Welcome to your daily briefing on healthcare developments in Georgia. Today we're covering 5 key stories including updates on georgia healthcare headlines, background & context. Let's dive in.
2 stories
The Georgia Department of Public Health (DPH) is the lead agency in preventing disease, injury and disability; promoting health and well-being; and preparing.
Relevant to healthcare professionals operating in GA.
Data dashboards including Medicaid, State Health Benefit Plan, and Georgia's Healthcare Workforce.
Relevant to healthcare professionals operating in GA.
Reach healthcare professionals
3 stories
Three application defects routinely delay payor enrollment: incomplete work-history explanations for any gap over 30 days, a malpractice carrier-history that does not reconcile with the explanation, and CAQH attestation that has lapsed. Each forces a back-and-forth with the credentialing committee.
A new clinician without active payor enrollment cannot bill for covered services for most plans. Each month of delay is foregone revenue that does not retroactively recover.
The MIPS cost performance category is calculated retrospectively by CMS using attributed Medicare claims; clinicians cannot directly affect what is attributed. The two attribution methods (TPCC and MSPB) capture different beneficiary cohorts. Practices that try to "manage" cost without understanding which patients are attributed to which clinician typically waste effort.
Cost is now 30% of the MIPS final score — the largest single category. Misunderstanding attribution is the leading cause of unfavorable payment adjustments in the next cycle.
A vendor is a business associate if they create, receive, maintain, or transmit PHI on behalf of the covered entity. They are NOT a business associate just because they happen to be in a building with PHI or could conceivably access it. The functional test matters, not the proximity test.
Forcing BAA execution on vendors who do not meet the functional test creates contractual bloat and weakens the negotiating position with vendors who actually do. Failing to execute BAAs with true business associates exposes the covered entity to OCR enforcement.
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