SCGhealth Blog

Watch out! Small businesses being targeted by malware, scammers

Monday, July 02, 2018

By Marla Durben Hirsch, contributing writer

It’s hard enough for physicians to operate their practices. But in recent weeks it’s gotten tougher as small businesses are being specifically targeted by criminals. 

There may be malware in your router.

The Federal Bureau of Investigation (FBI) released a warning on May 25 that foreign cyber actors had compromised hundreds of thousands of small office and home routers with malware known as VPNFilter. The malware can render the router inoperable. It can also collect information, exploit devices, cut off internet access and block network traffic.

The warning is related to a Department of Justice (DOJ) investigation of the cyberattacks. The DOJ obtained a court order on May 23 enabling the government to seize a domain that’s part of the malware’s command and control infrastructure. The infection will then be redirected to an FBI-controlled server, which can then capture information about the perpetrators and help identify victim devices. 

The FBI recommends that the routers be rebooted to temporarily disrupt the malware and aid in the potential identification of infected devices. Note that the routers can still be reinfected after the reboot, so the FBI also suggests that router owners consider disabling remote management settings on devices, securing the routers with strong passwords and encryption when enabled, and updating to the latest available versions of router firmware.

Several router manufacturers have issued their own instructions to deal with this malware threat. For instance, Linksys provides a link to its latest firmware update and recommends that passwords be changed periodically. If an owner believes that his/her router has been infected, Linksys also recommends that the owner perform a factory reset of the router. 

FTC: Watch out for scammers

So many small businesses have been taken advantage of by scam artists that the Federal Trade Commission (FTC) launched “Operation Main Street” with the Better Business Bureau and law enforcement on June 18. Operation Main Street will educate small business owners on how to recognize and prevent scams. The guidance lists some of the most common scams, such as:

  • Imposters claiming to be from the government or the utility company
  • Fake invoices
  • Unordered office or other supplies
  • Directory listing and advertising scams
  • Tech support scams
  • Offers to change online reviews
  • Credit card processing scams

The FTC flags the tactics that scammers use, such as using untraceable payment methods like wire transfers; pretending to be someone trustworthy, perhaps from a company you may know; and creating a sense of urgency, so you make a quick decision before checking out the situation.

Some of the protections the FTC recommends small offices take include:

  • Verify invoices
  • Secure files, passwords and financial information
  • Make sure that employees are familiar with the scams
  • Don’t believe caller ID or email/web addresses
  • Have a clear procedure for approving expenditures

The FTC also recommends that businesses report any attempted scams to the government. 


To protect your practice as much as you can, follow the instructions in any relevant warnings. 

And to make sure you’re on top of these warnings, sign up for email alerts from the United States Computer Emergency Readiness Team (US-CERT). 

Know the Signs of Physician Burnout

Wednesday, May 09, 2018

By Audrey Landers

During Mental Health month it’s important to think not only of your patients but also yourself. According to Medscape’s 2018 National Physician Burnout & Depression Report, as many as 42% of physicians feel that they are burned out. So often articles on this subject will focus on how burnout affects patient care and practice revenue, anything but the one person it affects the most: the physician.

No one wants to admit that they are under too much stress, physicians especially are often nervous about seeking help because they are afraid that it may reflect poorly on their ability to provide for patients. Because of this, it’s not uncommon for physician burnout to become worse over time. If ignored, physician burnout can be fatal. In fact, the average physician will lose eight colleagues to suicide during their career.

High occurrences of burnout have been recorded in physicians since the 1800s and it’s pretty clear why: Between the grueling hours and stress filled working environments, many physicians don’t have the opportunity to put their work behind them even for a moment.

What is Physician Burnout?
Physician burnout, sometimes called career fatigue, is exhaustion that is caused by extreme prolonged stress. It can penetrate every part of your life, causing physical, emotional and mental exhaustion. It can cause a physician to become depressed and lose all sense of personal accomplishment as well as make it difficult to focus on work.

