HealthMEDX

Reporting Reasonable Suspicion of a Crime in an LTC Facility

The Centers for Medicare & Medicaid Services released a revised memo on January 20 in regards to "Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility (LTC)".

The memo is revised to include updated versions of the Questions and Answers and Appendix One documents. In order to promote timely application of the protections offered by section 1150B of the Act for LTC facility residents, we are explaining now the current obligations of LTC facilities to comply with the law as it is plainly written, without any delay that might be occasioned by waiting for any administrative rule-making process that might further clarify application of the law.

"This memorandum informs SAs of the new section 1150B of the Act, which was established by section 6703(b)(3) of the Affordable Care Act and is entitled “Reporting to Law Enforcement of Crimes Occurring in Federally Funded Long-Term Care Facilities.”

In order to promote timely application of the protections offered by section 1150B of the Act for LTC facility residents, we are explaining now the current obligations of LTC facilities to comply with the law as it is plainly written, without any delay that might be occasioned by waiting for any administrative rule-making process that might further clarify application of the law.

Click here to download the memo.

HIMSS12 Preview: Using the Lessons of HIPAA 5010 to Ease ICD-10 Work

Many providers, payers, claims clearinghouses and software vendors continue to work toward HIPAA 5010 compliance even as the Jan. 1, 2012, deadline has passed and the federal government has instituted a brief grace period.

A session at HIMSS12 in Las Vegas will examine how some organizations have made a successful 5010 transition, and how lessons from can translate to ICD-10 implementation work.

HIPAA 5010 compliance is a patchwork right now, says Eric Mueller, president of WPC Services, the consulting subsidiary of Washington Publishing Co., which publishes HIPAA implementation guides. Many commercial payers, for instance, are ready for 5010 but most state Medicaid agencies are fall behind. Some clearinghouses have done a good job for large clients but not so good for smaller ones.

A core lesson from 5010 is that when things fail, it’s because of inadequate testing, Mueller says. And that will be magnified a thousand times with ICD-10 implementation, he says.

A 5010 example: A physician practice that uses a clearinghouse to submit claims to all its insurers may have successfully tested 5010 with the clearinghouse. But most clearinghouses do not directly connect with all of their clients’ insurers--the transactions move between two or three clearinghouses to reach all payers.

So, the practice will receive notices of successful submission of 5010 claims to its clearinghouse, but then will get back 835 remittance advice transactions from payers that have wrong or missing data elements. There’s a lot of room in that trail of electronic transactions for things to get screwed up, Mueller says. And that’s why it is important for providers to understand how data moves through all parts of the transaction chain and the types of decisions that payers are making on the data--how they are interpreting 5010 requirements. “Organizations that have been successful have really dug into the data to see test files and results of test files,” Mueller says. “Don’t accept blanket ‘we got it’ test responses.”

Things will get much more complicated with ICD-10. Providers get paid under contracted rates based on diagnostic codes, and when the codes change under ICD-10, the reimbursement will change. Unless a provider organization understands not just how it will handle ICD-10, but also how its software vendors, clearinghouses and payers are doing it, there will be problems, Mueller warns. “You have to dig in and own your project.”

Everyone in the chain--providers, vendors, clearinghouses and insurers--will get dinged if things aren’t right, Mueller says. But the non-providers will still be getting paid for their services. “It’s the provider who risks total disruption.”

Consequently, Mueller hopes to give attendees a number of tips that peers have used to be successful when migrating to different transaction sets and codes, and other lessons being learned about addressing ICD-10. The lasting impression he wants to leave: “Proper preparation prevents poor performance.”

http://www.healthdatamanagement.com/news/hipaa-5010-transactions-icd-10-himss-conference-43953-1.html

EMR vs EHR – What is the Difference?

By Peter Garrett / ONC Office of Communications , and
Joshua Seidman PhD / Director Meaningful Use

What’s in a word? Or, even one letter of an acronym?

