The proposed rule to delay the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014 is posted to the Federal Register, and there is only 1 week left in the 30-day comment period.

When proposing the delay to ICD-10, HHS took into consideration feedback that some provider groups have concerns about their ability to meet the Oct. 1, 2013 ICD-10 compliance date, based in part on implementation issues they have experienced meeting HHS’ compliance deadline for Version 5010 standards.

All HIPAA-covered entities must transition to ICD-10 to assure there is a smooth transition between provider organizations and trading partners, which will help avoid rejected claims and provider payment delays. By delaying the compliance date for ICD-10, as proposed in this rule, providers and other covered entities will have more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.

Not all groups, however, agree with HHS’ proposed compliance date change. The American Health Information Management Association (AHIMA) filed its comment letter today and continues to recommend there be no delay in the ICD-10 compliance deadline. Since a delay is likely, AHIMA stated it will continue to work with HHS and the healthcare industry to ensure the delay is as short as possible, preferably not more than 1 year.

“ICD-9 is antiquated and no longer adequately meets the challenge of a 21st century healthcare system,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, FACHE, in an AHIMA press release.  “ICD-10 should be implemented in a timely manner, and AHIMA is ready to continue assisting the healthcare community to prepare for the transition. We also encourage advance testing of the ICD-10 codes to be sure there are no further delays in the implementation deadline.”

According the AHIMA, a delay of more than 1 year would cause additional confusion for colleges and universities as to what they should be teaching. Students already have been trained in ICD-10 and are forced to use ICD-9-CM when they enter the work force.

AHIMA also advocated in the letter that transitioning directly to ICD-11 is not a viable option as implementation would not occur until after 2020, even in a best case scenario. In addition, the structure for ICD-10-CM/PCS is designed to make current and future healthcare technology systems ready for an easy transition to ICD-11.

To read about comments submitted by the College of Healthcare Information Management Executives (CHIME), click here. 

All comments are due to HHS no later than 5:00 pm ET on May 17, 2012, and can be submitted electronically by following the ‘‘Submit a comment’’ at Regulations.gov or by regular mail sent to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013

Will you be commenting on the proposed rule? If so, what are your thoughts on delaying the compliance date?

July 3, 2012, is the last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program.

For an eligible hospital or critical access hospital's first payment year, the EHR reporting period is a continuous 90-day period within a Federal fiscal year. In subsequent years, the EHR reporting period for eligible hospitals and critical access hospitals (CAHs) is the entire Federal fiscal year.

For 2015 and later, Medicare eligible professionals, eligible hospitals, and CAHs that do not successfully demonstrate meaningful use will have a payment adjustment in their Medicare reimbursement, according to the EHR Incentive Program Final Rule.

Get an overview of the Medicare EHR Incentive Program by reading the latest Fighting Fraud column by Holly J. Cassano, CPC.

A study by the Centers for Disease Control and Prevention published in the April 27 Morbidity and Mortality Weekly Report found that 30 percent of U.S. workers (approximately 40.6 million people) reported that they sleep six hours or less a night.

Among all workers, those who usually worked the night shift had a much higher prevalence of short sleep duration (44 percent, representing approximately 2.2 million night shift workers) than those who worked the day shift (28.8 percent, representing approximately 28.3 million day shift workers).  An especially high prevalence of short sleep duration was reported by night shift workers in the healthcare and social assistance (52.3 percent) industries.

For those in the health information management profession, working overnight is not uncommon. Perhaps you're a medical transcriptionist working in a hospital who is assigned to the third shift. Or maybe you're an independent contractor clocking in your hours long after your family is in tucked into bed.

Insufficient sleep can have serious and sometimes fatal consequences for fatigued workers and others around them, the CDC noted. For example, an estimated 20 percent of vehicle crashes are linked to drowsy driving.

Furthermore, researchers have discovered that sleep - and the importance of its timing, quality, and duration - can be tracked down to a cellular level in the human body. "We see traces of biological rhythm in every cell, tissue, organ," said Michael Twery, PhD, director of the National Center on Sleep Disorders Research, in an ADVANCE article. "Deviation from the proper length and quality of sleep can put us at risk for disease. Without enough sleep, the likelihood of mortality increases."

