Tools and services to stay on top of industry compliance requirements.
With changes and requirements throughout the healthcare industry at an all-time high, having an experienced team as a resource for information, technical tools and support makes the task of industry compliance less daunting.
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BCBS Programs & Incentives
- Integrated Patient Health Snapshot
- Seamless E&B Integration
- Annual Wellness Visit Recalls/Reminders
- Helpful resources: BCBS AL Resources
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Chronic Care Management (CCM)
- Training & configuration of chronic care documentation tools
- CCM billing tools to track and identify CCM
- Helpful resources:
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CMS
- Quality Payment Program (QPP)
- Doctors and Clinicians Preview Period for the 2021 QPP Program (starting 11/21/22)
- Also reference Doctors and Clinicians Preview Period Presentation Slides
- 2022 MIPS Quick Start Guide for Small Practices
- What’s New in 2022 for Small Practices
- Physician Fee Schedule (PFS) Final Rule – https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched
- Medicare Part D EPCS Compliance Requirement Deadline extended to January 1, 2022
- CMS Telehealth –audio & video required
- AMA Grid – https://www.ama-assn.org/system/files/2019-06/cpt-revised-mdm-grid.pdf
- MediSYS MIPS Assistance
- Routine monitoring of measure status
- Attestation Assistance
- Helpful resources:
- Appropriate Use Criteria (AUC) Update: While the proposed rule does not discuss the AUC program, CMS announced on Aug. 10, 2020 that the educational and operations testing period will be extended through 2021. As a result, there are no payment consequences associated with the AUC program and instead CMS encourages providers to use 2021 to learn, test, and prepare.
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Commercial Carriers – Electronic
- ClaimMD
- Change Healthcare
- Navicure
- Other Resources:
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COVID-19
- CDC Vaccine Information
- Telehealth Stand-Alone, No commitment
- MediSYS Contact-less patient engagement
- Co-Payments via text
- Account balance payments via text
- ‘Remote waiting room’ messaging
- Helpful resources: MediSYS COVID-19
- Credentialing Services
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Information Blocking Compliance
What is information blocking?
In general, information blocking is a practice by a health IT developer of certified health IT, health information network, health information exchange, or health care provider that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information (EHI). – as defined by the ONCCompliance Date is April 5, 2021 (subject to change)
Resources:
- HealthIT.gov – https://www.healthit.gov/topic/information-blocking
- AMA – https://www.ama-assn.org/practice-management/digital/new-information-blocking-rules-what-doctors-should-know
- ONC Cures Act Website: https://www.healthit.gov/curesrule/
- ONC Information Blocking Exceptions: https://www.healthit.gov/cures/sites/default/files/cures/2020-03/InformationBlockingExceptions.pdf
- ONC Information Blocking FAQ’s: https://www.healthit.gov/curesrule/resources/information-blocking-faqs
- ONC Information Blocking Webinars: https://www.healthit.gov/curesrule/resources/webinars
- OCR Individuals’ Right Under HIPAA to Access PHI: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html#:~:text=These%20differences%20are%20illustrated%20in%20the%20following%20table%3A,including%20a%20…%20%201%20more%20rows%20
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Medicaid Programs
- Quality Program Guidance
- ImmPRINT – Alabama Department of Public Health (ADPH) Enhanced Integration
- EPSDT Well Child Program
- Helpful resources:
- ACHN: Primary Care Providers (ACHN replaced Patient First in Sept. 2019) – Bonus Payments
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MediSYS Professional Organization Memberships
- Medical Association State of Alabama
- MGMA of Alabama
- Birmingham MGMA
- Other Resources:
- Medical Economics
- Birmingham Medical News
- MediSYS Events & Resources
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Occupational Health
- DOT Physical Exam – Generates Medical Examination Report Form
- Health Surveillance
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Prior Authorization / AUC
- Integrated Pre-certifications with BCBS AL
- In only 2 steps, navigate to the patient’s BCBS of AL insurance, automatically logging into the BCBS website. Easily check eligibility with the pre-populated patient information from MediSYS. Simply navigate to the referral and medical necessity tabs for pre-certifications.
- Appropriate Use Criteria (AUC) Update: In the CY 2022 Physician Fee Schedule Final Rule, CMS noted that the program is set to be fully implemented on the later of January 1, 2023 or the January 1 that follows the declared end of the public health emergency (PHE) for COVID-19. For updated information please visit: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program
- Integrated Pre-certifications with BCBS AL
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Rural Health Billing
- Automated rural health claims processing
- Automated payments posting
- Options to outsource your rural health billing
- Helpful resources: CMS Rural Health
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Telehealth
NEW Alabama Telehealth Law effective 7/11/2022
- Governor Ivey signed Act 2022-302, effective on July 7th, 2022, that implemented laws for the use of telehealth in Alabama. This act also repeals laws regarding a special license for out-of-state physicians to practice medicine across state lines.
- License requirements to provide telehealth services – Physicians must possess a full and active license to practice medicine or osteopathy issued by the Alabama Medical Licensure Commission or fall under either of these exceptions:
- Services are provided on an irregular or infrequent basis, i.e. less than 10 days or involving fewer than 10 patients in a calendar year; or
- Services are provided in consultation, as defined by law, with an Alabama licensed.
- Physicians should also review other federal laws that impact telehealth services (i.e. HIPAA, DEA rules, reimbursement requirements and more) along with the new Alabama law.
- Resources:
Telehealth Services – Medicare (effective May 27, 2022)
- Updates to existing POS Code Set:
- Revised description for POS 02: Telehealth Provided Other than in Patient’s Home
- Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology.
- New POS 10: Telehealth Provided in Patient’s Home
- Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
- Resources:
- Revised description for POS 02: Telehealth Provided Other than in Patient’s Home
View our recent User Conference Session where we discuss these changes and more! Clients can login to our intranet to view the session: Managing A/R: The Impact on Patients and Your Practice.
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Workers Compensation
- Defined financial responsibility
- Worker’s comp claims
- Worker’s comp electronic claim attachments
- Helpful Resource: Alabama Dept of Labor