Tag Archives: compliance

How can health plans manage unpredictable transplant costs?

While overall health care costs have been rising in the last decade, transplant costs have surged, becoming an unpredictable and volatile expense for payers. Financial projections are often hard to make in transplant episodes, which occur unexpectedly with costs varying widely based on organ type, clinical complexity, transplant facility and geography. Transplant providers themselves vary […]
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HIPAA audits and investigations — they’re baaaack…

If you didn’t receive a HIPAA pre-audit questionnaire from the U.S. Department of Health and Human Services Office of Civil Rights (OCR) last summer, you likely breathed a heavy sigh of relief. But don’t rest easy just yet, as your audit reprieve could be short-lived. Approximately 400 audits are coming, and organizations selected to be […]
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Ten days to a HIPAA audit — two scenarios

Situation analysis: You are a hospital compliance officer, and you’ve just received a call from an auditor with KPMG, a government contractor for HIPAA audits. “Did you get our letter?” he says. “You have 10 days before we conduct an audit.” Scenario one: You break out in a cold sweat. You had put a series […]
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Seven threats to health care privacy and security

Audits are coming, and last year’s risk assessments will no longer cut it. We’ve identified seven issues HIPAA security and privacy officers should consider and address in 2015. Business associates Get your business associates (BAs) on board and up to date because the HIPAA/HITECH Omnibus Final Rule of September 22, 2014, now requires covered entities […]
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Privacy and security audit preparedness — document, document, document!

When it comes to HIPAA, two of the most troubling events that keep health care executives awake at night are reportable data breaches and failing an audit by the U.S. Department of Health and Human Services Office for Civil Rights (OCR). Even with all the current publicity surrounding privacy and security, many organizations still fail […]
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Countdown to ICD-10: End-to-End Testing Ensures System Readiness

By now, most health plans have October 1, 2014 marked in red ink on their calendar. That date is well known (and sometimes feared) as the latest implementation deadline for ICD-10, set by the Department of Health and Human Services.  The ICD-10 coding system is the first change to the U.S. medical billing and disease-tracking […]
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ICD-10 Deadline Delay: No Time for a “Wait-and-See” Approach To Compliance

As is widely known by now, the deadline for compliance with ICD-10 was pushed back one year to 10/1/14.  Health plans should be using the extra time to continue on their path to transition; and some should even accelerate efforts to implement the new medical billing codes.