tci Medicare Compliance & Reimbursement - 2014 Issue 7
Industry Notes: Psychotherapy With E/M? Break Down Time Spent on Each
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Article Overview
This Find-A-Code industry notes article brings together a Medicare coding compliance reminder for mental health claims and several HIPAA enforcement and audit developments. It is relevant to clinicians, coders, compliance staff, and privacy/security teams who need to track documentation expectations, federal audit activity, and recent enforcement actions involving protected health information.
Why This Topic Matters
The article highlights documentation and compliance risks that can affect reimbursement, audit exposure, and privacy/security enforcement. It also helps readers monitor federal activity from CMS, HHS OCR, and the FTC that may influence practice operations and compliance programs.
Article Sections
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Psychotherapy With E/M: Documentation Time Requirements
Discusses a CMS compliance reminder about documenting psychotherapy time when psychotherapy is billed in conjunction with evaluation and management services. References the revised psychiatry and psychotherapy code set and related Medicare guidance.
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Random HIPAA Audit Program Ramps Up
Summarizes federal activity related to a pre-audit survey for covered entities and business associates and the broader restart of HIPAA audit efforts. Includes timing and program background from HHS and OCR.
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County Settles With HHS Over HIPAA Violations
Reviews a HIPAA enforcement settlement involving a county government and discusses the privacy and security concerns that led to the action. Focuses on breach-related compliance and HHS OCR enforcement.
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Beware: A HIPAA Breach May Bring You More Than Health Information Law-Related Penalties
Covers a court-related enforcement discussion involving the FTC and a HIPAA-regulated business, emphasizing the possibility of overlapping federal oversight. Mentions legal analysis and the relationship between HIPAA and FTC authority.
What You Will Learn
- How CMS is addressing documentation issues related to psychotherapy claims billed with evaluation and management services.
- What the HHS pre-audit survey is intended to support and why it signals renewed HIPAA audit activity.
- What kinds of privacy and security events can lead to HHS enforcement actions against public-sector entities.
- How FTC involvement may intersect with HIPAA-related security and privacy concerns.
Who Should Read This
- Medical coders
- Billing staff
- Mental health clinicians
- Compliance officers
- Privacy and security officers
- Healthcare administrators
- HIPAA compliance teams
Codes Discussed
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