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Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC
FHIMA President
I can’t believe that my term as FHIMA
President is almost over and that this is my final President’s message for
e-Coastlines. This year certainly has flown by. It has been an honor and a
privilege to serve the members of FHIMA as President this past year and I will
certainly miss leading such an impressive organization.
I am looking forward to an exciting
convention in July. This year we have an unprecedented number of sessions to
better meet the educational needs of our membership. I am also excited to be
hosting a President’s Reception on Tuesday evening July 15th. The
reception is open to everyone that registers for the full 3 days or for Tuesday
only. The reception has been made possible by an extremely generous donation
from Dwayne Lewis, President of DML Consulting. When you see Dwayne at
convention please be sure to thank him for his generosity and support and please
consider his company for your coding consulting needs.
Before we let our hair down and party on Tuesday evening, many
of us have lots of work to do on Monday before convention. This year we are
holding a formal orientation session for all incoming board members, committee
chairs, appointed positions and regional Presidents. Orientation will begin
Monday morning at 9 A.M. and will be followed by a Leadership Luncheon for all
incoming and outgoing positions. After lunch, HOD will start promptly at 1 P.M.
with a jam packed agenda. In addition to voting on proposed bylaws changes we
will be showcasing our online goal tracking system used for executing our
strategic plan, sharing a new regional affiliation agreement, and holding a
demonstration of Voter Voice. We will also have open discussion on the
following three topics:
When I look back at all that we have achieved this year I am
filled with a great sense of pride and accomplishment. When I began my term as
president I had a very ambitious to do list and it is only through the tireless
efforts of the committee chairs, committee members and those special
appointments, that everything on that list was accomplished (and even beyond!)
I could not have asked for a more talented and dedicated team of HIM
professionals then the one I have had the pleasure of working with this past
year. Our results this year far exceeded my expectations. I would like to
take this opportunity to extend my heartfelt thanks and appreciation to all the
committee chairs, committee members and fellow Board members for their
dedication and support during this past year.
I am proud to say that we have met all of the strategic goals
that we set for the past year. Our 5 objectives were:
-
Facilitate effective communication between FHIMA, regional leadership and our
members.
-
Create an environment that identifies recruits, prepares and supports leaders
within the organization.
-
Facilitate the employment of new graduates from HIM programs at the
baccalaureate and associate degree levels, and coding programs at the pre-degree
level
-
To be recognized by Florida State Senators and Representatives as the
leading authority on legislative issues affecting health information management
in our state
-
Form professional alliances with other healthcare related
organizations.
During my outgoing President’s Message at Convention, I will
highlight the specific accomplishments in each of these areas.
I am also proud to announce that this year we had an
unprecedented number of submissions for AHIMA’s CSA Core Service Achievement
Awards. The purpose of the CSA Core Service Achievement program is to recognize
excellence in Component State Association (CSA) efforts and to provide all CSAs
with information and ideas that can be applied to their own state efforts. FHIMA
submitted nominations in 6 out of 8 possible categories:
-
Continuing education programs relating to coding (including Coding
Roundtable activity)·
-
Member communications (such as a website, newsletter, geographic CoP,
or periodic releases of relevant news)
-
Recruitment and retention activities for students
-
Support for local accredited HIM education programs (professional practice
experience support, educator support)
-
Legislative and regulatory advocacy
-
Diversity programs (member or student recruitment, volunteer leadership
development, mentoring programs)
The winners will be announced in mid July.
I want to encourage those of you who
have not yet served in a volunteer capacity to do so. My years of service to
FHIMA have been extremely rewarding both personally and professionally. I have
gained many new skills and refined others all of which have benefitted me in my
career and I have also grown tremendously as a person, but perhaps the most
important benefit gained is the close friendships that I have developed with so
many other HIM professionals not only in Florida, but across the country. I can
honestly say that volunteering in your organization is one of the best decisions
that you will ever make.
FHIMA Announces 2008 Service Award Winners!
Congratulations to our deserving winners!
Distinguished Member- William Kelly McLendon, RHIA
Distinguished Service --Marjorie H. McNeill, PhD, RHIA, CCS
Distinguished Service-- Linda L. Renn, RHIT, CCS, CPC, CPC-H
Educator Award-- Sheila A. Newberry, MEd, RHIT
Literary Award-- Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC
Mentor Award-- Barbara R. Bermudez, RHIT
Outstanding Student -- Jenese L. Fuller
Outstanding New Professional -- Brittany T. Scriven, RHIA
Congratulations to the 2008 FHIMA Scholarship Recipients
HIM Program
Janine Vance
University of Central Florida
Brenda Church, RHIT, CCS
St. Stephens College
Charlotte Stockton Memorial Scholarship
Bethany Briggs
Seminole Community College, Coding Certificate Program
Thanks to the following who contributed to the
scholarship funds this year.
