You Must Meet the Requirements for Core Measure #15

I need a Security Risk Analysis? What is that? I get calls from Chiropractors or their staff with this question every week. Here is the information and links to help you better understand Core Measure 15.

But first, from: http://www.healthit.gov/providers-professionals/certification-process-ehr-technologies

“The Office of the National Coordinator for Health Information Technology (ONC) Certification Program provides a defined process to ensure that Electronic Health Record (EHR) technologies meet the adopted standards and certification criteria to help providers and hospitals achieve Meaningful Use (MU) objectives and measures established by the Centers for Medicare and Medicaid Services (CMS).

Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to use certified EHR technology.”

Translation: The Certified Software you purchased is required to meet certain criteria in order to be a Certified Technology by the ONC. The job of the software is to help you meet all of the requirements. They are all set up basically the same and have training requirements, video tutorials, how-to documents, and support staff available to you. It is important and necessary to use not only the software but to use the training and support available to your office.

The Core Measure #15, also referred to as “Protect Electronic Heath Information”, or “Security and Risk Analysis”

This Core Measure has been wreaking havoc on Chiropractors. It isn’t a number to report found on your Dashboard. It’s a report or template that should be provided by your software company and completed in your office during the reporting period. A security risk analysis comprises the following parts: Risk Analysis, Risk Management, Sanction Policy, and Information Systems Activity Review. Think of it as an audit of your software and how you and your staff are protecting the fragile information contained therein. It should be easy to get these 4 templates or forms, run the audit, complete the forms, and file them in a safe place. The problem is most offices skip this step, and attest “YES” anyway. Later, when asked by CMS to provide their Risk Analysis they fail to provide and have to pay their incentive back.

The Measure states: “Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.”

Going further, below you will find better description of the 4 things you need:

(From: http://www.gpo.gov/fdsys/pkg/CFR-2003-title45-vol1/pdf/CFR-2003-title45-vol1-sec164-308.pdf)

164.308(a)(1)(i) Standard: Security Management Process. Implement policies and procedures to prevent, detect, contain, and correct security violations.
(ii) Implementation specifications:
(A) Risk analysis (Required) - Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity
(B) Risk management (Required) - Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with 164.306(a). (Link found here: http://www.gpo.gov/fdsys/pkg/CFR-2010-title45-vol1/pdf/CFR-2010-title45-vol1-sec164-306.pdf)
(C) Sanction policy (Required) - Apply appropriate sanctions against workforce members who fail to comply with the security policies and procedures of the covered entity.
(D) Information system activity review (Required) - Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.

*****

More links regarding Core Measure #15. Some are full of long explanations, but still full of information.  

http://www.hitechanswers.net/meaningful-use-measure-and-hipaa/
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf
http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf
http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf
http://www.youtube.com/watch?v=ml4okcBxN6c
http://www.youtube.com/watch?v=1fDvzznChhg

Important “Little” Things in Chiropractic Medicare

Important “Little” Things in Chiropractic Medicare

• Item 14, date of current, must never be over 60 days old. When billing a covered service with an “AT” modifier (active treatment) and date of current is over 60 days old, this claim will be denied or flag an audit. 
• Treatment plan: Absence of a treatment plan is the greatest reason chiropractors lose their audits. A treatment plan may be one to 6 visits with an exacerbation as long as it is documented with a Federal Document.
• Maintenance care: For those chiropractors “treating” patient symptoms instead of correcting vertebral subluxations, think about this: Your patient is taking 9 prescription drugs, 5 being pain killers. They can’t feel anything from their waste down and you are going to call your adjustment “Maintenance care” because they have no pain? Need to rethink what your job really is.
• Medicare Replacement Plans: A Medicare replacement plan is a “cheaper” type of Medicare coverage that costs less with co-pays. The problem: Some Medicare replacement plans are IN Medicare and some replacement plans are OUT of Medicare. 
• IN Medicare plans, you must follow Medicare guidelines.
• OUT of Medicare plans, your patients are like any other patient out of Medicare and you do not have to follow Medicare guidelines UNLESS you bill the Medicare replacement company…. Now you have to follow Medicare guidelines. 

