Category: SOS Blog

FierceHealthPayer reported that the U.S. Department of Health and Human Services (HHS) has announced the opening of the health insurance marketplace mandated by the Affordable Care Act (ACA). The Exchange enrollment process has begun for individuals and for small businesses who want to try out the new site.

The ACA requires states to set up exchanges or marketplaces where consumers and businesses can shop for reasonably priced health insurance plans that meet the minimum requirements of the law. So far, only sixteen (16) states have taken on that responsibility. The other thirty-four (34) states’ exchanges will be included in the site being developed by HHS.

Take a look when you get a chance. There will not be actual insurance plans up for offer until October 1, 2013, but in the meantime, you can visit the site and read some of the available information and enroll if you like. If you work for an employer who does not provide health insurance and live in one of those 34 states with no exchanges of their own, this is where you will go to shop for coverage. If you are an employer with fewer than fifty (50) employees who is not required by ACA to provide health insurance, there is a section here for you as well. The site is far from complete, but there is already lots of useful information.

Do you already have affordable health insurance? Will you be using the Exchanges to locate coverage for yourself or your business? I certainly will be comparing plans, their coverage and their cost, with our current insurance once the exchange is open!

Several years ago, I sat next to a colleague at a conference. She was CEO of a much-larger-than-SOS behavioral health software company. We were listening to a presentation on costs and duplication of services to chronically mentally ill Medicaid recipients, and the efforts of community mental health organizations to provide needed services with limited Medicaid dollars. We looked at one another and agreed that the only way all of us, including the most vulnerable populations, are ever going to get reasonably priced high-quality healthcare services is when we have a single payer system.

Many of you know that I have spent the past eight years as primary caregiver for my elderly mother. A result of that process is significant experience with the Medicare system. My mother used traditional Medicare: doctors billed for services provided. Medicare and a Medigap policy paid for all covered services. Medicare Part D paid about 60% of medication costs. Our experience with the Medicare system was nothing but positive. Mom paid her extremely reasonable Medicare, Medigap and Part D premiums and she received all the care she needed from caring, outstanding providers.

This morning, I read my issue of FierceHealthPayer. They reported that a new study from Physicians for a National Health Program shows that we could save approximately $592 billion in healthcare expenditures next year if Medicare were extended to all. Gerald Friedman, Ph.D., a Professor in the Department of Economics at University of Massachusetts at Amherst details how these savings could be accomplished through a single payer system proposed in HR 676: The Expanded and Improved Medicare for All Act.

Dr. Friedman’s focus is on administrative costs. You know about those. They include your costs in meeting the requirements of myriad insurers in order to get paid for the services you render to your clients. Those costs include software, claim forms or clearinghouse fees, staff salaries and benefits, long distance charges for hours spent on hold with insurance carriers to verify coverage and object to claim rejections, to list only a few. These costs include insurer’s expenditures for their side of those same processes…and employers costs to shop for, administer, and pay for coverage.

Don’t think about other countries and their health care systems. Think about our 48 years with Medicare. Maybe Dr. Friedman and Rep. John Conyers, Jr. (D-Michigan), author of the bill, are onto something.

 

When most of us think of threat to the Protected Health Information (PHI) for which we are responsible, we think about breach by outside sources. After all, those of us who work in Behavioral Health and Substance Abuse are highly sensitized to the need to protect the privacy of our clients. Given that, we assure that our electronic systems are protected by adequate security….that the PHI is encrypted, that our firewall is effective, that no one is connecting remotely who should not have access. Right? We don’t as often think about what goes on inside our offices.

This morning, Seth sent the SOS staff an account reported by one of the HIPAA security blogs to which he subscribes. This event sounded very much like two that have happened to customers of SOS. Two staff members leave the practice taking patient information with them in order to feed a new practice/business. Most people immediately think about the theft of the patients by the departing provider. We think about the theft of the PHI and the breach report the practice may now be required to make.

Since the Office of Civil Rights (OCR) started real enforcement of HIPAA including fines, breaches have resulted in settlements averaging $1M each. Six out of nine of those breaches were the result of an insider’s actions, not those of an outsider. The fines mostly came about as the result of investigation by OCR of reports made by the health organization that experienced the breach.

Today I attended a webinar provided by IDExperts. They are one of my favorite sources of information about privacy and security of PHI. While their software may be beneficial to some of our larger customers, it is clear to me that our smaller practices and agencies are very much in need of information and education and could benefit from some of the resources available on their site.

