Tag: National Provider Identifier

MDaudit Releases Service Provider Workflow to Support Line Service Provider Audits, Enhanced Provider Education

MDaudit announced today the release of Service Provider Workflow. This latest enhancement to its industry-leading billing compliance and revenue integrity platform supports billing when rendering providers differ from service providers, reducing audit risks related to the billing of split/shared services.

Under changes to its Evaluation and Management (E/M) guidelines, the Centers for Medicare and Medicaid Services (CMS) require split/shared services — which are performed jointly between a physician and a non-physician practitioner (NPP) in the same group and in a facility setting — to be reported by the clinician who performs the substantive portion of the patient visit.

To qualify for billing under the physician’s national provider identifier (NPI), which nets a higher rate than those billed by NPPs, the physician must have performed more than half of the provided care, as determined either by time spent or through evaluation of key components including history, examination, or medical decision-making.

“Service providers perform and document services under the supervision of the rendering provider. However, under current CMS E/M guidelines, the claim is no longer billed by the rendering provider unless they have performed a substantive portion of the care, which introduces a new layer of complexity and compliance risk into the billing process,” said Catherine Proctor senior product manager, MDaudit. “MDaudit’s new Service Provider Workflow functionality reduces that risk by allowing customers to include the service providers who aren’t on the claim as part of an organized audit.”

Users can efficiently organize line service providers into provider groups and audit both professional- and hospital-based service providers. It also features the flexibility to perform audits at the rendering, attending, or service provider level, organize audits at the line service provider level, and exclude cases from rendering/attending provider-organized audits when different line service providers are involved.

“The benefits of this new process are numerous, including a better root cause analysis for errors and the ability to provide feedback directly to documenting service providers while more easily targeting residents, ‘incident to’ providers, locum tenens, and split/shared services,” said Proctor. “Service Provider Workflow features were popular asks from the MDaudit community, and we are excited to deliver them to our clients to help further reduce their audit risk.”

Ramped Up HIPAA Enforcement: A Government Myth or Reality?

Jay Hodes
Jay Hodes

Guest post by Jay Hodes, president, Colington Consulting.

A little more than a year ago the former Director of the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), Leon Rodriquez, referred to covered entities that did not realize they have business associate relationships in place. He went on to say that some business associates did not know that they were actually business associates. Rodriquez stressed it was both the responsibility of the covered entity and the business associate to understand this relationship does exist.

Regarding ramped up HIPAA enforcement and compliance, Rodriquez indicated future audits will be narrower in scope and include more organizations than ever before. Covered entities and their business associates also will be audited under the new permanent program, and audits will focus on vulnerabilities that could change year to year as new issues arise.  This appeared to be the start of an intended awareness program and fair warning.

With Rodriquez’s departure to Homeland Security in June, it seemed like the task of continuing the drum beat message of ramped up HIPAA enforcement fell to Linda Sanches.

Sanches is OCR’s senior health information privacy advisor. In that position, she oversees the HIPAA security and breach notifications audit program and may know a thing or two about the direction OCR wants to take with future audits. Sanches recently spoke at the Health Information and Management Systems Society (HIMSS) Privacy and Security Forum. However, she did not provide any striking revelations or critical insights about these new audits, just more of what the industry seems to know already, that these audits are coming.

Much like Rodriquez did in the past, Sanches spoke more in generalities than specifics. She indicated OCR was looking at a broader view of the entire healthcare industry as possible criteria for selection of who would be targeted for an audit. Using the National Provider Identifier (NPI) database is a method being considered to select entities like hospitals, practices and dental providers for audits.

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