Part A and Part B Medicare Contractors Task Force. This Task Force will be addressing educational issues of concern leading to the Medicare improper payment errors as calculated from the Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) Program. The new initiative is independent from the CERT team and CERT Contractors’ roles, which are responsible for calculating  the Medicare fee-for-service improper payment rate. During the conference call, the Part A and Part B Contractors provided an overview of the Task Force objectives and how they plan to proceed in the next few years.  The Contractors’ view this new partnership as a benefit to the provider community in that this level of  collaboration and consistency will help to reduce costly claim denials. The role of the A/B Task Force will be to:

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Will You Be Reimbursed Fairly For Patients Enrolled In Health Insurance Exchanges?

August 14, 2013

Beginning on October 1, 2013, numerous Health Insurance Exchanges (HIE) will be open for business allowing millions of uninsured people to begin fulfilling a mandate established by the Affordable Care Act (ACA).  Starting then on January 1, 2014 providers will begin to feel the impact of the ACA when  these newly-enrolled subscriber's health insurance plans come into play.

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Inpatient or Observation? CMS May Finally be Dealing with a Long-Standing Confusing Rule

August 7, 2013

The Centers for Medicare & Medicaid Services (CMS) and Members of Congress, have raised concerns about hospitals’ use of observation stays and short inpatient stays.  Over the years there has been confusion as to when a patient should be classified as an inpatient as opposed to an outpatient or in observation status. CMS proposed a hospital inpatient prospective payment system (IPPS) rule for FY 2014, published in the May 10, 2013 Federal Register, updating the current observation rule.  The proposal would streamline the rule in that admissions spanning at least two midnights will presumptively qualify as inpatient admissions for payment (under Medicare Part A); when an admission spans less than two midnights it will be considered an outpatient visit (paid under Medicare Part B). CMS does allow the documentation in the medical record to overcome these presumptions.  For example, a patient who is only in the hospital for one midnight census can be considered an inpatient if he or she left earlier than expected by the physician and the documentation in the medical record supports the physician's expectation that the patient would be in the hospital longer.  The proposed rule can be found on the Government Printing Office website.

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Bridging the Healthcare Gap? Nurses and Physician Assistants Taking over Physicians’ Duties.

July 31, 2013

Recently, nurses and physician assistants have seen an expansion in their scope of practice, allowing them to perform tasks that have traditionally been reserved for licensed physicians. The reason for this trend is twofold.  First, it is widely agreed that our country is currently experiencing a physician shortage, especially in the primary care arena.  Secondly, with the enactment of the Patient Protection and Affordable Care Act (“PPACA”) in 2010, millions of Americans will soon gain health insurance coverage, and the current healthcare system does not have enough physicians to administer their care.  The reasons supporting and opposing expanding nurses and physician assistants’ scope of practice are many.  It is with this landscape and the consistently diminishing reimbursement to healthcare providers, generally, that the industry is presented with the challenge of providing more patients with quality care more efficiently.

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