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The scoop for ISMS practice management professionals

January 2017
In this Issue

  • January 18 Webinar: Maximize Your Success for Quality Reporting Under MACRA


    The right tools can be critical for successfully reporting quality measures and monitoring performance. 

    Qualified Clinical Data Registries (QCDRs) collect clinical data for the purpose of patient and disease tracking, but also have the capability to submit data to the Centers for Medicare and Medicaid Services for reporting purposes required under new payment models. 

    Learn more by joining an ISMS webinar on Wednesday, January 18 from noon to 1 p.m. covering how to maximize your success for reporting using QCDRs. 

    ISMS members and their employed staff are invited to attend this webinar at no cost.

    The cost for all others is $150 per person. 

    Register today

  • Do You Know What to Do if Subpoenaed to Provide a Patient's Medical Records?


    The day may come when a subpoena appears for a patient's medical records. Are you prepared to respond? 

    Here are a few general tips to help a medical practice navigate a subpoena for protected health information (PHI):

    1. Immediately comply with subpoenas for PHI accompanied by a qualified protective order* (which means the data will be treated as confidential). If your standard procedure has been to first request a written release from the patient concerning a subpoena for PHI, ISMS advises that a written release from the patient is not necessary in this circumstance under federal HIPAA law.

    2. If you receive a subpoena labeled as a grand jury subpoena, you must also comply - but no protective order or authorization is required.

    For other subpoenas, a valid HIPAA authorization is required prior to the release of records.

    The U.S. Department of Health and Human Services offers general guidelines concerning court orders and subpoenas. You might also wish to contact your legal representative for recommendations.

    *A qualified protective order is a document that originates from a court, an administrative tribunal or between two parties that limits use or disclosure of PHI for any reason other than the use stated in the document.

  • 'Ask ISMS' and Get Your Questions Answered!


    Our 'Ask ISMS' feature in Off the Charts is dedicated to your questions.

    Of course, as a practice management professional of an ISMS member, you may contact the ISMS advocacy team with your questions at any time by calling 800-782-4767 ext. 1470, or  by sending an email.

    Q. We discovered we were overpaid by an insurer. What should we do?

    A. If you discover a payment error before the payer does, you need to take the initiative to research the causes of the overpayment and refund the money. There is no free lunch. As you may be aware, the Centers for Medicare and Medicaid Services (CMS) requires physicians who treat Medicare and Medicaid patients to return overpayments within 60 days of discovery.

    Private payers may have different specific policies regarding returning overpayments or incorrect payments. 

    But the bottom line is if you discover an overpayment, you are asking for headaches if you wait for the insurer to come to you and request the refund. You should reach out directly to your provider relations contact or other provider relations representative and communicate that you think an overpayment was credited to you. Be prepared to explain how you determined the overpayment, and any details about other claims, payments or denials that might be related to the issue. 

    The payer should be able to confirm whether the payment was in fact made incorrectly, and advise you on how to refund the money so that your account is clear. 

    If you aren't proactive in addressing overpayments, you could end up in a bad loop of payments/recoupments/receivables that could take months to unravel.


    Q. Is there a quick telephone option that calculates the billing portion owed by Medicare patients?  

    A. Yes, you can "dial up" to find out how much to bill a Medicare patient. Medicare recently added new functionality to its Part B Interactive Voice Response (IVR) system. 

    With the use of a phone, you can hear the playback of the patient responsibility amount per line item on a specific claim, including coinsurance and/or the amount applied to the deductible. 

    Here are instructions:

    1. Illinois billers should call 877-908-9499; Press 1.
    2. Select the "Claim Status" option (Press 2).
    3. Enter your 10-digit NPI and then select "Claim Details" (Press 1).

    If you need help, check out this Part B IVR User Guide.

  • Free Practice Management Help Available to Professionals Working for an ISMS Member

    As a practice management professional of an ISMS member, you have access to numerous resources, too! 

    Are you experiencing difficulties or hassles with various government agencies and third party payers including Medicaid, Medicare, private payers, HMOs, PPOs and the like? Need help with MACRA, medical records, HIPAA privacy and security policies, credentialing or reimbursement snafus?

    You don't have to go it alone. We can help. Contact the ISMS Division of Health Policy Research and Member Advocacy at 800-782-4767 ext. 1470, or by email.

    ISMS also has a special content page for our practice management professionals. 

  • Help Educate Asthma Patients About Their Medication Options in a School Setting


    Does your medical office treat children? You may be seeing an uptick in asthma flare-ups among young patients during January's frosty weather. The cold and flu season brings sinus and respiratory infections that can trigger or worsen asthma attacks, quickly causing severe symptoms. 

    To help inform students and parents about what procedures public and private schools must follow concerning asthma, access ISMS' medical legal guideline, Self-Administration of Asthma Medication in School. This resource covers the self-administration and self-carry of asthma medication and epinephrine auto-injectors by students in a school setting. 

    Questions? Contact ISMS' legal department at 800-782-4767 or by email.

    This medical legal guideline is password protected. If you wish to access this resource and need to request a username and password as a practice management professional of an ISMS member, please contact us.

    ISMS has streamlined our most popular member benefit!

    Access ISMS' handy, searchable Medical Legal Resources Index of more than 100 easy-to-use legal documents, letters and forms.

  • Lack of Effective Communication Services Could Lead to Lawsuits


    When hearing impaired or non-English-speaking patients come to your office, providing effective communication is not only necessary for securing an accurate diagnosis and developing a treatment plan, it's the law.

    Check out CTS LanguageLink, an ISMS Benefit Partner, offering interpretation and translation services via conference call, remote video or on-site personnel.

    ISMS members receive a 30 percent discount on per-minute fees, with no monthly minimum and no sign-up fee.

    Learn more

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