Physicians tackle HIPAA requirements and increased scrutiny by Government

The health reforms have not only affected the way in which healthcare is delivered but also the way in which information is shared among various professionals and entities in the health industry. Health Insurance Portability and Accountability Act (HIPAA) regulations have become more stringent for physicians, and patient privacy is one of the issues that are emphasized in the health reforms. Physicians are tackling this increased scrutiny by the government by adapting various methods in the various core and departmental processes involved in the delivery of healthcare.

The HIPAA and the HITECH Act have brought about new changes to the way physicians’ roles are scrutinized in the country. The privacy guidelines in the HIPAA Act are exhaustive and physicians need to be aware of these in order to avoid penalties in the form of cuts or worse. Moreover, these guidelines regarding patient privacy are not only applicable to physicians who follow proper EMR or EHR implementations and the reform guidelines but also to those who choose not to implement such requirements. Physicians need to disclose only the “minimum necessary” information needed for the particular purpose to certain entities. Even oral communication about patient information can be considered breach of privacy under HIPAA.

HIPAA compliance is not just necessary for physicians but is also applicable to their staff, on-site or otherwise. Physician assistants and professionals in other departmental processes also need to comply with HIPAA guidelines and prevent the breach of patient privacy by securely utilizing protected health information (PHI). With physicians using various methods to access and modify data on EHRs, the HIPAA privacy rules take on a new meaning. Those on the other end of the tech spectrum who still use paper based records cannot possibly implement such safeguards for privacy. Therefore adoption of EMR and EHR systems that are HIPAA compliant along with recruitment of compliant professionals in various departmental processes has become crucial to the well-being of a practice.

Providers are required to give notice of privacy practices to patients explaining how the health information of the patient is disclosed and used. Providers cannot reveal PHI to the patient’s employer unless there is a written permission from the patient for doing so. Healthcare providers are not allowed to reveal PHI to family members without receiving permission from the patient. In addition to these safeguards, there are other types of safeguards to be implemented such as physical safeguards of workstations and software used in accessing or modifying PHI. The onus of the protection of information lies with the physicians or practices and their staff and with the increasing volume of the information, it becomes necessary for physicians to hire professionals who are HIPAA compliant.

The departmental processes involved in the health care delivery system such as medical billing and coding, transcription, denial management, and revenue cycle management also need to be HIPAA compliant. Medical billing and coding services at medicalbillersandcoders.com, which is the largest consortium of medical billers and coders in the United States, are not only HIPAA compliant but also offer numerous other value added services such as consultancy, research and improved denial management.

Hospitals expand to attract well-insured patients despite pressures of healthcare reforms

Several hospitals are looking for well-insured patients beyond traditional market boundaries, both in prosperous suburbs and in nearby areas with growing, well-insured populations. According to a study by the Center for Studying Health System Change (HSC) hospitals seeking a competitive edge in the marketplace are targeting geographic expansion into new markets which are well-insured.

The study based on HSC’s visits to 12 nationally representative metropolitan communities, depicted that hospitals are expanding despite the pressures of the healthcare reform. Hospital strategies mainly include – building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems with several hospitals building near major highways to be accessible.

Hospitals expansions survey findings

• In all 12 markets surveyed results depicted that hospitals are looking for full-service hospitals or freestanding emergency departments, buying or establishing physician practices and developing a regional presence through emergency medical transport systems
• Recession rather than diminishing has heightened the drive among hospitals to pursue well-insured patients beyond traditional hospital market boundaries
• Expansion appears more frequent where large hospital systems were pursuing significant employment of physicians and where service-line strategies, such as cardiac or cancer care, were well entrenched

Impact on Hospitals & Independent physicians

The overall impact of hospitals’ geographic expansions is still to be observed, there are conflicting views within the industry regarding these new hospital competitive strategies, if they will increase costs, improve care or both. Hospitals are of the view that the expansions will increase efficiency, increase access and improve the quality of patient care, while payers and competitors argue such strategies will lead to elevated costs.

Also Independent Physicians in most markets due to health reforms who are faced with financial pressures along with difficulty in hiring younger physicians, who often prefer employment in larger organizations, are actively seeking the stability and security of employment in larger physician-owned or hospital-owned groups. According to the HSC study in fast growing and well insured Greer, SC, there are no more independent primary-care practices left.

Revenue cycle management amidst hospital expansion and reforms

Hospitals backing expansions as necessary countering that even though there are costs increases, their efforts provide increased high-quality care; will need to cater to higher patient influx and increased medical billing. Hence in this scenario along with the growing pressure of health care reforms, services of skilled service providers possessing the requisite credentials can be availed by hospitals and practitioners to maintain favorable revenue cycles management.

Medicalbillersandcoders.com the largest ‘Consortium of Medical Billers and Coders, servicing over 50 specialty US physicians, are constantly updated with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices. Medicalbillersandcoders.com has in-depth knowledge and expertise in the delivering the best quality services to hospitalists. Hospital employment will affect patients, hospitals and doctors – as healthcare will require greater coordination, greater use of clinical data and collaborative provider teams — which MBC is best positioned to deliver.

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