This is just a small example of the important Medicare information in our Seminars and/or in our Chiropractic Medicare DVD.

Seminars in Spring 2014

To register or for questions please call: (800) 692-4476

Date: Saturday, May 31, 2014
Time: 8:00 AM - 12:00 PM
Location: Mishawaka, Indiana
Location address:
 Holiday Inn Express

420 University Drive

Mishawaka, IN 46545

Hotel phone: 574-277-2520 for direction purposes only

CANCELLED
Date: Saturday, April 12, 2014
Time: 8:30 AM - 12:30 PM
Location: Reno, Nevada
Location address:
 Holiday Inn Express

2375 Market Street

Reno, NV 89502

Seminars in March 2014

New Seminar dates!!

Date: Saturday, March 29, 2014
Time: 8:30 AM - 12:30 PM
Location: Portland, Oregon
Location address:
 Holiday Inn-Portland/Airport
 8439 NE Columbia Blvd.
Portland, OR 97220
Hotel phone: (503) 256-5000 for direction purposes only
To register or for questions please call: (618) 395-3162

Date: Thursday, March 27, 2014
Time: 6:00 PM - 10:00 PM
Location: Mukilteo, Washington
Location address:
 Staybridge Suites
9600 Harbour Place
Mukilteo, WA 98275
Hotel phone: (425) 493-9500 for direction purposes only
To register or for questions please call: (618) 395-3162

Date: Thursday, March 27, 2014
Time: 8:30 AM - 12:30 PM
Location: Pacific, Washington
Location address:
 Quality Inn & Suites
 415 Ellingson Street
Pacific,  WA 98047
Hotel phone: (253) 288-1916 for direction purposes only
To register or for questions please call: (618) 395-3162

Important Advanced Beneficiary Notice of Non-Coverage Info

Newsletter
November 12, 2013
Chiropractic Medicare
Advanced Beneficiary Notice of Non-Coverage

On September 4, 2012 (yes, 2012) implementation of changes in manual instructions for changes in the Advanced Beneficiary Notice of Noncoverage (ABN) were presented. Some Medicare carriers like WPS were very forgiving and did not enforce the new ABN changes. However, many of the contracted Medicare carriers like National Government Services in Illinois that replaced Wisconsin Physician Services are requiring specific ABN update usage.
The applicability to Limitation on Liability (LOL) apply only when a provider believes that a Medicare covered service may be denied in a particular instance because to is not reasonable and necessary or because the item or service constitutes custodial care, which requires a provider to notify a beneficiary (patient) in advance when he/she believes that items or services billed to Medicare will likely be denied, either as not reasonable and necessary, or as constituting custodial care.
If such notice (ABN) is not given, providers may NOT shift financial liability to patients for these items or services if Medicare denies the claim. Patients are afforded “Limitation on Liability” protection when items or services are denied.
Compliance with Limitation or Liability Provisions: The Healthcare Provider who fails to comply with the ABN instructions risks financial liability and/or sanctions.
The Medicare Contractor will hold any provider who either failed to give notice when required or gave defective notice financially liable. A provider (notifier) who can demonstrate that she/he did not know, and could not reasonably have been expected to know, that Medicare would not make payment will not be held financially liable for failing to give notice.
However, a notifier who gave defective notice may not claim that she/he did not know, or could not reasonably have been expected to know, that Medicare would not make payment as the issuance of the notice is clear evidence of knowledge.
The revised ABN gives way to the Medicare Carriers to simply state; “When the provider bills Medicare and has had the patient sign an ABN on a covered service (98940, 98941, 98942), when the “GA” Modifier is used, the claim will automatically be denied as “Maintenance care”. The combination of “AT” and “GA” modifiers are NOT acceptable and can not be placed in the same billing line on the claim.
With this in mind....the “ABN” does not financially protect the doctor when billing a covered service (98940, 98941, 98942) when the patient signs an ABN and the services are denied by Medicare, since using the “GA” modifier tells the Medicare carrier to “deny the claim”. The providers financial protection is correctly documenting the Chiropractic Necessity of Care and not have the patient sign an ABN. When using the “AT” modifier, the doctor expects the Medicare carrier to pay and will not be held financially liable.

