Recent events have reminded me that most of the time people want to do the right thing. Some examples include the bus driver in Buffalo, New York who stopped his bus and calmly encouraged a woman to come with him instead of jumping off a bridge. Although he was later rewarded, his actions were independent of any personal gain. Another event was the Connecticut Rabbi who had bought a desk from Craigslist, found $98,000 that had fallen behind the drawers and returned it to the former owner of the desk. He too was rewarded, although he accepted the reward reluctantly. His actions were based upon motives to do the right thing, not for a potential gain.
If people are willing to extend themselves to others in these ways, why not extend themselves to their organization where they spend the bulk of their time? This is a follow up to my blog on Why Unethical Behavior Goes Unchecked in which I discussed how studies have shown that employees are reluctant to report misconduct because they fear retaliation or expect no follow through on their concerns. How can organizations change to help employees decide to not only report misconduct, but offer recommendations for a better workplace? Continue reading
This is a tale that begins in 2009 and has yet to have a successful ending. The government must have determined that with the adoption of EHRs the health care industry no longer needed an exemption for treatment, payment, and health care operations when providing the HIPAA required accounting for disclosures of patient information. In 2009 the HITECH Act introduced the new requirement that technologies as part of a qualified EHR are to provide an accounting for disclosures to include those for the purposes of treatment, payment and health care operations. HITECH listed two things to keep in mind in relation to this change, which are:
1. The interests of the patients and
2. The administrative burden for such an accounting. Continue reading
Strides seem to have been made towards a moderate approach to the oversight of Health IT. When I read recently that the Health Information Technology Policy Committee (HITPC) of the Office of the National Coordinator (ONC) approved the recommendations of its workgroup related to oversight of Health IT, I was intrigued. It seems that the Food and Drug Administration (FDA) has been increasingly interested in regulating Health IT. It is understandable that when software is directly linked to patient safety, regulation may be necessary to prevent unintended consequences. But where did that leave the rest of the software that managed administrative and other functions that providers rely upon? Does the non-patient care software require the same level of overhead and oversight as software that functions with a medical device? Continue reading
Have you ever noticed that when a sensational news article emerges everyone is attuned to the topic? And the more negative the subject matter, the more people are interested? It happened this week as the Office of Civil Rights (OCR) announced that Affinity Health Plan is being fined over $1.2 million. This fine is part of the settlement for alleged HIPAA violations such as neglecting to remove all patient identifiable information from leased photocopiers before returning them to the leasing agent.
Although the issue arose out of actions that took place in 2010, some people seem to be noticing the issue for the first time due to the size of the fine. I wondered why that is, that negative news garners more attention than neutral or positive messages. Continue reading
In following my own advice from my May 2013 blog, I’ve begun to read more on the topic of business ethics and the issues that organizations face in addressing various behaviors. I was surprised to read about a recent survey on ethics in Canadian organizations where 48 percent of those who observed misconduct did not report it. Although we don’t know the definition of misconduct used in the study, and even if it includes only the most egregious actions occurring within the organizations, the fact that employees do not feel compelled to report these activities is troubling.
I’m interested in why people don’t report to their companies if they observe unethical, illegal, or just wrong behavior. Most large companies provide training on their Code of Conduct, ethics, legal issues, and harassment. Is it that it takes effort and a bit of risk in order to report someone else’s wrongdoing? That appears to be case. In the same survey mentioned above, they found that 69 percent of respondents thought the company would not investigate the issue properly if it was reported and 23 percent feared a negative consequence, including retaliation. It appears that more training on the topic of reporting suspected wrongdoing is needed as well as efforts within companies to honor their commitments to address any report of suspected wrongdoing and keep the employee safe from harm. Continue reading
For years, it seemed the Feds focused primarily on hospitals when looking at medical necessity issues. Even if an admission was determined to be a medically inappropriate site of service, the hospital got dinged, and the admitting physician got a pass. Hospital compliance officers have bemoaned this for years, not because they wanted to see the physician sanctioned, but because they felt alone on the medical necessity iceberg. The docs didn’t seem to mind since it did not impact their bottom line. Boy, are things changing: I was reading recently in Report on Medicare Compliance of the third cardiologist to be sentenced to jail time for inserting a stent in a patient whose blockage was less than the required 70 percent to support performance of the procedure. Even though the physician believed the stent placement was appropriate in this individual, he was convicted of misrepresenting the diagnosis in the record in order to support medical necessity.
