Keep up-to-date on all the latest in security, training, standards, the community and much more in this edition of UHIN’s bi-monthly newsletter! If you have a comment or if there is a topic you would like to see us cover in an upcoming issue, please email us at email@example.com.
The Training Tip
Coordinating benefits for patients with multiple coverage is vitally important to ensure you are properly reimbursed. Following these helpful guidelines can help make submitting Coordination of Benefits (COB)/secondary claims go smoothly.
First, remember that the secondary payer needs to understand the entire history of the claim up to the point where you sent it to them for processing. Double check to ensure your COB claim includes all service lines and billed amounts from the primary claim, as well as all payments and adjustments (non-payments) adjudicated by the primary payer. The secondary payer will need all this information during processing.
Remember to wait a full 30 days between receiving the primary payment and sending the COB claim since the primary payer may actually send your COB claim for you. Medicare, after adjudicating a claim as primary, may automatically send your claim on to the secondary insurance. This is called an automatic crossover.
In fact, some payers are beginning to reject COB claims that are sent in too quickly; they want to wait to determine whether an automatic crossover will happen before they process a COB claim directly from the provider. Therefore, if you send your COB claim within 30 days of receiving the primary payment, some payers may reject your claim for being sent too soon.
It’s also important that you make sure your claim balances. In other words, ensure all the amounts on your primary claim are accounted for. For example, if you billed the primary insurance $100, then all of the paid amounts and adjustments (non-payments) that you list in the COB claim should add up to that $100 amount.
For questions or additional COB training, contact us at firstname.lastname@example.org.
Increasingly, mobile devices are becoming an important tool for health care providers. According to Research2Guidance, 80% of physicians use smart phones and medical apps. More than one in four employ some sort of mobile technology in the treatment of patients. Indeed, according to an infographic created by Wolters Kluwer Health:
- -72% of physicians use a smartphone to access pharmaceutical information, such as dosage, calculations, and side effects
- -44% communicate with staff via a smartphone
- -63% use a tablet to access medical research
With the increasing role that mobile devices play in delivering healthcare, what are some of the best practices for keeping health care data secure?
Becker’s Health IT and CIO Review shared these 5 simple steps to ensure PHI is kept safe on mobile devices.
- Activate the screen locking option – Requiring a password to access the device prevents unauthorized access. Today’s cell phone technology allows for a variety of authentication tools – from personal identification numbers (PINs) and “swipe pattern” passwords to finger prints and even facial recognition.
- Regularly update your security software – Having the most up-to-date security software and operating systems on your mobile device can help prevent unauthorized access.
- Avoid public WiFi – Only use a secure Virtual Private Network (VPN) connection to send or receive HIPAA-protected information. VPNs are encrypted, which prevents data from being readable if it is intercepted.
- Enable encryption – Encryption keeps information on mobile devices safer by making that information more difficult to read if it’s accessed without authorization. Many of today’s mobile devices have built-in encryption, but you can also buy and install the necessary tool.
- Install remote wiping and/or disabling options – This option allows you to clear a phone of all data remotely if your mobile device ever gets lost or stolen. In some cases, you even have the ability to selectively remove data.
As mobile devices continue to play an increasingly important role in the treatment of patients, the security of the personal health data on them will become even more paramount. These few simple steps can help keep the data on them safe.
The Latest on HIPAA Transaction Standards
The UHIN Standards Committee recently approved four new or amended standards, which are in varying stages of being adopted into rule:
- -Applied Behavioral Analysis (ABA): standardizes the use of certain procedure codes, modifiers, and units for ABA treatments, commonly used to treat autism spectrum disorder. Standardizing this billing helps to avoid confusion especially when submitting claims to secondary or tertiary payers. The goal is to eliminate the need for translation between payers.
- -Telehealth: standardizes the billing of claims and encounters for telehealth, including valid options to use for place of service modifiers.
- -Transparency Administrative Reporting: annually, most payers are required to report a variety of administrative statistics such as telephone wait times to the Utah Insurance Department (UID). This standard sets the expectation for what specifically needs to be reported and any associated deadlines.
- -Transparency Denial Reporting: each year, most payers are required to report which payments they denied and the reasoning behind the denial to the Utah Insurance Department (UID). This standard sets the expectation for what statistics needs to be reported and any associated deadlines.
