Monthly Newsletter

January 2022 Monthly Newsletter

Extreme Risk Protection Orders – HIPAA Update

The Office for Civil Rights (OCR) has issued guidance regarding how HIPAA permits covered health care providers to disclose protected health information to support applications for extreme risk protection orders that temporarily prevent a person in crisis, who poses a danger to themselves or others, from accessing firearms.

This guidance helps implement the U.S. Department of Justice's model extreme risk protection order legislation that provides a framework for states to consider in creating laws allowing law enforcement, concerned family members, or others to seek these orders and to intervene in an effort to save lives.  These orders can be an important step toward improving the public's safety by helping to prevent firearm injuries and deaths.

Review OCR’s HIPAA Privacy Rule and Disclosures of Protected Health Information for Extreme Risk Protection Orders.  Consider online HIPAA privacy/security training today.

January 2022 Integrated Outpatient Code Editor Changes

Learn about claims processing changes effective January 1, 2022 addressing:

  • Hospital outpatient departments
  • Community mental health centers
  • Non-Outpatient Prospective Payment System (PPS) hospital providers
  • Limited services when provided in a Home Health (HH) agency that isn’t under the HH PPS
  • Hospice patients for non-terminal illness treatment

For more information, see Change Request 12533 issued to your Medicare Administrative Contractor as the official instruction.

Use QW Modifier with Code 86328 for COVID Antibody Test in 2022

Effective January 3, 2022 you can append modifier QW to code 86328 as a CLIA waived test. Make sure your billing staff knows about these changes.  Your MAC won’t search their files to either retract payment for claims already paid or to retroactively pay claims. However, they will adjust claims you bring to their attention.

86328   Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Click Here for MM12557 notice from CMS regarding code 86328. Consider training as a Certified Outpatient Revenue Cycle Management (CORCM) professional offered online, on-demand.

Surgical Dressings & Medical Necessity

Follow Medicare guidelines to avoid unnecessary denials.  Medicare covers primary or secondary surgical dressings when used to protect or treat a wound and when needed after you debride a wound

  • Include clinical information in patients’ medical records that demonstrates a reasonable and necessary need for the type and quantity of surgical dressings; and
  • Evaluate the wound monthly and update the record, unless you document why you can't do a monthly evaluation and how you're monitoring the patient's ongoing use of dressings

Download the Surgical Dressings Policy Article A54563 from the CMS website for additional details.  Take the online, on-demand  Appeals Management course with option to certify as a Outpatient Clinical Appeals Specialist (COCAS).

OCR Issues New Guidance – Improving Access to COVID-19 Vaccines

The Office for Civil Rights (OCR) has issued guidance to ensure that entities covered by civil rights laws understand their obligations under federal law and regulations that prohibit discrimination on the basis of race, color and national origin (including language spoken). Click Here for more information.

Where is Your Organization on the Fraud Risk Indictor?

Based on information gathered in a False Claims Act (FCA) case, Office of Inspector General (OIG) assesses the future trustworthiness of the settling parties to decide whether to exclude them from federal health care programs.

Because OIG's assessment of the risk posed by a FCA defendant may be relevant to various stakeholders, including patients, family members, and healthcare industry professionals, OIG makes public information about where a FCA defendant falls on the risk spectrum.  Learn more about the OIG fraud risk indicator. Learn more about Healthcare Compliance training, online, on-demand.

Overbilling Facet Joint Injections?

Billing the correct number of units is vital when filing claims for many medical services.  In the case of Integrated Pain Associations and Central Texas Day Surgery, it has become a costly error.

These providers are paying $836,702 to resolve False Claims Act allegations for submitting claims to Medicare, Medicaid, and TRICARE for facet joint injections, transforaminal injections, and radiofrequency ablation procedures. The United States contends that the defendants billed for more units or levels of these procedures than they performed.

This is a Whistleblower Case - The civil settlement of these allegations includes the resolution of claims brought under the qui tam provisions of the False Claims Act by Susan Edwards. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Click Here to learn more about this case.

Former IHS Physician is Sentenced for Abusive Sexual Contact

Pedro Ibarra-Perocier, previously employed at the Wagner Indian Health Service (IHS) Clinic as a licensed physician, was sentenced to 120 months in federal prison, followed by five years of supervised release, a $35,000 fine, and a special assessment to the Federal Crime Victims Fund in the amount of $500.

From 2007 to 2018 this physician sexually abused five Native American women who came to see him at the clinic for medical appointments.  Ibarra-Perocier frequently locked the door to the examination room before he sexually abused those women. Click Here to read more about how this physician abused these women.

Access the AIHC free Human Resources Playlist which provides 4 short videos on workplace harassment and violence you can use for new-hire and annual training purposes.

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