In this edition of the bi-monthly UHIN Newsletter, you’ll find training and security tips, information from the community, and much more! 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
We all make mistakes, right? After all, to err is human. But what happens if you realize you had an error in your claim after-the-fact? Is there anything that can be done? Yes! UHIN’s corporate trainer suggests the following to correct your claim without causing further confusion.
Although you may be tempted to resubmit the corrected claim immediately, your first step should be to do nothing at all, just wait. Re-sending the claim right away could cause the resubmission to be rejected as a duplicate.
Watch for reports. Make a note of all the germain information from the claim such as the billed amount, service date, and/or patient account number to easily track the related reports.
If the claim gets rejected by a clearinghouse or payer, you can send the corrected claim again as an original claim. Once a claim is rejected, new copies are no longer marked as duplicates. However, if the original claim is accepted for processing and passed through adjudication for payment, although there is no official industry standard, typically a correction / replacement or cancellation will be required.
You should send a correction or replacement when the patient and provider identities are correct but other claim details are incorrect. For example, you might need to correct the number of units reported or the amount billed. Your software may call this setting, “Correction of Prior Claim” or “Replacement of Prior Claim.”
If the incorrect information affects the patient or provided identity, you must cancel the claim. Your software may call this setting, “Cancel of Prior Claim.” This cancelation is required to avoid benefit or tax implications being applied to the wrong member or provider.
At this point, you will know if you need to send a correction or cancellation or not. When sending these corrections/cancellations, remember the following:
- Make sure to mark the claim as a correction/replacement/cancellation. There should be an option for this in your claim software. Once you find the correct menu, select the appropriate option based on the criteria above.
- On a report from the payer, such as a 277CA, 835, or EOB, find and write down the number assigned by the payer for this claim. It may be labeled an ICN, TCN, or Payer Claim Control Number.
- In your claim software, find the “Original Reference Number” field, or similarly-named field. (For UHINt users, this is box 22.) Place the payer-assigned number in this field.
- Ensure the rest of the claim form contains the necessary details.
- For corrections/replacements: enter the details for the entire claim, including any corrections needed. Remember, the previous copy will be removed from the payer’s system, any money paid on the incorrect claim will be taken back, and this new claim will replace it.
- For cancellations: enter the details for the original, incorrect claim and send. This will remove the incorrect claim from the payer’s system. Once this is completed, you can send an original claim with the correct information.
When you think about protecting personal health information (PHI), you may think of firewalls and other forms of technology that help keep hackers at bay. Those certainly play an invaluable role. However, for all the media coverage hackers and ransomware receive, human error still plays an alarming role in breaches. According to the U.S. Department of Health and Human Services, Office of Civil Rights, hacking accounts for less than half of the breaches that occurred between January 1 – October 31, 2017. More than 1/3 (36%) were the result of employee error via unauthorized access or disclosure. Another 16% were caused by the theft of laptops, computers or other devices, and 3% were caused by the loss of a device or improper disposal of paper records.  Thankfully, there are steps that can be taken to help reduce the risk of human error to increase security.
- Create a culture of security at your organization. Keeping the PHI with which your organization has been entrusted safe isn’t just the job of the security. It’s not something only IT needs to handle. Security is every employee’s responsibility. Schedule regular security trainings, periodically review your policies to ensure everyone understands them, and offer “rewards” to staff “caught” keeping PHI secure. Creating an atmosphere in which security is always top of mind for every team member helps to foster a unified effort to keep PHI safe.
- Educate your staff about the importance of security. Helping staff understand the severe consequences of a breach can prove invaluable. Just one record being compromised can cost your organization up to $50,000. Multiple HIPAA violations can run in the millions of dollars and lead to incarceration. The negative publicity associated with even a “minor” breach can end careers, and more importantly, a PHI violation can irreversibly damage the lives of those individuals whose privacy has been violated.
- Assess your weaknesses. Doing a risk assessment provides your organization with a clearer understanding of where potential threats and vulnerabilities lie. This will provide you with insights into the areas your organization needs to improve, and can spark meaningful conversations between employees about the importance of security, leading to new ideas and initiatives.
