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House Returns with Genetic Nondiscrimination on the Horizon
The House of Representatives returned from spring break the week of 4/16 with HR 493, the Genetic Information Nondiscrimination Act (GINA), which is almost ready for floor consideration. The House Education and Labor Committee, the House Ways and Means Committee, and the House Energy and Commerce Committee all passed GINA with ease. It is now up to the House Rules Committee to iron out the minor differences in each bill passed by the three committees. Once this is complete, the bill will proceed to the House floor. For additional information on GINA, visit AHIMA’s Advocacy Assistant.
National Provider Identifier Update
The national provider Identifier (NPI) implementation date is scheduled for May 23. If you are a healthcare provider who bills for services, and if you bill Medicare for services, you need an NPI. Getting an NPI is free and easy. Once you obtain your NPI, it is estimated that it will take 120 days to do the remaining work to use it. Physicians and providers should be applying for their new NPI number, which will replace any identification number currently being used. Once the NPI is obtained, it can be used for billing testing prior to the implementation date and will be required for use on all claims submitted after that date. For information on the NPI, visit the Centers for Medicare and Medicaid Services Web site by clicking here. Physicians can apply for their new NPI online, thus speeding up the approval process. At this time, CMS estimates only 60 percent of physicians and providers have obtained their NPI.
Are You Ready for the Revised CMS-1500 Claim Form?
The deadline for submitting claims using the new CMS-1500 (08/05) claim form is April 2. This new claim form will replace the outdated form (12/90). The new claim form has been revised to create spaces for the new national provider identifier (NPI) number as well as other minor changes. All health plans, clearinghouses, and other support vendors should be ready to accept claims on the revised form by that date. For physicians, the first step is to obtain a new NPI number and then test the new claims form with the NPI. Click here for the change log. The instructions for the revised form can be found here.
House Passes Health IT Bill Calling for ICD-10 by 2010
On July 27, the US House of Representatives passed the Better Health Information System Act (HR 4157) by a vote of 270-148. With much help from AHIMA’s membership, policy makers ensured that section II of this legislation called for the implementation and use of ICD-10 by October 1, 2010. It also established an expedited procedure for updating standards that enable electronic exchange of health information. Now that separate health IT bills have passed the House and Senate, a conference committee between representatives of each body is required to iron out the differences in the legislation. The Senate bill (S. 1418) did not contain legislative language concerning ICD-10. In the coming weeks we will be informing you of the members of the conference committee and what actions will need to be taken to help retain the ICD-10 provisions in the conference committee’s compromise legislation. AHIMA supports the passage of HR 4157. To read more, click here.
Inclusive Membership Vote Postponed
The House of Delegates voted to postpone the vote on the Inclusive Membership Bylaws amendment. Rather than the vote taking place in June, it will now take place during the House of Delegates meeting October 8 in Denver, CO.
This Bylaws amendment proposed by the Board of Directors calls for a more inclusive AHIMA Active membership category to strengthen our ability to meet current work force demands and to influence the industry to change from HIM to e-HIM®. The new Active membership category would be amended to “Individuals interested in the AHIMA purpose and willing to abide by the Code of Ethics.” The Associate membership category would be combined with the Active category. The proposal comes from discussions at the 2005 and 2006 Team Talks and House of Delegates issue forums.
Members are discussing this proposed bylaws amendment in the AHIMA Community of Practice (CoP), State Leaders and House of Delegates CoP, and many geographic and practice CoPs. You can participate in the discussions and find documents explaining the proposal posted in the Resources section of the State Leaders and HOD CoP as well as in the April issue of AHIMA Advantage. To participate, click here and select the Communities of Practice logo. Enter your AHIMA ID number and password. Please note that your password may be your last name if you have not changed it or joined AHIMA online.
