To Text or Not To Text Patients? The Message from HIPAA.

 

Most of the 1.9 trillion texts Americans sent from their smartphones to friends and family last year wouldn’t be secure enough for healthcare settings. It’s unfortunate, because texting is a quick, easy and effective way to communicate.
It’s probably also no surprise that texting is the most popular smartphone feature, according to a 2015 Pew Research Center survey,  and 97% of Americans use their phones to text.
But like most other things, different rules apply in the healthcare world.
The HIPAA/HITECH privacy and security rules cover any communication with electronic protected health information (ePHI), including e-mail, social media and text messages. In an actual case, providers at a nursing facility requested nurses text them patient information. Even without evidence that an unauthorized person saw the messages, CMS intervened with a 10-point remediation plan to retrain staff, appoint a HIPAA security officer and revise their HIPAA policies and procedures.

Remember that texting leaves a record, unlike telephone calls. Plus it’s easier to know you’re reaching the correct person on the phone. The risk of texting sensitive patient information to another person is not zero – in public surveys, about one-third of people say they’ve mistakenly sent a text to the wrong person.
In addition, HIPAA/HITECH privacy violations can carry hefty fines, up to $50,000. So avoiding the temptation to text a colleague for a quick patient consult could save you money as well.

HIPAA Compliant Texting
Even so, the Joint Commission did not rule out all texting, according to Andrew A. Brooks, MD, orthopaedic surgeon and Chief Medical Officer at Tigertext, a secure mobile messaging firm.  In a piece for the American Academy of Orthopaedic Surgeons, Dr. Brooks points out that minimum requirements for HIPAA compliance include:
* Secure data centers—Onsite or offsite (cloud) data centers must use a high level of physical security and policies to review controls and conduct ongoing risk assessments.
* Encryption—ePHI is encrypted both in transit and at rest.
* Recipient authentication—Confirmation that any communication containing ePHI only goes to its intended recipient.
* Audit controls—The ability to create and record an audit trail of all activity, including text messages containing ePHI.
The sheer volume of text messages indicates an overall preference for this form of communication. The 1.92 trillion texts last year is almost double the 1 trillion sent in 2008, so who knows how many texts Americans will send going forward.
Texting Appointment and Wellness Reminders
Your practice may already send patients text reminders for upcoming appointments. There’s evidence this strategy can reduce your patient no-show rate. HIPAA rules generally do not apply to communications without ePHI.
Text reminders also seem to help patients with medication, healthcare and lifestyle reminders. As examples, researchers show chronic disease text messaging can help patients manage their diabetes, remind African-Americans with high blood pressure to take their medication, and help people increase their exercise and physical activity levels, although some say more research on best practices is needed.
Healthcare vendors offer apps that promise secure texting and would allow physicians and medical professionals to communicate within a HIPAA-compliant platform. Verify information complies with HIPAA because government agencies do not vet many of these apps. Also, if you chose to use a third-party secure texting platform, keep in mind the three requirements for securing PHI: confidentiality, integrity, and availability. Any platform chosen must satisfy all three elements, according to Mellette PC Healthcare Provider Attorneys in Virginia.
Another option, now that more than 80% of physicians use electronic health record systems, is to communicate with patients by sending e-mails through a secure patient portal. As you probably know, secure portals can help eligible providers meet Meaningful Use.
Whatever strategy you use, remind your staff to never transfer ePHI through non-secure methods of communication. And while we congratulate you on moving to the world of quick and convenient electronic communication with patients, here at Power Your Practice we also don’t want to see you financially penalized.
Figured out a great way to reach patients – and hear back from them – without violating HIPAA? Share your tips with colleagues below.

Damian McNamara

Damian McNamara is a Content Marketing Writer & Editor. He brings his journalism experience covering 18 medical specialties to cover practice management, cloud technology and health IT best practices to Power Your Practice readers.

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CAQH CORE Announces New National Healthcare Operating Rules

CAQH CORE Announces New 

National Healthcare Operating Rules

Health plans, healthcare providers, and the clearinghouses and vendors that support them, now have national operating rules to improve how they can work together as trading partners. The voluntary operating rules will help streamline the electronic data exchange of four more healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan.

CAQH CORE recently announced that the Phase IV CAQH CORE Operating Rules package has been approved and the industry should begin coordinating voluntary implementation. Reaching this milestone is the result of enormous effort by the multi-stakeholder CAQH CORE collaboration, which includes a wide range of public and private entities.

