What is HIPAA? Why Does my Practice Need to Comply?

Published by Pradip Sengupta, CEO of IPS Technology Services http://www.ipstechnologyservices.com/

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted by Congress with two titles (or sections). The first title protects an individual’s access to healthcare and portability of coverage when there is a pre-existing condition. The second title—which is of utmost importance to the healthcare industry—protects identifiable patient healthcare information by implementing safeguards to prevent healthcare fraud, providing for medical liability reform and providing administrative simplification to allow for compliance to these requirements.

 

Under HIPAA, health care providers MUST provide adequate security protection for all patient electronic medical records (EMRs). Disseminating personal, identifiable healthcare information or failing to prevent the theft or use of such information can result in very hefty fines, paid to the U.S. Department of Health & Human Services. Failure to comply with HIPAA regulations can cost a provider up to $1.5 million per calendar year in fines. In 2012, the most prevalent violation of HIPAA was the failure to protect private medical records from theft—an offense that the United States government treats as seriously as the willful dissemination of patient medical records.

Violations of HIPPA can affect large entities such as hospitals, health insurance companies and pharmacies as well as smaller entities like medical and dental practices. The U.S. Department of Health and Human Services identifies these violations through randomized audits and audits triggered by non-compliance events. As more patient records are being transferred to electronic media, electronic security and privacy is becoming very important to protect patients and reduce fraud. If not done correctly, healthcare providers put themselves and their practices at risk of fines, lawsuits, and in some cases, jail time for the involved parties.

To know more about Healthcare IT implementation best practices, feel free to call IPS Technology Services at 248-835-9895 or go to http://www.ipstechnologyservices.com/

No portion of this article will be copied or reproduced without written permission from IPS Technology Services.

Content of this blog is IPS Technology Services Confidential; All rights reserved.

 

What is ACO or Accountable Care Organization? Why is the Healthcare Industry Adopting it?

Published by Pradip Sengupta, CEO of IPS Technology Services http://www.ipstechnologyservices.com/

ACO or Accountable Care Organization aims to provide well-coordinated, patient-centered healthcare with the goal of achieving improved health, improved patient experiences and lower costs.   The fundamental premise of ACO is to set up processes and infrastructure to help providers get reimbursed based on outcome (quality) and not based on fees for service (quantity) which is required by the new Healthcare Law when it is fully enforced.  This is why the trend towards adopting ACO by the providers is up as reported by Leavitt Partners, a healthcare consulting firm in Salt Lake City.  According to Leavitt Partners, there are 330 ACOs in operation as of November 2012—up from 164 in 2011. 

To discourage over-utilization, many payers have shifted from fee-for-service compensation, which rewards physicians for treatment volume, to risk-sharing arrangements that prioritize outcomes. Under the new system, when treatments deliver the desired results, provider compensation may be less than before.

So how does an ACO work?  The core of ACO is sharing of information throughout the healthcare continuum by all related parties through effective implementation of Healthcare IT tools and adoption of a well understood care delivery process.  In order to implement ACO successfully and for effective care coordination, a payer-provider partnership is a must and it needs at least the following main components:

• Electronic Healthcare Record (EHR) tool as the core of the healthcare process continuum
• Information Registry to record diseases and correlate them with patient groups 
• Health Information Exchange (HIE) to provide the infrastructure to transfer information from one organization to the next (provider or payer) 
• Analytics to slice and dice data to derive meaningful results and make informed decision to improve quality and lower cost
• Interoperability to make sure that the information traveling from one organization to the other using disparate tools can be interpreted to maintain continuity 
• Messaging a large part of which is communication among different parties providing care to the patient; it also means timely information sharing between the patient and provider
• Revenue Cycle Management (RCM) establishment of which refers to the entire medical billing process from beginning to end and its effective management 

Implementation of the above features helps providers meet not only ACO requirements but also helps them meet a set of guidelines defined by the CMS for the establishment of ACO under the three year Medicare Shared Savings program.  This in turn will help increase revenue, improve quality of service and also prepare providers for the next decade.   

 

Additionally, as ACOs continue to proliferate, it will likely soon include an accreditation process that may be managed by the National Committee on Quality Assurance (NCQA). Recently, the NCQA worked with employers, policymakers, providers and patients to establish a program that ensures ACOs meet the needs of patients, consumers, private purchasers and public payers.   

 

In summary, ACOs are here to stay and it is going to be an immensely important tool to stay in business because the benefits are proving to be real.  It will improve the quality of care and reduce waste as well as help organizations implement value-based care concepts in a step-by-step fashion.    

To know more about Healthcare IT implementation best practices, feel free to call IPS Technology Services at 248-835-9895 or go to http://www.ipstechnologyservices.com/

No portion of this article will be copied or reproduced without written permission from IPS Technology Services.

Content of this blog is IPS Technology Services Confidential; All rights reserved.