sourdoughpablo wrote on Saturday, December 17, 2016:
Right r.e. transmittal 3083.
The security rule applies to practitioners who are using the internet to transmit data used to document or justify billings. This does not apply to fax over land lines. If you never communicate financial or clinical information digitally for those purposes, then you are not a “covered entity” wrt the security rule, and you do not have to comply with HIPAA regulations in any part. Communicating with patients directly regarding their clinical situation does not make you a “covered entity”. I assume that this distinction exists because the government has the right to regulate interstate commerce, but does not have the right under the first amendment to regulate direct communication between physicians and patients.
This is a major reason that I want to use OpenEMR rather than a cloud-based solution like Charm. Charm is an elegant package and easy for a low-volume practice to implement. But with Charm, all the data is on the cloud, so any time I print up a chart note to fax to an insurance company or a lawyer, I have transmitted clinical information over the internat in order to use it for billing purposes, and I become a “covered entity” with regards to the HIPAA security rule.
I am a non-participating provider, and as such I still have the right to send paper claims in to Medicare. I’m not so sure that this means that I can have the patients send paper claims to Medicare directly—I haven’t looked into this in detail. Medicare can of course punish me by reimbursing me more slowly, or at a lower rate, if I’m not using an EMR and/or not billing them electronically.
Since I’m in solo practice rather than working in an institutional or group practice setting, I have the ability to make these choices if I choose to do so. I would imagine that this is the case for many users of OpenEMR.
Since I am not a participating provider in other managed care setups, I don’t have any specific contractual obligation to private insurers. Their contract is with the individuals they insure, not with me. So I’m not legally obligated to bill these private insurers directly. But the patient may need to give them a HCFA form as part of their billing process.
[Yes, you are right about the modifier 25 belonging with the E&M code! Thanks for pointing that out.]