- Reinforce that simplicity can be meaningful. Being diligent doesn’t have to be burdensome. Consistent reminders that everyday tasks such as keeping workspaces clear of any PHI, being cautious of potential “phishing” emails, locking computers, changing passwords, using complex passwords, and locking drawers all play vital role in protecting PHI. Your IT department can even develop fake phishing emails to educate your staff about the threats emails can play.
- Remember that security efforts never end. Whatever your current efforts are today, they may not be sufficient tomorrow. Stay abreast of new tools available, understand new threats being posed, and keep challenging employees to stay vigilant.
Human error – intentional or not – remains a primary cause for data breaches. Thankfully, there are simple measures any organization can take to help prevent a simple mistake from becoming a costly one.
Every year 2.8 million older Americans suffer a fall, and injuries related to falls are one of the primary reasons people lose their independence. The Centers for Disease Control has a new campaign to keep seniors from falling, stay active and live independent lives.
Older people can reduce their chances of falling through:
- Regular exercise – keeping active helps improve balance and builds strength.
- Reviewing medications – talking to doctors and/or pharmacists about prescribe and over-the-counter medications, supplements and vitamins helps make sure that dosages or side-effects are not increasing the risks of falling.
- Annual eye and hearing exams – updating eyeglasses and ensuring there are no inner ear issues are important parts of preventing falls.
- Safe homes – floors that are free of clutter, throw rugs with non-slip backing, well-lit stairs, tubs with handrails, and lamps or lights close to beds are just some of the easy steps that can help prevent falls.
- Being assessed for fall risk – a simple 12-question assessment can offer healthcare providers with important insights into a patient’s risk for falling.
UHIN’s Third Annual HIT Conference – Interoperability in Times of Crisis
More than 125 healthcare professionals attended the Third Annual UHIN HIT Conference this year where they learned of the invaluable role interoperability plays during times of crisis. An impressive lineup of speakers provided both national and local perspectives addressing crises as wide ranging as rising healthcare costs to natural disasters.
Genevieve Morris, the Principal Deputy National Coordinator for Health Information Technology offered the keynote, providing insights into the current interoperability landscape. She explained how the ONC is successfully expanding interoperability nationwide thanks to the dual efforts of improving usability while decreasing the regulatory burdens on providers. She also outlined the ONC’s 2018 interoperability targets:
- Technical – focusing on patient/provider data matching, data quality and standards
- Trust – looking at privacy / HIPPA, intellectual property and permitted purposes
- Financial – making the business model to share data and creating incentives
- Workforce – encouraging provider IT staff and clinical informatics careers
Ms. Morris also stressed that the technical and trust targets on interoperability align well with the 21st Century Cures Act as the law looks to provide uniform conditions of certification (Technical), while increasing common exchange frameworks and agreements, and decreasing information blocking (Trust).
Discussing interoperability during Hurricane Harvey, Gijs van Oort, PhD and Phil Beckett, PhD, the CEO and CIO of Health Access San Antonio (HASA) were joined by Nick Bonvino, CEO of Greater Houston Healthcare. The three HIE leaders shared how after two days of rain, an unprecedented 52” of additional rain water battered Houston, forcing thousands of citizens to evacuate. Staff from the two HIEs joined medical teams at shelters to provide access to medical records and medication information for evacuees. A full 70% of records requested were found. Proving irrefutably that interoperability can save lives.
Dr. Karen DeSalvo, former acting Assistant Secretary for Health and Human Services, and formerly National Coordinator for HIT, shared her belief that the nation is making impressive progress on the interoperability roadmap, which was developed during her tenure at the ONC. Taking audience questions, she argued that patient expectations that their records are shared is driving demand for interoperability. She also stated that interoperability can play a vital role in public health, helping states to avert disease outbreaks and the costs associated with epidemics.
Sen. Brian Shiozawa, M.D., a member of the Utah state Senate, and a practicing emergency room physician, provided insights on the use of interoperability in every day hospital settings. Addressing the advantages of having information from various sources available, Sen. Shiozawa spoke of the cost savings realized by eliminating redundant tests. Moreover, he stressed the invaluable role interoperability plays in battling the opioid crisis.