AHIMA and AMIA Announce Support for New Work Force Bill
Last week AHIMA and the American Medical Informatics Association (AMIA) announced their support of legislation designed to ensure a work force capable of innovating, implementing, and using health communications and information technology. The legislation proposed by Congressman David Wu (D-OR) would authorize the National Science Foundation to award grants to higher education institutions to develop and offer educational and training programs for healthcare workers and professionals in applied health and medical informatics. According to AHIMA CEO Linda Kloss, MA, RHIA, "without a plan to train healthcare workers at all levels of healthcare delivery, the goal of an improved, interconnected healthcare system may never be met."
In 2005, AHIMA and AMIA hosted a summit to develop strategies to address work force challenges related to electronic health records and a national health information infrastructure. For a copy of the AHIMA/AMIA summit report, "Building the Work Force for Health Information Transformation," click here.
CMS Publishes FY 2007 IP-PPS, Extensive Discussion on DRGs
The Centers for Medicare & Medicaid Services has finally published its proposed Medicare inpatient prospective payment system (IP-PPS) for fiscal year (FY) 2007 (71FR23996). The 476-page proposed rule includes a number of reimbursement changes for hospital that have not been on the IP-PPS system. The rule also discusses proposals to refine the diagnosis related group system to “better recognize severity of illness among patients” and other changes over the next two years. The proposed rule can be found in the April 25 Federal Register by clicking here.
CMS Publishes Final COP Rule for OASIS
The Centers for Medicare and Medicaid Services (CMS) has published a final rule making revisions to the Conditions of Participation (COP) for home health agencies with regard to reporting outcome assessment information set (OASIS) data (70FR76199). The final rule is based on responses received to a January 1999 interim final rule that added the OASIS process as a requirement for home health agencies. The process was legislated in 1997 as part of the Balanced Budget Act and serves as the basis for the Home Health Prospective Payment System. In 2003 the Medicare Prescription Drug, Improvement, and Modernization Act provided for additional changes to be made to the requirements. This final rule covers these changes, including the timing and lock process associated with OASIS reporting. The changes are effective June 21, 2006. The final rule can be found in the December 23 Federal Register by clicking here.
Senate Passes Health IT Legislation
In the rush before the Thanksgiving recess, the U.S. Senate passed S. 1418, the “Wired for Health Care Quality Act,” by unanimous consent. S. 1418 is the first health information technology legislation to be passed by either body of Congress. Supported by AHIMA, if enacted, S. 1418 would statutorily establish the Office of the National Coordinator of Health Information Technology and the American Health Information Collaborative. In addition, the legislation would create requirements for federal purchasing of health IT, require the secretary to develop criteria for standards implementation and certification, permit the secretary to award grants for health IT initiatives, and require the secretary to study the impact of state law variations relating to licensure, registration, and certification of medical professionals and the impact on electronic health information exchange. Finally, the bill would require relevant federal agencies to develop a healthcare quality measurement system and for the secretary to develop a health information technology resource center through the Agency for Healthcare Research and Quality. For additional details on this legislation, visit the Advocacy Assistant.
Physician Assistants Bill Passes Ohio Senate
S.B.. 154, Physician Assistants, as passed by the Ohio Senate, would increase the authority of physician assistants and gives those professionals the ability to write prescriptions for certain medications if they are working under the supervision of a physician. Other provisions in the bill would eliminate the requirement that a supervising physician be on the premises and personally evaluate a new patient or an established patient with a new condition before a physician assistant’s treatment plan can be initiated; eliminates the requirement for a supervising physician’s countersignature on a physician assistant’s medical order before
the order can be executed; permits supervising physicians to grant “physician-delegated prescriptive authority” to physician assistants; permits a physician assistant to prescribe any drug or therapeutic device listed on a formulary; expands the types of drugs and therapeutic devices an advanced practice nurse may furnish to patients; establishes a master’s degree requirement as a condition of eligibility to receive a
certificate to practice as a physician assistant. The bill now goes to the Ohio House for deliberations. To access a copy of S.B. 154 please click here.
Integrated Perinatal Health Information System
The Ohio Department of Health and the Office of Vital Statistics are sponsoring an Integrated Perinatal Health Information System (IPHIS) that will capture and share information related to Ohio births via a centralized database.
