July/August 2012 MBJ

MEDICAL BUSINESS JOURNAL With the rise in theft of personal electronics comes an action plan to stop fraudsters in their tracks

July/August 2012 Issue 5 Volume 3

The Monthly Newsletter for the Informed Healthcare Professional

In this Issue 2..............................................................................................…….........MMI on Facebook/Twitter 2......................................................................................................……..............A Free Gift to You! 3..........................................................................................................................CMS News Updates Anti-Fraud Command Center More ACO’s Means Better Care Pre-Payment Audits on August 27 Administrative Simplification 4...............................................…………………ONC i2 Challenges Direct from Health2con.com 5......................................................…...............……........Theft of Personal Electronics on the Rise 6......................................................…........................……................…Management Aptitude Test 7.............................................………..EHR is Improving Care while Accelerating Meaningful Use 7...........................…....................................…..AMA Takes a Stand Against the Obesity Epidemic 8............................................................................................………………..Contribute to the MBJ

THE MEDICAL BUSINESS JOURNAL July/August 2012

Medical Management Institute Updates Facebook.com/MMIFan Have you “liked” us yet?

While we work hard to keep members informed of our current promotions and upcoming courses via email, we are also always having give-aways and promotions exclusively on facebook.com/MMIFan! Don’t miss out on the fun and educational gifts which include everything from gift cards that can be used towards courses at our Institute, to iPads! We are always updating the page with helpful resources, interesting articles, and upcoming CEU courses/ webinars through accredited and widely recognized organizations.

Go to www.facebook.com/MMIFan, and join in on the conversation!

A Gift for You! Enroll before Sept.1 and receive a $50 gift certificate If you enroll in the RMC, RMM, CPC, or CCS-P online certification program (with or without the iPad) before September 1, 2012, you will receive a $50 gift certificate! This can be applied towards any of our other certification programs and CEU self study courses or webinars and is completely transferrable.

As a gift to our MBJ readers, we have included a $100 gift certificate below which can be applied towards our CEU self study courses, webinars, and certification programs! To redeem this, you can place your order online at www.mmiclasses.com $100 Gift Card This is our gift to you for being a valued reader of the MBJ! Be sure to cut this out and save it to apply towards any MMI CEU courses or certification programs.

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Tiffany LaPlante, RMC, winner of $150 gift certificate through facebook.com/MMIFan

using the promo code at checkout, or you can place the order over the phone with a member services representative at 866-892-2765. If you don’t feel that you will use the gift card, then pass it on to a friend or co-worker! We have a great referral program- if you refer somebody that signs up for a certification program, you automatically receive either $150 cash, or $250 towards any of our services...your choice! Please feel free to contact us with any questions about the gift card or referral program.

Email: student@mmiclasses.com Phone: 866-892-2765

Anti-Fraud Command Center Up and Running

“Our expectation is that this center will pay for itself many times over.”

As one more step in the Obama Administration's effort to combat health care fraud and waste, the launch of an anti-fraud Command Center went live on July 31, 2012. The Command Center has brought together Medicare and Medicaid officials, state officials, the Federal Bureau of Investigation, and other anti-fraud investigators and groups in an extreme effort to identify fraud and stop it in its tracks.

Peter Budetti, CMS Deputy Administrator & Director of the Center for Program Integrity

Investigations of fraud used to take weeks to be dealt with, but with new technology it happens in a matter of hours. The new partnership was developed with the outcome being to reveal scams and potential fraud using sophisticated predictive analytics, and to then halt these attempts immediately.

The capability to recognize payments being billed to different insurers for care given to the same patient in multiple cities on the same day has huge potential, as well as the ability to detect schemes using sophisticated technology and analytics on industry-wide health care data.

activity, there are already visible results.

According to Dr. Peter Budetti, CMS Deputy Administrator and Director of the Center for Program Integrity, the government has recovered over $4 billion this year alone, and has had the largest health care fraud busts in history in 2012.

With the Command Center speeding up However, while this is obviously a huge anti-fraud efforts, the health reform law accomplishment, there are still those allowing tougher sentences on fraudsters, worried that this may not be the answer. improved screenings on Medicare & Medicaid providers and suppliers, and The Command Center, consisting of a suspended payments to providers and couple dozen computer workstations, suppliers engaged in suspected fraudulent new detection systems, and a giant

screen, cost $3.6 million and is estimated to cost more than $60 million annually, making some believe that it may just be a huge waste of money. However, Budetti is confident in the Command Station stating, "Our expectation is that this center will pay for itself many times over."

