hipaa compliance strategies for ipas and medical groups · the hipaa colloquium at harvard...
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THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
A. John Blair, III, MDChairman and Chief Executive Officer
Taconic IPA, Inc.Fishkill, NY
HIPAA Compliance Strategies for IPAs and Medical Groups
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Background
Practicing Physician 15 yearsRevenue ReductionsPaper HasslesLegal IssuesManaged Care Constraints
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Background
Managing Partner - Medical Group 10 yearsPractice Manager / AdministratorStaffBudgetsBusiness Associates / Vendors
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Background
Owner - Billing Company5 yearsReimbursementClaims IssuesInformation TechnologyEDI
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Background
Chairman and CEO - IPA2 yearsUnderstanding of the Healthcare Community
• Hospitals, Laboratories, Pharmacies, Payors, Providers
Payor NeedsPhysician ComplianceMotivating Physician Community
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic IPA
2300 Physicians500 core physicians
• 10-80% case mix (average 30%)• 125 offices
– Range 1 to 60 physicians per office– Average 4 physicians per office
• Target group– Pilot Projects– Teaching Initiatives
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic IPA
One payorMultiple insurance products
HMO, PPO, POS, Indemnity, etc.150,000 covered lives6 counties
Mid-Hudson Valley, New York
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic IPA
What we do NOT doCollective bargainingRisk
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic IPA
What we DONetwork developmentCredentialingPeer ReviewPilot Projects
• Internet Initiative• Evidence-based Medicine• Physician – Patient E-mail
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic IPA
What we DOPhysician and Physician Office Staff Services
• Provider Relations• IT Training and Support• Compliance and Coding• HIPAA
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
HIPAA – State of Mind
Revenue reductionsRegulatory burdensLegal burdensOIG recommended compliance planHIPAA delaysHIPAA hype
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
HIPAA – State of Mind
25% of small practices are working on HIPAA EDI issues17% of small practices have initiated planning for HIPAA
(Source: Phoenix Health)
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
HIPAA – State of Mind
Office surveysInterviewed by provider relations staff
125 offices / 500 core physiciansAugust 2001< 30% knew of HIPAA< 10% actively preparing for HIPAA
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Changing State of Mind
Make it SIMPLE
Save them MONEY
Motivation
Buy-In
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
The Plan
CommunicationEducationTrainingSupport
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Communication
Provider RelationsTaconic Talk
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Provider Relations Staff
Acknowledged best physician support staff by communityHistory of support
Payor policies and proceduresCodingClaims supportComplianceInternet Initiative
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Taconic Talk
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Education
October 2001 SeminarGeneral overviewEngaging speakerDinner meetings5 days5 locationsSponsored by IPA250 attendees
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Education
April 2002 SeminarDetailed discussionDeadline reviewTools3 days3 sessions per daySponsored by IPA and local medical societiesOver 500 attendees
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Training
October 2002 deadlineCompliance extensions
• Paper form• Online form
Electronic transactions testing Spring 2003April 2003 deadline
PrivacySecurity (tentative)
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Training
Privacy officialPolicies and Procedures
HIPAA staff trainingSeminarsEducational Materials Online SourcesDocumented training
Compliance manualPhysician Involvement
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Support
ExamplesPrivacy policiesAuthorization for release of PHIBusiness Associate agreementsVendors
Legal and Consulting staff Second tier questions by officesOn retainer by IPA
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Monetary Benefit
Standardized EDIStaff efficienciesDecreased denialsIncreased reimbursementDecreased A/R
Long term cost savingsAfter expense of privacy and security measures
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Results
August 2001< 10% of core offices planning for HIPAA
August 2002> 90% of core offices planning for HIPAA
Nationally <17 % offices planning for HIPAA
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
Contact Information
A. John Blair, III, MDChairman and CEOOne Summit Court, Suite 200Fishkill, NY 12524T (845) 897-6359F (845) [email protected] www.taconicipa.com
THE HIPAA COLLOQUIUM at
Harvard UniversityAugust 22, 2002
A. John Blair, III, MDChairman and Chief Executive Officer
Taconic IPA, Inc.Fishkill, NY
HIPAA Compliance Strategies for IPAs and Medical Groups
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