The National Sleep Foundation recommends that healthy adults sleep seven to nine hours per day. How much sleep did you get last night?

A survey conducted by KLAS, a research firm specializing in monitoring the performance of healthcare vendors, reports that many providers are looking seriously at purchasing inpatient computer-assisted coding (CAC) solutions within the next year or two.

An American Health Information Management Association (AHIMA) workgroup defined CAC several years ago as "the use of computer software that automatically generates a set of medical codes for review/validation and/or use based upon clinical documentation provided by healthcare practitioners."

Adding a CAC system is an integral part of providers'ICD-10 readiness strategy, according to the KLAS report Computer-Assisted Coding: A Glimpse at the Future of HIM Technology released April 23.

"Providers worry their staff will not be ready in time for ICD-10," stated author of the report Graham Triggs. "Though the market is young and no vendor has fully proven itself in the inpatient space, provider confidence that computer-assisted coding technology will ultimately create greater efficiency, productivity, and ICD-10 readiness is high."

If you are planning to purchase a CAC product, be sure to read "Finding the Right Fit With CAC" written for ADVANCE by Lorri L. Luciano, RHIA. With CAC technology, Luciano identifies several criteria that should be prioritized: the Natural Language Processing approach, workflow, coding accuracy, traceability of codes and ease of use, and coder adaptability. This article also has helpful checklists to review when evaluating CAC vendors.

CAC will change the way coding professionals work in the future, Luciano states, so be sure to get involved now with your facility's CAC selection committee.

(Editor's note: This guest blog was written by Jill Hoffman, managing editor of Executive Insight.)

The Centers for Medicare & Medicaid Services (CMS) has awarded National Government Services Inc. a $111 million contract to support the Next Generation Desktop (NGD) for the next 5 years.

NGD has held the contract since the NGD's inception. The NGD desktop application is used by all Medicare Contact Center Customer Service Representatives (CSRs) to answer millions of calls from Medicare beneficiaries. It reduces the amount of time required to help Medicare beneficiaries and improves the CSRs ability to provide more timely and accurate service for inquiries.

One key function of the application is to allow CSRs to access information the beneficiary may have previously entered into the Medicare Web site, MyMedicare.gov. For example, if someone had been in the process of choosing a Medicare Prescription Drug Plan but needed assistance, that individual could call 1-800-Medicare and the CSR would have the information previously entered at their fingertips. 

"Data integration is a critical innovation in the health care IT arena," Tim Masheck, National Government Services vice president of Health Information Technology, explains. "Such technology enables those on the front lines to provide better patient care and a more pleasant experience overall. National Government Services is proud that we were called upon yet again to ensure the integrity of this critical application."

1-800-Medicare received 26 million calls last year with approximately 3,500 CSRs at the call center using the NGD desktop tool to assist callers with their Medicare inquiries.

One weekend afternoon last fall, a burglar broke into an office and stole some computer equipment. That fairly commonplace crime resulted in one of the biggest patient health data breaches in history. Probably without knowing it, the thief snatched a computer whose hard drive contained more than 4 million unencrypted patient medical records, including names, addresses, birth dates, phone numbers, email addresses, medical record numbers, diagnoses and other information. Shortly afterward, 11 class action lawsuits were filed on behalf of those patients, seeking more than $1 billion in damages. It was a costly misadventure -- and completely avoidable.

This sort of data breach is all too common. According to the U.S. Department of Health and Human Services, 40 percent of large patient health data breaches involve lost or stolen devices. Every healthcare provider that handles and stores unencrypted patient data in a traditional client-server system may be vulnerable. They wouldn't be, if they were instead using secure private cloud systems.

A growing number of vendors (my company is one of them) provide web-based secure private cloud systems, where health records are automatically encrypted, and - most importantly - never reside on a local computer hard drive or server. In client-server systems, the norm throughout healthcare, data is stored on local servers usually housed in a room in a hospital or administrative center. Records are routinely downloaded and uploaded back and forth from desktop and laptop computers to local servers. And most of this data is not encrypted.