Recognizing Burnout
Knowing that you are burnt out and need help is the first step. Take the time this month, and every month, to recognize the signs of burnout:

You feel that you are not as engaged with your peers as you once were.
While not many physicians will admit they aren’t as engaged with patients, in Medscape’s survey 42% of physicians with some form of depression acknowledged that they are less engaged with staff and colleagues. You may miss details of what they say, or respond late. You may also be more irritable around them and get frustrated more easily when they make mistakes. 

You don’t have time for yourself
On average, physicians work nearly 60 hours a week, a number that most Americans would find completely unacceptable in the long-term. Once you factor in things like average daily commute (one hour) average time spend cleaning and cooking each day (two hours) and eight hours for sleep, there’s only about four hours of free time left each day. And four hours might sound great until you get around to dividing them up between interactions with friends and family, obligations like pet care, and incidentals like being stuck on the highway an extra 30 minutes because of an accident a few miles down the road. You might begin to realize that you don’t actually have as much time for yourself as you thought.

You don’t have enough time for your patients
More than 50% of physicians agree that their work is often bogged down with bureaucratic tasks, regulations, and increased computerization of their workplace. These tasks don’t feel important when you have patients you need to see and every paper, every chart, and every button click only gets in the way of you doing your job.

You could describe yourself as depressed
This may seem obvious but that makes it no less true. Whether you feel you could be clinically depressed or only depressed in the colloquial sense, this feeling is a sign of burnout. Especially if you feel the depression is mainly caused by work and would go away if you were to enter another career.

If you feel that these signs describe you, you are not alone. Over half a million physicians in the US alone suffer from some form of burnout.

Screen for Depression During Mental Health Awareness Month

Wednesday, May 02, 2018

By Audrey Landers

Depression is an often misunderstood and underestimated mental illness. Many consider it to be a simple sadness that can be powered through, but that could not be further from the truth. Sadness is a normal human emotion, and one that can often help to make a person stronger by learning to deal with it. It is caused by difficult, upsetting and hurtful events. With sadness, there is a resolution to work towards or a lesson to learn that can help one overcome it. Depression is another beast entirely. Depression is not triggered by any particular event and causes those who suffer from it to feel worthless, hopeless, and unmotivated in every situation. Depression can change a person’s personality, make them have thoughts of death or suicide and make them lose interest in things they once loved. Unlike sadness, depression is long-lasting, with symptoms lasting more than two weeks and occurring chronically.

It is estimated that more than 300 million people worldwide suffer from depression, with approximately 16 million American adults having suffered at least one depressive episode in the last year. 

Screen for Depression and Report MIPS Measures
Throughout the year you can do your part to bring awareness to depression by screening for it, which coincidentally will allow you to report the Merit-based Incentive Payment System (MIPS) Measure 134: Preventive Care and Screenings: Screening for Depression and Follow-up Plan. The measure should be reported at least once for each patient age 12 and older seen during the performance period. If the screening is positive, there must be a documented follow-up.

The accepted exceptions for this measure are patient refusal, an urgent situation, and decreased functional capacity seen in the patient.

Quality Data Code  Performance  Service Provided 
 G8431  Performance Met

Screening for depression is documented as positive
a follow-up plan is documented

 G8510  Performance Met
Screening for depression is documented as negative

 G8433  Denominator Exception

Screening for depression not completed
reason documented

 G8432  Performance Not Met
Depression screening not documented

 G8511  Performance Not Met

Screening for depression is documented as positive
no reason documented

In addition to this MIPS measure, SCG Health has also licensed the Qualified Clinical Data Registery (QCDR) Measure MSSIC1: Pre-Surgical Screening for Depression. This measure, created by the Michigan Spine Surgery Improvement Collaborative, is similar to MIPS 134 but is only performed before a surgical procedure.

May is National Mental Health Awareness Month. Mental Health America first started the awareness campaign in 1948, this year the theme is Fitness #4Mind4Body. MHA hopes this theme will help bring awareness to the connection between mental health and fitness. The organization will be distributing information on topics like nutrition, exercise and sleep throughout the month to encourage people across the country to do what they can to better both their physical and mental health.

Balancing Environmentalism and Hygiene in Your Bathroom.

