The HIPAA Journal

APRIL 1, 2025

On October 9, 2023, Azura Vascular Care identified suspicious network activity, with the forensic investigation confirming that hackers had access to its network between September 27, 2023, and October 9, 2023, during which time they potentially stole the protected health information of patients.

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HIPAA Documentation Billing Scheduling 61

The HIPAA Journal

MARCH 19, 2025

An investigation was launched which revealed an unauthorized third party had access to the email account for 2 months since November 6, 2023, and other email accounts may also have been accessed. On January 14, 2025, an employee emailed a document to a personal email account.

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HIPAA Documentation Insurance Medication 76

Health Populi

FEBRUARY 27, 2024

That’s the mantra coming out of this week’s annual Capitol Conference convened by the National Association of Benefits and Insurance Professionals (NABIP). FYI you might know of NABIP by its former acronym, NAHU, the National Association of Health Underwriters).

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Billing Insurance HIPAA Hospital 141

The HIPAA Journal

MAY 26, 2025

The lawsuit was filed in response to a cyberattack and data breach detected on or around April 25, 2023, when ransomware was used to encrypt files. Non-SSN subclass members can submit claims for up to 2 hours of lost time at $25 per hour and documented out-of-pocket losses incurred as a result of the data breach.

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HIPAA Documentation Scheduling Insurance 62

Health Prime

OCTOBER 10, 2024

According to The State of Mental Health in America 2023 , 21% of adults are currently experiencing a mental illness, which equates to over 50 million Americans. Mental health providers must ensure they use the correct diagnosis and procedure codes when submitting claims to insurance companies.

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Billing Medical Coding Documentation Insurance 97

The HIPAA Journal

MAY 21, 2025

Two large data breaches were reported in April that occurred way back in 2023, a ransomware attack on the City of Long Beach and a cyberattack on Dameron Hospital in California. The mailing vendor sent out 1095-C tax forms, however, an 18-digit code on the front of the envelope included each recipients Social Security number.

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Business Associate HIPAA Hospital Insurance 80

The HIPAA Journal

MARCH 21, 2025

A New York woman has avoided a jail term for a criminal violation of the Health Insurance Portability and Accountability Act (HIPAA), having been sentenced to probation. On March 23, 2023, Tonya DAgostino, 53, of Farmington, New York, mailed a parcel via USPS Priority Mail to an individual in Medina, New York.

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HIPAA Documentation Insurance 50

The HIPAA Journal

JULY 9, 2024

SouthCoast Health and Privia Medical Group in Georgia have notified patients about a cyberattack and data breach that occurred in June 2023. During that time, files on the network were viewed or copied.

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Triage HIPAA Documentation Billing 124

Arkenea

JULY 12, 2024

Medical insurance verification software is developed to automate the process of verifying patients’ insurance coverages. This software is connected to the insurance company’s database to retrieve real-time data on a patient’s insurance status. CDC reveals that 10.9 CDC also reveals that 3.9 In 2022, 92.1

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Insurance EHR / EMR Medication Patient Satisfaction 52

Minority Nurse

FEBRUARY 22, 2024

Financial Constraints and Budgetary Cuts Healthcare institutions often face financial constraints, with shrinking budgets and reduced reimbursements from insurance companies and government programs. link] Joint Commission (2023, August 24). link] Mcfanhn, C (2023, August 24). link] Muoio, D (2023, August 24).

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Patient Care Critical Thinking Hospital Patient Safety 111

ACMA Blog

JULY 9, 2024

FTC Conducts Investigation into PBMs Because PBM practices lack transparency and accountability to the public, in 2022, the Federal Trade Commission (FTC) requested data and documents of business practices to the six largest PBMs: Caremark Rx, LLC, Express Scripts, Inc., pharmacies in 2023. OptumRx, Inc., drug prescriptions.

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Insurance Patient Centered Care Medication Certification 98

The HIPAA Journal

MARCH 7, 2025

A further hacking incident was experienced in 2021 and was disclosed by Apria Healthcare in May 2023. Hackers had access to its network between August 27, 2021, and October 10, 2021, and potentially viewed or obtained personal, medical, health insurance, and financial information.

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HIPAA Documentation Insurance Medication 81

The HIPAA Journal

APRIL 4, 2025

Dameron Hospital Notifies Patients About November 2023 Data Breach Dameron Hospital in Stockton, California, has recently sent notification letters to patients about a November 2023 data breach. Notification letters were mailed to the affected individuals on February 21, 2025.