3M Health Information Systems
Central Florida Health Information Management Association
Gulf Coast Health Information Management Association
Iqueu Consultants, Inc.
Ocean Health Information Management Association
Outsourcing Solutions, Inc. (OSi)
Panhandle Health Information Management Association
Professional Outsourcing, Inc.
Pyramid Healthcare Solutions
Southwest Health Information Management Association
Stat Solutions, Inc.
Suncoast Health Information Management Association
FHIMA 2008 Scholarship Contributors for Charlotte
Stockton Memorial Scholarship
Professional Outsourcing, Inc.
Stat Solutions, Inc.
It is such a worthy cause for the future of our Health Information leaders
and FHIMA is proud to be able to provide these scholarships for many years
to come!
Congratulations to the 2008-2009 FHIMA Board of Directors!
On Tuesday, July 15, 2008, the 2008/2009 Board of Directors
will be installed at the Annual Membership Luncheon. The new officers will
be:
President
Dwan Thomas Flowers, MBA, RHIA, CCS
President-Elect
Kimberly Eichner, MBA, RHIA
Past President/Director
Stacie Buck, RHIA, CCS-P, LHRM, RCC, CIC
Directors
Barbara Bermudez, RHIT
Monica Cole, RHIA, CCS
Lisa Libby, RHIA, CCS
Dean Ritchey, RHIA
Diana Spaulding, RHIT, CCS
Kelly Wilson, MBA, RHIA, CHP
Chief Delegate
Lori Langley, RHIA
Executive
Director
Carolyn Glavan, MS, RHIA
Seminole Community
College Starts Programs
Seminole Community College will start offering an associate
degree in science and health information management later this fall at its
new Altamonte Springs campus.
See reprints of articles showcasing this program by clicking
on the following links:
The Orlando Business Journal announces Seminole Community
College's new A.S. in HIM:
http://www.bizjournals.com/orlando/stories/2008/06/09/daily29.html
You can find specific information about the curriculum by
visiting:
http://www.scc-fl.edu/medicalcoding/media/info-packet.pdf
FHIMA
presents… CCS/CCS-P Exam Preparation Workshop
Are you preparing for the exam? Attend this workshop and
you will feel more prepared!
When: Saturday, SEPTEMBER 13th 2008 8:30am-4:00pm
Location: Miami Dade College
More information and registration information will be posted
on the FHIMA website in the coming weeks. Please check the What’s New
section of the FHIMA website (www.fhima.org)
for more information when available.
An
Invitation to attend the FHIMA Leadership Conference
FHIMA would like to extend an invitation for members to
attend the FHIMA Leadership Conference. This conference will be held
Friday, September 19th and Saturday, September 20th at
the Marriott Renaissance Hotel in Tampa, Florida.
The Leadership Conference has been a forum for the state’s
regional HIM association leaders to gather to discuss and plan the
leadership direction of FHIMA and regional associations. It is an
educational opportunity as well as an excellent opportunity to start getting
involved with your association! The FHIMA Board of Directors is committed
to improving communications with members so we have opened up the conference
to all FHIMA members! Come see what it is all about, get inspired to
volunteer for your professional association, meet new colleagues and earn
CEU’s!
Meeting information and registration is still being
developed at this time. Check the What’s New section of the FHIMA website as
details on cost, registration and hotel information will be posted there
when available. The conference will start at 1pm on Friday, September 19th
and end at 5pm. On Saturday, September 20th we will start at 8am
and end around 4pm.
Compliance Alert
By: Kathy Reep
Florida Hospital Association
Subcommittee on Regulations,
Health Care, and Trade Hearing on “The Impact of CMS Regulations and
Programs on Small Health Care Providers”
Background and Overview
The House Small Business Subcommittee on Regulations, Health Care, and Trade
held a hearing May 14 to discuss the impact of Medicare CMS regulations and
programs on small health care providers. Testifying before the Subcommittee
was the Chief Financial Officer (CFO) for the Centers for Medicare &
Medicaid Services (CMS), Timothy Hill, whose testimony largely
focused on CMS’ implementation of the Medicare Recovery Audit Contractor (RAC)
program.
Hearing Summary
At the outset of the hearing, Subcommittee Chairman Charles Gonzalez
(D-TX) noted that the Small Business Committee has jurisdiction over
the Regulatory Flexibility Act (RFA). As such, the Committee is
charged with ensuring that CMS and other Agencies comply with the provisions
set forth in the Act, including those pertaining to small businesses.
