ADVANCE Perspective: HIM : Coding

Online Spat Involves CPT Codes

Cheryl McEvoy — Fri, 10 Jul 2009 21:58:00 GMT

From time to time, we all complain. We used to keep it among friends, family or a goldfish with a compassionate ear, but with the advent of social media, it's become all too easy to tweet a 140-character rant for all to hear. Now, a physician is using...(read more)

Grider Says Tearful Goodbye

Lynn Jusinski — Tue, 07 Apr 2009 20:35:00 GMT

Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, COBGC, CEMC, CCS-P, said an emotional goodbye as she passed the gavel to incoming AAPC National Advisory Board (NAB) President Terry Leone, CPC, CPC-P, CIC. Grider received several standing ovations during today's...(read more)

Enthusiasm Abounds at AAPC!

Lynn Jusinski — Mon, 06 Apr 2009 17:12:00 GMT

It's the second day at the American Academy of Professional Coders (AAPC) conference in Las Vegas, and the attendees are currently chowing down on breakfast. Yesterday's welcome session was high energy and humorous. AAPC directors took on roles in a skit...(read more)

Hope Everyone Behaves on the Planes

Lynn Jusinski — Fri, 03 Apr 2009 14:44:00 GMT

The ADVANCE staff will be rather far flung early next week. Cheryl McEvoy is heading off to Chicago for the HIMSS conference, and I'm boarding a flight to Las Vegas early Sunday morning to take in the AAPC show. We'll be bringing you all sorts of conference...(read more)

AAPC Pleased With ICD-10 Implementation Date

Lynn Jusinski — Fri, 16 Jan 2009 19:39:00 GMT

The American Academy of Professional Coders (AAPC) scored a victory yesterday when it was announced that ICD-10 implementation would be pushed back from 2011 to 2013.

AAPC took an opposing view to that of the American Health Information Management Association, which advocated for an implementation sooner rather than later. AAPC made efforts to push back the proposed implementation date, and the Final Rule for adoption for ICD-10 does just that.

In a press release, AAPC thanked members for submitting comments on the proposed rule and reasserted its steadfast claim that 2011 is just too soon for ICD-10 implementation. "In the face of opposition from other coding organizations, the AAPC stood firm in its belief that a delay was necessary and in fact would reduce the overall cost of implementation," the press release reads. "The delay of 2 years is a victory for all providers, payers and coders."

AAPC also shunned ideas that coders need to begin training now, citing that 3 to 4 years is too long of a span for coders to retain ICD-10 training. "There are other organizations, coder credentialing and otherwise, that are attempting to get everyone to panic and jump quickly into training," the academy said. "We reiterate that it would be a mistake for any coder to jump into training immediately."

The academy is also devising plans to handle the ICD-10 implementation, and noted that eight regional conferences focused solely on ICD-10 will be held by AAPC in 2013. AAPC will also release an overall plan on handling the implementation, and said that would be out soon.

RAC Permanent Program Delayed

Lynn Jusinski — Wed, 05 Nov 2008 14:08:00 GMT

The Centers for Medicare and Medicaid Services (CMS) announced yesterday that an automatic stay will be imposed on the contract work of the four Recovery Audit Contractors (RAC) program. The stay is required as a result of protests filed with the Government Accountability Office (GAO) by two unsuccessful bidders, Viant Inc. and PRG Schultz, USA Inc., for the RAC program, according to CMS.

The stay will mean that all work for all four contractors will stop until a GAO ruling, which must be made within 100 days, or by early February. CMS stated, in a brief note on its Web site, "The four RAC contracts--and any work under those contracts--are on hold pending the outcomes of the protests."

According to the AHA, CMS noted that it's still preparing for the RAC program throughout the country and said that further details will be posted about the postponement on the CMS Web site.

The automatic stay is more a matter of contractors' complaints over who should've gotten the permanent contracts to do RAC audits. The spat is unlikely to affect the RAC program permanently, and as it stands, work on the RAC program will resume when the matter is settled. According to The RAC Report (subscription required), PRG Schultz, one of the contractors that filed with the GAO, had the lowest percentage of appeals overturned during RAC demonstration. PRG Schultz is arguing that CMS denied it a place in the permanent audits because of its high contingency fee bid. The RAC Report said that CMS put the brakes on all RAC activity on Monday, an even stopped an education session already in progress.

The RAC Report also quoted Joseph Zebrowitz, MD, executive vice president of Executive Health Resources, Newtown Square, PA, who said that planning for the RAC program shouldn't be delayed by facilities because of the automatic stay. "I think it's important that this delay is not because of any question of whether the RACs are fair, or good, or legal," Dr. Zebrowitz said. "The RAC program is unchanged, and there is nothing out there to say that anything is going to be different. [CMS] just can not start when the contractors are in doubt. Once they resolve these complaints, they will start up."

