Practice Update

Our newsletter provides Hill Physicians' care providers and practice staff with news and tips on programs, procedures and tips for optimal practice efficiencies. For a print version of this page, please click here. For past issues, please see the Practice Update Newsletter Archives.

In the May 2010 Issue:

Personal Health Records Motivate Consumers
New Online Health Center for Back Pain
Hill Insite Password Changes
Expanded pre-bariatric surgery program in Sacramento
Health Net Healthy Baby Program
Hill Physicians Records Retention Policy
RelayHealth Provides Parent Access to Child Health Records
Medicare Fraud, Waste, and Abuse

2011 Ingenix Coding Books (order form)

Personal Health Records Motivate Consumers to Act: Survey Shows Doctors May Hold Key to Increasing Adoption

(The following article is taken from an alert released by California HealthCare Foundation on April 13, 2010.)

Americans who have access to their health information through personal health records (PHRs) report that they know more about their health, ask more questions, and take better care of themselves than when their medical information was less accessible to them in paper records. These findings are contained in a new national survey of consumer attitudes toward using online tools to manage their health, released today by the California HealthCare Foundation (CHCF).

The survey shows 1 in 14 Americans has used a personal health record. Users say that secure, password-protected PHRs give them the confidence they need to access their personal information online, and when they do, they pay more attention to their health. One in three PHR users say they used the PHR to take a specific action to improve their health — sparking hope that these technologies could be the long-needed tools that help engage patients in taking better care of themselves. Significantly, such benefits are most pronounced among populations that have been difficult for health care providers to engage: patients with multiple chronic conditions, less education, and lower incomes.

"We know that most health care is self-care, since most people only see their physicians periodically," said CHCF President and CEO Mark D. Smith, M.D., M.B.A. "This survey shows that when individuals have easy access to their health information, they pay greater attention to their health. And for the first time, a survey documents that PHRs empower some people — including some of the heaviest users of the health system — to take better care of themselves."

Efforts to increase use of health information technology (IT) have received broad bipartisan support from federal lawmakers. The American Recovery and Reinvestment Act of 2009 included up to $29 billion to support doctors in adopting online health records. Government, businesses, and the health care sector see health IT as a way to improve quality of care, better engage patients, and ultimately reduce costs.

Despite the growing availability of PHRs through health plans and online services, the survey shows most Americans have yet to try PHRs or related applications. While usage rates of these tools are relatively low, they have doubled over the last two years.

Doctors may hold the key to increasing acceptance of PHRs. The survey found that respondents who said their doctor uses an electronic health record (EHR) were more likely to want a PHR. They were also more interested in devices and applications than people whose doctor does not have an EHR.

Privacy remains a concern. Many of those surveyed expressed concern that their medical information could be used by companies, health insurance plans, researchers, and others, and one-third said they would consider hiding some information from their provider because of that fear. Still, two-thirds of those surveyed said privacy concerns should not stand in the way of learning how technology can help improve health care.

The survey of 1,849 people was conducted by Lake Research Partners for the California HealthCare Foundation between December 18, 2009, and January 15, 2010.

For the complete survey, please go to:

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey

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Help Your Patients Manage Back Pain with our New Online Health Center

Our new Back Pain Management Online Health Center is designed to provide your patients with comprehensive, evidenced-based back pain information. With an emphasis on behavioral, integrative, and shared decision-making approaches, this online resource educates patients suffering from back pain on a variety of self-management techniques and prescribed treatments.
This online health center is available to all patients, regardless of medical group.
Visit www.HillPhysicians.com/BackPain to learn more.

Features include:

Tools to help patients make diagnosis and treatment decisions
Extensive health library topics on causes, diagnosis and treatment of back pain
Tips for getting and staying active at a level appropriate for pain patients
Resources to manage stress and address the negative feelings that often accompany pain
Information on how to access massage, yoga, chiropractic and acupuncture services (Hill Physicians members only)

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Hill inSite Password Changes

To improve security, all Hill inSite users will be required to change their passwords to align with “stronger” password criteria. Next month, all Hill inSite users will be assigned a temporary password. You will be notified by direct mailer and a message will be posted on the Hill inSite home page with more details on how and when to change to a new password.

