For the past two days the National Committee on Vital and Health Statistics has been hearing testimony from the industry on what constitutes the “meaningful use” of health IT. Defining the term is no small matter, as it triggers $17 billion in Medicare and Medicaid incentives for the adoption of electronic health record systems. The incentives are part of the American Recovery and Reinvestment Act, or ARRA.

Under the provision, an eligible professional can receive $44,000 in incentives beginning in 2011. After several years, that carrot turns into a stick. In 2015 eligible providers who are not meaningful EHR users will begin receiving reduced reimbursement. Reductions will reach 97 percent of the fee schedule in 2017.

Speaking at Tuesday’s hearings, newly named national coordinator for health IT David Blumenthal noted that defining meaningful use would also affect EHR product certification, funding, and training.

AHIMA offered comments during the hearings, advising that the elements of meaningful use improve the coordination of care, promote health information exchange, and improve the capture and use of data for secondary purposes such as quality and public health reporting. (more…)

The ICD-10-CM/PCS final rule requires a major transition in academic programs as well as in the field. Institutions currently teaching ICD-9-CM in baccalaureate, associate, and certificate programs must transition their curricula to ICD-10-CM/PCS in coordination with the industry’s transition to the new coding systems. Educators will be among the first in the country who need to learn ICD-10-CM/PCS.

The April practice brief “Transitioning to ICD-10-CM/PCS—An Academic Timeline” outlines how and when HIM academic programs should begin integrating ICD-10-CM/PCS education into their curriculum. The article lays out the academic transition into three phases: preparation, hybrid, and full implementation. The countdown to integrating ICD-10-CM/PCS begins on August 1, 2010, when educators should start expanding curriculum content on courses affected by ICD-10-CM/PCS changes. (more…)

There won’t be a delay on the ICD-10 final rules, according to the Centers for Medicare and Medicaid Services. The final rule for implementing ICD-10-CM and ICD-10-PCS will go into effect March 17.

The policies in the final rule are considered to be officially adopted on that date. The regulations for the HIPAA electronic transaction standards—published the same day in a separate rule—will go into effect at the same time. The HIPAA transactions must be updated to accommodate the use of the ICD-10-CM and ICD-10-PCS code sets. 

Before becoming official, the rules had been subject to a regulatory review by the new presidential administration, as well as a 60-day hold for Congressional review required by HIPAA. The final rules were published January 16, 2009.

ICD-10-CM/PCS must be implemented by October 1, 2013; the HIPAA electronic transaction standards must be operational by January 2012 and January 2013.

For more on the preparation for the ICD-10 transition, visit AHIMA’s ICD-10 Web site for analysis, tools, training, education, resources, and information.

AHIMA mailed the first issue of ICD-TEN today, a free e-newsletter on preparing for the transition to ICD-10-CM and ICD-10-PCS. You can subscribe with just an e-mail address.

Each issue contains news, practical coding information, the steps for implementation, educational resources, and more. The newsletter comes out monthly.

AHIMA also offers a wide range of ICD-10 information on its Web site.

AHIMA has posted a 13-page analysis of the final rule on the implementation of ICD-10-CM and ICD-10-PCS. The summary is a good overview of the lengthier final rules published in the Federal Register.

The final rule was published January 16. It designates ICD-10-CM and ICD-10-PCS as medical data code sets under HIPAA, replacing the 30-year-old ICD-9-CM set. There is a single compliance date of October 1, 2013.

In the final rule, the Department of Health and Human Services states that the greater detail and granularity of ICD-10-CM/PCS will enhance the ability to measure quality outcomes and provide more precision for value-based purchased initiatives such as the hospital-acquired condition payment policy. (more…)

The Centers for Medicare and Medicaid Services issued a final rule for implementation of ICD-10-CM and -PCS this morning, with an implementation date of October 1, 2013.

The new code set will replace the 30-year-old ICD-9-CM set. CMS had originally set a 2011 deadline in its notice of proposed rule making last year. The final rule summarizes the varied industry response that proposal received.

A second rule sets implementation dates for HIPAA transaction standards necessary to support ICD-10. Upgrade to the X12 version 5010 standard has a deadline of January 2012. Implementation of NCPDP version D.0 is required in January 2013.

HHS offers a fact sheet summarizing both rules.

(This story was updated 1/16/2009 with links to the published rules.)

Anita Majerowicz, MS, RHIA, is director of clinical coding and reimbursement at AHIMA. She offers this look at the 2009 CPT updates in the upcoming February print issue of the Journal.

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Changes to CPT codes for 2009 include 293 additions, 133 revisions, and 92 deletions. This article highlights some of the more notable changes; a comprehensive list can be found in appendix B of the 2009 CPT code manual. The changes took effect January 1.

E/M Codes

Numerous changes were made to the pediatric E/M codes, including newborn care services, delivery and birthing room attendance and resuscitation services, pediatric critical care patient transport, and inpatient neonatal and pediatric critical care services. Coding professionals should read the extensive revisions to the instructional notes, as many codes were renumbered for 2009.

A new section titled “Newborn Care Services” was added to report the physician services provided to newborns in a variety of settings from birth through the first 28 days of life. These services are reported using codes 99460–99463, replacing deleted codes 99431–99435. They include the maternal and fetal history, newborn history and physical examination, ordering of diagnostic tests and treatments, discussions with the family, and documentation in the patient’s health record.

(more…)

Physicians seeking to transform their primary-care practices are seeing increasing support for the patient-centered medical home model. Growing recognition from payers and new help with the transition are advancing the model as a viable future for primary care.

In December consulting company TransforMED began offering products and services publicly for the first time, following a two-year national demonstration project aimed at showing the healthcare model’s efficiency and benefits to both patients and physicians.

TransforMED, a wholly owned subsidiary of the American Academy of Family Physicians, offers services ranging from practice assessments and consultations on partial implementation to assistance with full medical-home operations. The company’s services are offered in tiers, allowing a practice to transition in incremental steps. (more…)

The clarifications continue over CMS’s approach to signature stamps. This past July CMS issued a clarification that stamps were not permissable on any medical record. Now a new clarification advises that some payers do not accept stamps but the Conditions of Participation do not prohibit them.

In the latest memorandum, dated October 24, CMS writes that the Conditions of Participation:

“do not prohibit the use of rubber stamps in a hospital setting, when properly controlled, for authentication of medical record entries. However, as a point of information for surveyors and providers, we are taking this opportunity to add an information-only statement to the interpretive guidance for §482.24(c)(1) to note that some payers, including Medicare, may not accept such stamps as sufficient documentation to support a claim for payment.”

AHIMA has submitted official comments on the adoption and implementation of the ICD-10-CM and ICD-10-PCS classification systems. In part, AHIMA:

• Recommends that the implementation of the two classifications and the related HIPAA transaction updates should occur over a three-year period, with the date of final compliance no later than October 1, 2012
• Supports a single compliance date across the entire US healthcare industry and recommends that the compliance date, once designated, not be extended, which would cause confusion and add costs (more…)