Jonathan Bush’s Post

Historically, health care providers seeking patients’ information for treatment purposes have been guided by HIPAA’s definition for Treatment and related regulatory guidance. Over the last month, there have been many discussions at the federal level about narrowing the Treatment use cases that require a response under the Trusted Exchange Framework and Common Agreement (TEFCA), a new federally-endorsed health information exchange network that is designed to simplify connectivity between organizations, improve patient care, and enhance population welfare. Last week Zus Health participated in several meetings in Washington D.C. where we advocated for providers’ rights to access patient data for treatment purposes under TEFCA.  Our efforts helped ensure that the treatment use cases of our customers, including those of the value-based care community, remain protected. Yesterday, the Department of Health and Human Services Office of the Office of the National Coordinator for Health Information Technology (ONC) released a new Exchange Purpose (XP) Implementation SOP for Treatment that codified the new approach, and which narrows the treatment use cases that require response under TEFCA: https://lnkd.in/e_DFfBgs At Zus Health, we remain committed to promoting and prioritizing #interoperability and exchange of health care data, and look forward to working with the ONC on ways to improve and expand the reach of TEFCA. We also want to extend our #gratitude to our #customers for their trust and support, and to our external partners, including Kno2, who have collaborated with us in this endeavor. Together, we are shaping the future of #healthcareinteroperability and helping our customers focus on what they do best: #delivering #exceptional #patientcare. 

Effective Documentation ✍ In Health and Social Care, the importance of effective documentation is often overlooked. However, without it the quality of care can become inconsistent, registrations can be jeopardised and reputations can be destroyed. The importance of this is only amplified when, like us, the majority of your work is in community-based settings, sometimes unregistered, or in the family home. These settings present very real challenges that we as an organisation are proud to have overcome by continually investing in our process, management structure and technology. At JMR Healthcare Ltd , we are working with PatientSource to utilise their digital care monitoring software that is then designed bespoke to our service needs. This allows us to digitally manage all of our residential homes and intensive community packages, meaning staff can complete all necessary documentation on an iPad that we can then access and export live information to key stakeholders at a moment’s notice. Having this software has also enabled effective care management of packages to be far more streamlined by allowing our Registered Managers, Field Care Managers and Quality and Assurance Manager to access and review all documentation instantly, from anywhere.  

