September 23, 2013, marked the day the medical industry changed according to the new HIPAA regulations set forth by the government. However, two different levels of compliance were established: a minimum standard and a higher standard. Although the regulations leave some leeway as to the level of compliance, conforming in a more sophisticated manner may help your office get paid more quickly.
April 27, 2016, marked another very important day in the way that physicians get paid. Implemented in 1966, the Medicare Access and CHIP Reauthorization Act, known as MACRA, regulated how doctors received monies from Medicare. This regulation is changing the current fee for service structure substantially under the premise of tying the payment of physicians directly to the quality of service that physician gives to patients.
MACRA is one of the few healthcare laws that both sides of the political spectrum agreed upon, which means that, regardless of the final fate of Obamacare or any other controversial healthcare initiatives, the new MACRA is likely here to stay.
HIPAA and MACRA
With the overwhelming support for MACRA comes a new level of implementation for HIPAA as well. With the new MACRA rule, HIPAA compliance becomes even more important. In short, doctors will no longer get money for simply providing services to patients. A new quantifier is now on the scene, which is known as the MIPS Composite Performance Score; it will determine what percentage of the billed Medicare payment that a physician will actually receive. By the year 2022, the adjustments will have the ability to vary by as much as 9 percent up or down. The overall effect of MACRA will likely be felt in markets outside of Medicare as well, because the Centers for Medicare and Medicaid Services (CMS) is not-so-subtly using its influence to get private payers to change their payment structures to a similar format.
Physicians: How to Get Paid
To maximize the monies paid to them, physicians should be ready to comply with a HIPAA Security Risk Analysis, which would require the physician to meet certain requirements to protect the health information of patients by an implementation of a certified electronic medical records technology. Any office that does not comply undergoes the risk of receiving a 0 base score, a 0 performance score and an information performance category 0 score. Physicians should pay special attention to the Protect Patient Health Information measure to maximize their scores.
Physicians are advised to beat the government to the punch: Perform an internal HIPAA Security Risk Analysis before it becomes necessary. Make sure that your office is as compliant as it possibly can be, so you will receive higher percentage payments much more quickly than physicians who overlook the new regulation.
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