Lots to Learn

Lynn Jusinski — Tue, 14 Oct 2008 05:03:00 GMT

I'm always amazed by just how much there is to learn in the HIM field, and that's never more apparent than when I'm out at conferences. This year's AHIMA Convention has been packed with interesting sessions and general sessions that really show just how much things are changing in the field, and how anyone in the HIM profession is indeed a lifelong learner.

The urge to learn will definitely come in handy with ICD-10 on the horizon. Everywhere I turn here in Seattle at the convention, people have ICD-10 on their minds, and RAC audits are right up there, as well.
I attended the AHIMA press conference today on ICD-10. AHIMA CEO Linda Kloss, RHIA, FAHIMA, stressed the importance of ICD-10 and how the longer we as a nation wait to ditch ICD-9, the costlier it will be for everyone. "The longer the U.S. delays in implementing ICD-10-CM and ICD-10-PCS, the more information systems and software programs will need to be converted retroactively, resulting in higher conversion costs projected for hospitals, physicians and other health care entities," Kloss stated.

Here at the conference, I've been trying to gauge the reaction to the announcement that ICD-10 will soon be a reality. I'm hearing an anxious excitement. HIM professionals are worried about their historical data that will be in the outdated ICD-9 system and whether or not software vendors will be prepared for the switch. And they are looking forward to the enhanced capabilities that ICD-10 will offer--with more codes, coders can achieve a higher level of granularity, not to mention that the conversion will help catch our nation up to the other parts of the world that have already been through the implementation.

AHIMA is preparing for the change, according to Jill Dennis, JD, RHIA, AHIMA senior vice president, advocacy and practice leadership. "We'll be rolling out resources designed for various industry segments, to help break the change process down into manageable parts," Dennis said.

Dennis added that AHIMA is also evaluating how coding certification will have to change to accommodate the ICD-10 change. Overall, AHIMA plans to help the HIM field transition to the new code set. "AHIMA is fully committed to providing a wide variety of resources to assist health care organizations and the entire industry in minimizing disruption and maximizing the value of this long, long overdue change," Dennis said.

How do you feel about the switch to ICD-10? Are you anxious, excited or both? What are you most looking forward to?

CMS Announces RAC Contractors

Lisa Algeo — Tue, 07 Oct 2008 13:03:00 GMT

On Oct. 6, the Centers for Medicare and Medicaid Services announced the names of the new national Recovery Audit Contractors (RACs). The new RACs are:

Diversified Collection Services, Inc. of Livermore, California, in Region A, initially working in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and New York.
CGI Technologies and Solutions, Inc. of Fairfax, Virginia, in Region B, initially working in Michigan, Indiana and Minnesota.
Connolly Consulting Associates, Inc. of Wilton, Connecticut, in Region C, initially working in South Carolina, Florida, Colorado and New Mexico.
HealthDataInsights, Inc. of Las Vegas, Nevada, in Region D, initially working in Montana, Wyoming, North Dakota, South Dakota, Utah and Arizona.

Additional states will be added to each RAC region in 2009.

Can ICD-10 Finally Be Happening?

Lynn Jusinski — Wed, 20 Aug 2008 13:04:00 GMT

There's some movement on the ICD-10 front. The Department of Health and Human Services (HHS) proposed replacing ICD-9 codes with ICD-10 codes by October 2011.

According to HHS Secretary Mike Leavitt, "We are taking a giant step forward toward developing a health care system that focuses on quality and affordability through the implementation of health information technology. The greatly expanded ICD-10 code sets will enable HHS to fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities."

Leavitt called the conversion "essential" to developing a nationwide electronic health information network. The HHS press release also states that the ICD-10 codes will help with the implementation of EHRs and will provide added granularity, which will aid in identifying specific health conditions.

The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Kerry Weems called this "the right time" to move to ICD-10, and added that CMS will work with the health care system to make sure that the transition to ICD-10 is a smooth one.

The American Health Information Management Association (AHIMA) has advocated in the past for the use of ICD-10. AHIMA CEO Linda Kloss commented that "We are excited to see that HHS has taken this significant step forward, but now we must see a positive response to the [notice of proposed rule making] so that final rules can quickly be issued and the health care industry can finally get implementation started."

More information on the proposed rule can be found here. The comment period for the proposed rule ends at 5 p.m. ET on Oct. 21.