Some people use the terms “electronic medical record” and “electronic health record” (or “EMR” and “EHR”) interchangeably. But here at the Office of the National Coordinator for Health Information Technology (ONC), you’ll notice we use electronic health record or EHR almost exclusively. While it may seem a little picky at first, the difference between the two terms is actually quite significant.The EMR term came along first, and indeed, early EMRs were “medical.” They were for use by clinicians mostly for diagnosis and treatment.

In contrast, “health” relates to “The condition of being sound in body, mind, or spirit; especially…freedom from physical disease or pain…the general condition of the body.” The word “health” covers a lot more territory than the word “medical.” And EHRs go a lot further than EMRs.

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

• Track data over time
• Easily identify which patients are due for preventive screenings or checkups
• Check how their patients are doing on certain parameters—such as blood pressure readings or vaccinations
• Monitor and improve overall quality of care within the practice

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”

The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.

And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

• The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
• A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
• The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
• The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.

So, yes, the difference between “electronic medical records” and “electronic health records” is just one word. But in that word there is a world of difference.

 

Top 5 Rejections Related to HIPAA 5010

I know we have touched on some of these before but I think it's helpful to have this information continually at the forefront. Ken Bradley, with The Daily Practice, has come up with a list of the top 5 rejections:

It has been over two full weeks since HIPAA 5010 became the required transaction standard, and by now many practices are beginning to see how the upgrade’s many changes are impacting claim rejections. For the past couple of weeks, I have been monitoring trends in claim rejections—specifically looking at ones that are directly related to 5010. As can be expected, there was an uptick in a number claim rejections. Within all of these rejections, five specific ones caught my eye because each one could easily be corrected so practices can avoid such rejections in the future. Here is a quick look at these five rejections and how to prevent them:

1. No Medicare Secondary Payer (MSP) reason code on a primary claim. In Version 4010, claims only required MSP on secondary claims submitted directly to Medicare. Now, however, healthcare providers must submit an MSP indicator on both the primary and secondary claim when Medicare is reported as the secondary payer. If this information is not included, the claim will be rejected.

2. Lack of drug units when a National Drug Code (NDC) is present. A drug quantity and unit of measurement are required whenever an NDC is listed on a claim. Some clearinghouses and technology vendors will proactively reject claims that have an NDC but don’t have the drug quantity and unit of measurement.

3. No detailed description of an unlisted service. Now in 5010, any claim using an unlisted Current Procedural Terminology (CPT) or HCPCS code must also include the code descriptor or payers will reject the claim. Make sure to work with coders and practice staff to make sure this level of description is used for unlisted codes because this was not required in 4010.

4. ZIP codes are only 5 digits. Addresses for both facilities and billing providers now require a nine-digit ZIP code—this is a distinct change from Version 4010, where only the five-digit ZIP code was required. If you don’t know your nine-digit code, contact your local Post Office or visit www.usps.com. Once you have it, incorporate it into all claims—if needed, reach out to your clearinghouse or practice management vendor to ensure this information is correctly incorporated into your system.

5. Billing provider address is a PO Box. In Version 4010, practices could use a PO Box address for the billing location. With 5010, the bill to address must be a physical street address rather than a PO Box or lock box address. Before making any changes to claims, your practice should verify its address information in the National Plan and Provider Enumeration System (NPPES) to ensure address information is up-to‐date and accurately reflects your actual street address.

If your practice does not use a PO Box or lock box, you do not need to worry or make any changes. Changing the way you submit your street address is ONLY necessary if you are currently using a PO Box or lock box address on claims. If your practice uses one of these for your billing address, contact your clearinghouse or practice management vendor to work through this issue.

Although these five codes are causing issues for many practices around the nation, they are not the only rejection reasons that have been on the rise over the last few weeks because of 5010. The transition to HIPAA 5010 definitely has had some hiccups, but with some due diligence practices can easily overcome these issues. We recommend monitoring and tracking your claims rejections and denials carefully over the next few months. If you notice any unusual trends, be sure to contact your clearinghouse or practice management vendor to uncover the reason for the issues and determine how to prevent them moving forward.

