Rx2000HIPAA Digest, Volume 5 > > #1 From: LHarring@gw.dhs.state.ri.us Subject: Re: medicare fraud > #2 From: michelle.chaudry@mcleodcg.com Subject: RE: Hcfa 1500 and UB92 > #3 From: hipadmin@rx2000.org Subject: A Great Program! > #4 From: Petehc@aol.com Subject: Re: medicare fraud > #5 From: jasonlu88@hotmail.com Subject: Web-based medical sotware > #6 From: medimage@voicenet.com Subject: Re: medicare fraud > #7 From: medimage@voicenet.com Subject: Re: Web-based medical sotware > #8 From: PRESSER@GNYHA.org Subject: MSO/IPA a health plan > > > ********** Message #1 ********** > From: LHarring@gw.dhs.state.ri.us > To: > Subject: Re: medicare fraud > Date: Mon, 27 Mar 2000 11:02:20 -0500 > > If you haven't found your answer yet, you may wish to contact the RI = > Medicare Fraud Unit at 401-459-1714. > > Lynne Harrington > RI Dept. of Human Services > > >>> 03/25/00 08:01PM >>> > could you please give me you input on the law that is now holding coders = > and billers l responsible is Medicare find fraud in the billing even if = > the coders and billers or not a party to any fraud just poor billing = > practices, also could you give me the name of the law and were it can be = > found my administer thinks I'm making this up about who is liable > > Mary M mmbm@thegrid.net > > > ********** Message #2 ********** > From: michelle.chaudry@mcleodcg.com > To: > Subject: RE: Hcfa 1500 and UB92 > Date: Mon, 27 Mar 2000 10:18:09 -0600 > > Mike, > > It seems as if they have addressed this issue and have eliminated the chance > for provider specific misinterpretation. > > Thought I would share the requirements with you all: > Can health plans require changes or additions to the standard claim? > Currently, some insurers accept the de facto standard claim (e.g., UB-92) > but also require additional records (e.g., a proprietary cover sheet) for > each claim submitted. Others have special requirements for data entered into > the claim, which make it non-standard. > Under the law, health plans are required to accept the standard claim > submitted electronically. They may not require providers to make changes or > additions to the standard claim. They must go through the private sector > standards setting process to get their requirements added to the standard in > order to effect desired changes. Health plans may not refuse the standard > transaction or delay payment of a proper standard transaction. > An additional standard will be adopted for electronic health claims > attachments, which health plans will be required also to accept. Until that > standard is adopted (by February, 2001), health plans may continue to > require health claim attachments to be submitted on paper. No other > additions to standard claims will be acceptable. > I hope this clears up any further ambiguity for everyone, > Michelle Chaudry, MIS, RHIA > McLeod Consulting Group, Inc. > Advisory Consultant > 708-862-5029 > Michelle.Chaudry@McLeodCG.com > > > -----Original Message----- > From: Rx2000HIPAA@rx2000.org [mailto:Rx2000HIPAA@rx2000.org] > Sent: Friday, March 24, 2000 1:00 PM > To: Rx2000HIPAA@rx2000.org > Subject: Re: Hcfa 1500 and UB92 > > > Michelle: > > That's the "gotcha" that they do not appear to address. Presumably you > would > be on your own to get required data to the intermediary/claims processor any > way you and they agree upon (the interemdiaryy/processor would most likely > develop some forms/templates to follow). HCFA's goal is to encourage > everyone to move towards electronic transactions, but leave some wiggle room > for those who can/will not do it themselves > > Mike Cohen > > MRC Consulting Group > (630) 653-9242 > MRCCG@aol.com > www.MRCCG.com > > > In a message dated 3/24/00 12:14:56 PM Central Standard Time, > Rx2000HIPAA@rx2000.org writes: > > << My question is the new electronic format requires additional information > that is not currently captured on the UB92- HCFA 1500. How will the > current > forms address the missing new data requirements? Even with the > intermediary > converting the forms into an electronic format they must somehow receive > all > of the required information. >> > > > ********** Message #3 ********** > From: hipadmin@rx2000.org > To: > Subject: A Great Program! > Date: Mon, 27 Mar 2000 13:49:17 -0600 > > Dear Rx2000 Listserv Readers, > > We are very excited about the great lineup of speakers and presentations we > have for the April 25-26 Special Interest Group (SIG) meeting in > Minneapolis! They include: > > - Kevin Thurm, Deputy Secretary, Department of Health and Human Services > > - Joseph Broseker, Deputy Director of Provider Billing and Education, > Health Care Financing Administration > > - Rick Telesca, Senior Research Advisor, GIGA ePractice Research Group > > - Richard Fischer, Partner, Foley & Lardner > > - Allan Abramson, VP of Information Integration, Allina Health System. > > - James Bradley, CEO, Abaton.com, a division McKesson/HBOC > > - Steve Curd, CIO, Healtheon/WebMD > > - Dave Moertel, Electronic Commerce Unit Manager, Mayo Foundation > > The evening reception on the 25th and the concluding afternoon roundtable > discussions