Regulatory and Compliance Issues
Hygeia is committed to full compliance with healthcare regulations and guidelines stipulated by the U.S. government and regulatory agencies. Our policies and procedures adhere to all aspects of the regulations that impact our services and our clients' business operations. Select one of the links below to learn more:
Health Insurance Portability and
Accountability Act (HIPAA) Compliance
U.S. Prompt Payment Regulations
New York State Health Care Reform Act (HCRA)
Provider discount abuse occurs when a Payer intentionally or unintentionally breaches the contracts they pay a PPO to access in order to maximize discounts on medical services. The most common contract breaches include silent PPO use and PPO stacking. Healthcare Providers are becoming increasingly aware and less tolerant of these unauthorized and undisclosed practices.
At Hygeia, we have a long-standing reputation for encouraging Payer-clients to comply with managed care contracts and support efforts to prevent Provider discount abuse. We educate clients about the impact of non-compliance on their access to strong discounts and long-term financial success. Our compliance protocol clearly demonstrates the financial benefits of avoiding silent PPO and PPO stacking arrangements.
For more information about the importance of managed care compliance, please select the link below:
Health Insurance Portability and Accountability Act (HIPAA) Compliance
The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in August 1996 and is designed to improve the effectiveness and efficiency of the U.S. healthcare system and mandates national standards in several areas.
In accordance with the HIPAA, Hygeia contracted with HIPAA consultant, Incepture, to perform an independent analysis of our operations and HIPAA-AS Gap Assessment. We reviewed all applicable business practices, and implemented policies and procedures to ensure full compliance with the standards for privacy of individual health information and electronic data interchange (Title II). In further support of our commitment to compliance, Incepture conducted a HIPAA Privacy and Security Orientation for all Hygeia staff members in Miami, FL and Toronto, Canada.
For additional information about HIPAA, please select the link below:
U.S. Prompt Payment Regulations
In 1982, the U.S. Congress enacted the Prompt Payment Act, which required Federal agencies to pay their bills on a timely basis or risk paying penalty fees if payments are made late. In 2001, over forty states extended Prompt Pay legislation to health care plans, requiring them to pay or deny claims within a state specified time frame.
Typically, 45 days is allotted for payment on claims that require no additional information from the health care provider or from a third party. Electronic claims are normally required to be paid within 15-30 days. Many of these states currently apply penalty fees for late payment, which can range from 10-18 percent annually.
For more information about Prompt Pay legislation, please select the link below:
New York State Health Care Reform Act (HCRA)
On January 1, 1997, New York State implemented its Health Care Reform Act (HCRA), which requires all non-Medicare payers to make surcharge payments on various services offered by Ambulatory Surgical Services, Clinical Laboratories, Comprehensive Clinics and General Hospitals for the subsidization of indigent care and healthcare initiatives. The surcharge level varies by payer class, and is based upon the revenue paid to the hospital on the re-priced claim and not on billed charges.
For more information on the New York State Health Care Reform Act, please contact a Hygeia Payer Marketing representative at partners@hygeia.net.