When making comparisons between client-server and secure private cloud systems, I'm not talking about public cloud systems. The difference is critical. A secure private cloud is built around a high-security private database where each client's data is protected in its own database schema. Public cloud refers to a cloud infrastructure that is available to the general public and where data may be stored in various database locations depending on availability. Public cloud should not be used for patient health data.

Many healthcare administrators like client-server because they feel safer keeping their patient data within reach. But that's like hiding money in your mattress and feeling like it's safer than the bank. You can't keep an eye on that mattress all the time, nor can health system personnel keep watch over every piece of local equipment that might contain health records. Secure private cloud is like taking money out of your mattress and putting it into a bank.

In fact, banks have been using secure private cloud and web-based systems for years, as have military contractors. If secure private cloud can be safe enough for your money and your national security, surely it can be safe enough for your patient health data.

For security reasons, I won't tell you the name of Perminova's private database or where it's located, except that it's ensconced in an anonymous warehouse at the back of a nondescript business park.

Walk in the front door, which is open 24-hours a day so clients can always access their data, and you feel like you've stumbled into black ops guarding a national security secret. A small window of bullet-proof glass fronts a uniformed attendant scrutinizing a bank of closed-circuit video screens. Cameras sweep the waiting room, whose walls are Kevlar-impregnated. A secured iron door with biometric fingerprint and face scanners leads into what's known as a man-trap. The man-trap is a small room with more cameras where the inside door won't open until the outside door is locked. Visual and verbal security checks must be passed before you're released from the man-trap. Then you pass through a hallway with more cameras and another barred door with a biometric fingerprint scanner. Inside, the data center looks like a prison with servers as inmates. The giant warehouse is filled with rows of cells; each vendor's server banks are locked in separate cells. The data center is managed around-the-clock by data security experts.

By contrast, in most client-server systems at hospitals, onsite servers and other hardware are housed in a server room, which is basically protected by a locked door, if that. Meanwhile, desktop computers sit unguarded, while laptops maybe locked in a file cabinet or taken home. Healthcare IT staffs are spread thin with many duties, such as servicing all computers and other equipment. Data security is important, but it's only one of many responsibilities for them.

With web-based systems using software-as-a-service and storing data in a secure private cloud, patient information is entered and accessed directly into the secure private cloud, not onto software that resides on desktops and laptops. When you hit "save," you're saving to the secure private database, not to your laptop or PC. So if a computer is lost or stolen, patient health information remains safe.

Cloud computing is exploding right now in many industries - including industries where security is very important. Healthcare has lagged behind, largely due to security concerns; preconceived notions about cloud computing and security abound. With each new patient data breach caused by a stolen laptop or insider snooping, it's time to consider that secure private cloud is an answer, not a threat.

It is projected that Texas will need an additional 10,000 HIT workers for the state's $103.6 billion healthcare industry by 2013. This gap is much larger than the original estimation that Texas would require an additional 3,500 HIT workers between 2010 and 2015. The results from this survey have shown the original 3,500 figure to be grossly under-estimated.

Led by Susan H. Fenton, PhD, the survey was conducted as part of a contract with the Texas Workforce Commission, with funding for the project coming from the governor's office through a Wagner-Peyser grant. The study data was accumulated by conducting HIT employer focus groups across the state and through a statewide HIT employer survey.

The HIT Employer Needs Assessment has demonstrated that Texas providers (clinics and hospitals) are conservatively estimated to need 9,500 HIT employees between now and 2013. Non-providers (HER vendors and consultants) reported needing an additional 500 HIT employees by 2013, so it is conservatively estimated that Texas will need an additional 10,000 HIT workers by 2013.

According to the report detailing the study, results indicate that the current Texas HIT workforce is insufficient to meet the needs. This gap will only grow and the quality of care for Texas citizens will suffer if action is not taken. Bridging this gap will require a collaborative effort between employers, educational providers, public organizations and others to develop and implement a plan of action.

To read the full text of the report, go to www.health.txstate.edu/him/TxHIT-workforce/news/contentParagraph/03/document/TexasHITEmployerNeedsAssessment_RELEASED_03302012.pdf

(Editor's Note: This guest blog covering the AAPC's 20th National Conference was written by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC.)

As the final day of the AAPC conference comes to a close, members are on information overload. Attendees start on a run and end with a slow, tired walk to their classes.