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Great News about the My True Body Pre-Bariatric Education Program!

This Sacramento Area program has proved so successful for our bariatric surgery candidates to fulfill their pre-surgery requirements that we are now offering the program at two sites! If you have patients who are first thinking about having this surgery, classes are now offered at:

Mercy Methodist Hospital campus every Tuesday evening
Mercy San Juan Hospital campus every Thursday evening

Remember to submit a Member Health Improvement referral form so you patient can be registered.

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HealthNet Healthy Baby Program

Health Net has developed a Health Baby program available for EVERYONE, not just Health Net members. You can view the program via Health Net’s website (HealthNet.com). The program link is on the main page and does NOT require a member number to access the health education information. It’s a series of 5 videos, available on-demand 24/7 for your convenience and privacy. Topics include Smoking Cessation, Exercise, Nutrition, Safety and Breastfeeding. There are some additional “perks” available if you are a Health Net member, but the prenatal health education information is available to everyone.

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Records Retention

As providers in the Hill Physicians network, it is important for everyone to abide by the same minimum standards for record retention. Please take note of the current Hill Physicians record retention policy as stated in the Hill Physicians Medical Group Physician Agreement:

“Physician shall keep accurate, complete, timely and legible medical records for all Enrollees and shall maintain and store all medical records in a safe and secure location to ensure the privacy and confidentiality of such records at all times. Physician agrees to retain its financial and medical records relating to Enrollees at all times during this Agreement and for a period of ten (10) years beyond the termination of this Agreement, or longer, if and as required by properly recognized Federal or State governmental agencies.”

If you have any questions or would like more information, please contact your Practice Support Advisor.

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Parents Want Electronic Communication with Children's Providers

A recent article from Healthcare IT News cites two different studies that reveal parents' preference for electronic communications with their child's physician.

RelayHealth enables Hill Physicians providers to communicate with their patients exactly as these polls are highlighting and is made available by HPMG at no cost to the practice. All that is needed are an internet connection and a computer. If you’re interested in more information, please contact 866-RELAY-ME (866.735.2963).

Click here for the article referenced above.

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Medicare Fraud, Waste and Abuse

Fraud, waste and abuse have been an ongoing concern in all segments of our health care delivery system, including Medicare. It is important to understand what constitutes fraud, waste, and abuse in order to combat it. The information below will provide some background information on the topic as well as help you understand the possible penalties involved and how to report suspected Medicare fraud.

How Does CMS Combat Fraud?

Close coordination with contractors, providers, and law enforcement agencies.
Developing Medicare Program compliance requirements that protect stakeholders.
Early detection through Medical Review and data analysis.
Effective education of physicians, providers, suppliers, and beneficiaries.

Fraud Waste & Abuse Defined

Fraud	An intentional act of deception, misrepresentation, or concealment in order to gain something of value.
Waste	Over-utilization of services (not caused by criminally negligent actions) and the misuse of resources.
Abuse	Excessive or improper use of services or actions that are inconsistent with acceptable business or medical practice. Refers to incidents that, although not fraudulent, may directly or indirectly cause financial loss.

Examples include:

Charging in excess for services or supplies.
Providing medically unnecessary services.
Billing for items or services that should not be paid for by Medicare.
Billing for services that were never rendered.
Billing for services at a higher rate than is actually justified.
Misrepresenting services resulting in unnecessary cost to the Medicare program, improper payments to providers, or overpayments.

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The Risks of Fraud, Waste and Abuse

Examples of Risks to Individuals:

Unnecessary procedures may cause injury or death.
Falsely billed procedures create an erroneous record of the patient’s medical history.
Diluted or substituted drugs may render treatment ineffective or expose the patient to harmful side effects or drug interactions.
Prescription narcotics on the black market contribute to drug abuse and addiction.