UHIN’s Chief Medical Informatics Officer, Matt Hoffman, M.D. was the final speaker of the conference. He offered attendees a glimpse into Utah’s HIE, UHIN’s cHIE. He highlighted ADT notifications, which alert providers when a patient is admitted or discharged from a hospital, and provided a demonstration of dashboards used to help prevent costly hospital readmissions.
We’re already busy planning next year’s conference. It’s sure to be an event you won’t want to miss!
New Medicaid Card with Unique ID Number Coming Next Year
New Medicare cards will be arriving in mailboxes beginning in April 2018. These cards will have a new Medicare-generated number that is unique to the person, rather than their Social Security Number. The purpose of the new cards is to help to protect privacy and patient identity. You can find more information about the new Medicare cards at CMS.gov.
In the Community
Influenza takes a considerable toll on Americans each year, causing millions of illnesses and medical visits, hundreds of thousands of hospitalizations and thousands of deaths. Here are important updates for encouraging your patients to protect themselves and their families this year by updating their shots.
2017–2018 Recommendation Highlights. The Advisory Committee on Immunization Practices (ACIP) and The Centers for Disease Control and Prevention (CDC) continue to recommend an annual influenza vaccination with an injectable influenza vaccine for everyone 6 months and older, including pregnant women. The recommendation not to use live attenuated influenza vaccine (LAIV) was extended for the 2017–2018 season. The inactivated influenza vaccine information statement (VIS) will be used again this season. Full recommendations for the 2017–2018 influenza season are online at https://www.cdc.gov/mmwr/indrr_2017.html.
Vaccine Supply. Manufacturers have projected they will produce between 151 million and 166 million doses of injectable influenza vaccine for the 2017–2018 influenza season, which should ensure sufficient supply of vaccine.
When to Vaccinate. Optimally, vaccination should occur before onset of influenza activity in the community. We recommend vaccination by the end of November, if possible. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations when vaccine is available. Vaccination efforts should continue throughout the season because the duration of the influenza season varies and influenza activity might not occur in certain communities until February or March. Vaccine administered in December or later is still likely to be beneficial even if given after the influenza season has begun.
Safe Vaccine Administration. When you “know the site and get it right,” you can help prevent shoulder injuries such as deltoid bursitis—generally caused when vaccines are injected high on the shoulder and the needle enters a shoulder bursa. This error occurs mostly among adults. The CDC provides comprehensive vaccine administration resources at: https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html.
Below are some data that might inform your conversations with patients in the upcoming months:
Influenza vaccine can prevent flu illness and hospitalization. The CDC estimates that influenza vaccination prevented approximately 5.1 million influenza illnesses, 2.5 million influenza-associated medical visits, and 71,000 influenza associated hospitalizations during the 2015-2016 season, with an overall vaccine effectiveness of 48 percent.
Influenza vaccination was found to reduce deaths in children. A study in Pediatrics showed that influenza vaccination is effective in preventing influenza-associated deaths among children.
Influenza vaccination may make illness milder. While some people who get vaccinated may develop influenza, vaccination may make their illness milder. A 2017 study in Clinical Infectious Diseases (CID) showed that influenza vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized influenza patients.
Tools and resources to make your conversation with patients easier. HealthInsight has developed a toolkit with multiple resources for helping providers educate their patients and improve their vaccination rates. Included in that toolkit is a document on motivating patients to get vaccinatedthat can help you start the conversation. The Adult Immunizations Toolkit is available for clinicians and physician offices and home health agencies.
Updated influenza vaccine information for providers and patients is available at http://www.cdc.gov/flu.
Thank you for all you do every year to help protect your patients, families, and communities against influenza.
UHIN’s New Look
You may have seen UHIN’s new look. We feel that the bold colors and new logo better reflect who UHIN is and where we are headed as a company. As part of our re-branding, we also updated our mission to: “Positively impact healthcare through reduced costs, improved quality, and better results driven by innovative healthcare technology solutions.” We’re excited about our company and it shows!