Reed Pew, chairman and chief executive officer of the AAPC, addressed the attendees during the awards luncheon. Among the honorees were the 2012 Regional Spirit Award winners from Region Four, consisting of members from Georgia, Alabama, Puerto Rico, Florida, Tennessee, and the Bahamas.

Donna Williams, CPC, CPMA, of the Chesapeake, Va., chapter, who was attending her second national conference, wanted to go outside of her comfort zone and learn more about HCC coding. She attended a session presented by Dennis T. Tse, MD, CPC, and reported that Dr. Tse broke the topic down so well that it truly made sense. 

"This was one of the best conferences I have attended," Williams said. "It was well organized." When asked what her favorite session overall was, she replied that hands-down it was "Understanding Diabetes for ICD-9 and ICD-10" presented by Sheri Poe Bernard, CPC, CPC-H, CPC-P, CPC-I.  Williams added that the information she gained all week long was not only accurate but also valuable from a payer perspective.

Myra Burk, CPC, CPC-H, from Rockford, Il., who was attending her first conference, loved the different educational choices and especially found it helpful to have payers involved as presenters and participants during sessions. Burk attended the popular Anatomy Expo Wednesday where physicians from a variety of specialties provided an insider's look at the anatomic and physiologic nuances of the human body. Her top picks were presentations by plastic surgeon Govind Acharya, MD, about the skin and interventional radiologist David Zielske, MD, about peripheral procedures during cath procedures.

Even though glitches are a part of any conference, the overall take-away was positive. Many thanks to the organizers, Melanie Mestas, Sandra Nestman, Amy Evans and the AAPC conference team; without them and all of their hard work, the conference would not have been possible.  A huge thanks also goes out to audio visual company WebbAV for their creativity; without their combined talents, our general sessions would not have been as fabulous and entertaining as they were.

Join us next year April 14-17, 2013, in the "Happiest Place on Earth," Orlando, Fla., and Disney World.

Susan Ward has more than 20 years of coding and billing experience. She currently works for a reconstructive plastic surgeon in Phoenix. Susan is a certified PMCC instructor for the AAPC and was a member of the 2007-2009 AAPC National Advisory Board.

(Editor's Note: This guest blog covering the AAPC's 20^th National Conference was written by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC.)

Day three of the AAPC's 20^th National Conference held in Las Vegas started with a hot breakfast with the exhibitors and some great networking among the record number of attendees. 

After breakfast, Joseph Nichols, MD, and Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC, gave a presentation on the relationship between clinicians and coders as it relates to ICD-10 implementation. Members were able to understand that their roll is important in the successful implementation of ICD-10. Working closely with providers in reviewing current documentation is the key to a smooth transition.

Education continued with breakout sessions, again affording the attendees the opportunity to enhance their coding abilities and skills. Members enjoyed the opportunity to validate what they know and get answers to questions during sessions.

Following the education portion of the day, the AAPC held a "Family Feud" general session where members were organized by regional area and competed in four exciting rounds for the AAPC 2012 Regional Spirit Award. Five members from each of the eight regions were selected to participate in the Coder's Feud on stage and answer survey questions posted on the AAPC Member Forum. Fun was held by all. Stay tuned for announcement of the winner.

Susan Ward has more than 20 years of coding and billing experience. She currently works for a reconstructive plastic surgeon in Phoenix. Susan is a certified PMCC instructor for the AAPC and was a member of the 2007-2009 AAPC National Advisory Board.

(Editor's Note: This guest blog covering the AAPC's 20^th National Conference was written by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC.)

Reed Pew, chairman and CEO of AAPC, started day two with a message for members to embrace change and face the fears in their professional and personal lives. He discussed the changes that the membership has already faced and the new challenges on the road ahead.

In the keynote presentation, Brad Barton, CSP, shared personal stories about how to overcome adversity, which left the membership with a positive outlook and the knowledge to take charge of their lives. The attendees gained an understanding that through empowering one's self, your outlook on life and your career is all in your own hands. He reminded the audience that life is 10 percent what events happen to us (circumstances) and 90 percent how we respond to it (empowerment).

First-time attendee Rhonda Nash of Dallas said, "The opening was great and so very motivational." Damaris Ramirez of Leonia, N.J., said the keynote speaker was "awesome to get energized for conference."