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Hospital Follow-Up HIPAA Insurance 69

Medical Economics

JUNE 9, 2025

Canceling services and coordinating mail forwarding are important tasks to prevent unnecessary expenses and ensure receipt of important documents. Financial advisor According to a 2023 Medical Economics survey , only about two-thirds of physicians who were looking to exit their businesses hired a financial advisor.

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Transfers Documentation Medication Follow-Up 52

Medical Economics

JULY 8, 2025

Industry data showed that insurers on HealthCare.gov denied about 19% of in-network claims in 2023 ; that’s $73 million out of $319 million in claims filed. For example, if you see a spike in denials from a particular insurer due to eligibility, you know exactly where to focus your front-end efforts.

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Huddles/Rounds Follow-Up Medication Patient Experience 52

Arkenea

JUNE 9, 2025

C-CDA C-CDA (Consolidated-Clinical Document Architecture) was created by HL7, ONC (Office of National Coordinator for Health Information Technology), HIE (Integrating the Healthcare Environment), and the Health Story Project. HL7 states that C-CDA provides a library of templates and prescribes their use for specific document types.

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Unit Organization and Environment Documentation Patient Satisfaction Patient Care 52

Healthcare Law Insights blog

JULY 7, 2023

A handful of FCA circuit court decisions issued in 2023 are noteworthy as well. Importantly, although the court assumed the relator engaged in some protected activity, the court found that in many of her communications she, at most, characterized discrepancies in therapy documentation as mistakes or possible computer glitches, not fraud.

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Transfers Hospital Documentation Admissions 52

Valant

JULY 29, 2024

This code is acceptable to insurers when used to describe a marked change in mental health status not attributable to other factors. Check out the 2023 ICD-10 updates here. Altered mental status, unspecified (R41.82) is a billable ICD-10 diagnostic code under HIPAA regulations from October 1, 2020, to September 30, 2021.

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Diagnostics HIPAA Insurance Medication 97

The HIPAA Journal

MAY 23, 2025

Over the course of two weeks, the hackers exfiltrated sensitive data such as full names, Social Security numbers, dates of birth, contact information, provider information, billing information, insurance information, medical record numbers, diagnoses, and treatment information. More than 50 facility partners were affected by the breach.

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HIPAA Documentation Billing Insurance 84

The Healthcare Blog

APRIL 2, 2024

billion (or 60% of its total revenues) represent clinical and business services provided to United’s Health Insurance business. Source: 2023 UNH 10K For most of the past decade, Optum has been driving force of incremental profit growth for United. billion in 2023 (55% of total). in the third quarter of 2023.

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Tests Hospital Insurance Follow-Up 132

The HIPAA Journal

MAY 9, 2025

A settlement has received preliminary approval from a judge to resolve a class action complaint against Imagine360 over a 2023 hacking incident involving its Citrix file-sharing solution.Imagine360 is a Chesterbrook, Pennsylvania-based company that offers health plan administration and telemedicine services.

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Transfers HIPAA Insurance Documentation 57

The HIPAA Journal

MAY 22, 2025

Class members may submit a claim for reimbursement of documented monetary losses reasonably traceable to the data breach up to a maximum of $10,000 per class member.

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HIPAA Insurance Documentation Scheduling 52

Health Prime

JUNE 22, 2023

According to a recent Precedence Research report , the gastroenterology market size 2023 is USD 54.56 Accurate gastroenterology coding and documentation Accurate coding and thorough documentation are the foundation of successful medical billing. billion, expected to grow to USD 93.8 Billion by 2032.

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Best Practices Billing Medication Documentation 52

The Healthcare Blog

MARCH 13, 2024

Many patients must contend with well-documented side effects such as nausea, diarrhea or the significant loss of lean body mass (ie. muscle) and bone density. Again, those are lifetime side effects. and some patients simply tire of giving themselves a weekly injection.

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Documentation Insurance Patient Care Medication 96

Healthcare Law Insights blog

NOVEMBER 21, 2023

The good news for administrators is that they are permitted to submit affidavits or other documents from outside the administrative record that show that the conflict of interest played no role in the decision-making. A documented history of arbitrary claims denials by the administrator. Reliance Standard Life Insurance Co. ,

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Documentation Follow-Up Medication Insurance 52

ACMA Blog

JUNE 25, 2024

It is the insurance or payers’ way of controlling costs by approving or denying certain medications, procedures, or devices that may not usually be covered or is on a higher tier on the formulary. Clinical Documentation Specialist (CDS): A CDS can help in the PA process by accurately documenting patient records.

