Medicare Compliance & Reimbursement

Plus: There are 2 new CMS Innovation Models to look forward to in the new year.

Falling in line with cyber Monday’s tradition of glitches and deceit, a cybersecurity firm targeted HIPAA entities and business associates masquerading as OCR director, Jocelyn Samuels, through email that used an HHS letterhead in a phishing scam.

“The email prompts recipients to click a link regarding possible inclusion in the HIPAA Privacy, Security, and Breach Rules Audit Program. The link directs individuals to a non-governmental website marketing a firm’s cybersecurity services,” the HHS press release from Nov. 28, 2016 said. “In no way is this firm associated with the U.S. Department of Health and Human Services or the Office for Civil Rights. We takethe unauthorized use of this material by this firm very seriously.”

The HHS and OCR jointly urged covered entities and their associates to alert employees immediately of the fraudulent activity and to contact the OCR directly with any leads or information regarding the scam.

Resource: For the link to the HHS press release and details on how to contact the OCR regarding this phishing operation, visit https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/.

In other news…

With change inevitable in the new year with a new administration, MACRA-backed initiatives continue to forge ahead as the Jan. 1, 2017 start date fast approaches. Keeping in line with other releases, the CMS Innovation Center has two more offerings to look forward to.

“These two Beneficiary Engagement and Incentives (BEI) Models are the Shared Decision Making Model (SDM Model) and the Direct Decision Support Model(DDS Model),” said Patrick Conway MD, CMS principal deputy administrator and chief medical officer and Andy B. Bindman MD, AHRQ director in a Dec. 8, 2016 CMS blog post. “Beneficiary engagement broadly refers to the actions and choices of individualswith regard to their health and healthcare, and these decisions impact cost, quality and patient satisfaction outcomes.”

Here’s a short overview of the two of models:

• The SDM Model will be for providers engaged in an Accountable Care Organization (ACO) and will require a face-to-face between patient and physician, sharing in the decision making of the treatment plan. The patient will have one of six CMS-determined, preference-sensitive condition.
• The DDS Model allows beneficiaries to garner research from Decision Support Organizations then bring that information to their clinician and apply it to their care.

Both models highlight patient engagement efforts already in progress through the Agency for Healthcare Research and Quality’s (AHRQ) SHARE approach model, which aim to improve the discourse between physician and patient—providing more efficient and affordable care in the process.

For those interested in either of the programs, the application period for the non-binding, letter of intent runs from Dec. 8, 2016 to March 5, 2017.

Resource: To read the complete CMS blog post, visit https://blog.cms.gov/2016/12/08/improving-the-quality-of-care-for-medicare-beneficiaries-by-increasing-patient-engagement/.