Monday, April 30, 2018

By Audrey Landers

Sometimes, keeping clean is dirty business. Walk into just about any public bathroom and you’re likely to find at least one industrial sized trash bin filled with hundreds of paper towels. Maybe there will also be a few ancient air-dryers ineffectively blowing lukewarm air. After you wash your hands you’ll try the air-dryer (it’s more hygienic, right?) but you’ll probably just end up grabbing three or four too-thin paper towels anyway, as one study found that air-dryers are woefully slow and inefficient at getting rid of excess water. There’s more than one problem with this picture.

Image from

Let’s tackle the myth that air-dryers are the more hygienic option first. Recently, a study published in the Journal of Applied and Environmental Microbiology found that air-dryers actually spread bacteria. “Well sure,” you might think, “not everyone is as diligent at washing as I am.” But I’m afraid that’s wrong too. Air-dryers don’t only spread the bacteria left on your hands after washing, they also spread all the other nasty bacteria in the bathroom. This is not the first study to suggest this. In 2015 a similar study was performed by a team of microbiologists from the University of Westminster and they found that air-dryers can blow bacteria up to three feet off the ground.

The University of Westminster study concluded that paper towels were the most hygienic way to dry your hands, though they aren’t as environmentally conscious. If you’re looking to keep your office green, then air-dryers are still the way to go. But let’s be honest here, if you’re already willing to ignore how unhygienic an air-dryer is, you may as well throw caution to the wind and wipe your hands on your pants rather than waste electricity. You can be a bit more environmentally conscious by using recycled paper towels, the production of which uses 31% less energy than the production of virgin paper towels. With recycled paper towels however, you could be sacrificing hygiene. Research has suggested that bacteria can thrive in recycled paper towels because of the starches that are used as binding.

If, like SCG Health, you work in a small office with few visitors or if you have a staff-only restroom, there is another option that may work for you. Using non-disposable hand towels is a way to keep your hand-drying hygienic and green. We keep a basket of small hand towels that are used once. At the end of the day we collect the basket of used towels and wash them. The cloth towels dry your hand quickly and effectively and allow SCG Health to cut down on unnecessary paper waste. It is important to have multiple towels, because having only one towel that is used over and over throughout the day can allow bacteria to collect

Which option is right for you?

Unfortunately, you’ll have to answer that for yourself. However, I can give you a few suggestions:

  • For small offices: reusable cloth towels are effective, clean, and can add a little bit of luxury to your office.

  • For large offices: opt for paper towels, you might feel bad about the waste, but don’t worry. It only takes about two weeks for a paper towel to decompose.

  • In emergencies: if you have absolutely no other options, then fine, dry your hands on your pants. Just don’t try to shake hands with me after.

CMS about to crack down on billing for drug tests

Monday, April 23, 2018

By Marla Durben Hirsch, contributing writer

If you bill for specimen validity testing done in conjunction with drug testing, heads up: the Centers for Medicare & Medicaid (CMS) has taken the rather unusual step of issuing a “reminder” on how to do so correctly. 

Specimen validity testing is used to analyze urine specimens and determine whether they’ve been adulterated or tampered with. 

In a new Special Edition MLN Matters article, issued on March 29, 2018, CMS reiterates Medicare’s policies regarding correct coding and instructions for billing specimen validity testing when done as part of drug testing. 

The article, SE18001, first lays down the groundwork: Services that Medicare pays for must be reasonable and necessary, and clinical lab services must be ordered and used by the physician who is treating the patient or by a qualified ancillary practitioner. Current coding for testing for “drugs of abuse” relies on (1) screening (known as presumptive testing, CPT codes 80305- 80307) and (2) quantitative or “definitive” testing that identifies the specific drug and quantity of it in the patient (HCPCS codes G0480-G0483). Only one code from each code range may be reported per date of service. 

There’s also a definitive drug testing code, G0659, that was created to recognize labs that are performing a less sophisticated version of these tests. The work performed in this test approximates the work performed in CPT code 80307. 

Importantly, “providers performing validity testing on urine specimens utilized for drug testing shall not separately bill the validity testing.” 

The agency stresses that this is not a policy change, but serves as a reminder of Medicare requirements. CMS implores providers to “please make sure your billing staffs are aware of these instructions.”

