Monthly Newsletter

May 2022 Monthly Newsletter

Addressing a Time of Crisis in Healthcare Edition

Member Updates

New FAQ for Membership Renewal and CEU Inquiries

We have compiled a list of Frequently Asked Renewal Questions and Answers for AIHC Members.  You do not need to be logged in to view this page – click here.


Are You a Subject Matter Expert?

Are you a subject matter expert and have time to volunteer your contributions and ideas?  Get published by submitting an article for our blog (read the editorial guidelines).  Contact Us with ideas on topics you want for the summer Free Webinar Series and topics to update our YouTube Channel for you! 


Also, Contact Us with your thoughts on free webinars for “beginners” where new workforce members can participate, such as Introduction to Evaluation & Management coding; Introduction to Modifiers; Introduction to Auditing medical records.

View Remote, Hybrid and Other Positions Posted on our Job Board

Open positions throughout the United States are posted on the AIHC Career Center Page in the following categories:

  • Appeals Management, RCM, Medical Billing and Coding
  • Auditors / Investigators / Quality Analyst / Healthcare Consulting
  • Compliance & HIPAA Officers / Regulatory Directors

Check one of the new listings for the position with the U.S. Department of Veterans Affairs.  Scroll through all categories – Click Here.

Yep – Study Shows Association between Clinician Distress and Inappropriate Use of Antibiotic Rx


Joint Commission April 26, 2022


The overprescribing of antibiotics in U.S. outpatient settings is an urgent public health concern. The majority of these antibiotic prescriptions are written for acute respiratory tract infections (RTIs), even though antibiotics are inappropriate for treating viral RTIs such as bronchitis, sore throats, common colds and the flu.


A new study from the May 2022 issue of The Joint Commission Journal on Quality and Patient Safety, “Clinician Distress and Inappropriate Antibiotic Prescribing for Acute Respiratory Tract Infections: A Retrospective Cohort Study,” is available to read on the Joint Commission website.

Healthcare Workforce Burnout and Shortage Crisis

Stress of healthcare workers continues to be a concern.  Work stress refers to the harmful physical and emotional effects when job requirements do not match workers’ resources or needs. Work stress can lead to poor mental and physical health. Mental health includes a person’s psychological, emotional, and social well-being and affects how we feel, think, and act.


The COVID-19 pandemic has introduced additional elements of fatigue, strain, loss, and grief for healthcare workers. Many healthcare workers experienced increased workload in the face of short staffing and shortages in critical personal protective equipment. These shortages continue, which leads to increased anxiety and the risk of personal harm. Some healthcare workers report symptoms consistent with post-traumatic stress disorder related to the pandemic. Some also reported residual symptoms due to personal infection with COVID-19, according to the Centers for Disease Control (CDC).


Many healthcare workers place the well-being of others before self. On the surface, this dedication to patients may seem admirable. However, it can ultimately be harmful if it delays or prevents workers from getting the help that they need for their own health and well-being.


The National Academy of Medicine (NAM) announces a National Plan for health workforce well-being. Until the final National Plan’s release, the Clinician Well-Being Collaborative’s 2022 activities will continue to inform its development. The draft plan will be released in May 2022 for public input. The NAM will also host a public input event on May 20, 2022 from 3:00 – 4:30 pm ET on the day of the draft’s release.  Learn more.


If you are a health care worker or leading a health care organization, NAM has well-being resources for you.

Insider Threats in Healthcare

An insider threat in healthcare can be posed by a member of the organization’s workforce, or a contractor, who has access to assets or inside information concerning the organization's security practices, data, and computer systems. The person could use this information in a way that negatively impacts the organization. The type of insider threat can be malicious, a result of negligence of accidental.

 

Did you know that most health care organization invest more funds on insider threats with malicious intent when negligent insider threats are actually more common?  According to Ponemon’s 2020 Insider Threats Report, 61% of data breaches involving an insider are primarily unintentional, caused by negligent insiders.


Read the 04/21/2022 “Insider Threats in Healthcare” PPT published by the HHS Cybersecurity Program, Office of Information Security to learn more about insiders threats.

Did You Read the Guidance to Address Billing Errors?


The Medicare Provider Compliance Newsletter


The Centers for Medicare & Medicaid Services (CMS) releases the Provider Compliance Newsletter twice each year.  Learn about avoiding common billing errors and other erroneous activities when dealing with the Medicare Fee-for-Service (FFS) Program. This newsletter includes guidance to help health care professionals address and avoid current top mistakes:

  • A review of Recovery Auditor findings and lack of documentation for medical necessity related to total hip arthroplasty is highlighted for professional, inpatient and outpatient claims. 
  • Also included in the newsletter are improper payment findings of two Comprehensive Error Rate Testing (CERT) audits for hospice and DMEPOS.

CMs also advises providers to review Section 5.9 of the Medicare Program Integrity Manual (PIM), chapter 5 for DMEPOS compliance. The medical record may include records from hospitals, nursing facilities, home health agencies, and other health care professionals.