According to Gonzalez, several of CMS’ current programs are “causing
particular concerns among small providers,” including the Medicare RAC
program – a program that was initially authorized by the Medicare
Modernization Act of 2003 (MMA) as a three-year demonstration project
but has since been made a permanent fixture of the Medicare program via the
Tax Relief and Health Care Act of 2006 (TRHCA). Under TRHCA, the
Department of Health & Human Services (HHS) is required to expand the RAC
program from a demonstration operating in only three initial states
(California, Florida, and New York) to a nationwide program no later
than January 1, 2010.
Gonzalez cited CMS statistics, noting that CMS under the RAC demonstration
program recovered over $371 million in improper Medicare payments paid to
providers and suppliers in 2007. Of that amount, approximately 96 percent of
payments recovered were considered Medicare “overpayments” to providers and
suppliers with only an estimated four percent of payments termed
“underpayments.” “I find it hard to believe that this represents the true
proportion of underpayments,” Gonzalez stated. Furthermore, Gonzalez went on
to express concern over CMS’ payments to RACs (on a contingency fee basis),
as well as what he considers to be a “lack of proper oversight” on CMS’
part.
In testimony to the Subcommittee, CMS CFO Timothy Hill stated the Agency’s
work with respect to the RAC program and its overall efforts to restore
fiscal integrity in the Medicare program. Hill pointed out that in January
of 2008, the Office of Management & Budget (OMB) listed Medicare as one of
the top three federal programs making improper payments – with an estimated
$10.8 billion in improper payments made during fiscal year (FY) 2007. “Since
1996, CMS has reduced the Medicare fee-for-service error rate from 13.8% to
3.9%,” Hill noted in his written testimony.
According to Hill, CMS has been working very closely with physicians and
other providers to improve the current RAC program prior to its nationwide
deployment. For instance, CMS convened monthly meetings with various state
and national associations to discuss issues pertaining to the current RAC
program as well as ways to improve the demonstration and the upcoming
permanent nationwide program. As a result of those efforts, CMS has
incorporated a number of changes into the Request for Proposal (RFP) for the
permanent RACs, including: (1) requiring that the permanent RACs employ a
medical director (an M.D. or D.O.) and a certified coding expert; (2)
requiring that permanent RACs pay back their fees if they lose at any
level of appeal (as opposed to under the demonstration when the RACs were
only required to pay back their contingency fees if they lost at a 1st-level
appeal but not at subsequent levels); (3) allowing permanent RACs to review
claims in the current FY; (4) imposing a maximum look-back date for improper
payments – permanent RACs will have a three-year look-back window (though no
earlier than claims paid before October 1, 2007); (5) requiring permanent
RACs to operate a web-based system to provide transparency and access to
providers involved in the audit process; (6) establishing a limit on the
number of records a RAC may request from a provider; and (7) emphasizing
provider education and training with respect to the RAC program.
In response to a question posed by Gonzalez as to how many physicians each
RAC would be required to have on staff, Hill noted that while each RAC is
required to have a medical director on staff (who is a physician), CMS does
not place parameters around the actual number of physicians that must be on
staff. It is the job of the medical director, according to Hill, to ensure
that the review of the therapist, nurse, or other professional staff
auditing the provider, is correct.
When asked about the California RAC program and the 40 percent error rate
found in the state’s RAC audits, Hill conceded that the California RAC
demonstration became a “poster-child for bad decision-making” but was quick
to point out that the Agency has taken great measures to ensure that an
independent evaluation of the inpatient rehabilitation claims in the state
were reviewed and that problems were resolved.
The committee probed Hill about CMS’ contingency fee arrangement with the
RACs, specifically inquiring as to the percentage of the fees kept by a RAC
when an appeal is overturned by a federal judge. In responding, Hill
provided the following example to illustrate how the process works.
According to Hill, of a sample of 100 claims, about 13-15 of those claims
will be appealed. Of that amount, only about four claims are actually
overturned – a rate that is consistent with Medicare fiscal intermediaries (FIs)
and carriers.
Hill went on to elaborate that most of the improper payments were the result
of either: (1) an inaccurate assessment of what is medically necessary –
e.g., performing a service that could have been done in a different (and
perhaps less expensive) setting; (2) coding inaccuracies; or (3) lack of
documentation or insufficient documentation.
Hill later noted that there are similar incentives for RACs to identify
underpayments as there are to detect overpayments. However, based on CMS’
assessment of claims over the last 10 years, most of the time Medicare is
overpaying and there are very few instances in which the program actually
underpaid the provider.
