The worst has happened: You’ve become the target of a government fraud/abuse investigation. State and/or federal agents have arrived with a warrant, allowing them to enter and seize documents identified in the warrant. What do you do?
This past January, the Department of Health and Human Services (HHS), Office of Civil Rights (OCR) published a Final Rule that significantly raises the accountability of business associates under HIPAA. For example, business associates must now comply with the Security Rule provisions, including administrative, physical and technical safeguards regulations, as well as the written policy and documentation requirements, and large portions of HIPAA also now apply to subcontractors of those business associates.
Insurance verification validates a patient’s coverage with the third-party payer, and establishes the patient’s financial responsibility (co-insurance, co-pay, deductible, and annual out-of-pocket limits), per his or her contract with the third-party payer.
Your scheduling staff affects the profitability of your practice in many ways, including how they handle referrals. Determining the need for provider referrals prior to the patient’s arrival can mean the difference between payable or denied services. In the worst case scenario, the service may be a total write-off, if the provider is in-network with the third party payer but failed to receive a required referral prior to rendering the services.