Monthly Archives: October 2015

HIPAA Compliance Audits on the Horizon

Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report's recommendations and that they need to do more oversight actvities.

Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.

Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.

Make plans in the near term to address all HIPAA compliance requirements.

NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR's activities.
See the full report at http://oig.hhs.gov/oei/reports/oei-09-10-00510.pdf

1500 Claim Form Diagnosis Reporting with ICD-10- No Decimals

Reporting Diagnosis on the 1500 with ICD10 should NOT have decimals as they are implied. When reporting diagnosis in block 21 of the 1500 there is a 7 character limit and the use of a decimal will drop the final character of a 7 digit code. Therefore diagnosis on the 1500 should be reported without a decimal and simply the characters with no spacing.

Note the following examples of 3, 4, 5, 6, and 7 character codes.

R51, M545, M5431, M25511, MS134XXA

NUCC 1500 Claim Form Manual

http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v3.pdf

 

ITEM NUMBER 21

TITLE: Diagnosis or Nature of Illness or Injury

INSTRUCTIONS:

Enter the indicator between the vertical, dotted lines in the upper right-hand portion of the field.

Enter the codes left justified on each line to identify the patient’s diagnosis and/or condition. Do not include the decimal point in the diagnosis code, because it is implied. List no more than 12 ICD-9-CM or ICD-10-CM diagnosis codes. Relate lines A - L to the lines of service in 24E by the letter of the line. Use the greatest level of specificity. Do not provide narrative description in this field.