Examples of Risks to Providers:

Failing to provide medically necessary services.
Offering beneficiaries a cash payment as an inducement to enroll in Part D.
Selecting or denying beneficiaries based on their illness profile or other discriminating factors.
Making inappropriate formulary decisions in which costs take priority over criteria such as clinical efficacy and appropriateness.
Altering claim forms, electronic claim records, medical documentation, etc.
Limiting access to needed services—for example, by not referring a patient to an appropriate provider.
Soliciting, offering, or receiving a kickback, bribe, or rebate (for example, paying for a referral of patients in exchange for the ordering of diagnostic tests and other services or medical equipment).
Billing for services not rendered or supplies not provided would include billing for appointments the patient failed to keep. Another example is a “gang visit” in which a physician visits a nursing home billing for 20 nursing home visits without furnishing any specific service to individual patients.
Double billing such as billing both Medicare and the beneficiary, or billing Medicare and another insurer.
Misrepresenting the date services were rendered or the identity of the individual who received the services.
Misrepresenting who rendered the service, or billing for a covered service rather than the non-covered service that was rendered.

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Administrative Sanctions
Administrative sanctions may include any of the following actions: denial or revocation of Medicare provider number application; suspension of provider payments; addition to the OIG List of Excluded Individuals/Entities (LEIE); and license suspension or revocation.

Civil Monetary Penalties (CMPs), Litigation and Settlements
The Social Security Act authorizes the imposition of CMPs when Medicare determines that an individual or entity has violated Medicare rules and regulations. Typically, penalties involve assessments of significant damages such as CMPs up to $25,000 for each Medicare Advantage enrollee adversely affected. Also, the United States Attorney's Office may file a civil suit or decide that the interest of the Medicare Program is best served by settling a case out of court. The civil suit or settlement may include a Corporate Integrity Agreement (CIA). A CIA requires the individual or entity to accomplish specific goals (e.g., educational plan, corrective action plan, reorganization) and be subject to periodic audits by the federal government.

Civil and Criminal Penalties
The False Claims Act is a law under which a provider can be fined $5,500 - $11,000 for each false claim. If the government proves it suffered a loss, the provider is liable for three times the loss and up to five years in prison and fines of up to $25,000 for violations of the Anti-kickback Statute. If a patient suffers bodily injury as a result of the scheme, the prison sentence may be 20+ years.

Best Practices for Preventing Fraud, Waste, and Abuse

Establish effective lines of communication with colleagues and staff members.
Ask about potential compliance issues in exit interviews.
Take action if you identify a problem.
Remember that you are ultimately responsible for claims bearing your name, regardless of whether you submitted the claim.

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Reporting Potential Fraud, Waste, and Abuse

Everyone has the right and responsibility to report possible
fraud, waste, or abuse. Report issues or concerns to your organization’s compliance office or compliance hotline and/or, The compliance officer or compliance hotline of the applicable Medicare Advantage Organization or Part D MA Organization or Part D Plan Sponsor(s) with whom you participate. Compliance hotline numbers are available on each organization’s web site and/or, 1-800-MEDICARE. You may report anonymously and retaliation is prohibited when you report a concern in good faith.

Whistleblower Protections
A whistleblower is defined as an employee, former employee, or member of an organization who reports misconduct to people or entities that have the power to take corrective action. A provision in the False Claims Act allows individuals to report fraud anonymously and/or sue an organization on behalf of the government and collect a portion of any settlement that results. Employers cannot threaten or retaliate against whistleblowers.

Fraud, Waste, and Abuse Resources

Federal government web sites are sources of information regarding detection, correction, and prevention of fraud, waste, and abuse:

Department of Health and Human Services Office of Inspector General:
http://oig.hhs.gov/fraud/hotline/

Centers for Medicare and Medicaid Services (CMS):
http://www.cms.hhs.gov/FraudAbuseforProfs/

CMS Information about the Physician Self Referral Law:
http://www.cms.hhs.gov/PhysicianSelfReferral

CMS Prescription Drug Benefit Manual
http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/PDBManual_Chapter9_FWA.pdf

Medicare Learning Network (MLN) Fraud & Abuse Job Aid
http://www.cms.hhs.gov/MLNProducts/downloads/081606_Medicare_Fraud_and_Abuse_brochure.pdf

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Ingenix Coding Books for 2011

Coding books and other products from Ingex are now available for 2011. Ingenix offers a special volume discount to Hill Physicians providers so be sure to get the order form here.