What’s new in X12
Three times a year, X12 subject matter experts from across the industry convene at the X12 Standing Meeting to develop new standards and implementation guides. Typically, attendees will choose one or two workgroups to attend for the duration of the event. It’s in these workgroups that change request are created, public comments are reviewed, and changes necessary to meet the industry’s needs are recommended and discussed.
UHIN’s Standards Committee gives the Utah community an opportunity to present requests for future X12 developratice managementent, which are then carried to X12 and advocated for by UHIN and Standards representatives.
Below are updates from the most recent X12 Standing Meeting:
- -The group is working to clarify the CTX segment in the 999. Although no changes to the actual segment are planned, how the segment should be used will be clearer.
- -In the 277CA, the STC12 data element position is being completely removed. This is where payers have been adding free text information. A proposal has been made for an additional STC01 code to be created with any free text to be entered in a PWK segment instead. For this implementation to proceed, the new code and PWK alternative must still be approved.
- -In the 837, the committee is considering adding an “Original Claim Creation Date” in the 2300 loop. This would reflect the date the claim was created out of the PRATICE MANAGEMENT system, and will remain untouched even if dates in the header are changed by clearinghouses as files pass through. The intention is for this to assist tracking.
- -The unified agenda for 2018 includes attachments. The committee is optimistic for either a Notice of Proposed Rule (NPR) or Interim Final Rule (IFR) to be announced in August. With an NPR, a comment period is required, however with an IFR a comment period is allowed but not required.
- -Additionally, the currently recommended attachment version remains 6020, however as it is not a HIPAA guide there’s no regulation for it. The 277 transaction (which is separate from the 277CA) is the solicited response to a 276.
- -With 277 and 277CA in 7030, payers will be required to report status on the line level, except when the entire 837 file is rejected for an overarching reason on the claim level.
- -Public comment is being solicited for the proposed amendments to 270, 835, 829 and 276.
Comments can be submitted at http://forums.x12.org/.
Join us for the Provider Education Summits
It’s time for the annual Provider Education Summits! The 4-city Summits are scheduled for:
Salt Lake City – March 21
Ogden – March 27
Provo – March 28
St. George – April 11
These ever-popular events are always free and provide an opportunity for billers, coders, front desk and support staff, medical assistants, and other office personnel to learn about a variety of topics from industry experts.
Among this year’s wide-ranging topics are sessions focusing on trouble shooting EDI claims, credentialing, HIPAA and privacy, tips and guidelines about common coding errors, dealing with difficult clients, and the always-popular payer panel – extended this year to allow for more questions to be answered!
To learn more about the upcoming Provider Education Summits or to register for one of these free education events, visit https://uhin.org/events/provider-education-summit-2018/.
Engaging patients and employees is key to positively impacting your bottom line. Christopher Katis, UHIN’s Director of Corporate Communications, will help you gain ideas to create a positive patient experience, and learn the communication methods needed for a great work environment!
Wednesday, February 21 at 12:30 p.m. Register at https://uhin.org/events/event/webinar-positively-impacting-your-bottom-line/
In the Community
February is American Heart Month: Talk to Your Patients about Heart Health
Heart disease is the leading cause of death for both men and women in the United States. This year cardiovascular disease will take the lives of more than 800,000 Americans.
American Heart Month honors health professionals, researchers and heart health ambassadors whose dedication to fighting heart disease enables countless Americans to live full and active lives. The observance aims to reduce the burden of heart disease by raising awareness, taking steps to improve individual heart health, and encouraging colleagues, friends and family to do the same.
Clinicians are reminded to have conversations with their patients about heart health. Million Hearts® offers a number of resources for clinicians to aid them in identifying patients with undiagnosed hypertension, including a clinical video, an interactive hypertension prevalence estimator tool, as well as additional references, resources and case studies.
The American Heart Association’s National Wear Red Day® encourages individuals, groups and companies to show their support in the fight against heart disease. Each year, on the first Friday in February, millions of women and men come together to wear red, take action and commit to fighting heart disease. National Wear Red Day this year is Friday, Feb. 2. You can also spread the word by posting #HeartMonth and #HeartDisease on social media.
HealthInsight is working with health care professionals and community stakeholders in Nevada, New Mexico, Oregon and Utah to lower cardiac risk and improve cardiac health. For more information on HealthInsight’s efforts around cardiovascular health and Million Hearts, visit healthinsight.org/cardiovascular-health.