on the 26th, > are always extremely popular at Rx2000 SIG meetings and will provide you > unique > opportunities to have a dialogue with these presenters and with your peers > from the healthcare community. > > Full details about the meeting and registration information is on the > Rx2000 website at http://www.rx2000.org . As always, this SIG meeting is > open to members of the Institute as well as non-members. I look forward to > another great SIG meeting and to seeing you there! > > Joel Ackerman, Executive Director > Rx2000 Institute > ackerman@rx2000.org > > > ********** Message #4 ********** > From: Petehc@aol.com > To: Rx2000HIPAA@rx2000.org > Subject: Re: medicare fraud > Date: Mon, 27 Mar 2000 17:46:28 EST > > You need to see an attorney familiar with Fraud and Abuse. I am not an > > Attorney. The legal concepts involved are "reckless conduct" and > "deliberate > > disregard." > > > Pete Biagiotti > Aon > 818-363-9435 > > ********** Message #5 ********** > From: jasonlu88@hotmail.com > To: rx2000HIPAA@rx2000.org > Subject: Web-based medical sotware > Date: Mon, 27 Mar 2000 16:06:47 PST > > My clinic has been evaluating different electronic medical record and > practice management systems for some time, and we are not ready to invest > the kind of money most companies quoted us. I heard some companies are > offering web-based medical softwares which you can subscribe on a monthly > basis. I am interested to hear about experience using these services and > your opinion on issues such as privacy and confidentiality. > > Jason Lu > > > ********** Message #6 ********** > From: medimage@voicenet.com > To: > Subject: Re: medicare fraud > Date: Mon, 27 Mar 2000 20:09:18 -0500 > > > > ---------- > From: Rx2000HIPAA@rx2000.org > To: Rx2000HIPAA@rx2000.org > Subject: Re: medicare fraud > Date: Monday, March 27, 2000 11:02 AM > > > If you haven't found your answer yet, you may wish to contact the RI > Medicare Fraud Unit at 401-459-1714. > > Lynne Harrington > RI Dept. of Human Services > > >>> 03/25/00 08:01PM >>> > could you please give me you input on the law that is now holding coders > and billers l responsible is Medicare find fraud in the billing even if the > coders and billers or not a party to any fraud just poor billing practices, > > > > One could always resort to placing blame of billing error on a "software > glitch" similiar to the Whitehouse's e-mail system for instance;-) > > dk > > > also could you give me the name of the law and were it can be found my > administer thinks I'm making this up about who is liable > > Mary M mmbm@thegrid.net > > > ********** Message #7 ********** > From: medimage@voicenet.com > To: > Subject: Re: Web-based medical sotware > Date: Tue, 28 Mar 2000 08:47:19 -0500 > > > You're referring to ASPs (Application Service Providers). This application > rental concept is being trial-ballooned in the IT/Software industry. > > A few points of concern regarding ASPs: > 1. If your Telecom provider or ISP is down for a day, you're down for a > day. > 2. You're local equipment configuration will require continous remote > monitoring to accurately employ the vendor's current code/software. > 3. Remote access = security issue. > 4. The ASP is effectively an outsourcer of which you have little regulatory > control over. Their compliance, business and HR problems are also yours. > 5. An ASP may reduce In-house IT budgets. > 6. ASPs may increase expenses elsewhere. > 7. Inbound and outbound hardware/software firewalling will ultimately be > your responsibility. > 8. Adequate firewalling will be expensive. > > ASP is a solution for many existing IT vendor problems. > 1. Software piracy. > 2. Software products that are shipped very buggy and will require > continual/daily upgrades. > 3. Lack of long term customer committment i.e. fleeing customers. > 4. Vendor's current inability to cash in on individual healthcare > transactions. > > Being the first on the block to experiment with a vendor solution disguised > as a customer solution may be risky. > > my2cents > dk > > ---------- > > From: Rx2000HIPAA@rx2000.org > > To: Rx2000HIPAA@rx2000.org > > Subject: Web-based medical sotware > > Date: Monday, March 27, 2000 7:06 PM > > > > > > My clinic has been evaluating different electronic medical record and > > practice management systems for some time, and we are not ready to invest > > the kind of money most companies quoted us. I heard some companies are > > offering web-based medical softwares which you can subscribe on a monthly > > basis. I am interested to hear about experience using these services and > > your opinion on issues such as privacy and confidentiality. > > > > Jason Lu > > > ********** Message #8 ********** > From: PRESSER@GNYHA.org > To: rx2000HIPAA@rx2000.org > Subject: MSO/IPA a health plan > Date: Tue, 28 Mar 2000 09:41:01 -0500 > > Does anyone have the answer to the following? > > Is a mso/ipa that has a full risk contract considered a "health plan" or > provider under hipaa and therefore subject to the rules? > > Stewart M. Presser > Vice President > Greater NY Hospital Association > (212) 506-5444 > >