A New Title for Coders

Lisa Algeo — Mon, 11 Feb 2008 15:51:00 GMT

In this week's Hands-on Help column titled "Automating the Coding Process," authors Leslie A Fox, MA, RHIA, FAHIMA, and Patty Thierry Sheridan, MBA, RHIA, discuss the role of computer assisted coding (CAC) and its impact on the coding function and the coding professional.

The article provides details on the different types of CAC and how the new technology creates new roles for skilled coding professionals.

"New coding professionals will be learning a completely different set of competencies than today's coders," explained Kathy Johnson, RHIA, director of coding services at CARE Communications. "Coders will be in positions that require interacting with providers, understanding documentation and reimbursement requirements, and knowledge of quality measures and reporting."

In the article, Johnson goes on to say, "The coding professionals will play a significant role in educating providers and working with them on the use of documentation terminologies and tools. It's critically important for coders to have a role in the EHR implementation right now. They can help providers define documentation requirements including where to record documentation in an EHR and the structure of that documentation. This involvement will make a difference in reflecting accurately the codes that translate the services and complexity of care provided. Expert coding editors will also be in positions to mine and analyze data."

With coders learning new skills and job responsibilities changing, Fox stated, "I am wondering if at one point you would envision the title coder changing to something else. Although throughout this discussion we have been using coding editor, I don't think the title really captures the expertise needed to assure accurately coded clinical data. Editing traditionally refers to changing or preparing text for publication. Clinical coding is so much more than that. I like data quality experts, which denotes mastery of a body of knowledge related to clinical data input and output accuracy."

So, what do you think? Fox, Sheridan and Johnson are asking for your thoughts on a new job title for coders. What should future coders, working with CAC, be called? We'll take your suggestions and create a reader opinion poll. Please enter your suggestions below in the comments section.

Don't Get Ripped Off

Lisa Algeo — Fri, 09 Nov 2007 20:37:00 GMT

"Start earning money in just a few weeks." "Get your degree from home." We've all seen the infomercials, commercials and advertisements that boast "You too can become a medical transcriptionist in 10 days," or "Become a medical coder and earn top dollar."

Unfortunately, there are many people out there looking for a quick, cheap education that will lead them to the promised land of gainful employment. Some people pay a lot of money for these "study-at-home" programs, only to find out later that they received a substandard education and they can't get hired due to lack of education and experience.

The key is doing your homework before you enter a medical transcription or coding program. Many people don't engage in the appropriate research before selecting an educational program and find themselves feeling "ripped off" once they finish.

Visit our Student Center and the Find a School link to start your educational program search. Also, the Association for Healthcare Documentation Integrity (AHDI) has a number of resources to explore before starting your health care documentation career.

According to the Nov. 7 issue of Vitals, the e-newsletter of AHDI and the Medical Transcription Industry Association (MTIA), if you have already spent money and time on a work-at-home program and now believe the program may not be legitimate, contact the company and ask for a refund. Let company representatives know that you plan to notify officials about your experience. If you can't resolve the dispute with the company, file a complaint with these organizations:

The Federal Trade Commission works for the consumer to prevent fraud and deception. Call 1-877-FTC-HELP (1-877-382-4357) or log on to http://www.ftc.gov/.
The Attorney General's office in your state or the state where the company is located. The office will be able to tell you whether you're protected by any state law that may regulate work-at-home programs.
Your local consumer protection offices.
Your local Better Business Bureau.
Your local postmaster. The U.S. Postal Service investigates fraudulent mail practices.
The advertising manager of the publication or television station that ran the ad. The manager may be interested to learn about the problems you've had with the company.

Have you had a bad experience with a coding or transcription program? Share your thoughts.

RAC Ready?

Lisa Algeo — Tue, 06 Nov 2007 16:07:00 GMT

Are you ready for the Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractor (RAC) program? If not, it’s time to get a move on. It seems that CMS may be accelerating its plans to expand this project to all 50 states. It has recently conducted a demonstration RAC project in the states of California, Florida and New York.

On Oct. 19, CMS put out a contingency fee based request for proposal (RFP) for recovery audit contractors. It states that March 2008 is the earliest date that providers can expect inpatient and outpatient hospital coding reviews in all 50 states. Although the rollout timeframe for RAC review has not yet been determined, now is the time to start preparing.

Our Nov. 5 Hands-on Help column discusses RACs and speaks with Starla Stavely, MM, RHIA, who has first-hand experience as a former HIM director in Florida. She offers some insight to the program and suggestions on how HIM professionals can get ready.

I’d love to hear from other HIM directors who’ve had experience with RACs. If you’re from California, Florida or New York and you have some words of wisdom to share with your fellow colleagues, please comment here. Your advice could be the key to getting other HIM directors motivated so they will be RAC ready too.