Another great resource is subscribing to the AIHC newsletter.  Forward this Email and ask your coworkers to Subscribe to Our Newsletter .

Is Your Organization Tracking Denied Claims?

Revenue Cycle Managers (RCMs) should be paying close attention to how denied claims are handled. Achieving a health bottom line is complex and incentives need to ensure that metrics used to determine A/R performance are not causing an increase in writing-off claims that should be appealed. So, are we asking the right questions? Are denied claims written-off or appealed?  If appealed, what is the success of overturning the denial?


Access free articles on Revenue Cycle Management, Denials and Appeals.  There are just a few seats open for the May 18-19, 2022 Appeals Camp in Tampa, so register today.  Register for the online Outpatient RCM training and certification.  Learn more to enhance your revenue while maintaining compliance!

New Report on Top Routinely Exploited Vulnerabilities

Protecting patient’s health information is critical for both Covered Entities and Business Associates to comply with HIPAA rules. Did you know, all organizations should immediately report incidents to CISA (Cybersecurity & Infrastructure Security Agency) at https://us-cert.cisa.gov/report, a local FBI Field Office, or U.S. Secret Service Field Office?


CISA offers a range of no-cost cyber hygiene services to help organizations assess, identify, and reduce their exposure to threats. By requesting these services, organizations of any size could find ways to reduce their risk and mitigate attack vectors.


Cybersecurity authorities encourage organizations to apply recommendations in the Mitigations section of a new this Cybersecurity Advisory published April 27, 2022.  Read “2021 Top routinely Exploited Vulnerabilities” advisory posted by CISA.  AIHC recommends utilizing free resources, then supplementing with structure training as well. AIHC offers low-cost workforce training in HIPAA in addition to a full, online certification program for HIPAA privacy/security officers.

New (free) Cybersecurity Resource


Have You Heard About Multi-Factor Authentication (MFA)?


Securing health care data in a world of increasing cybersecurity risks is a challenge!  Why care about cybersecurity?  Protecting our intangible risk, such as reputation, we must be concerned with potential ransomware locking your organization out of medical records; and then there are the associated HIPAA fines related to a breach. But there are free resources, such as the new Fact Sheet from the HHS 405(d) taskforce entitled Multi-Factor Authentication which addresses a layered approach to security data. 

2022 MHPAEA (Parity Law) Report to Congress


Increasing Access to Mental Health and Substance Use Disorder (MH/SUD) Coverage


There are protections in federal law, collectively known as “parity,” designed to ensure that certain types of health plans cover mental and substance use disorders no less generously than they cover other health issues.  This means that deductibles, copays, out-of-pocket maximums, and treatment limitations for mental health or substance use disorders must not be more restrictive than corresponding requirements or parameters offered for medical and surgical benefits.


The Mental Health Parity and Addiction Equity Act (MHPAEA) requires the Secretary of Labor to submit a report to the appropriate committees of Congress on compliance by group health plans (and health insurance coverage offered in connection with such plans) with MHPAEA’s requirements. 


The government has new MD/SUD benefits resources to help people seeking care to better understand their rights.  Click Here for April 27, 2022 press release with hyperlinks to these resources or visit SAMHSA (Substance Abuse and Mental Health Services Administration) publications on Parity for MD/SUD Benefits.  Click Here for the 2022 MHPAEA Report to Congress.  This 2022 Report outlines the first steps in a change in course marked by more rigorous enforcement, greater stakeholder engagement, and increased collaboration to identify ways to support the Administration’s effort to increase access to MH/SUD treatment.


Click Here to access online training for psychiatric providers, coders and billers provided by the American Institute of Healthcare Compliance.

Law Enforcement Action to Combat Health Care-Related COVID-19 Fraud


Cases allegedly exceed $149 million in false billings


On April 20, 2022, the Department of Justice (DOJ) announced charges against 21 defendants for their alleged participation in various fraud schemes involving health care services that exploited the pandemic and resulted in COVID-19-related false billings to federal programs as well as theft from pandemic assistance programs. Click Here to read the DOJ press release. Watch the related Video. 

 

Learn more about the OIG Fraud Risk Indicator and False Claims Act (FCA) settlements on the risk spectrum.  Learn more about detecting fraud, abuse and how to improve compliance today. 

CLINICAL APPEALS SPECIALIST

May 18-19, 2022 in Tampa

Training Camp 

with the option to certify online

HIPAA COMPLIANCE

Online Training 

with the option to certify online

CORPORATE COMPLIANCE

Online Training

with the option to certify online

https://aihc-assn.org/courses/corporate-compliance/

CONDUCTING INTERNAL INVESTIGATIONS

Online Training

with the option to certify online

REVENUE CYCLE MANAGEMENT

Online Training

with the option to certify online

AUDITING FOR COMPLIANCE

Online Training

with the option to certify online

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