An exact implementation date is not yet known, but it is speculated that plans are to have new software and changes to the data collected on mother and facility worksheets implemented by the end of the year.
 View details about this new system.
Contact the Ohio Department of Health for more information.
Telephone: (614) 995-7466
E-mail: community@odh.ohio.gov
CMS To Stop Processing Non-HIPAA-Compliant Medicare Claims
CMS Administrator Mark McClellan on Thursday announced that beginning Oct. 1, CMS will stop processing electronic Medicare payment claims that are not HIPAA compliant, AHA News reports.
A contingency plan in effect since Oct. 16, 2003, had allowed Medicare to continue accepting noncompliant electronic claims after deadline. Noncompliant claims now will be returned to the provider to be resubmitted as compliant claims, AHA News reports.
According to CMS, 1.45% of claims submitted by hospitals as of June were noncompliant, AHA News reports. "We'll be working with the noncompliant providers between now and Oct. 1 with the goal of getting as close to 100% as possible before then," McClellan said.
CMS said it expects to end the contingency for other electronic health care transactions in the future (AHA News, 8/4).
HHS Secretary Unveils National Collaboration for HIT
On June 6, HHS Secretary Mike Leavitt announced the formation of a national collaboration that will advance the national plan for most Americans to have electronic health records within 10 years. The cornerstone of this effort, a public/private collaboration called the American Health Information Community (AHIC), will help nationwide transition to electronic health records—including common standards and interoperability. The AHIC will provide input and recommendations to HHS on how to make health records digital and interoperable and ensure that the privacy and security of those records are protected. Leavitt will appoint up to 17 commission members.
Leavitt said the AHIC will make recommendations on how to protect privacy and security; identify and make recommendations for prioritizing health information technology achievements that will provide immediate benefits to consumers; make recommendations regarding the creation of a private-sector, consensus-based, standard-setting harmonization process and a separate product certification process; make recommendations for a nationwide architecture that uses the Internet to share health information in a secure and timely manner; and make recommendations on how the Community can be succeeded by a private-sector health information initiative within five years. To learn more, click here.
HIPAA Security Rule Takes Effect
As of 4/21/05, physicians, hospitals, insurance companies and other health professionals are now required to be in compliance with the HIPAA security rule. The new rule applies to the electronic, administrative and physical security of health information and establishes 13 standards with which health care providers must comply.
The security rule requires health groups to have on staff a chief information security officer, perform an analysis of security risks, take safeguards to address security vulnerabilities and train employees on compliance. Violators of the rule are subject to a $250,000 penalty and 10 years in prison.
The rule is the third installment in a series of HIPAA rules; previous rules have aimed to standardize the format for submitting and processing medical claims and limit who may have access to an individual's medical records. The HIPAA rules also have made it easier for patients to obtain their own records and request changes if they perceive an error.
According to the Journal, the cost of complying with the regulations is "substantial." The American Hospital Association estimates that hospitals will spend $22 billion over five years to comply with the second HIPAA regulation. Surveys have indicated that many providers are not in compliance with HIPAA standards (Conkey, Wall Street Journal, 4/21).
Sub. HB 331 Changes Copy Cost Rates for Medical Records
The 125th General Assembly in Ohio enacted Substitute House Bill 331 to amend House Bill 508 enacted in March 2001. Effective immediately, Sub. HB 331 extends the law governing fees for copies of medical records, changes the fees that that healthcare providers and medical records companies may charge for copies of medical records, and changes who may receive one free copy of the medical record.
View the section of Sub. HB 331 pertaining to copy costs.
Below are highlights of the changes to HB 508:
The fee schedule for patients and their representatives cannot be charged a search (or copy labor) fee anymore, however the per page fee is:
 For data recorded on paper: $2.50 per page for the first ten pages; $0.51 per page for pages 11 through 50, and $0.20 per page for pages 51 and higher. Plus the actual cost of postage if mailed.
For data recorded other than on paper: $1.70 per page.