For more information on the Command Center visit http://blog.cms.gov/ 2012/07/31/command-center-speedsup-anti-fraud-efforts/

ACO’s = Better Care

Pre-Payment Audits

$9 Billion Saved

As of July 1, 2012, 88 new Accountable Care Organizations (ACOs) have signed on with CMS, which means better care for Medicare patients and a lot of money saved. ACO's enter into the agreement to show that they are committed to the quality of care they provide to people with Medicare, while also having the opportunity to partake in savings through the better quality care.

The Recovery Audit Prepayment Review demonstration is proposed to cut improper payments before they even occur. To ensure that providers comply with all Medicare payment rules, Medicare Recovery Auditors (RAC) will inspect claims before payment. This is another effort from the Obama Administration to fight and prevent healthcare fraud, which was a goal set in 2010.

A new rule that will cut red tape for doctors, hospitals, and health plans was announced on August 7. This rule, in combination with a previously issued regulation, will save up to $9 billion over the next ten years. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.

[Source: http://www.cms.gov/ResearchStatistics-Data-and-Systems/ Monitoring-Programs/CERT/RACPrepay-Review.html ]

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THE MEDICAL BUSINESS JOURNAL July/August 2012

CMS News Updates

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THE MEDICAL BUSINESS JOURNAL July/August 2012

ONC i2 Challenges Direct from Health2con.com On June 8, 2011, the Office of the National Coordinator for Health Information Technology (ONC) announced the launch of the Investing in Innovation (i2) Initiative, a bold new program designed to spur innovations in health IT. The program centers on prizes and competitions to accelerate the development of solutions and communities around key challenges in health IT.

SMART-Indivo App Challenge The “SMART-Indivo Challenge” is a call to developers to build an Indivo app that provides value to patients using data delivered through the SMART API and its Indivo-specific extensions.

The app will be either an HTML5/XHTML Web app or an iOS app that runs against the Indivo Developer Sandbox, where it can access patient demographics, medications, laboratory tests, and diagnoses using Web standards. Developers could, for example, build a medication manager, a health risk detector, a patient-friendly laboratory visualization tool, or an app that integrates external data sources (see http://www.healthdata.gov/) with patient records in real time.

More information about SMART and Indivo APIs can be found at http://indivohealth.org/smartindivo-app-challenge/.

Mobile HTML5 web app submissions are welcome, as are native applications built on Indivo's iOS Framework.

The Million Hearts Risk Check Challenge Are you at risk for heart attack and stroke? Are your loved ones? If you are like many Americans, these thoughts have crossed your mind, only to be replaced by the demands of the day and often returning in quiet moments. In communities across America, there are thousands of convenient and inexpensive ways to know your risk for heartrelated conditions. Often, all it takes is scheduling a screening with your doctor or at a pharmacy.

However, nearly 15% of people at risk for cardiovascular disease (CVD) are undiagnosed and less likely to take preventive action.

Million HeartsTM and the Office of the National Coordinator for Health IT (ONC) are sponsoring a developer challenge and outreach initiative to inform millions of Americans who may be unaware they are at significant risk for CVD , encourage those who think they may be at risk to take action, and direct both to community pharmacies to

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“I am delighted that ONC, five city health commissioners who are champions for heart health, community pharmacies, Archimedes, and Surescripts are working together to make sure people have the technology at their fingertips to get a read on their heart health and take steps to improve it.”

Janet Wright, M.D., FACC

receive blood pressure and cholesterol screenings.

Million Hearts and ONC seek to replace ignorance, worry, and inaction with knowledge, empowerment, and a means for referral.

The outreach initiative and winning app will: 1.

Reach individuals across the country, taking special aim at those who may be at risk for CVD and don’t know it.

2.

Deploy an engaging user interface that provides consumers with a quick health risk assessment, motivate them to obtain a more accurate risk assessment by entering their blood pressure and cholesterol values, and

3.

Direct them to nearby community pharmacies offering affordable and convenient blood pressure and cholesterol screenings.

This initiative will be a part of the Million HeartsTM initiative, a public-private partnership led by CMS and CDC to prevent a million heart attacks and strokes by 2017, and will be executed

by Million Hearts partner organizations and others aligned with its aims. Initially, four cities – Chicago, Baltimore, San Diego, and Tulsa – will aggressively promote consumer participation in the initiative, and it will subsequently be rolled out nationally.

