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May 19 - 21, 2023
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Resources

09/282017

Analytical Approach to MACRA

News by Dr. Jose Delgado

MACRA is upon us and the urgency to act is paramount. However, rather than panicking and throwing away resources without a plan, we recommend more of an analytical approach. Find what tasks are needed, determine where you are, decide upon what can you do, make a plan and implement on a timely basis.

October 2nd, 2017 is the last day to start collecting data for MACRA. For some healthcare professionals this means nothing so let me put it into context:

Failure to act will expose some healthcare professionals and organizations to a 4% penalty on payments which may go…

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09/282017

HIPAA Security – Cybercrime

News by Dr. Jose Delgado

Just last week I received an email from one of my suppliers.  The gist of the email was as follows:

“On September 1st, 2017, we were informed by our 3rd Party Ecommerce Provider that their software platform which hosts our website experienced a data breach.  The investigation indicates the intrusion began in early July 2017 and was remediated prior to August 24th, 2017.  During this time, the attackers gained access to certain customer information.”   

The sad part is that certain customer information turned out to be our credit card information with all corresponding information needed to complete transactions. Worse than…

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09/212017

HHS Finalizes Rule Impacting Health & Coverage Providers

News Covered entities, Department of Health and Human Services, Health Coverage, HHS, Language Assistance, Notice of Non-Discrimination by Samantha Prokop

Earlier this Spring, the Department of Health and Human Services (“HHS”) finalized a rule that seeks to protect individuals from discrimination on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping.

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09/142017

Section 1557 of the Affordable Care Act

News Affordable Care Act, Covered entities, non-discrimination, Section 1557 by Samantha Prokop

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, disability and age by any health care program or activity which receives federal funding from the Department of Health and Human Services.  It is the first Federal civil rights law to broadly prohibit sex discrimination in health programs and activities.  The Department of Health and Human Services recently issued a final rule implementing regulations related to Section 1557 of the Affordable Care Act, which were effective July 18, 2016.  Certain notice provisions are effective October 16, 2016.

 

For health care providers, the rule applies to “covered entities” who receive

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08/312017

MACRA/MIPS Advancing Care Information

News by Dr. Jose Delgado

I started this article and previous seminars by referring to MACRA as Medicare’s new payment system. However, that concept is incorrect and an oversimplification of MACRA.  MACRA stands for “Medicare Access and CHIP Reauthorization Act” and while the same will affect how Providers will get paid it is not necessarily a payment system.  Medicare considers MACRA a Quality Program and refers to MACRA as their Quality Payment Program.  At this point in time I feel comfortable writing that MACRA is a data collection initiative from Medicare that uses a bonus program as an incentive to get Providers to participate. Using…

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08/312017

Increasing Revenues in the Healthcare Arena

News by Dr. Jose Delgado

“We live in interesting times.”

“It is the Wild West out there.”

“Change equals opportunity.”

I have heard all of these before and I keep hearing them as it relates to healthcare business. I have also heard that there is no money in medicine; and of course all the rumors about socialized medicine. Sad part about it is that I’m also seeing Providers getting out of the business and giving control to business people who are eager to jump in.

The truth is that the business of medicine is changing and medical schools do not train its students in the…

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08/312017

Healthcare Businesses Compliance and Liabilities

News by Dr. Jose Delgado

If you are in the healthcare arena; can you afford a $50,000 a day per violation fine?

I remember reading many years ago that farmers were the biggest gamblers as every year as they chance that their crops will be healthy but not too healthy so that they receive a fair price for their products. In today’s day and age, I think that Healthcare Professionals in the United States are the biggest gamblers as we spent many years studying before we hit the field and yet your next patient could be your last. Even worse, the compliance requirements in the…

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07/312017

Diagnosis Code Concerns and Awareness

News actuaries, billing companies, coding priority, Diagnosis code, EHR and diagnosis codes, ICD, ICD 10, ICD 9, maximum number of diagnosis, payment systems by Dr. Jose Delgado

Recently I was at a community meeting and a representative from the local Accountable Care Organization (ACO) spoke about the issue of some Providers reporting four diagnosis codes per visit.  At first, I didn’t think anything of it but then it dawned on me.  It is all about money.

Without going into actuaries, risks and costs formulas the point is simple, healthier individuals use less resources. This means that if you simply use a few codes you are telling Payors (insurance companies and Medicare) that your patients are healthier than others that use multiple codes. As a result, these Payors…

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07/302017

SRA’s are Here to Stay!

News Advancing Care Information, HIPAA, HIPAA Fines, HIPAA Security Risk Assessments, HITECH Audits, MACRA, meaningful use, Medicare Access and CHIP Reauthorization Act, Medicare payment system, MIPS, SRA by Dr. Jose Delgado

There have been some discussions as it regards the HIPAA Security Risks Assessments (SRA) and the requirement to perform one. Some rumors claim that SRA’s are no longer required as they were part of Meaningful Use and this program has been terminated. Other rumors claim that SRAs are only for Medicare Providers and that the same do not apply to those that do not treat the Medicare population. Our intent with this article is to get the record straight.

Conducting a HIPAA Security Risk Assessments (SRA) is a legal requirement that is not going anywhere. There have been some changes…

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07/292017

MACRA by the Numbers

News 2019 payment, APM, HIPAA risk assessment, MACRA, meaningful use, Medicare Access and CHIP Reauthorization Act, Medicare Payment, Medicare quality Measures, MIPS, PQRS, Security risk assessment by Dr. Jose Delgado

MACRA (the Medicare Access and CHIP Reauthorization Act) is in a simplistic way Medicare’s new payment system. MACRA was approved with bilateral support, in other words, is not going anywhere as democrats and republicans agreed and approved the same. MACRA also requires action from the Medicare Providers if they wish to maximize their Medicare reimbursement. Therefore, and based on the complexity of the same we have decided to provide you some key information in a numerical fashion as to increase understanding…

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