Let ICD-10 implementation and Meaningful Use work with each other

By Carl Natale, ICD10 Watch-  Now that it's 2012, and you have reached HIPAA 5010 compliance, it's time to work on your electronic health record (EHR) and Meaningful Use initiatives. Or do you need to start ICD-10 implementation next?

Lessons Learned during CCHIT Certification

By Beth Ann Muthig, Product Analyst for HealthMEDX  

By now you have heard the wonderful news that HealthMEDX Version 7.1.10 has received Full Product Certification by the Certification Commission for Health Information Technology (CCHIT) and for components for the ONC-ATCB 2011/2012 Certification of both eligible provider and hospital.  The criteria support the Stage 1 meaningful use measures requirement to qualify eligible providers and hospitals for funding.  This funding is not currently available for post acute care. 

About three years ago, my boss said, “We have this project for you, you will love it; it will only take about one year and only about 15 % of your time, a walk in the park”.   Well, it has been more like hiking the Appalachian Trail, which can be done by one person but much more rewarding surrounded by a great group of hikers!

Let me tell you about our trailblazers and the human side of our successful certification process.   Certification was much more than just one team effort to prepare for this process; it was an effort that involves everyone who “touches” our product:  every Vision user, every HealthMEDX employee and our Certification Managers from CCHIT   played a role in bringing this project to such a successful conclusion.  It was more than two years in the making, more than 5200 development hours, and more than 1400 hours of review, testing and dress rehearsals for the actual days of testing.  I had the pleasure of shepherding HealthMEDX through the certification process from the early planning stages to post inspection with our wonderful team.  It was certainly a life challenging event.  One of my proudest moments was our day of actual testing; our core team of presenters was absolutely on script and made us all very proud at HealthMEDX to be represented by such fine individuals.   

What were our top 10 lessons learned through this process?

1.  Take the process very seriously- it is not easy.  Every round of CCHIT certification criteria, every NIST procedure for meaningful use bore close watching; every iteration had some material change that created a new development requirement.  Some were minor tweaks, some required major rewrite of a component of our product, and some required new functionality that did not exist two years ago.
2. Take opportunities to educate.  We continue to educate the acute care world on terminology and concepts used in the post acute world, from concepts of integrated product line that serve both the needs of a continuing care retirement community with both home health and skilled nursing, to simple terms such as problem list in acute world is called diagnosis list in the post acute world. 
3. Security testing is demanding. The security and interoperability were some of the more rigorous aspects of certification from documenting all the detail we use to protect data in transit to demonstration.  Clinical team members went from knowing how your heart works to knowing how to generate encryption hashes! 
4. Read the fine print.  Testing procedures and interpretation of these testing procedures was critical; this impacted the dress rehearsals on our perceptions that we were showing the product correctly.
5. Spend your time wisely.  Time management of all the individuals contributing to the project was extremely important to allow timely follow up on specific expectations during this incredibly challenging project. 
6. Educate on the fine print.  Detailed training guides with the new functionality were critical to the end user including rational for including in the new functionalities, such as Medication Reconciliation and the Continuity of Care Document.
7. Rehearse! Dress rehearsal after dress rehearsals set the stage for a seamless test script execution with CCHIT both for CCHIT certification and Meaningful Use.  Being a web-based desktop sharing application with the jurors was something needed practice because there would be no human eye contact to know how we were doing. Often we continued test scripts without any response from jurors. 
8. CCHIT Staff were always there. Responsiveness and the willingness of the staff at CCHIT to engage with us, to get questions answered, and their patience made the process so successful.
9. Keys:  Patience, dedication and professionalism were the winning combination. 
10.  Deep Breath and get ready for 2013/2014 Testing!

 

HealthMEDX Vision Obtains Full CCHIT Certified® 2011 LTPAC Status

HealthMEDX’ electronic health record (EHR) HealthMEDX Vision version 7.1.10 has passed Certification Commission for Health Information Technology (CCHIT^®) long term post-acute care (LTPAC) inspection, and is a  CCHIT Certified® 2011 LTPAC EHR with additional certification for both the Skilled Nursing Facility and Home Health.