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Understanding Healthcare Start Up Issues

Health Care

Use this guide to help understand the laws and regulations that apply to health care businesses and the health care industry.

Click on one of the following links to jump to that section of the page:

• Antitrust
• Environmental Compliance
• Eye Care
• Facilities Management
• HIPAA
• Mammography Services
• Medical Device Reporting
• Medical Practitioners
• Medicare & Medicaid
• Taxes
• Workplace Health & Safety
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Sole Proprietors Insurance Costs and Definitions

Being a sole proprietor is the easiest way to start a new business. The business entity consists solely of one individual, the owner. Insurance coverage is very important for any business especially for a sole proprietor. It provides a safety net for sole proprietors in case of any unforeseen risks that occur in running the business. This is important since a sole proprietor guarantees a business with his own money as well as money from the business.

Errors & Omissions Insurance

Every business, regardless of size, should consider errors and omissions insurance. This is particularly important for sole proprietors who bear the financial burden of the business alone. This insurance covers when a business makes a mistake and the mistake causes financial harm to another individual or entity. This insurance protects a sole proprietor from having to fund the entire cost of defending against an action that occurs during work. This insurance can also be referred to as malpractice insurance or professional liability insurance. The average cost of errors & omissions insurance can vary from $500 to $2500 a year for a sole proprietor, as of July 2011.

General Liability

Another type of insurance for sole proprietors to consider is general liability insurance. This basic insurance covers injury claims, property claims and advertising claims. Most sole proprietors carry this kind of insurance since it covers all kinds of employment. Insurance companies require sole proprietors to fill out questionnaires answering numerous questions before they give quotes. Costs for general liability insurance depend on the location of the business, yearly revenue and the past claims history of the sole proprietor. It could be as low as $500 to as high as $15,000 a year for a sole proprietor, as of July 2011.

Related Reading: Sole Proprietorship & Health Insurance

Factors in Cost

There are many factors that are considered in determining the cost of insurance for a sole proprietor. These factors include the type of business being insured, the state where the business is located, the annual revenue for the business, the number of professionals providing service and whether or not there have been any claims in the past. Sole proprietors are the only individuals that need to be insured for their business, a factor that usually reduces the cost of the insurance.

Other Insurance

Besides general liability insurance, sole proprietors need to consider the cost of health insurance. Health insurance premiums can be deducted from sole proprietor's income for tax purposes. The price of a health insurance plan depends on a number of factors including the age of the individual and whether the individual smokes or is overweight. These risk factors typically lead to higher premiums. Health insurance premiums under a sole proprietor can range from $508.76 for an individual and $1,294.31 for a family as of July 2010.

ClaimPay MD - Payment Options

Need to Pay Your Bill?

ClaimPay MD offers convenient online payment by credit card or checking account. All you need is your ClaimPay MD's account number and ZIP code.

Account Billing Plan

ClaimPay MD's account billing plan* is similar to how credit card statements work. We bill you for individual insurance policies just as a credit card company bills you for purchases made at individual retail and service stores. Then we apply your payment on your monthly balance to your account, not to individual insurance policies—the same way a credit card company applies your payment to your monthly balance, not to individual purchases.

Flexible Payments
With the account billing plan, you may pay the minimum monthly amount due, the full account balance or any amount in between. If you pay more than the minimum due, we apply the difference as a credit to your account. You won’t receive another bill until the credit in your account is not enough to pay the minimum amount due..

Payment Schedule
We issue your statement at least 20 days before the payment is due. To continue your policies in force, you need to pay at least the minimum amount due. If we receive less than the minimum due, all the policies in your account could be canceled. If your policies are not canceled for the non-payment, the full account balance may be required on future billings.

View a sample personal insurance billing notice
View a sample business insurance billing notice

Electronic Funds Transfer

With electronic funds transfer, your payment is automatically deducted from your bank account each time your premium is due. No checks to write. No postage to pay. No need to worry about forgetting to make your payment.

Each payment appears on your bank statement for easy record keeping. When you use electronic funds transfer, you avoid transaction charges that are applied to monthly billings when you pay by check or credit card.

To sign up for electronic funds transfer:

• Download, print off, fill out and sign the Policyholder Authorization for Electronic Funds Transfer
• Attach a voided check or savings account slip
• Mail the Authorization Agreement and voided check or savings slip to your insurance agent

Be sure to pay the current amount due on your policy and any additional invoices you receive. This will ensure that your coverage is continued until your electronic fund payments begin.