If you think your PHI could ever be viewed by an inappropriate person based on employee mistakes, the loss of portable devices, or the theft of patient information by someone with whom you contract, you need to assure that you have protective policies and procedures in place, that your employees are adequately trained, and that you all follow the needed procedures. Hiring a consultant or buying software to write policies for you and then forgetting about them is a major mistake. You must develop a culture of compliance to assure the safety of PHI. The Ponemon Institute, in a study sponsored by IDExperts, found that only 52% of employers believe they have policies and procedures to prevent and detect unauthorized patient data access. Are you part of that 52% or of the 48% who do not have adequate policies and procedures to protect your PHI?

What does your organization do to protect PHI? What is your role in whatever your organization does? When was your last HIPAA Privacy/Security training? Do all staff attend including providers and executive staff? Do you have Business Associate Agreements with all the businesses who might have access to your PHI? If I were to come to you as a client, would I feel assured that my PHI is protected from preying eyes and secure from threat?

Please share your thoughts and comments below.

 

Since returning to the office regularly after my intermittent absences of the past year, I have had a difficult time renewing my weekly blogging schedule. In order to ease back in, I have decided to do very short blog posts that will provide information that has come across my desk recently. I am hopeful this will help me get back into a rhythm of regular posting and also get useful information to you. Once I have a regular pattern re-established, I will add in longer posts. Thanks for bearing with my changes and transitions.

 

As a resident of the state of Florida, I was very glad to see an article this week in FierceHealthIT reporting that several states, including ours, have begun working together to assure access to health information during a disaster. Hurricanes are a big concern for us here. Since my Mother was displaced from Louisiana to Florida by Katrina in 2005, we have seen precious little movement to assure that, eight years later, patients will continue to be treated properly when they do not have access to their own physicians and pharmacies.

The new collaboration described in this article will allow exchange of health records for persons displaced from their homes by widespread disaster. The states participating are Alabama, Georgia, Louisiana, Florida, South Carolina, North Carolina, Virginia, Michigan, Wisconsin and West Virginia. The plan is to have connection with at least one other state through a Health Information Exchange (HIE) to assure access to patient records. The Southeast Region HIT-HIE Collaboration (SERCH) Final Report published in July of 2012 explores the legal and technical details required of such a project.

A guidebook prepared by the Agency for Healthcare Research and Quality (AHRQ) provides information for providers on how to connect into a system that will allow sharing of information in case of emergencies like natural disasters. A Guide to Connecting Health Information Exchange in Primary Care was published by AHRQ in May of 2013.

These projects aimed at linking local records to regional systems to be shared in case of emergency may at some time help all of us. This is just a beginning step toward solidifying what electronic health records can do for us.

Please share your thoughts about this kind of healthcare information exchange in the comments below. Thanks for reading.

This post on ICD-10 preparation and implementation is offered by Manon Faucher, SOS’ Lead Support Tech.

 

“Is SOS ready for the implementation of the ICD-10 codes?”

SOS has received many calls and e-mails from our customers asking us this question. Actually we should be asking you, ‘Has your practice implemented a process for the adoption of the new ICD-10 codes?’ Have you researched and planned for training of your providers and staff? Once you have trained your staff who will be responsible for revising all your accounts and assigning the new ICD-10 codes? Will you have someone overseeing and reviewing the process to assure the proper codes are used? As you can see, most of the intensive labor will not be on SOS but will be on your practice.

There are many online documents that will provide transition planning guides, resources and training information. You need to start researching your options now. Various sites such as those offered by the Centers for Medicare and Medicaid Services (CMS), American Psychological Association (APA), and the Centers for Disease Control (CDC) are great sources of information; and right now, information is your friend. The more you and the staff of your organization can learn about the ICD-10 codes related to the ICD-9 codes you currently use, the better prepared you will be.

It is important that you remember that there will NOT be a one-to-one code conversion utility or methodology to translate an ICD-9 code to an ICD-10 code. There are tools available to help you know which codes to use, but if you enter one ICD-9 code these tools will return multiple possible ICD-10 choices. Your clinicians must choose among the options…or provide enough information for your coding specialist to do so intelligently. SOS will NOT have a utility built into the system to convert the ICD-9 codes, but we will make it easy for you to link to your favorite crosswalk site to do look-up as you have the need.

To answer the question above, SOS has the ability to include both ICD-9 and ICD-10 codes in our next generation of software. On October 1st, 2014 the program will start including ICD-10 codes on your claims by default. If some insurance companies are not ready on October 2014 to receive the ICD-10 codes, you can set these insurance carriers to include ICD-9 instead. This can be done on a payer by payer basis.

As a note, ONLY the 5010 ANSI format will allow for the ICD-10 codes. If you are using any of SOS Electronic Claims Modules (this does NOT include the ‘Export CMS 1500 form for 3rd party products’), you do not need to worry. If you are using different Electronic Claim software you need to verify that by October 2014 they will have the ability to send in the 5010 ANSI format.

Has your organization begun preparations? What are you doing to get ready? Please share your experience in the Comments below.