Topic a New Sore Spot for CMS

SE18001 itself doesn’t state why it issued this particular reminder, but a quick look at the references at the end of the article reveals what’s going on. The Department of Health and Human Services’ Office of Inspector General (OIG) recently reported that CMS had improperly paid 4,480 labs and physician offices a whopping $66.3 million for these tests from 2014 to part of 2016. 

Even after CMS updated its automated system edits to identify and prevent these improper payments in 2016, OIG still identified $1.8 million in improper payments from April 1 through December 31 of that year. 

OIG also found that at this rate, CMS would lose $12.1 million due to such improper payments over a five-year period. Ouch. 

What physicians can expect 

While the OIG has had lab testing (and lab/physician deals) in its cross hairs for years, this is yet another lab testing issue that will now come under increased scrutiny. 

And while this reminder about urine testing may be spurred by the OIG report, it’s also likely due in part to the fact that more physicians are conducting or ordering these tests in light of the current focus on opioid addiction and substance abuse disorders. This also puts more pressure on CMS to pay for them correctly. 

If you have billed for these tests in the past, expect your Medicare Administrative Contractor to take another look at those claims. The OIG specifically recommended that CMS instruct the Medicare contractors to recover the improper payments. You may want to conduct a self audit and double check that you complied with these billing rules. 

And if you currently bill for these tests, make sure that you’re doing so correctly. CMS will be taking a closer look at them. And the fact that CMS just issued a “reminder” indicates that CMS expects everyone to know the drill. 

Seven Days of Previews: THESOURCEAWARDS

Friday, April 20, 2018

By Audrey Landers

“What are the best practices for a provider website?”

This question was asked by a member of a healthplan way back in 2013. At the time there weren’t any answers. We took that as a sign and created THESOURCEAWARDS, an awards program with the mission of finding the best practices of informing, engaging and educating clinicians, practices, and facilities.

Basically, we hope we can turn this program into the Oscars of the health information industry. Just without the lavish ceremony and designer ballgowns…we are trying bend the cost curve.

THESOURCEAWARDS are coming back for 2018 and we can’t wait to find out who will earn awards. We’ve brought back categories like best provider portal, best educational program, best written communication and best mobile app. Stay tuned to voice your opinion!

Seven Days of Previews: Office Personalities!

Thursday, April 19, 2018

By Audrey Landers

Every office is full of characters, from the organizers and the worry warts to the pranksters and the collectors. Back in 2015 we began a project to categorize these characters, and for SCG Health’s seventh birthday we wanted to give you a special sneak peak of who’s to come:

We will be picking things back up with Credentialing Craig.

Craig is a laid back guy who knows credentialing is all about one thing: documentation! Keeping copies of every email and notes on every phone call helps Craig stay ahead when credentialing physicians.

Each character’s page will be complete with links to references, resources and just about anything else that they (and you) might find helpful. Be sure to keep an eye out for Craig’s official release, as well as his coworkers.

Alcohol Awareness and Screening with MIPS Measure 431

Wednesday, April 18, 2018

By Audrey Landers

According to the Centers for Disease Control and Prevention (CDC) one in 10 deaths among adults is related to excessive drinking. With April being Alcohol Awareness Month, this is the perfect time to pay special attention to the Merit-Based Incentive Payment System (MIPS) Measure 431- Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

While unhealthy alcohol use can have long-term risks such as certain cancers, the short-term risks are far more pressing. It’s common knowledge that drinking impairs your judgement, reaction time and motor skills and can lead to injuries, accidents and violence even in those who do not drink regularly. These issues are only made worse in an alcoholic who will experience the effects of alcohol far more often than the average person, and may be less likely to notice them.

MIPS Measure 431
On average, those who die alcohol-related deaths have their lifespan shortened by 30 years, and by screening for alcohol abuse you may be able to help keep some patients from losing such a large portion of their lives.

MIPS Measure 431 is defined as the percentage of adult patients who were screened for unhealthy alcohol use using a systematic method at least once within a two-year period and received counseling if identified as an unhealthy alcohol user.