📢 𝘈 𝘴𝘶𝘳𝘷𝘦𝘺 𝘣𝘺 ProviderTrust 𝘢𝘯𝘥 Healthcare Dive 𝘳𝘦𝘷𝘦𝘢𝘭𝘦𝘥 𝘯𝘦𝘢𝘳𝘭𝘺 𝘢𝘭𝘭 𝘩𝘦𝘢𝘭𝘵𝘩 𝘱𝘭𝘢𝘯 𝘥𝘦𝘤𝘪𝘴𝘪𝘰𝘯-𝘮𝘢𝘬𝘦𝘳𝘴 𝘢𝘪𝘮 𝘵𝘰 𝘣𝘰𝘰𝘴𝘵 𝘱𝘳𝘰𝘷𝘪𝘥𝘦𝘳 𝘤𝘳𝘦𝘥𝘦𝘯𝘵𝘪𝘢𝘭𝘪𝘯𝘨 𝘦𝘧𝘧𝘪𝘤𝘪𝘦𝘯𝘤𝘪𝘦𝘴 𝘢𝘯𝘥 𝘪𝘯𝘤𝘳𝘦𝘢𝘴𝘦 𝘪𝘵𝘴 𝘧𝘳𝘦𝘲𝘶𝘦𝘯𝘤𝘺 𝘸𝘪𝘵𝘩𝘪𝘯 𝘵𝘩𝘦 𝘯𝘦𝘹𝘵 18 𝘵𝘰 24 𝘮𝘰𝘯𝘵𝘩𝘴. 𝐎𝐩𝐞𝐫𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐜𝐡𝐚𝐥𝐥𝐞𝐧𝐠𝐞𝐬 𝐥𝐨𝐨𝐦 𝐥𝐚𝐫𝐠𝐞, 𝐰𝐢𝐭𝐡 64% 𝐨𝐟 𝐜𝐫𝐞𝐝𝐞𝐧𝐭𝐢𝐚𝐥𝐢𝐧𝐠 𝐭𝐞𝐚𝐦𝐬 𝐚𝐥𝐫𝐞𝐚𝐝𝐲 𝐫𝐞𝐩𝐨𝐫𝐭𝐢𝐧𝐠 𝐚𝐧 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞𝐝 𝐰𝐨𝐫𝐤𝐥𝐨𝐚𝐝 𝐚𝐧𝐝 30% 𝐟𝐚𝐜𝐢𝐧𝐠 𝐚𝐧 𝐮𝐧𝐦𝐚𝐧𝐚𝐠𝐞𝐚𝐛𝐥𝐞 𝐛𝐚𝐜𝐤𝐥𝐨𝐠 🫣 NAMSS - National Association Medical Staff Services has identified a framework to address these challenges and elevate the standards of initial provider verification. 13 𝐞𝐬𝐬𝐞𝐧𝐭𝐢𝐚𝐥 𝐜𝐫𝐢𝐭𝐞𝐫𝐢𝐚 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐢𝐧𝐢𝐭𝐢𝐚𝐥 𝐜𝐫𝐞𝐝𝐞𝐧𝐭𝐢𝐚𝐥𝐢𝐧𝐠 𝐨𝐟 𝐩𝐫𝐚𝐜𝐭𝐢𝐭𝐢𝐨𝐧𝐞𝐫 𝐚𝐩𝐩𝐥𝐢𝐜𝐚𝐧𝐭𝐬: 👉 Proof of Identity 👉 Education and Training 👉 Time Gaps 👉 Professional Licensure Verification 👉 DEA and Controlled Substances Certifications 👉 Board Certification Verification 👉 Practice History Timeline Verification 👉 Criminal Background Disclosure 👉 Sanctions Disclosure/Government Database Checks 👉 Health Status Inquiry 👉 National Practitioner Data Bank (NPDB) Queries 👉 Malpractice Verification 👉 Professional and Peer References NAMSS recommendations extend beyond the core 13 standard and include 𝐈𝐧𝐭𝐞𝐫𝐧𝐞𝐭 𝐁𝐚𝐜𝐤𝐠𝐫𝐨𝐮𝐧𝐝 𝐂𝐡𝐞𝐜𝐤𝐬 and 𝐒𝐨𝐜𝐢𝐚𝐥 𝐌𝐞𝐝𝐢𝐚 𝐑𝐞𝐯𝐢𝐞𝐰𝐬. 𝘗𝘶𝘣𝘭𝘪𝘤 𝘱𝘳𝘰𝘧𝘪𝘭𝘦𝘴 𝘤𝘢𝘯 𝘰𝘧𝘧𝘦𝘳 𝘪𝘯𝘴𝘪𝘨𝘩𝘵𝘴 𝘪𝘯𝘵𝘰 𝘱𝘳𝘰𝘧𝘦𝘴𝘴𝘪𝘰𝘯𝘢𝘭𝘪𝘴𝘮 𝘢𝘯𝘥 𝘤𝘰𝘯𝘥𝘶𝘤𝘵 𝘢𝘭𝘵𝘩𝘰𝘶𝘨𝘩 𝘵𝘩𝘪𝘴 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘦 𝘳𝘦𝘲𝘶𝘪𝘳𝘦𝘴 𝘳𝘦𝘴𝘱𝘰𝘯𝘴𝘪𝘣𝘭𝘺 𝘪𝘯𝘵𝘦𝘨𝘳𝘢𝘵𝘪𝘯𝘨 𝘧𝘪𝘯𝘥𝘪𝘯𝘨𝘴 𝘪𝘯𝘵𝘰 𝘵𝘩𝘦 𝘰𝘷𝘦𝘳𝘢𝘭𝘭 𝘦𝘷𝘢𝘭𝘶𝘢𝘵𝘪𝘰𝘯. 𝐑𝐞𝐚𝐝 𝐦𝐨𝐫𝐞 𝐚𝐛𝐨𝐮𝐭 𝐞𝐚𝐜𝐡 𝐨𝐟 𝐭𝐡𝐞 𝐬𝐭𝐚𝐧𝐝𝐚𝐫𝐝𝐬 𝐢𝐧 𝐨𝐮𝐫 𝐥𝐚𝐭𝐞𝐬𝐭 𝐚𝐫𝐭𝐢𝐜𝐥𝐞 ▶ https://lnkd.in/gFfSEHKH #NAMSS #Credentialing #HealthcareProviders #HealthcareAdministration #OperationalEfficiency #HealthcareStandards #CredentialingStandards #DEA #ControlledSubstances #Certifications #MedicalCertifications #NPDB #Practitioners