The fee schedule for all other requesters is as follows:
$15.35 records search fee
Plus per page fee of: $1.02 per page for the first 10 pages; $0.51 per page for pages 11 through 50, and $0.20 per page for pages 51 and higher. Plus actual postage costs if mailed.
For data recorded other than on paper: $1.70 per page.
One free copy of the medical record upon request to: The Ohio Bureau of Workers’ Compensation; The Ohio Industrial Commission; The Ohio Department of Job and Family Services; The Ohio Attorney General; A patient or their rep for Social Security Disability Claims in accordance with ORC 3701.741(C).
To view Sub. HB 331 in it's entirety, go to the website of the 125th Ohio General Assembly and enter Bill number 331.
Click Here to view a summary of HB 508 to understand the history of copy cost fee legislation.
ODH Updates Hospital Charges for Copying Medical Records
February 26, 2007 - The Ohio Department of Health (ODH) this week released the updated amounts hospitals can charge for copying medical records. Ohio Revised Code 3701-742 requires that ODH increase the amounts using the Consumer Price Index—a 3.2 percent increase for 2007. For requests made by patients or their representatives, hospitals may now charge $2.67 per page for the first 10 pages, 55 cents per page for pages 11-50, and 22 cents per page for pages numbering more than 50. With respect to data recorded on something other than paper (e.g. X-rays, CDs), the new maximum charge is $1.82.
View details of the 2007 increase.
Find the controlling statutes—RC 3701.741 and 3701.742—by searching for those sections by clicking here.
HL7 Announces Industry’s First EHR-S Functional Requirements Standard
On February 21, 2007, international healthcare IT standards development organization Health Level Seven (HL7) announced the passage of the healthcare industry’s first American National Standards Institute-accredited standard which specifies the functional requirements for an electronic health record system (EHR-S). The standard outlines important features and functions that should be contained in an EHR system. The standard’s functional model contains approximately 1,000 conformance criteria across 130 functions, including medication history, problem lists, orders, clinical decision support, and those supporting privacy and security. To view the complete press release, click here.
Bush Signs into Law Patient Data Breach Security Measures
On December 22, 2006, President Bush signed the Veterans Benefits, Health Care, and Information Technology Act of 2006 in an effort to stop the increasing number of security breaches at the Department of Veterans’ Affairs, Government Computer News reports. The law aims to establish procedures and regulations that govern medical record data mining, notification of persons potentially affected by a data breach, fraud alerts, credit monitoring, identity theft insurance, and credit protection services. It also requires the way in which contracts are written with regard to use of patient data and data breaches. Those vendors under contract during the security breach will be held liable for the damages. For more information, click here.
CMS Medicare Program Posts Correction of Notice on Changes to the Hospital IPPS and Fiscal Year 2007
A notice in the January 5 Federal Register details corrections to the wage index and technical errors that appeared in the October 11, 2006, Federal Register (71FR59886) titled “Medicare Program: Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates” (72FR569). For detailed information on the corrections, click here.
Analysis of 2007 OPPS Final Rule Available
AHIMA has prepared an analysis of the highlights of the revisions to the Hospital Outpatient Prospective Payment System that are considered to be of particular interest to HIM professionals. The analysis is available by clicking here.
AHRQ Releases 2006 National Healthcare Quality Report
The Agency for Healthcare Research and Quality has released the fourth annual National Healthcare Quality Report (NHQR) in collaboration with an HHS-wide interagency work group. The NHQR demonstrates that while most measures of quality are improving, the pace of the change is modest. Quality improvement varies by setting and phase of care. Overall, the NHQR finds that variation in healthcare quality remains high. The report examines and tracks the quality of healthcare in the US using the most scientifically credible measures and data sources available. Measures of healthcare quality address the extent to which providers and hospitals deliver evidence-based care for specific services as well as the outcomes of the care provided. To read highlights from the report, click here.