As the day moved on, attendees started the educational tracks, which were composed of an incredible selection of information. With so many aspects of coding (specialties practices, HCC Coding, ICD-10, HIPPA, compliance), members were not short on subjects to choose from.  From networking with one another to meeting with the exhibitors during lunch, to more education in the afternoon and ending with an exhibitors reception, the day was enjoyed by all. 

First-time attendee Katurah Jones of Bronx, N.Y., said her favorite session was about ASC's because of the "information and understanding gained with proper modifier use and how different payer polices play a key role in coding."

Susan Ward has more than 20 years of coding and billing experience. She currently works for a reconstructive plastic surgeon in Phoenix. Susan is a certified PMCC instructor for the AAPC and was a member of the 2007-2009 AAPC National Advisory Board.

(Editor's Note: This guest blog covering the AAPC's 20^th National Conference was written by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC.)

With record numbers attending AAPC's 20th National Conference in Las Vegas, Nevada, members were excited to receive their registration packets and T-shirts as they were greeted by national advisory board members and AAPCCA board of director members. First-time attendees got extra attention so that they knew what to expect and where to be.

Sunday morning started out with the AAPCCA presenting leadership training. Officers of local chapters discussed great ways to plan chapter meetings and how to find resources. Demi Peal, Overland Park, Kansas Chapter said "knowing we officers are not alone" was beneficial, and many great ideas were talked about. Melissa Brown, CPC, CPC-I, CFPC, RHIA, chair of the AAPCCA board of directors introduced the regional representatives to more than 300 attendees.

The official start of the conference was enjoyed by all Sunday afternoon. The AAPC's Angels presentation by national advisory board members was about the importance of having certified professional coders working within medical practices. Attendees were laughing, singing and cheering in their seats.

With everyone armed with the knowledge to be the Coding Angel in their practice, attendees lined up to attend a "Get to Know Your Local Chapter" event. Chapters from every region brought all sorts of goodies to share. Prizes were given away, and money was raised for the Red Cross and "Feed America." A newly introduced scholarship program by the AAPCCA was added to the mix of incredible opportunities that our membership can do to help others.

The first day ended with the AAPC's legal advisory board sharing incredible information and answering questions from the membership.

Susan Ward has more than 20 years of coding and billing experience. She currently works for a reconstructive plastic surgeon in Phoenix. Susan is a certified PMCC instructor for the AAPC and was a member of the 2007-2009 AAPC National Advisory Board.

A press release issued by the American Medical Association states that the AMA and state and national medical specialty societies sent a letter to the Centers for Medicare and Medicaid Services expressing serious concern about an onslaught of overlapping regulations that affect physicians. The AMA cited the value-based modifier, penalties under the electronic prescribing program, physician quality reporting system, and electronic health record incentive program, along with the transition to ICD-10, as all occurring within a short amout of time.

"Facing all of these deadlines at once is overwhelming to physicians, whose top priority is patients," said AMA President-elect Jeremy Lazarus, MD. "We have asked CMS to develop solutions for implementing these regulations in a way that reduces the burden on physicians and allows them to keep their focus where it should be - caring for patients."

Do you agree that changes from CMS are needed?

AAPC (http://www.aapc.com/), the nation's largest training and credentialing association for the business side of medicine, announced its 2012 National Conference in Las Vegas April 1-4, 2012, at the Rio Hotel. Health care professionals from all over the country will get the opportunity to learn some of the hottest topics in the industry, including ICD-10, auditing, compliance, practice management, coding and billing, and much more.

"Each conference is a very exciting time for our membership and this year is no exception," stated Melanie Mestas, AAPC conference director. "We want everyone to have fun, learn, network, and then go home feeling renewed about their careers and excited about the future of the industry. This will be one conference not to be missed."

Some of the 2012 conference highlights:

• Anatomy Expo
• Keynote Presentation-Got Magic?
• 72 Specialty Breakout Sessions
• Amazing Networking and Continuing Education Opportunities

Registration for the conference is open until March 20. AAPC Member price is $795 and the non-member price is $1,095. Conference and hotel packages are also available via the conference home page.