Reference:
CMS Manual System Pub 100-04 Medicare Claims Processing:
"Chapter 30 Financial Liability Protections, Section 50 - Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN)"

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

***Special Invitation: Please Join us on November 21st.
Hampton Inn Dayton-Dayton Mall, 8960 Mall Ring Rd., Dayton, OH 8:00 am to 12:00 noon. A great chiropractic Medicare Seminar covering all the important changes in Medicare and becoming compliant.
Call to register at (618) 395-3800.

Newsletter from 10/21/2013 and a November Seminar

Newsletter from:
October 21, 2013
Chiropractic Medicare
1. Medicare Window for Enrollees
2. Medicare Replacement Plans

1. Medicare Enrollees: We are presently in the Medicare window for those first Medicare enrollees or for present Medicare patients to change their Medicare Coverage and/or Supplemental insurance. If a Medicare patient goes out of Medicare into a “Medicare replacement” plan, you may wish to inform them of their cost factors. (Medicare replacement plans, both in Medicare and out of Medicare, are cheaper than regular Medicare. The reason...both have a co-pay and other coverage not as complete.)

     If your Medicare patient does a “Medicare replacement plan” for example, three (3) years before they realize the coverage is poor and not as good as Medicare....when they return to Medicare, their premium now in Medicare increases 10% each year they have been out of Medicare for the rest of their life. (Out of Medicare for 3 years...now the premium in Medicare is 30% higher for the rest of their life.)

2. Medicare Replacement Plans: There is Medicare Part A: Hospitalization; Medicare Part B: Physician Services;Medicare Part D: drug Coverage and Medicare Replacement Plans in Medicare and Medicare Replacement Plans out of Medicare.
Those Medicare patients in Medicare, we must follow all Medicare guidelines, even though they may have a $35.00 Co-pay and reimburse nothing.

     However, some Medicare patients bail out of Medicare into a private P.P.O. called “Medicare Replacement”. They also have a co-pay and usually reimburse little or nothing. This replacement is out of Medicare and we are not required to bill or follow Medicare guidelines unless....you bill this company for your non-Medicare patient. Now you have agreed to follow all the Medicare guidelines on this NON-Medicare patient in a Medicare replacement PPO outside of Medicare.

     Most Medicare carriers have a program you can access online to check eligibility, get duplicate remittance advice, etc. and it is also where you can find if your patient is in a Medicare Replacement in Medicare or in a Medicare Replacement out of Medicare. Example: WPS has C-SNAP and NGS has CONNEX. Look for yours with your Medicare carrier or call them and ask when it will be available for your area.


NOVEMBER SEMINAR
Date: Thursday, November 21, 2013
Time: 8:00 AM - 12:00 PM
Location: Dayton, Ohio
Location address:
Hampton Inn Dayton/Dayton Mall 
8960 Mall Ring Road
Dayton, OH 45459
Hotel phone: (937) 439-1800 for direction purposes only
To register or for questions please call: (618) 395-3162  

Newsletter from 10/15/2013

Newsletter
October 15, 2013
Chiropractic Medicare

     A large number of Medicare Carriers lost contracts bringing new Medicare Carriers in several states. If you are in a state with a new Medicare Carrier, be aware of the “Local Coverage Determination” (LCD) changes. CMS delivers the guidelines, however, the Medicare Carriers can produce their own Local Coverage Determinations (LCD) that can have a major impact on your practice. Especially if you are unaware of the changes.
     An Example:WPS Medicare Carrier in Illinois lost their contract to National Government Services (NGS). WPS followed the ABN guidelines as presented by CMS. However, NGS Carrier has indicated that we cannot use the “AT” and “GA” modifiers together. This indicates to them that the patient signed the ABN indicating this adjustment was “maintenance care” which is a non-covered service, and will automatically be denied payment.
If this is true....the doctor has lost the ability to financially protect themselves if a covered service is denied by Medicare.
     ***** So...be sure to visit your Medicare Carrier’s web site, register for webinars and special training presentations. Most carriers have a free service (NGSConnex for Illinois) where you can check eligibility, submit claims and appeals, and obtain financial information.