billing system

NJ flunks Medicaid data security audit

Mon, 05 May 2008 06:59:58 -0400

A new audit has concluded that New Jersey has not put adequate security measures in place to protect sensitive Medicaid program data. The review, conducted by the New Jersey Office of the State Auditor, concluded that the program isn't monitoring access to data such as Social Security and tax identification numbers, DEA numbers and birth dates. This information could be used against, not only the more than one million patients covered by the New Jersey Medicaid program, but also physicians who participate in the program. Officials with the state Department of Human Services, which runs the Medicaid program, told New Jersey legislators that employees can only access areas in which they work, which limits the systems' vulnerability. However, they admitted that they don't know which records employees view.

To learn more about the audit:
- read this Philadelphia Inquirer article

Related Articles:
CMS security holes expose patient data
Maine struggles with Medicaid billing system

ALSO NOTED: Brooklyn HIE to begin operations; Mass. e-prescribing up in 2007; and much more...

Mon, 11 Feb 2008 06:59:50 -0500

> The Brooklyn Health Information Exchange has begun developing an enterprise master person index in preparation for beginning operations this summer. Article

> E-prescribing seems to be growing in Massachusetts. Participants in a payer-sponsored e-prescribing network there sent 8.4 percent more prescriptions in 2007 than 2006. Article

> Foundations have agreed to provide almost $1 million to set up an EMR and billing system in at least 13 school-based health centers in greater New Orleans. Article

> Case study: A Las Vegas medical group has rolled out a portal which allows patients to perform key functions such as making appointments, refilling prescriptions and viewing their electronic medical records. Article

> Wyoming's health data organization has set up a Web site to help educate providers about RHIOs and help them come to terms with privacy and security concerns. Article

And Finally... Putting doctors in key health IT positions sounds good, but making it work is harder than it sounds. Article

MN requires insurers, providers to file electronically

Sun, 01 Jul 2007 20:01:36 -0400

Minnesota providers and insurers will soon become the first in the United States required to file all claims electronically. A new law, which takes effect in 2009, includes all business-to-business transactions, as well as transactions between providers, insurers and the state.

The law also impacts worker's comp claims, chiropractic, dental and pharmacy claims and medical care claims filed through auto insurance plans. Insurers and providers will be required to follow a standard e-claim format developed by a consortium of payers, providers and state agencies.

The rule comes after a 2006 state study found telephone follow-up for claims and eligibility cost the state $15.5 million to $21.8 million annually. State officials, who expect to see major cost savings through the new requirement, cite a study by America's Health Insurance Plans estimating e-claims costs at 85 cents each, while paper claims cost $1.58 each to process.

To find out more about the new rules:
- read this Minneapolis Star Tribune article

Related Articles:
Humana, BCBSFL offer real-time claims adjudication. Report
Maine struggles with Medicaid billing system. Report

Case study: Maryland clinics share EMR

Sun, 20 May 2007 20:01:34 -0400

In many cases, it's still the deep-pocketed providers that are rolling out EMR technology. But a group of Maryland clinics are bucking this trend, counting themselves among the few that share an integrated clinical, registration, scheduling and billing system. A group of eight clinics offering care to the underserved participate in the network, run by the Community Health Integrated Partnership (CHIP), sister organization to the Maryland Community Health System health plan. CHIP's efforts include a $2.9 million drive to computerize the clinics' medical records; CHIP spends $800,000 per year to run the administrative systems. CHIP has been working to centralize administrative functions since 1996, and has managed to convince participants to agree on system specs, key features and a single software vendor. With members generating 86,000 consultations per year, digitizing records should prove to be quite an effort, but execs seem determined to make it happen. Ultimately, the group hopes to take what it learns and share its knowledge with providers throughout the state's Medicaid program.

To learn more about the project:
- read this piece from The Examiner

Related Articles:
NYC to distribute EMR at no cost. Report
Medicaid programs work on shared EMRs. Report
New Orleans clinics connect to charity hospitals. Report

Maine struggles with Medicaid billing system

Sun, 26 Nov 2006 19:01:35 -0500

For two years, Maine has tried to make its flawed Medicaid billing system work. Now, state administrators are ready to throw up their hands and kill the system, which has already cost the state and federal government $56 million. If administrators pull the plug, there's no other system available to pay the state's roughly 7,000 Medicaid providers.

The system immediately began rejecting claims in January 2005, when it first went live. To keep care available to patients during this period, the state sent out $500 million in estimated payments to providers. Once the system began paying bills, meanwhile, many providers were paid twice. The system can now pay most bills, but can't meet HIPAA requirements or analyze claims data. Attempts to fix the remaining problems have brought down the billing system again. The state needs to re-collect $131 million in twice-made payments if it hopes to balance its budget.

To learn more about Maine's Medicaid computing issues:
- read this piece in The Lincoln County News

Related Article:
CMS security holes expose patient data. Report