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Platforms

Nationwide Research and Expertise

By partnering with MediSked you are gaining an extremely well networked research and compliance partner and guide. We have over 50 years in home care / human service management and regulatory experience. Our ever growing team of consultants and industry professionals are available for information and product review and we are constantly monitoring regulatory websites, association updates and clinical guidelines in addition to attending top level meetings to provide up to date software solutions. A sampling of some federal organizations our team monitors to continue to deliver compliant software solutions:

    • Centers for Medicare and Medicaid Services (CMS) Updates and Guidance
    • CMS Policy and Memo Guidance to States and Regions
    • National Association of Home Care and Hospice (NAHC)
    • National Association of State Medicaid Directors
    • Oversight / Population Leaders
    • Other Provider Agencies

Some of the keys to our success in compliance and where our customers see so much value in being our partners is the built- in business rules or workflows and compliance packs that come with our solution.

  • Implementing business rules
    • Our flexible platform allows providers to implement rules and prevent errors
    • Compliance requirements can be implemented across the agency and down to the program/service level
    • As providers adapt to changing regulations, MediSked Connect will as well. With a web-based system, software changes can be implemented immediately upon release
  • Compliance Packs
    • The MediSked Compliance Organization carefully reviews individual state and waiver rules and regulations
    • The overall goal of the organization is to research certain areas of the market to ensure MediSked is compliant with any rules and regulations that are published in the market
    • Very few oversight bodies “certify” a software system within their populations. Our research and on-going monitoring is crucial for the many provider agencies in our populations
    • Some examples of review areas include:
      • Service descriptions and service codes
      • Applicable HIPAA standards and requirements
      • Electronic signature requirements
      • Electronic billing / Payment requirements
  • MediSked can be utilized to assist with the tracking and requirements of the following
    • Accreditation Commission for Home Care Inc (ACHC)
    • Agency for Healthcare Research and Quality (AHRQ)
    • Community Health Accreditation Program (CHAP)
    • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • National Committee for Quality Assurance

 

Due to the regulatory nature of our industry, there are important laws and acts in which MediSked is required to abide by. These include:

  • HIPAA and Protecting PHI
    • After the passage of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Privacy and Security Rules were adopted to implement the provisions contained within HIPAA
    • These two rules are otherwise known as the ‘Standards for Privacy of Individually Identifiable Health Information’ (Privacy Rule) and the ‘Security Standards for the Protection of Electronic Protected Health Information’ (Security Rule)
  • Health Information Technology for Economic and Clinical Health Act (HITECH)
    • Congress passed the HITECH Act in 2009 as part of the American Recovery and Reinvestment Act of 2009.
    • Of particular interest:
      • Business associates are now directly liable for HIPAA violations
      • Breach notification is expanded
      • Additional information regarding the sale of PHI
      • Secretary of HHS is directed to issue guidance on the meaning of “minimally necessary”
  • Digital Signature Compliance
    • Federal law defines an electronic signature as “an electronic sound, symbol, or process, attached to or logically associated with a contract or other record and executed or adopted by a person with the intent to sign the record”
    • Health and Human Services (HHS) Guidelines for Electronic Signatures
    • CMS Guidance – Memorandum Ref: S&C-05-14 – Electronic Signature Guidance
    • Public Law 104-191 – Health Insurance Portability and Accountability Act of 1996 (HIPPA)
    • Medicaid Learning Network Updates
  • Electronic Billing Information
    • CMS Code List Monitoring
    • 005010X
    • Partnered with CLAREDI and EDIFECTS to assure HIPAA standard compliance
    • HIPAA Standards and Transactions List
      • ASC X12 837P – Health care claims – Professional
      • ASCX12 837I – Health care claims – Institutional
      • ASCX12 270/271 – Eligibility for a health plan (request and response)
      • ASCX12 835 – Health care payment and remittance advice
      • ASCX12 278 – Referral certification and authorization (request and response)

Our Research and Compliance organization is acutely aware of the special areas of concern that the Office of the Inspector General has for health and human service agencies. We work closely with our customers to ensure our product not only covers these areas but makes agencies standards of excellence in complying to these areas.

Risk areas – special areas of OIG concern

  • Billing for items or services not rendered
  • Duplicate billing
  • Billing for visits to patients who do not qualify for the service
  • Over-utilization
  • Insufficient documentation to evidence that services were performed and to support reimbursement

 

Claim development and submission process requirements

  • Provide sufficient and timely documentation of all services … prior to billing
  • A claim should only be submitted when appropriate documentation supports the claim
  • Pre and post claim submission processes should be in place to ensure that claims submitted for reimbursement accurately represent medically necessary services actually provided, supported by sufficient documentation and in conformity with any applicable coverage criteria for reimbursement

 

WHAT OUR CUSTOMERS ARE SAYING:

“MediSked makes it possible for us to have a very effective compliance program”