There's been a lot of talk around the #Convergence agenda of clinical systems within an ICS - this is a super article on the pros & cons https://lnkd.in/eKkwpxzB

There's been a lot of talk around the #Convergence agenda of clinical systems within an ICS - this is a super article on the pros & cons https://lnkd.in/ezkCXEa9

The 21st Century Cures Act Final Rule. Health Law Alert by Lamb McErlane attorneys Vasilios Kalogredis and Sonal Parekh, Esq. The Department of Health and Human Services’ (“HHS”) final rule “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing” relating to the 21st Century Cures Act (“Cures Act”) became effective on Monday, March 11, 2024. This rule implements the Electronic Health Record (“EHR”) Reporting Program provision of the Cures Act by establishing new Conditions and Maintenance of Certification requirements for health information technology (“Health IT”) Developers under the Office of National Coordinator (“ONC”) Health IT Certification Program (the "Program”).   The Cures Act is applicable to entities that (i) provide health care or are considered a health care provider[1], and (ii) hold Electronic Health Information (“EHI”). EHI is, in essence, the health records of a patient that is stored on a hard drive, server, or any other electronic platform. The intent behind this rule is to increase patient accessibility to EHI. While the final rule focused mostly on Health IT Developers, the rule included several key provisions for health care providers to which the rule is subject.   Read the full alert here: https://lnkd.in/e_HZtnZt #curesact #HHS #healthcarelaw #healthlawattorney #healthcarelawblog

Clinical Governance: great workshop to start the last day of #app2024

Having the right guide by your side can help employers make strategic decisions when it comes to managing risk, cost, and care outcomes. Check out this article from BenefitsPRO about the advantages of a #tpa with integrated medical management services. https://lnkd.in/ehSCGdpt

Organizations that approach quality management as a tool to drive continual improvement, as opposed to one that looks at quality as a nuisance and cost burden, will be more successful at improving outcomes.” In this article, IQVIA’s Senior Principal of Technology Anthony Hudson shares his predictions for how organizations can be successful in the year ahead. Hint: it’s less about their use of intelligence technology, and more about how they’re analyzing the data. https://bit.ly/4cBFAXC #QMS #eQMS #QualityCompliance

Excited to share that Humana will implement code editing rules🥳 Please refer to the source link; it's excellent and provides suggestions for modifiers, MUE/ maximum allowed units, physician qualifications required, and conditions for reimbursement. These coding edits promise to streamline processes and ensure compliance for fellow coders. Initial code editing rules for the Oklahoma Medicaid implementation: Humana will apply the code editing rules listed in this document to Oklahoma Medicaid claims submitted to Humana for dates of service beginning April 1, 2024. These code editing rules will be applied on the first day this plan is in effect. How to submit questions about a specific code editing rule You can submit questions about code edits through our code-editing questions tool on Availity Portal. If you are not registered on Availity: 1. Go to Availity.com and select “REGISTER” to sign up. 2. Once logged in, select the “More” tab. 3. Under the “Claims” heading, select the “Research Procedure Code Edits” link to access the tool. If you do not see this link, contact your Availity administrator to request access. 📚Source: https://lnkd.in/gnyDvuT5 #humana #payerupdates #ama #icd10 #cpt #stayinformed #knowledgesharing #letsconnect #availity #2024vision