Tips for Surviving a Federal HIPAA Audit

Being contacted by the Department of Health and Human Services (HHS) or the Office for Civil Rights (OCR) for a HIPAA audit can be a very scary situation. The best way to survive a federal HIPAA audit is ensuring that you have the proper procedures in place every single day on the job. A single employee who is non-compliant could cost your practice a lot. 

Make Sure It’s Valid

Unfortunately, some scammers try to take advantage of practices by pretending to be OCR representatives conducting an audit and asking practices to purchase “certification” services. OCR and HHS will only make contact with your practice via email or certified letter. You always have a right to respond to ask for proof of validity, and that will not be held against you during the audit process. There is no certifying body for HIPAA compliance in existence, so any organization that approaches you claiming that they are one is lying.

Educate Your Employees

One of the best prevention strategies is educating your employees of the serious consequences of a HIPAA violation.

  • A HIPAA violation that occurs without knowledge: $100-$25,000 violation
  • A HIPAA violation due to reasonable cause: $1,000-$50,000 violation
  • A HIPAA violation due to willful neglect, but fixed within 30 days: $10,000-$50,000 violation
  • A HIPAA violation due to willful neglect that is uncorrected or corrected after 30 days: $50,000 violation

Reminding employees of the steep cost associated with each violation regularly can help to ensure compliance.

Tips for Survival

When preparing for a federal HIPAA audit, ask yourself the following:

  • Are our HIPAA policies and procedures regularly updated and effective? You should have things like a Breach Notification policy on hand and in effect.
  • Is our HIPAA training regularly updated and effective? How do we know it’s working? Every practice is required to hold HIPAA trainings for employees that are up-to-date, as well as maintain detailed records showing when employees attended the training and tests or surveys showing they understood the content.
  • Has our practice completed a risk assessment? This aspect of HIPAA often lies under the radar, but it’s a requirement as part of the HIPAA security management processes.
  • Have we had HIPAA breaches? If you have had a breach, you should make sure that all documentation has been properly completed.

Keep Your Practice HIPAA-Compliant with Vetters Enterprises

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

The Exciting Prospects of Pharmacogenomics

One of the newest and most promising developments in genetic testing could also help counteract the opioid epidemic. Pharmacogenomics is the practice of gene testing to determine how a patient’s body will react to specific medications. Pharmacogenomics is now covered by most insurances.

 

Genetics Affect More Than Previously Thought

Every person has thousands of genes that dictate their characteristics, from the color of their eyes to their blood type. As scientific research continues to advance, it is becoming apparent that genetics affect far more than was previously thought. Pharmacogenomics examines a patient’s genes for variations that may show whether or not a medication could be an effective treatment. Aside from helping to determine the efficacy of a drug treatment, this can also help to identify potential allergies before they occur.

The Basics of Pharmacogenomics Testing

The core purpose of pharmacogenomics testing is to determine whether or not a medication is appropriate for a patient. A patient will have a blood or saliva sample taken, and various tests will be performed to determine:

  • If a medication could be an effective treatment for the patient’s condition
  • What the ideal medication dosage should be
  • Whether or not an allergic reaction is likely to occur

Why Pharmacogenomics

Aside from the obvious benefits of the above, pharmacogenomics serves a variety of medical purposes. The study hopes to lead to drugs that are more customized to proteins, enzymes and RNA within each patient’s DNA. These high-powered medicines will do less damage and work more efficiently thanks to their customization.

The dosages for current medications will also become more accurate as height, weight and age will not be the only parameters. Instead, genetics will help customize the medication’s dosage, lower the chances of an overdose and help to reduce the likelihood of drug abuse.

Countless Patients Can Benefit

Depression is an incredibly common condition, and finding the right medication and dosage for patients is notoriously tricky. Pharmacogenomics could greatly assist with finding ideal psychiatric medications for struggling patients without the need for constant adjustments. With over 1 in 20 Americans suffering from depression, many people could stand to benefit.

Increase the Efficacy of Your Practice with Vetters Enterprises

Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.

The Shift from Volume to Value: The Challenges

Now that we have covered the basics of volume-based reimbursement and value-based reimbursement and all of the wonderful benefits it will bring, we will address some of the anticipated challenges your healthcare facility might face.

In Case You Missed It

Healthcare providers are currently shifting from volume-based reimbursement plans to value-based reimbursement. This dramatic change is designed to benefit patients, healthcare providers and the payers. Value-based reimbursement promises to give patients the highest quality care for the lowest possible amount and shift the focus of healthcare providers to the actual health of their patients.

Medicare and Medicaid

As the baby boomer population grows older and more reliant on Medicare for their medical expenses, the reimbursements that healthcare facilities receive will decrease. In addition to the growth in Medicare patients, the use of Medicaid has also grown. The new mix of revenue will definitely take a toll on your office’s bottom line if you are not prepared.

Reconciling Volume-Based and Value-Based Payments

The next challenge healthcare providers face is reconciling the new value-based reimbursement model with your current fee-for-service environment. Tracking progress can be tricky, as you need to maintain detailed logging in two different payment systems at the same time. Your accounting systems and software might need a major upgrade in order to track value-based reimbursement patients, populations, and billing.

Keeping Track of Quality Measures

Most incentives for practices that meet certain value standards rely on keeping track of quality measures. You are probably already used to submitting some quality measures, but their effect on your bottom line might be new. The value-based reimbursement shift means that your ability to meet quality standards, benefit patients and cut costs is directly tied to whether or not you receive incentives or penalties.

This transition period is the perfect time to have an evaluation performed on your facility’s systems to see where you can further reduce costs and increase efficiency. Vetters Enterprises specializes in practice management, revenue cycle optimization, and private practice business support. We can perform detailed assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.