To make this scenario even worse, only one patient’s stent procedure was misrepresented in the medical record, but the hospital had to refund all cases of stents placed by this physician for the past two years. Medicaid paid $6.088.45 for the one case that was found to be inappropriate, but the hospital had to repay the Feds $256,800! Continue reading
Once again, the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) has kept true to its work plan. In May, they issued their Semiannual Report to Congress for the first six months of the fiscal year. There were no real surprises, and the amounts of recoveries and savings to HHS continues to rise. We all hear about the sensational arrests accomplished by the combined efforts within the Medicare Strike Force Teams. However, in reviewing the report I discovered the OIG has completed some interesting work that is worth paying attention to.
Assessment of Hospital Reporting of POA Indicators
As the OIG tends to follow the money, no one should be shocked that they are continuing to evaluate the accuracy of the Present on Admission (POA) indicators for Medicare inpatient claims. In their 2012 report they found an overall error rate of three percent. While low, the OIG did have some findings in which to help the industry improve on coding accuracy. Developing conditions and exemption codes were identified as areas for further training. Did the OIG just help us figure out where to focus our coding audits and training? Continue reading
On May 3, 2013, CMS hosted a daylong meeting titled, “Billing and Coding with EHRs.” It was an interesting and exciting exchange between insightful speakers representing physicians, EHR vendors, CMS administrators, regulators, and industry experts on coding, documentation and medical informatics. Steven J. Stack, MD chairman of the American Medical Association’s Board of Trustees, charged that EHRs have largely become a tool for billing, compliance and litigation. He further asserted that physician productivity has been negatively impacted due to the EHR use mandate. According to Dr. Stack, “documenting a full clinical encounter in an EHR is pure torment.” Add to this that in the 2013 Work Plan, OIG intends to look at ”potentially inappropriate (E/M) payments in 2010” because CMS Contractors have noted “an increased frequency of medical records with identical documentation across services.” Continue reading
Have you had one of those re-energizing moments where you want to take something you heard and act upon it right away? That was my experience at the recent Health Care Compliance Association (HCCA) Annual Institute in late April. Participating in a discussion with a room full of compliance and ethics professionals on the topic of business ethics, I found myself wanting to bring ethics more to the forefront of my daily interactions at work.
I read last year’s Wall Street Journal article, “Why We Lie,” to learn an important point: People are less apt to cheat or lie when given reminders of the right things to do at the time they are making a decision. Although we think our ethics training is fabulous, it appears to have less impact on the decisions that good people make every day to do the right thing (or not). The author, a professor of Behavior Economics at Duke University, goes on to describe the contagious nature of cheating, where others may follow the lead of the cheater. Continue reading
On March 21, I told you about the new regulation from CMS – 1455R, which is an exciting opportunity for hospitals to recoup some dollars otherwise lost on denied inpatient stays. Specifically, CMS says,
The hospital may submit a Part B inpatient claim for payment for the Part B services to the extent the services furnished were reasonable and necessary, that would have been payable to the hospital had the beneficiary originally been treated as an outpatient rather than admitted as an inpatient, except when those services specifically require an outpatient status.
The hospital could re-code the reasonable and necessary services that were furnished as Part B services, and bill them on a Part B inpatient claim. This proposed policy would only apply to denials of claims for inpatient admissions that are not reasonable and necessary, and would not apply to any other circumstances in which there is no payment under Part A, such as when a beneficiary exhausts Part A benefits for hospital services or is not entitled to Part A. Continue reading