HIPAA BASICS FOR PROVIDERS

CMS has been kind enough to provide a seven page document called “HIPAA Basics for Providers: Privacy, Security and Breach Notification Rules”.  If you are just getting started with HIPAA, or you want to remind everyone in your practice about HIPAA requirements, give this link a click:  http://www.hhs.gov/ocr/privacy/hipaa/understanding/training/hippaprivacysecurity.pdf

Probably the most common HIPAA problem is medical employees who wrongly use HIPAA as a reason not to provide basic information.  HIPAA is supposed to be a commonsense approach to keeping PHI private when needed, but also on how to share PHI when needed.  Hopefully this guide can help your small practice learn when to share PHI and when not to.

REALLY BIG IRS PENALTIES

Each year employers are required to file information returns with the IRS with regard to their employees, wages, etc. (usually on forms W-2 and 1099).  Since ACA, certain large employers, or those with self insured plans, are also required to file forms 1094/1095.  These forms contain information to the IRS with regard to the number of employees and other ACA related health information.  Starting in 2015, the potential penalty for failing to file a return, or filing late or incompletely, has doubled to $250 per day for each form.  Theoretically, a 50 person employer could be faced with up to $25,000 per day.  The statutory maximum penalty is now $3,000,000 per year.  Hint: Don’t forget to file W-2’s, 1099’s and 1094/1095s.  While there may be a reasonable cause or good faith regulation that may limit some of the harm here, pay your tax provider this year to check and double check your informational filings.

YELP YOUR HOSPITAL

The age of transparency continues.  ProPublica has joined with Yelp to add information to Yelp rating pages on hospitals.  The information includes estimates of wait times at emergency rooms, doctor communication satisfaction and ratings of the quiet areas of the hospitals.  Likely other information will be added later.  While one can certainly question the usefulness and accuracy of Yelp ratings, such ratings, whether on Yelp or other websites are likely to spread and continue to add additional information about your practice, clinic or hospital.

Takeaway – pay attention and review the websites to see what they say about you.  Whether it is your billing practices, wait times, friendliness of your staff or other information, this will affect the public view of your practice.

HOSPITAL BILLING TROUBLES

Negative publicity about hospital billing practices is leading not only the public, but politicians, to question many of these practices.  Often hospital bills are confusing, opaque and breathtaking in amount.  Many arrive months after the care has been given, and no understandable information is shared with patients with how these hospital bills were originally created, how primary and secondary billing occurred, etc.  Patients, get a bill from a hospital that they cannot understand, but demands immediate payment.

Reid Hospital in Richmond, Indiana recently suffered terrible publicity about errors in its billing system, incorrect reports to credit rating agencies, etc.  While patients are willing to accept and trust hospitals in their care, bad hospital billing practices drive patients into a rage.

With increased patient participation in hospital ratings online, hospitals and clinics should carefully review their billing practices and greatly improve them or likely face legislative efforts to force these changes.

Our recommendations:

• Make hospital bills understandable.  Use non jargon English to explain each of the charges and how they were calculated.
• Explain how the patient’s insurer was billed and the insurer’s response along with any secondary billing.
• Don’t make your initial bill threatening.  Demanding payment within two weeks after waiting six months to send a patient a bill is an invitation to litigation and dissatisfaction.  Include information on the bill plainly stating payment methods, alternatives and offers to discuss the bill in person with someone who can speak patient English as opposed to hospital billing jargon.
• Audit your own bills.  A striking number of hospital bills contain errors and overcharges.  When patients discover these errors, their entire trust in the hospital billing process is destroyed.
• Provide a payment platform online.  This platform, ideally, should show a number of alternatives for payment, and allow the patient to pay any patient responsibility amounts online and for the patient to be able to periodically check how their payments are affecting the liability and what remains.
• Consider providing patient billing advocates.  Have these advocates available to patients to help them navigate and help them understand the billing process and how a patient can challenge what he/she feels is an error or overcharge.

The payment system is broken, and it is certainly an opportune time for hospitals in particular to fix this system.  The result will be better collections and happier patients.

ANOTHER LARGE INDIANA DATA BREACH

Following prior large data breaches, including that of Anthem, Medical Informatics Engineering discovered it had exposed information including names, addresses, birth dates, social security numbers and health records.  This breach affected patients served by 44 hospitals and other radiology centers in Indiana, Ohio and Michigan.  MIE provides services to a large number of other medical centers in 38 states.  The entities affected are listed on the company’s website, but include Concentra, which apparently operates hundreds of medical centers in 38 states, Allied Physicians, Inc. in Fort Wayne, Franciscan St. Francis Health in Indianapolis and others.  Like Anthem, MIE is offering the just stunningly helpful remedy of credit monitoring.

This newsletter is edited by Paul Wallace of Jones ∙ Wallace, LLC, a member of the American Bar Association Healthcare Law Section and the American Health Lawyers Association who has been representing physicians and healthcare practices for over 25 years.  Mr. Wallace assists physicians in health practices in contract items, federal legal compliance, creation of practice entities, estate and wealth planning and similar issues.  Please feel free to call if you have any questions on this newsletter or legal matters at (812) 402-1600 or pwallace@joneswallace.com.