New Medicare COPs Effective in January
New Conditions of Participation (COPs) for hospitals covered under the Medicare and Medicaid programs go into effect this week and on January 26, 2007, according to separate Federal Register notices made on November 27 and December 8, 2006. On Monday, COPs related to patient rights and specifically to the use of restraints and seclusion went into effect. On Friday, January 26, COPs related to history and physical examinations for admissions and surgery, verbal orders, postanesthesia evaluation, and securing medications will go into effect.
AHIMA has prepared a review and analysis of the two COP notices, which can be found at http://www.ahima.org/dc/index.asp. The Federal Register notices can be found at http://www.access.gpo.gov/su_docs/fedreg/a061127c.html and for the H&P/verbal orders notice and http://www.access.gpo.gov/su_docs/fedreg/a061208c.html for the patient rights notice. Both notices are posted under the Centers for Medicare and Medicaid Services heading.
CMS Issues Further Updates to Medicare Conditions of Participation
The Centers for Medicare & Medicaid Services have issued additional updates (71FR71378) to the Medicare and Medicaid Programs Hospital Conditions of Participation (COP). The newest set of updates addresses patients’ rights and the exercise of rights, privacy and safety, and confidentiality of patient records. The bulk of these regulations (and the comments published) address the standards for restraint and seclusion of patients (including documentation). The standard for confidentiality of patient records essentially follows the HIPAA requirements. These standards are effective on January 8, 2007, and the standards and requirements can be found in the December 8 Federal Register by clicking here. The previous COP update on verbal orders was printed in the November 27 Federal Register and can be viewed by clicking here. AHIMA is currently developing an analysis on these regulations that will be published in the next few weeks.
CMS Issues New Hospital COP Rules
After many years, the Centers for Medicare & Medicaid Services (CMS) have issued (71FR68672) a revision to the Hospital Conditions of Participation (COP). The new regulations are effective on January 26, 2007. Affected by the change are medical staff, nursing services, pharmaceutical services, anesthesia services, and medical record services.
The COP changes for medical staff allow a medical history and physical and examination (H&P) to be completed not more than 30 days before or 24 hours after admission for each patient. Qualifications for who can perform an H&P are also addressed. Nursing services rules are modified to cover who can receive and authorize verbal orders as well as orders and signatures for drugs and biologicals. Pharmacy changes relate to the security of drugs and biologicals, while anesthesia changes relate to the services provided to the patient.
The medical record changes address the content of the record, the record’s integrity and completeness, and the timing related to inclusion of the H&P and updates. Verbal orders are addressed as follows: all orders, including verbal orders must be dated, timed, and authenticated promptly by the ordering practitioner with some exceptions. For the five-year period following January 26, 2007, all orders (including verbal orders) must be dated, timed, and authenticated by the ordering practitioner or another practitioner responsible for the care of the patient. All verbal orders must be authenticated based on federal and state law. If there is no state law that designates a specific timeframe for the authentication of verbal orders, verbal orders must be authenticated within 48 hours.
AHIMA is developing a detailed analysis of these new COP rules which will be available soon. The final rule (including a review of comments and the rational used by CMS) is available in the November 27 Federal Register by clicking here and looking under CMS.
Federal Register Publishes OPPS Rule
The November 24 Federal Register featured the hospital outpatient prospective payment system (OPPS) and 2007 CY payment rates. Visit the website to view the new rule. A summary of the OPPS final rule will be posted on the AHIMA Web site later this month. (Please note that this is a large file and may take a few moments to open.)
CMS Posts Final Rule for HHA PPS
The Centers for Medicare and Medicaid Services (CMS) published its final rule updating the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system (PPS) for home health agency (HHA) services (71FR65884). The final rule also sets forth policy changes related to Medicare payment for oxygen, oxygen equipment, and certain durable medical equipment. It also responds to public comments on a requirement that HHA payments be based on the reporting of specific quality days by HHAs. The rule becomes effective on January 1, 2007, and can be found in the November 9 Federal Register by clicking here.