HealthMEDX has completed the full certification process including verification of implementation at client sites.   “Completing the full certification of HealthMEDX Vision was a top priority across our organization” stated Dan Cobb, Chief Technology Officer at HealthMEDX.  “This has been an important focus for HealthMEDX and one we have plans to keep up with as new certification criteria become available in the future.”

This certification has been achieved not long after HealthMEDX Vision 7.1.10 received ONC-ATCB 2011/2012 certification.  Details on this certification can be found at http://www.cchit.org/products/2011-2012/arrafinalruleeligibleprovider/3419.

Read the official announcement here.

Care Area Assessments Review Guidelines for Long Term Care

The National Guideline Clearinghouse has updated the guideline summaries for the following guidelines from the American Medical Directors Association, which may assist you to help facilitate the Care Area Assessments (CAAs) review:

• Altered nutrional status in the long-term care setting. This updates a previously published guideline summary.
  
• COPD management in the long-term care setting. This update a previously published guideline summary.
• Heart failure in the long-term care setting. This updates a previously published guideline summary.
  
• Parkinson's disease. This updates a previously published guideline summary.
• Transitions of care in the long-term continuum.
• Urinary incontinence. This updates a previously published guideline summary. 

A new report, Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection, examines current evidence for C. difficile diagnosis, treatment, and prevention methods. The report finds that the standard antibiotic treatments—oral vancomycin, metronidazole, and the newly approved fidaxomicin—are equally effective for curing initial C. difficile infections. However, recurrence of C. difficile infections was found to be less frequent for those who used fidaxomicin rather than vancomycin. Clostridium difficile is a dangerous healthcare-associated infection and a growing health care problem, especially among older adults and those with weakened immune systems. The report is accompanied by clinician and consumer summaries, as well as a CME activity and faculty slides for clinicians.

HealthMEDX Passes SSAE 16 Type II Review

January 10, 2012 The HealthMEDX Data Center for cloud computing clients has passed stringent Statement on Standards for Attestation Engagements (SSAE) No. 16 auditing standards providing increases assurance that patient and resident data managed by HealthMEDX is secure.

The HealthMEDX cloud computing model allows clients to focus on patient and resident care by freeing up critical resources from information technology management.  Client’s databases are maintained and accessed easily through the secure and reliable HealthMEDX cloud.  HealthMEDX recently completed the audit process to ensure the organization’s data center and hosting operations meet the SSAE 16 guidelines.  SSAE 16 effectively replaces SAS 70 as the authoritative guidance for reporting on service organizations.  These updated examination guidelines mirror new international reporting standards. 

Chris Bingham, Vice President of Infrastructure for HealthMEDX, talks about what it means for clients. In addition, there is a link to what SSAE 16 means for the information technology industry. To read the entire article, click here.

HealthMEDX's VisionReceives ONC-ATCB 2011/2012 Certification

January 4, 2012 – HealthMEDX announced today that HealthMEDX Vision 7.1.10, is 2011/2012 compliant and was certified as an EHR Module on January 3, 2012 by the Certification Commission for Health Information Technology (CCHIT®), an ONC-ATCB, in accordance with the applicable Hospital certification criteria adopted by the Secretary of Health and Human Services. HealthMEDX Vision 7.1.10 was also certified as an EHR Module in accordance with the applicable Eligible Provider certification criteria.  The 2011/2012 criteria support the Stage 1 meaningful use measures required to qualify eligible providers and hospitals for funding under the American Recovery and Reinvestment Act (ARRA). 

“This certification was a focus area for HealthMEDX.  We feel these certifications mean a lot for our clients and for our industry” stated Dan Cobb, Chief Technology Officer at HealthMEDX.  “Addressing these types of certification standards is crucial to the success of the organizations utilizing the HealthMEDX Vision solution.”

You can read the entire press release here, which includes all the certification criteria that HealtMEDX Vision, Version 7.1.10 meets.