The purpose of the campaigns (and the new consumer app developed through this challenge) is threefold. Developers should keep these purposes in mind throughout the development process: 1.

Encourage further testing (specifically blood pressure and cholesterol), especially for those with some risk,

2.

Encourage lifestyle changes for those at some risk, and

3.

Encourage seeing a health professional if they are at high risk.

[Source: http://www.health2con.com/ devchallenge/challenges/ ]

CIO John Halamka, MD

THE MEDICAL BUSINESS JOURNAL July/August 2012

“It is no longer sufficient to rely on policy alone to secure personal mobile devices.

Institutions must educate their staff, assist them with encryption, and in some cases purchase software/hardware for personal users…”

CIO John Halamka, MD, of Beth Israel Deaconess Medical Center

Theft of Records Leads to Action Plan “Teaching moment” With the theft of unencrypted laptop computers and mobile devices ramping up this past year, social security numbers, home addresses, and other personal information has been tremendously compromised. Consequently, Medical Centers and Hospitals are having to spend money and time offering free credit monitoring to the affected patients, and are now looking for answers to prevent this from happening again.

Beth Israel Deaconess Medical Center announced on July 23rd that 3,900 patients are now at risk following the theft of a physician’s personal laptop, however they have taken this as, according to the CIO John Halamka, MD, a “teaching moment.” Dr. Halamka has set up an action plan to conduct, “an aggressive campaign to ensure every mobile device is encrypted,” with the focus on encrypting laptops, iPads, and other tablet computers. Staff will be required to submit all of their electronics to “Service Depot’s,” which are stations that

will be set up around their campus that will scan the devices for vulnerabilities, check configuration settings, and fully encrypt the electronics. If any laptops, tablets, or mobile devices are detected on the network that have not been screened, all Internet access privileges will be blocked.

Having been responsible for patient’s records being stolen, Dr. Halamka will not be cutting any corners in attempting to fix this problem and prevent it from ever happening again. In his blog called “Life as a Healthcare CIO”, he writes; “As I’ve told the press, it is no longer sufficient to rely on policy alone to secure personal mobile devices. Institutions must educate their staff, assist them with encryption, and in some cases purchase software/hardware for personal users to ensure compliance with Federal and State regulations.”

Read the rest of Dr. Halamka’s blog at http://geekdoctor.blogspot.com/

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Excerpt from the MMI Management Aptitude Test 1. When establishing salary ranges, local salary surveys of comparable positions should be performed ________ by the practice a. monthly b. bi-annually c. annually d. weekly 2. Which of the following is not a Medicare Part B choice: a. Original Medicare b. Medicare Part D c. Medicare Savings Account d. Midcoast 3. When preparing the Income Budget, one must consider which of the following? a. all listed answers b. each physician’s production potential c. the practice’s production potential d. the appointment schedule 4. After a paycheck is issued, who is responsible for a lost paycheck? a. payroll department b. the company c. the employer d. the employee 5. Medicare allows the use of either the 1997 Exam Documentation Guidelines, 1995 Guidelines or both. a. true b. false 6. The practice manager can either be a physician or nonphysician member. a. true b. false

7. What level of service is the most utilized through the U.S.? a. Level 3 b. Level 1 c. Level 4 d. Level 2 8. OSHA is organized under a. National Safety Council b. Department of Labor c. Better Business Bureau d. Regional Government 9. What is CLIA? a. Clinical Laboratory Improvement Amendments b. Congressional Labor Improvement Act c. Center for Labor Intensive Achievements d. Complex Law for Incorporated Assurance 10. When preparing the Expense Budget, one must consider which of the following? a. b. c. d.

Direct Expense Personnel Cost Overhead All listed answers

ANSWERS:

1. c, 2. d, 3. a, 4. d, 5. a, 6. a, 7. a, 8. b, 9. a, 10. d

THE MEDICAL BUSINESS JOURNAL July/August 2012

Are you Cut Out to be a Manager?

Score less than 8/10? You should look into taking the RMM training program to become a Registered Medical Manager! Visit mmiclasses.com/rmm.html for more details.

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AMA Taking a Stand Against Obesity Goal is to educate

As part of the Obama administration's ongoing effort to improve healthcare quality, meaningful use of Electronic Health Records (EHR) technology is becoming widespread.

By adopting EHR in a "meaningful way” clinicians can, "...know more about their patients, make better decisions, and save money," according to The Office of the National Coordinator for Health Information Technology. EHR is critical in providing higher quality and effective health care, and according to a national survey, physicians who have adopted at least some of the technology are very pleased.

