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You have certainly found the right place for the most up-to-date information about Ambulance & Fire Billing.
Feel free to browse our site to find valuable information that you need; sign up for our newsletter to get regular updates sent directly to your mailbox.
PCC is a leading Ambulance and Fire Billing Service dedicated to maximizing your revenue while meeting all federal and state guidelines. We specialize in billing so you can specialize in patient care.
Please contact us to find out what PCC can do for you!
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Hot Topics In the Industry - Contact PCC at: 1.877.882.9911
June 1, 2010 is the enforcement deadline for the Identity Theft “Red Flags” Rule issued by the Federal Trade Commission (FTC). The Red Flags Rule are regulations that require financial institutions and creditors to develop and implement written identity theft prevention programs. The program is to detect the warning signs or *red flags* of identity theft, the steps to prevent it, and how to minimize the damages that could result from identity theft. The FTC found in a survey that 5% of identity theft victims have had some form of medical identity theft and indications show that the numbers will increase in the days ahead.
The number of cases identified from medical identity theft has risen this year partly due to the increased use of electronic medical records and also due to the current economic conditions. Identity theft is extremely lucrative with minimal risks involved and has said to be one of the fastest growing crimes in America. Medical insurance cards are bringing $50-$60 each on the black market while social security cards are only $1.00 as it is much easier to submit a false claim to an insurance company and there are lifetime benefits on insurance in the millions of dollars. A victim of medical identity theft in Texas reported to receiving bills totaling thousands of dollars for a Life Flight air ambulance service and emergency room services from a hospital in a state that he had never visited.
The Federal and State officials will take action against those that do not comply with the Red Flags Rule which has been implemented to combat identity theft. The FTC has increased penalties from $2500 to $3500 per violation with possible additional financial impact from having to write off ambulance services related to the treatment of the identity theft victim.
It is vital that your billing company be proactive and takes compliance as seriously as we do in today’s healthcare industry.
 HITECH ACT
On February 17, 2009,a bill was enacted called The American Recovery and Reinvestment Act of 2009 or better known as the “Stimulus Bill” which includes the Title XII, Health Information Technology for Economic and Clinical Health Act (HITECH). The HITECH Act contains significant changes to the HIPAA Privacy and Security Rules as well as numerous other changes that will have a major impact in the information and technology areas of health care.
Included in the HITECH Act are several new requirements that have been amended to HIPAA:
- Requires notification in the event of a breach of unsecured PHI
- Restricts the sale and marketing of PHI
- Strengthens enforcement mechanisms
- Applies portions of HIPAA’s Privacy and Security rules directly to Business Associates.
HHS Office of Civil Rights is now responsible for enforcement of HIPAA-HITECH to ensure that ambulance services and health care providers are in compliance with the regulations. Penalties for violations of the regulations have risen substantially with HITECH. Civil penalties apply to any privacy or security violation, even unintentional ones. Criminal penalties will apply directly to the employee as well as the ambulance service. Some states may also now be able to prosecute too. The new tiered-penalty structure is now based on the level of knowledge:
- Without knowledge, $100 per violation up to $25,000 per year for violations of the same requirement
- Due to reasonable cause & not willful neglect, $1,000 per violation up to $100,000 per year for violations of the same requirement
- Due to willful neglect, $10,000 per violation up to $250,000 per year for violations of the same requirement
- Due to willful neglect and not corrected within 30 days, $50,000 per violation up to $1.5 million dollars per year for violations of the same requirement.
There are many more provisions within the HITECH Act that we will expand on in the future but as the health information technology improves and more regulations in the horizon, it is important that such information remains private and secure. It is vital that your ambulance service stay updated on the current and updated regulations in order to stay compliant in the health care industry.
RAC ~ Recovery Audit Contractor
The RAC program has been implemented for all regions. The RAC program is intended:
"...to reduce Medicare improper payments through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments."
The regional RAC for region D is HealthDataInsights. They are contracted to implement audits on payments already made by CMS Medicare to ensure proper payment has been made. If they audit a claim and feel it is an overpayment then they will send out a Demand Letter stating that they have reviewed a certain claim and have determined it to be an overpayment and requests that money be refunded. This is an excerpt from an example letter:
“This letter is to notify you that Medicare has made an overpayment to you for the amount of $_______.
A brief description of the claims associated with this overpayment can be found on the "Overpayment Report" page. In order to correct this overpayment, please refund $_______by xx/xx/xxxx.”
What does that mean to you? If you receive one of these letters and PCC handles your billing, please forward to us as soon as possible. The review process gives 40 days from the date on the letter for us to provide supporting documentation showing why the payment should not be considered as an overpayment. If the supporting documentation is not sent in a timely manner, the amount shown on the letter will be forwarded to Medicare to review to determine if a recoupment will be made on a remittance advice (Medicare Check). Audits can be done on claims with dates of service as far back as October 1st, 2007 currently. After October 1st, 2010 these audits will go back up to three (3) years for the date of service.
What if PCC doesn't currently handle your billing? You should contact us to find out what we will do for you to ensure all of these important issues are managed for you in a timely, efficient, and secure manner.
Contact PCC for your free over-the-phone or onsite consultation.
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