Online Payment

If you are not set up for electronic funds transfer and need to make sure your insurance payment arrives on time, you can use your credit card (Visa®, MasterCard® or Discover®) or checking account to pay your bill online. All you need is your ClaimPay MD account number and the ZIP code shown on your billing statement. Enter your payment through our website:

Make Online Payment Now

Payment must be entered on the website by 6:45 p.m.Pacific Time, Monday-Friday (excluding holidays), to be credited to your account the same day.

The same transaction fees that apply to mailed payments are applied to each online payment. A payment entered on the website is applied to your credit card or taken from your checking account the following business day.

For website assistance, contact IT Support between 6 a.m. and 6 p.m. CT, Monday-Friday (excluding holidays).

Phone:
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Email: 

If you get voice mail, please leave a number where you can be reached.

If you have billing questions, contact your independent insurance agent.

Payment by Phone

To make a payment by phone, call (360)  and respond to the automated prompts. You can choose to pay by checking account, savings account or credit card.

Pay-by-phone is available to all direct-billed policyholders for standard invoices, as well as audits. Accounts currently registered for electronic funds transfer (automatic payments) are not eligible.

Payment by Mail

* Electronic funds transfer and online credit card and checking account payment are available to business insurance policyholders in the states where ClaimPay MD has business..

 

Included with Servie

Claim Scrubber

Improve accuracy by checking all claims against a database of more than 10 million common claims edits. Automatically scrub claims and make edits before filing.

Electronic Remittance Advice

Post copays, deductibles, and government and commercial payments instantly to patient accounts. Reduce paperwork and confidently store account information in the cloud.

Batch Payments

Record payments from multiple claims and patient tickets all at once. Turn claims over to secondary plans or patient responsibility in seconds.

Patient Statements and Collections

Minimize overdue copays with easy-to-understand statements, broken down by visit. Automatically print letters to patients with outstanding and delinquent balances.

Reporting and Analysis

Take control of your fiscal health. Track reimbursements and outstanding payments with dozens of standard and hundreds of customizable reports.

Trade Name Checker

Your Search Criteria:   License Type: All Business Licenses Business Name: ClaimPay MD County: All Counties   No matches were found for your search.   Information Current as of 09/18/2015 6:39AM Pacific Time

Outsource or In House Medical Billing Facts

	In-House	Outsourced
Billing department costs	$118,000	$4,000
Software and hardware costs	$7,500	$500
Direct claim processing costs	$3,600	$122,500
Software and hardware costs	$5,500	$2,000
% of billings collected	60%	70%
Collections	$1,370,900	$1,623,000
Collections costs	$129,100	$127,000
Collections, net of costs	$1,241,800	$1,496,000

Some background on our cost assumptions follow.

Billing staff costs.

IN-HOUSE: This was calculated by adding up the median salary of two medical billing employees ($80,000), healthcare costs for two employees ($9,000), federal and state taxes for two ($12,000), and training costs to keep the employees updated on the latest industry developments ($2,000). Finally, we’ve included $15,000 in ancillary costs for statement paper, office space, office hardware and other miscellaneous costs.

OUTSOURCED: We factored in five hours of time per week required to manage tasks related to billing at approximately $15 per hour. Even the best medical billing service will require follow up from a practice about particular issues. That adds up to approximately $4,000 per year in administrative costs.

Software and hardware costs

IN-HOUSE: We’ve factored in an annual cost of approximately $7,000 for practice management software (~$200 per month, per doctor) and another $500 for computer hardware costs. This does not include the upfront cost of a software system.

OUTSOURCED: This reflects the computer and printer the practice would still need to interact with the billing service and print documents.

Direct claim processing costs.

IN-HOUSE: Clearing house fees for a provider submitting 20,000 claims per year would be approximately $300 per month ($100 per physician), or $3,600 annually.OUTSOURCED: A medical billing service usually charges a percentage of the amount collected as their fee. The industry average varies widely by specialty. We’ve used 7% for our primary care practice.

Percentage of billing amount collected

IN-HOUSE: The percentage of revenue that a practice collects varies widely by specialty as well. Our hypothetical practice collects 60% of what it actually bills. According to industry experts, this describes an in-house billing department that is average at bill collection.

OUTSOURCED: A practice can expect a 5% to 15% increase in the amount they’re able to collect by switching to a billing service. We factored in a 10% increase in the amount of money collected by a billing service as an average between the two. Many firms can help increase collection rates even more.

