As we start the new year, it is a great time to review regulatory updates and implement necessary changes to reduce your risk. This article summarizes billing and coding changes as well as HIPAA updates.
Scope-of-practice violations are among the most common – and costly – regulatory risks for doctors and medical practices. These occur when:
- A provider performs tasks they are not legally permitted or trained to do.
- Tasks are delegated to staff whose licensure does not authorize those activities.
In today’s rapidly evolving healthcare landscape, many physicians are seeking ways to grow their practices without compromising the quality of care. Scaling a medical practice involves more than simply seeing more patients - it requires strategic expansion of operations, staffing, technology, and patient engagement systems. When done correctly, it can increase profitability, improve efficiency, and enhance patient satisfaction. Below are steps you can take to scale your practice.
Nearly everyone texts to communicate. It’s quick, easy, and convenient. However, texting with patients carries professional, legal, and ethical risks, including:
- Privacy and HIPAA compliance. Standard texting is not secure. Messages can be intercepted, viewed on shared devices, or accidentally sent to the wrong number. Therefore, any patient’s personal health information sent via text risks a HIPAA violation and possible fines.
The Centers for Medicare & Medicaid Services (CMS) has proposed significant reforms to the Medicare Part B payment methodology for skin substitute products. If adopted, the proposed changes1 would significantly decrease the reimbursement rate for such services.
While most healthcare providers are compassionate and want to provide optimal care to their patients, implicit biases exist. Healthcare providers may not be aware of implicit biases, which may be subtle and unintentional, that can influence clinical interactions, lead to a lack of trust between the patient and the healthcare provider, and result in healthcare disparities.
All healthcare professionals like to receive positive online reviews. It’s a great way to let people know about you and the exceptional care you provide. Which, in turn, can help send new patients your way.
A doctor’s obligations regarding how to respond to medical records requests from Medicare, Medicare Advantage, and insurance companies can easily cause confusion. Receiving medical records requests is a frequent and common occurrence and it’s important to note that responding to these records requests does not require the doctor to acquire a medical records release form from the patient first.
HIPAA Rules for Releasing Medical Records
In fact, HIPAA allows medical records to be released without a patient release form in many different settings, including for patient treatment, billing, etc. Because HIPAA allows information sharing for billing purposes, any language on a CMS 1500 form is superseded by HIPAA guidelines – the CMS 1500 form does not prevent a release of records that is otherwise allowed by HIPAA.
Regarding record requests from Medicare, Medicare Advantage, or commercial insurance plans, HIPAA also allows the doctor to provide medical records without a patient release form. HIPAA allows sharing of patient records for purposes of “health care operations,” which includes quality control, audits, licensure matters, etc. Additionally, most (if not all) provider agreements contractually require doctors to provide records to the insurer or to Medicare upon request and doing so does not require a patient release form.
Patient Medical Records Release Forms vs. Informed Consent Forms
Also keep in mind that a patient medical records release form is different from an informed consent form. A medical records release form pertains to the sharing of health information, while an informed consent form relates to the authorization of medical procedures or treatments after understanding the associated risks.
Comply with Medical Records Requests to Avoid Issues
A simple and reliable recommendation is that doctors comply with record requests from Medicare, Medicare Advantage, and commercial insurers, and remember that patient medical releases are not required to do so. Furthermore, refusing to comply with record requests is playing with fire – Medicare can revoke a doctor’s billing privileges for refusing to comply, and insurers can terminate the doctor’s provider agreement for failure to comply. It is never advisable for a provider to withhold or refuse to provide records in response to a request from a payer, whether governmental or private.
UPDATE 2/10/25: The Feb. 12, 2025 date referenced in this article has been delayed to April 13, 2025 by all seven Part B Medicare Administrative Contractors (MACs).
The Centers for Medicare & Medicaid Services (CMS) recently finalized Local Coverage Determinations (LCDs) for skin substitute grafts and Cellular and Tissue-Based Products (CTPs). Released by all seven Part B Medicare Administrative Contractors (MACs) on November 14, 2024, these policies will govern the use of skin substitute grafts for Medicare Part B beneficiaries for services rendered on or after February 12, 2025. The new policies set forth coverage requirements and limitations, including a list of covered and non-covered skin graft products, for the treatment of diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs).
