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Sometimes You've Got To Be Your Own Snitch

Sometimes when you mess up – and that mess up involves Medicare, Medicaid, or funds from another government healthcare program – not only do you have to fix the mess, but you may also have to go back and make amends to limit your liability and hedge against civil and/or criminal prosecution later. Hospitals do it. Physician groups do it. Ambulance providers do it. Home health does it. What? Get busted for coding, documentation, and billing problems. The federal government developed the Self-Disclosure Protocol (“SDP”) for healthcare providers to be able to bring themselves forward to the government in a...

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GUEST POST: Website Disclosures Pursuant to the Board’s Business Promotion Rules - By Laura Diamond, Attorney

In today’s environment, a practice website is a nearly essential element to a well-rounded marketing strategy. A strong website is an effective and cost-efficient way to promote a dental practice. It also can provide information to current and prospective patients. Practice websites are considered business promotion by Texas State Board of Dental Examiners and must comply with the Board’s rules regarding advertising.       Overall, the Board’s business promotion rules require dentists to communicate truthfully to the public. To that end, Rule 108.59 delineates the four essential disclosures required by dental practice websites. These components represent the minimum information...

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Data Backup versus the Data Backup Plan

Okay folks – we need to talk about your data backup.   Dental offices, as covered entities, must meet Implementation Standards to get in compliance with the HIPAA security rules. There are two types of implementation standards: required and addressable. Required means it must be done and there is only one right way to do it. Addressable means it must be done, but you have options. However, if you aren’t going to do it, you must document in writing why. Substantiate. Substantiate. Substantiate.   Backing up your data (the act/action) is an addressable implementation standard. You’ve got to do it,...

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Do Your Claims Say "Liar, Liar Pants on Fire?"

As you can see from the title, today’s discussion centers on dental claims, which are utilized to seek reimbursement for services rendered.    Under the HIPAA Transactions and Codes Sets Rule, dentists are required to use a designated code set for billing purposes. These codes are the ADA Current Dental Terminology.   Under the HIPAA Unique Identifier Rule, dentists and physicians are required to obtain and use a National Provider Identification (NPI) number for professional purposes, which is like a professional social security number.   The ADA established a uniform claim submission form which is commonly used for claims submission...

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HIPAA Alert: $475,000 Hit for Late Breach Notification By Jeanine Lehman, Attorney

On January 9, 2017, the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), announced the first HIPAA enforcement action and settlement based on the late reporting of a breach of unsecured protected health information (PHI). Presence Health, a large Illinois healthcare network, settled potential violations of the HIPAA Breach Notification Rule by paying $475,000 and implementing a corrective action plan. The breach involved missing paper-based operating room schedules containing the PHI of 836 individuals. Information included individuals’ names, dates of birth, medical record numbers, dates of procedures, types of procedures, surgeon names, and types of anesthesia....

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