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AI, Health Care & HIPAA – New Compliance Challenges
Recorded Webinar
Artificial Intelligence (AI) is transforming health care, drawing on vast resources of health information to reshape everything from diagnosis to treatment, payment, health care operations, research and much more. AI’s reliance on individually identifiable health information raises patient privacy and security questions that were unimaginable when the HIPAA Rules were developed.
The problem can be stated simply – what is AI, and what does it mean for HIPAA compliance?
AI is not coming to health care – it is here. And so is HIPAA, one of the few laws in place covering PHI that fuels health care AI. There is no question that AI will be regulated, the question is how and when. In the meanwhile Covered Entities and Business Associates must address AI HIPAA compliance to protect themselves from violations and reduce the risk of damage to their reputation, stability and financial well-being.
Venue: Recorded Webinar
There are several parts of seeing a patient and receiving payment for professional services. Eligibility ensures that the patient’s insurance coverage is active on the date of service that the services will be rendered and that their plan covers the services planned. There are different methods of receiving eligibility information and we are going to discuss these. Once eligibility is verified, certain procedures require the provider to contact the insurance company to receive prior authorization. Unfortunately, every insurance company has different requirements, making it difficult to manage. It is important that offices keep track of the current policies for the insurance companies they work with the most, and ensure these authorizations are performed prior to the service being performed. Medical necessity is normally reported by the ICD-10-CM codes. These codes justify why a procedure or service is performed based on the patient’s condition. The insurance companies may have policies that define the services they consider medically necessary based on the diagnosis. If the information on the claim does not meet their guidelines, the claim will be denied. Insurance companies are requiring that authorization for services be obtained for more services and procedures. It is also common that employers will change insurance plans to save money on monthly premiums. This session will walk through how offices can obtain eligibility before the patients are seen to confirm that the insurance information that is available is accurate and the patient is covered for services to be rendered. Then when the patient is seen, any services or procedures that are ordered may need to be prior authorized for that reimbursement will be received. The final piece is that the medical necessity requirements for the procedure or service is being met according to insurance company policies and guidelines. Attendees will benefit from this webinar in that we will discuss all of these aspects of a medical claim that may have to occur before the insurance company even processes it and will reduce the number of claims an office can receive because these steps were not taken. Methods available for eligibility When is the best time to verify eligibility Know when prior authorization is needed Getting authorization for special circumstances What to do when prior authorization has to be changed Why does medical necessity play a role in reimbursement There is never a guarantee of payment
ICD-10-CM updates for 2025 will become effective on October 1, 2024. These updates will include several guideline changes as well as multiple updates & additions to the specific chapters. This webinar will discuss the new guidelines as well as specific code categories in which you need to be alert to changes that may impact your code selection. All chapters will be included to ensure your specialty is covered. It is important that you be proactive and prepared when submitting your claims with discharge dates of October 1. Missed update information may cause a processing & reimbursement delay. Webinar’s Goals Be aware of guideline changes Learn about chapter specific additions & updates Ensure you are prepared with new code information Align with your software vendors to implement any necessary changes Target Audience Revenue Cycle Managers & staff Billers Coders Clinical Documentation Staff Finance Managers Denial Management Staff Physicians Mid Level Providers Claims Follow Up Staff
Critical Access Hospitals (CAHs) must comply with the Centers for Medicare & Medicaid Services’ Conditions of Participation located in Appendix W in the manual. This eight-part webinar series will cover the CAH CoP manual. There were changes and new regulations for CAHs in 2020, including a change to all the tag numbers, some which do not include Interpretive Guidelines or Survey Procedures. Changes include infection prevention and control and antibiotic stewardship, QAPI and Swing Bed changes. This seminar will help CAHs comply with specific CoP problem areas, such as nursing care plans, necessary policies and procedures, medication administration and drug storage, and informed consent to name a few. Part Three of Eight: Physical Plant & Environment, Emergency Preparedness Objectives Describe expectations for a safe environment for patient care Recall the requirements for equipment maintenance and an alternative management program Explain the importance of maintaining ventilation, temperature, and lighting within a CAH Describe the mandatory training and exercises for an emergency preparedness plan Physical Plant and Environment Construction and maintenance Equipment, preventive maintenance and AEM Physical environment Disposal of trash Storage of drugs Life Safety from Fire LSC waivers Fire inspections Emergency Preparedness Emergency Plan Policies and procedures Communication Plan Training and testing Power systems Appendix and Resources
Calling all medical coding professionals, CDI and auditors, it’s that time again! Join us as we take a deep dive on all updates related to the Official Guidelines for Coding and Reporting for fiscal year 2025. Together, we will be evaluating all affected diagnosis codes which includes additions, deletions and revisions. Knowledge is power so let’s be proactive and review our updated guidelines to ensure quality reporting, accuracy, compliance and proper reimbursement. Webinar Objectives Review the changes to the Official Guidelines for Coding and Reporting FY 2025 Know diagnosis codes that were deleted, added and revised in each affected chapter Understand documentation best practices in impacted diagnosis codes Questions and Answers Who Should Attend HIM Coding Directors, Managers, Supervisors Hospital Coding Staff Clinical Documentation Improvement Management and Staff Reimbursement Specialists Coding Compliance Management and Staff Auditors and Educators