With childhood obesity on the rise, it is no wonder that so much blame has been put on the place where kids spend most of their day; at school. School cafeteria food is notoriously high in sodium and fat with little variety and options for vegetables, however a huge focus is now on the vending machines. They are stocked full of potato chips, cookies, and sugary soft drinks, and nutritionists are saying that the amount of vending machines in schools has tripled in the past 30 years.

The National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention conducted a national survey of office-based physicians who have adopted EHR systems. According to the survey, 85% were either somewhat or very satisfied with the EHR system, and the majority said that if they were given the choice, they would purchase the system again. Over half of the physicians in the survey have reported that their EHR system already meets "meaningful use" requirements, while also reporting that the system has already helped alert them to potential errors that would have otherwise been overlooked.

Representatives of the food and beverage industry have said that they support selling healthier snacks and drinks in school.

However, there is no sign of them backing down on the sugary snacks being made available, which is why health food advocates are having to think creatively.

The American Medical Association (AMA) voted on June 20th at its Annual Meeting to adopt policy addressing the obesity epidemic which, according to AMA board member Alexander Ding, MD, will be improving “…consumer education on the adverse health effects of excessive consumption of beverages containing added sweeteners…”

While EHR has proven to play a valuable role in improving healthcare quality and saving money, there are also Medicare and Medicaid EHR Incentive Programs through the Centers for Medicare and Medicaid Services (CMS). Incentive payments are available to eligible health care professionals and hospitals who adopt certified EHR technology and achieve meaningful use.

The new policy is taking a new angle by taxing beverages with added sweeteners and using the revenue generated to finance consumer education campaigns. The AMA will also continue to advocate research into the potential effects of long-term consumption of non-caloric sweeteners in beverages, such as “Sweet and Low” and “Splenda,” particularly in children and adolescents.

You can learn more about how to become a "meaningful user of EHR" by visiting http://www.cdc.gov/nchs/data/ databriefs/db98.htm.

[Source: http://www.ama-assn.org/ama/pub/news/news/ 2012-06-20-ama-policy-addresses-obesity.page ]

THE MEDICAL BUSINESS JOURNAL July/August 2012

EHR Improving Care Moving meaningful use forward

Sign up for any certification program before September 1st & receive a $50 MMI Gift Card!

Gift card is transferrable and can be used towards CEU courses and certification programs.

Visit mmiclasses.com/courses.html for more details on the certification programs. Terms & conditions apply.

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THE MEDICAL BUSINESS JOURNAL July/August 2012

Write for the MBJ! Become a contributor and reap the benefits Interested in contributing articles to the MBJ, or would like to use the space for advertising? Contact us! We are always looking for a new perspective, story, or update, especially from our loyal students and alumni. And, if we choose to include your work, you can receive CEUs! Details follow: Benefits (if your work is chosen): • 2 CEUs for 1 page article (790 words, 10 pt font) • 4 CEUs for 2 page article (1,580 words, 10 pt font) • Your work in a nationally distributed publication Topics to Write About : • Coding Updates • Industry News • Upcoming Events • Helpful Resources • “Day in the Life of a…” (medical coder, manager in a physicians office, etc.)

For more details: For more details on what to write about or how to submit work, contact Carleigh Thomson by email at mbj@mmiclasses.com, or call 866-892-2765 extension 240.

THE MEDICAL BUSINESS JOURNAL The Medical Management Institute 3330 Preston Ridge Road Suite 380 Alpharetta, GA 30005 Phone: 866-892-2765 Email: info@mmiclasses.com

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MBJ The Medical Business Journal (MBJ) is a monthly publication designed to report the latest news and trends in the medical billing, coding, and management industry.

Editor-in-Chief: Carleigh Thomson Copy Editor: Rob Hassett, RMC, Julia Scott, RMC, Carleigh Thomson Contributors: Bobby Keene, Rob Hassett, Carleigh Thomson Layout and Design: Carleigh Thomson The Medical Business Journal is a monthly source of up-to-date information on all issues affecting the healthcare industry. Its content ranges from medical coding and billing to healthcare reform legislature and beyond. The MBJ is not affiliated in any way with the Department of Health and Human Services, Medicare, or the Centers for Medicare and Medicaid Services. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional services, and is not a substitute for individualized expert assistance. The CPT codes, descriptors, and modifiers are copyrighted by the American Medical Association. For more information, please call MMI at: (866) 892-2765