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Medical Assistant Documentation Insurance Certification 40

ACMA Blog

OCTOBER 16, 2023

It is the insurance or payers’ way of controlling costs by approving or denying certain medications, procedures, or devices that may not usually be covered or is on a higher tier on the formulary. Clinical Documentation Specialist (CDS) : A CDS can help in the PA process by accurately documenting patient records.

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Medical Assistant Documentation Certification Medical Coding 40

Healthcare Law Insights blog

JANUARY 15, 2025

From 2018-2023, OCR observed a 102% increase in breaches affecting 500 or more individuals, with 167 million affected in 2023 alone. Attachments should be in Microsoft Word or Portable Document Format (PDF). On December 27, 2024, the U.S. population. [1] Follow the instructions at: [link] for submitting electronic comments.

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HIPAA Business Associate Follow-Up Documentation 52

Health Prime

JUNE 22, 2023

According to a recent Precedence Research report , the gastroenterology market size 2023 is USD 54.56 Accurate gastroenterology coding and documentation Accurate coding and thorough documentation are the foundation of successful medical billing. billion, expected to grow to USD 93.8 Billion by 2032.

Best Practices 40

Best Practices Billing Medication Documentation 40

Healthcare Law Insights blog

AUGUST 28, 2023

4] From court documents, it appears the government argued that Dr. Elfenbein knew that the patients whose insurance would be billed for E/M services would be with physicians “less than five minutes,” [5] and that Dr. Elfenbein told employees that E/M services were “the ‘bread and butter’ of how we get paid.” [6] 11, 2023). [4]

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Billing Tests Documentation Insurance 52

The HIPAA Journal

DECEMBER 24, 2022

The Health Insurance Portability and Accountability Act of 1996 placed a number of requirements on HIPAA-covered entities to safeguard the Protected Health Information (PHI) of patients, and to strictly control when PHI can be divulged, and to whom. The table will be updated to include the multiplier for 2023 when it is officially applied.

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HIPAA Business Associate Follow-Up Medication 126

Relias

JUNE 1, 2023

More technology is not always the best solution In a recent healthcare provider survey , half of healthcare executives said the revenue cycle is a top priority for software investment in 2023. 5 – Educate clinicians on required documentation Clinicians sometimes omit important documentation.

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Documentation Admissions Follow-Up Scheduling 52

Relias

JUNE 1, 2023

More technology is not always the best solution In a recent healthcare provider survey , half of healthcare executives said the revenue cycle is a top priority for software investment in 2023. 5 – Educate clinicians on required documentation Clinicians sometimes omit important documentation.

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Documentation Admissions Follow-Up Scheduling 52

ACMA Blog

OCTOBER 8, 2024

Many healthcare providers may prescribe treatments that are not considered routine or may be expensive, an insurance company may need prior authorization (PA) to determine whether they will cover what the healthcare providers recommends 4. The healthcare provider must get approval from the insurance company.

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Medication Insurance Documentation Follow-Up 40

Relias

FEBRUARY 1, 2023

It will be imperative for medical practices and organizations to focus on their billing and denial management to maximize revenue in 2023,” noted Cristy Good, MPH, MA, senior industry advisory and coding expert at MGMA. Some insurance companies have a list of “preferred” infusion drugs and won’t pay for other drugs.

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Insurance Billing Documentation Hospital 10

Relias

APRIL 27, 2023

Better retention As many as 58% of medical practices said that staffing is their biggest challenge for 2023, according to an MGMA Stat poll. Top 10 healthcare revenue cycle training priorities with the best ROI What training topics are the most important for the healthcare revenue cycle in 2023? It’s hard even for experts to keep up.

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Critical Thinking Follow-Up Billing Best Practices 52

ACI Medical & Dental School

OCTOBER 24, 2023

ACI Medical & Dental School Prepares Students for In Demand Healthcare Jobs ( Updated for 2023 ) The National Healthcareer Association (NHA) has released their 2023 Industry Outlook , which continues to show that jobs for allied health professionals in the US are growing at 13%, a much faster rate than other professions.

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Medical Administrative Assistant Medical Assistant Certification Continuing Education 52