The counseling for those who are identified as unhealthy alcohol users can be short, with the minimum requirement being a 5-15 minute conversation including topics like how to identify high-risk situations for drinking, proper coping mechanisms, and strategies for reducing alcohol consumption. 

You will be required to score at least 97.08% in order to get 9 points when reporting this measure for 2018.

Performance  Service Provided 
 G9621  Performance Met
Patient identified as an unhealthy alcohol user when screened for
unhealthy alcohol use using a systematic screening method
received brief counseling

 G9622  Performance Met
Patient not identified as an unhealthy alcohol user when screened for
unhealthy alcohol use using a systematic screening method

 G9623  Exception

Documentation of medical reason(s) for not screening
for unhealthy alcohol use

 G9624  Performance Not Met

Patient not screened for unhealthy alcohol screening using a systematic screening method 
patient did not receive brief counseling, reason not given

This year the National Council on Alcoholism and Drug Dependence (NCADD), the organization who created Alcohol Awareness Month, has chosen the theme “Changing Attitudes: It’s Not a Rite of Passage.” The intention is to start a conversation about how teenagers and young adults are first introduced to alcohol, and challenge the flippant attitudes surrounding it.

Tax Day means BIRTHDAY to SCG

Wednesday, April 18, 2018

Photo credit: Storyblocks

Seven years ago I left UnitedHealthcare. Honestly, its hard for me to believe it was that long ago as my roast, hosted by my former colleagues, is still fresh in my mind. I believe I will always be remembered for my addiction to Snickers and Dr. Pepper. My pallete hasn't changed, but my waist line has. Now I'm onto diet drinks and protein bars. Ahh the joys of being 40!

Read the full blog on LinkedIn.

Meet the Measure: Assessment of Patients for Obstructive Sleep Apnea

Monday, April 16, 2018

By Audrey Landers

Last week we gave you a sneak peek at the six measures SCG Health has created for the 2018 MIPS reporting year, but that’s not all we have to offer. We’ve also licensed 21 measures from 7 other Qualified Clinical Data Registries (QCDR), including AQI51-Assessment of Patients for Obstructive Sleep Apnea.

An estimated 22 million American adults have sleep apnea. Those with obstructive sleep apnea (OSA) have an especially high risk.OSA is the most common form of sleep apnea, and occurs when throat muscles relax. OSA is characterized by blocked airways and can cause those who suffer from it to snore loudly or even stop breathing during sleep, forcing them awake in order to reopen the airway. Overweight or obese patients are more likely to suffer from sleep apnea, though it can also be caused by old age. In addition, Men are twice as likely as women to developed sleep apnea.

Sleep apnea doesn’t only affect patients when they are asleep. Those who suffer from OSA often suffer from fatigue during the day due to constantly being woken up by lack breathing during the night. Other complications can include high blood pressure, heart problems and type two diabetes. Sleep apnea can also put strain on a patient’s relationship, as the loud snoring can disturb the sleep of their partner.

In addition to these problems, OSA can also cause serious issues for patients who receive anesthesia. Patients with OSA are naturally at risk for airway obstruction, and likely to be more sensitive than the average patient to the effects of anesthesia. In addition, patients with OSA may have more difficulty regaining consciousness after being sedated. Screening for OSA allows the surgical team to be aware of any extra risks and can allow you to create a more personalized care plan for your patients.

AQI51-Assessment of Patients for Obstructive Sleep Apnea is a QCDR measure owned by the Anesthesia Quality Institute. This measure is defined as the percentage of patients, aged 18 and older, who underwent an elective procedure under anesthesia who were screened preoperatively for Obstructive Sleep Apnea (OSA) using a standardized tool prior to the procedure. You must report this measure any time a patient undergoes an elective procedure under anesthesia during the reporting period.

Unlike many of the other measures we’ve covered in the SCG Health blog, the numerator options for this measure are very strait forward. Either you performed the screening or you didn’t.

Performance   Service Provided
 10A20  Performance Met

Patient was screened preoperatively for Obstructive
Sleep Apnea (OSA) using a standardized tool prior to
the procedure.

 10A21  Performance Not Met  

 Patient was NOT screened preoperatively for
Obstructive Sleep Apnea (OSA) using a
standardized tool prior to the procedure

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