CMS Risk-adjusted, 30-day Mortality Measures
The Centers for Medicare and Medicaid Services (CMS), in partnership with the Hospital Quality Alliance, will begin publicly reporting risk-adjusted, 30-day mortality measures in June 2007 on the Hospital Compare Web site. The rates will include data for all Medicare patients with principal hospital discharge diagnosis of acute myocardial infarction or heart failure, from all acute care and critical access hospitals in the nation. A 30-day mortality measure for pneumonia will be added to the public reporting process pending National Quality Forum endorsement.
Prior to the national implementation of mortality measures reporting in June 2007, CMS will conduct a dry run of the process to familiarize hospitals with the background of the measures and their facility's mortality rates. In December 2006, each hospital will receive a hospital-specific report describing its mortality rates, based on 2003 Medicare claims. The rates contained in these initial reports will not be posted publicly on the Hospital Compare Web site.
The American Hospital Association (AHA) plans to organize conference calls with the CMS team assembling the data so that hospitals can ask questions directly. AHA will send additional information about these calls to hospitals in the near future. For additional information regarding CMS’s public reporting of mortality measures, click here.
Congress Adjourns with No HIT Agreement
On 9/30/06, the House and Senate adjourned without completing action on health information technology legislation—reconciling HR 4157, the “Health Information Technology Promotion Act,” and S. 1418, the “Wired for Healthcare Quality Act.” This legislation is likely to be finalized by Congress when they return for their lame duck session on November 9 following the elections. Discussions with Congressional staff as to why this bill did not get completed indicated that the legislative language amending the Stark anti-kickback act to allow hospitals to provide physicians with health information technology was problematic for Senate negotiators because it did not require the technology to be interoperable. In addition, the $650 million in grant authority provided for in S. 1418 was problematic for House negotiators as HR 4157 only provided for $40 million.
Negotiations will continue over the next month with the intention of developing a final version of health information technology legislation. For more information on this legislation, you can visit the Action Center in the AHIMA Advocacy Assistant by clicking here.
Final IPPS Rule Released
The Center for Medicare & Medicaid Services (CMS) is reforming the existing reimbursement system for hospital inpatients. Selected changes are effective October 1, while others will be phased in over a three-year period for hospital acute care inpatient prospective payment. CMS has engaged a contractor to assist with completing an evaluation of alternative DRG systems that may better recognize severity than the current CMS DRGs and meet other criteria that would make them suitable to adopt for purposes of payment under the inpatient PPS. CMS expects to complete this evaluation this fall as part of moving forward on adopting a revised DRG system that better recognizes severity in the inpatient PPS rulemaking for FY 2008. However, in an effort to improve the CMS DRG system’s recognition of severity of illness for FY 2007, 20 new DRGs have been created and 32 others have been modified.
CMS will begin to use estimated hospital costs instead of charges as a basis for payment, with full implementation in FY 2009. CMS will also begin to use severity of patients’ illnesses to calculate DRG payments, with full implementation planned for FY 2008. Details are available by clicking here and will be published in the August 18 Federal Register. The July/August 2006 issue of the Journal of AHIMA provides additional insight into the new DRG system for IPPS in the "Word from Washington" column and a practice brief "The Evolution of DRGs." To view articles in the FORE Library: HIM Body of Knowledge click here.
CMS and OIG Publish Final Regulations to Facilitate HIT Adoption
The Centers for Medicare & Medicaid Service (CMS) and the HHS Office of the Inspector General (OIG) have issued final regulations relative to safe harbors that have been adopted under the physician self referral regulations (or Stark law) and the federal anti-kickback statute (71FR45140 and 71FR45110 respectively). The two regulatory changes have been categorized by HHS Secretary Mike Leavitt as a great step forward in the mean to facilitate HIT adoption. The two rules set up means for healthcare organizations to share technology and systems. Both new regulations are considered more flexible than the proposed rules that were released in the fall. Concurrently, the House of Representatives HR 4157 also includes legislation regarding these same provisions and it is expected that House leadership and the secretary will ensure that there is coordination in any future refinement of the rules. Both rules are effective October 10. The CMS and OIG final rules were published in the Federal Register on August 8 and can be found by clicking here.
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