Our cost comparison favors outsourcing billing, mainly based on the ability of a billing service to collect a higher percentage of the billed amount. Of course, this introduces a big “if.” That is, outsourcing makes more sense if the billing service improves collections significantly (i.e. on the order of 10%).

But there are other factors – beyond costs – that a provider must consider in its decision making. Let’s examine the two approaches to compare advantages and disadvantages.

In-House Process

The in-house procedure for processing insurance claims involves a number of steps that are universal to every practice. First, employees enter information into the medical billing software program from a “superbill,” which is gathered during a patient’s visit. The superbill contains particular diagnosis and treatment codes, among other patient information, which the insurance company uses to determine if the claim is legitimate.

Via the practice’s billing software, the provider then submits the claim to a medical billing clearing house, which verifies the claim and sends it to the payer. The clearing house scrubs the claim for the errors (for a fee) before passing it on to the payer. By not submitting claims directly to a payer, the provider saves time, money and lowers rejection rates. The clearing house also has the ability to format and submit claim data en masse in the various insurance company formats.

Once the claim is rejected/accepted by the payer, notification of the claim’s status is sent to the clearinghouse, which updates the provider on the status of a claim. If a claim is rejected, the provider’s staff resubmits the claim once additional information has been gathered. The practice will be charge for each claim submission, even if it’s a correction.

EHR software – especially those EHRs with a integrated practice management system – has the potential to make in-house billing easier for a practice. EHR software, when integrated with a practice management system, will populate both system’s data fields. Diagnosis codes and other information needed for billing doesn’t need to be keyed into another system. This eliminates a second round of data entry. This tighter integration may be one factor that helps keep billing in-house.

                                                                Outsourced Process

The process for outsourcing billing is more straightforward for practice staff. Superbills and other documents are scanned and electronically sent or mailed to the medical billing service. The medical billing service takes care of the data entry and claim submission on behalf of the provider. Most billing services charge a percentage of the collected claim amount. The industry average is approximately a 7% charge for processing claims through a medical billing service.

The medical billing service takes care of much of the “dirty work” associated with the billing process. It will also follow up on rejected claims, pursues delinquent accounts, and even send invoices directly to patients. The convenience factor is a major reason that providers choose to outsource.

If a practice is using EHR software, then the process is even easier. Information from a patient’s superbill is stored in the EHR and electronically transmitted to the billing service. This eliminates the need to send paper records to the billing service. And because the EHR software eliminates an extra round of data entry, accuracy is also improved.

One possible issue here is data integration between the EHR software and the billing service. The type of data being exchanged between the provider and the billing service will need to match, or else the data will need to be converted to a different format. Depending on the billing service, data conversion may be an option.

Should You Outsource Your Billing?

Besides costs, there are other factors that would spur a provider to consider outsourcing their billing.

• Your billing process is inefficient. If you’ve been watching your collections drop while the time to collect increases, you may have issues in your billing department. Outsourcing to a third-party billing service typically decreases the number of rejected claims and decreases the time it takes to receive payment from a payer.
• You have high staff turnover. Turnover is an issue in any industry but turnover in a provider’s billing department is especially damaging. Claim processing is the economic life blood of a practice and a new addition or replacement in the billing department will inevitably lead to slowdown in the processing of claims.
• You’re not tech savvy. Keeping your billing in-house will require an investment in practice management software. Add in training for your staff and the significance of this investment becomes clearer. If you don’t want to deal with software upgrades and occasional technical issues, outsourcing is probably a good choice.
• You’re a new provider. New providers have plenty to learn and worry about aside from their billing. Outsourcing their billing right off the bat can give them much needed relief from the day-to-day stress of launching a new practice, without a trial by fire in hiring, training and managing employees.
• You have different priorities. Many doctors are not strong on the business side of running a practice. They became doctors to help patients – not worry about the administrative/clerical side of the business.  Outsourcing the billing process eliminates the hassle and frees doctors to concentrate on patients.

It’s important to note that a medical billing service isn’t a silver bullet for in-house billing issues. Billing services can vary widely in their efficiency and accuracy when processing claims. If a provider chooses a billing service that is lax and prone to errors, the headaches surrounding billing issues won’t get better – they’ll get worse.

Which Approach Should I Choose?

It’s important for a practice to factor in their individual costs and preferences when deciding whether or not to outsource their medical billing. In an apples-to-apples comparison, we found that outsourcing had the higher net income. However, cost isn’t the only issue practices should consider.  There are plenty of other factors involved in this business decision that may be as – if not more – important than costs.