News & Information

It is important for providers to understand the critical nature of the Business Associate Agreement (BAA). Far too many healthcare providers are neglecting this component of HIPAA, which can be a costly mistake. For years providers have been warned that if they are a HIPAA Covered Entity (CE) they MUST have properly executed BAAs for all their business associates. Failure to do so could cost millions. Penalties begin at $50,000 per violation with a maximum of $1.5 million per year for repeats of the same violation.

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On February 16, 2016, CMS, in conjunction with major commercial health plans and physician groups, released the first set of core measures, which will be used as the basis for quality-based payments. Part of the MACRA - SGR repeal was to begin to implement payment systems based on quality measures rather than the previous PPS system. This announcement marks the beginning of this process.

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NAMAS Weekly Auditing and Compliance Tips

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The PQRS program continues for 2016. CMS has recently began to publish a list of preferred measures by specialty. Keep in mind that these are preferred lists which means that there can be additional measures which apply.

The following are the CMS preferred 2016 Specialty Measure Sets:

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It turns out that there is a whole batch of new external cause codes for "Exposure to supernatural forces." They are in a new block from X40-X49.  You might want to pass this on to your contacts.  You can review the new codes here: Proposed new ICD-10 codes for 2017!

Noteworthy examples include:

X42.221_ Struck by invisible jet

X42.41 Injury due to contact with kryptonite

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