Are you ready for the Red Flag Rules?

Red Flags that the World Privacy Forum recommends for health care providers are:

1. A complaint or question from a patient based on the patient’s receipt of: 
   -a bill for another individual, 
   -a bill for a product or service that the patient denies receiving,  
   -a bill from a health care provider that the patient never patronized, 
   -a notice of insurance benefits (or Explanation of Benefits ) for health services never received.
2. Records showing medical treatment that is inconsistent with a physical examination or with a medical history as reported by the patient.
3. A complaint or question from a patient about the receipt of a collection notice from a bill collector.
4. A patient or insurance company report that coverage for legitimate hospital stays is denied because insurance benefits have been depleted or a lifetime cap has been reached.
5. A complaint or question from a patient about information added to a credit report by a health care provider or insurer.
6. A dispute of a bill by a patient who claims to be the victim of any type of identity theft.
7. A patient who has an insurance number but never produces an insurance card or other physical documentation of insurance.
8. A notice or inquiry from an insurance fraud investigator for a private insurance company or a law enforcement agency.

Health care providers – whether they are for-profit, non-profit or governmental entities – may have obligations under the FTC Red Flag rules. Medical identity theft – particularly involving insider access to data – is a real concern in the health care sector, and is included expressly in the Red Flag Rules Guidelines. Because most healthcare providers defer payment for services, they are considered creditors and are subject to the Red Flag Rules.

Attend our April 2009 Leadership Seminar to learn more about implementing these rules.

Healthcare Trend 2009

In December 2008 five significant issues impacting provider health care delivery in 2009 were predicted by the Noblis Center for Health Innovation, a leading non-profit advisory firm to health providers.  Based first quarter results, how do you think they did?

1. Consumer demands will continue to change

– Healthcare utilization will be stable or even decline as consumers delay in seeking routine care.
– Consumers will continue to seek medical information/knowledge via Web resources.
– Medical travel will increase, expanding the competitive environment.

2. Budgets will be trimmed and capital investments delayed

– Margins will decline, negatively affecting investment income, philanthropy, interest payments, unemployment, cash flow, bad debt, and charity care.
– The economic downturn will force most hospitals to trim their operating budgets in 2009, resulting in hiring freezes of non-clinical staff, lay-offs, and other expense reductions.
– The credit market will tighten further and bond ratings will fall, limiting hospitals ability to access capital.
– The recent health care construction boom will continue, but at a much slower rate.

3. The health care industry will consolidate even further

– Hospitals that have historically relied on investment income, municipal funding of indigent and charity care, and low interest rate credit lines will experience an increase in bankruptcies, program closures, and/or hospital closures.
– Small hospitals and rural hospitals will be the most at risk in today’s economy.

4. The workforce will be in transition

– Physician responses to their own financial uncertainties will vary, but will include slowed/delayed retirements, seeking employment/practice purchase, and decreased acceptance of no pay/slow pay (including Medicaid) patients.
– Innovative staffing alternatives will be explored by hospitals and physicians as they seek ways to operate more efficiently and expand volumes without adding cost.
– Nursing vacancies may lessen with some inactive nurses returning to the workforce.

5. Health reform will not be universal, but it will be everywhere

– Healthcare reform will be a high priority on the national level although significant national system reform is unlikely in the short term.
– Hospitals will increase efforts to fund care for their uninsured patients.

If you are experiencing the economic effects on your practice, On Call Medical can assist you with a practice assessment.  Practice owners and administrators can openly share their concerns regarding their practice, and review materials such as financial statements, marketing strategies, and practice reports with On Call Medical’s consultant. The program will allow practice owners and managers a structured, unintimidating environment through which to seek help. The strategy session will provide time to analyze detailed areas of the practice, providing for the development of concrete ideas that will help healthcare practices brace for the economic troubles facing healthcare.  Call Tony Rinkenberger at 763-544-1000 to inquire about and to participate, or email him at tony.rinkenberger@oncallstaffing.com.

Concerns regarding the Stimulus funding for eHealth

Although there is promise in obtaining some assistance with the cost of an EMR from the Federal Stimulus funding, there are some lingering conserns among providers according to an article in the Florida Times-Union Transition to electronic medical records slow, costly.

Cost and interoperability concerns still remain.  If providers implement now to avoid the rush later, they are not in the financial position to wait until 2011 for the incentive money to be forthcoming.

As I talk with providers, I also encounter specialists that have implemented specialty specific EMRs that are not necessarily CCHIT certified.  CCHIT certification is expected to be among the standards to demonstrate “meaningful use” of their EMR.

Providers should be talking with their EMR vendors to determine how they are going to work with them to meet the requirements to receive incentive money.  Providers that have not yet implemented an EMR should be very cautious as they choose a vendor.  

Remember too, that meaningful use goes beyond choosing the right software, but also includes using this tool to improve processes and provide higher quality care.

For more information and assistance in implementing an EMR that is right for your practice and meets the requires for the incentive, please contact Tony Rinkenberger at 763-544-1000 or tony.rinkenberger@oncallstaffing.com.

On Call Medical  will help you implement and manage highly customized, comprehensive and cost-effective medical billing and account receivable solutions that will meet the requirements of the new rules mentioned above and proven to improve the profits, revenues and quality of life for health care providers.