Reprinted with permission from
the Florida Hospital Association, 307 Park Lake Circle, Orlando, FL 32803
Inpatient Prospective Payment System Hospital and Long Term Care Hospital Review
and Measurement Fact Sheet
Background
This fact sheet describes a change that is being made by the
Centers for Medicare & Medicaid Services, with regard to the review of acute
inpatient prospective payment (IPPS) hospitals and long term care hospitals
(LTCHs). Medicare Fiscal Intermediaries (FIs) and Medicare Administrative
Contractors (MACs) will now conduct medical review to prevent improper
payment of inpatient hospital claims. Medical review is the process
performed by Medicare contractors to ensure that billed items or services
are covered and are reasonable and necessary as specified under section
1862(a)(1)(A) of the Act. In addition, the Comprehensive Error Rate Testing
(CERT) contractor will now conduct medical review to measure inpatient
hospital payment error rates.
Previously, in addition to their focus on quality issues,
the Quality Improvement Organizations (QIOs)’ responsibilities included the
following for acute IPPS hospitals and LTCHs:
The Hospital Payment Monitoring Program (HPMP), which was
performed on a postpayment basis and consisted of 2 parts:
1. Utilization review of randomly selected claims for
payment purposes, and
2. Measurement of the accuracy of Medicare Fee-for-Service (FFS)
payments to acute IPPS hospitals and LTCHs (that is, the "error rate")
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Performance of provider-requested higher-weighted
diagnosis related group (DRG) reviews;
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Review of Emergency Medical Treatment Active Labor Act (EMTALA)
cases; and
-
Performance of Expedited Determinations.
QIOs are no longer responsible for the functions previously
included in the HPMP. They will retain responsibility for quality oversight
in all Medicare FFS settings, provider-requested higher-weighed DRG reviews,
EMTALA reviews, provider education on quality of care issues, and expedited
determinations.
Rationale
CMS is making this change as part of its commitment to
improving the efficiency and quality of health care delivered to Medicare
beneficiaries. The transition of responsibility for measuring and preventing
improper payments to inpatient hospitals from the QIOs to the FIs, MACs, and
the CERT contractors will allow the QIOs to concentrate on improving patient
quality of care and maintaining quality improvement and provider assistance
efforts. This transition also aligns the oversight of acute IPPS hospital
and LTCH claims with that of all other Medicare FFS provider types.
Timing
The transition is occurring in two phases:
-
The CERT contractor began reviewing claims for the
purpose of measuring error rates for acute IPPS hospital and LTCH claims
on April 1, 2008.
-
We anticipate FIs and MACs will begin reviewing acute
IPPS hospital and LTCH claims, for the purpose of determining the
appropriate payment due and preventing or reducing improper payments,
this summer.
Hospitals will start receiving medical record requests from
the CERT contractor in May, and FIs and MACs will begin requesting medical
records later this summer.
Responsibilities
-
The activities related to acute IPPS hospital and LTCH
review that will now be performed by a different review entity are: FIs
and MACs will perform medical review of acute IPPS hospitals and LTCH
claims, on either a prepayment or post-payment basis, to ensure that
they are for covered, correctly coded and reasonable and necessary
services and will conduct claim adjustments, as appropriate, on claims
which are not.
-
FIs and MACs will conduct provider feedback, through
their medical review departments, based on findings from medical review
of acute IPPS hospital and LTCH claims. They will also continue to
conduct provider education, through their provider outreach and
education department, on issues related to submitting inpatient claims
correctly as part of their goal to reduce the error rate.
-
The CERT contractor will perform reviews on a
post-payment basis, in order to determine the degree to which Medicare
FIs and MACs are paying acute IPPS hospitals and LTCHs claims
appropriately, in accordance with coverage, coding, and medical
necessity guidelines.
These utilization reviews, provider education, and error
rate measurements will be conducted in a manner consistent with that used by
FIs, MACs, and the CERT contractor in the review and error rate measurement
for all other Medicare fee-for-service (FFS) claims.
The activities related to acute IPPS hospital and LTCH
claims review which will continue to be performed by the QIOs are:
-
Quality of Care Reviews due to beneficiary complaints,
complaints other than from beneficiaries, and quality of care reviews
for cases referred by CMS or CMS designated entities (e.g. FIs,
Carriers, MACs, SSAs, OIG).
-
Utilization reviews for Hospital requested
higher-weighted DRGs;
-
Utilization reviews referred by CMS or CMS designated
entities (e.g. FIs, Carriers, MACs, SSAs, OIG.) for cases involving
issues such as transfers and readmissions;
-
Review of Emergency Medical Treatment Active Labor Act (EMTALA)
cases;
-
Expedited determinations; and
-
Provider education on quality of care issues, and other
issues under their purview
(e.g. hospital-requested higher weighted DRG review, etc.).
Claim Review Process
The coverage and payment guidelines used by the FIs, MACs
and CERT contractor will be the same as used in the past by the QIOs, though
some claim selection and review procedures will be different.
Notification and Record Submission: The hospital will know
when a claim has been selected for review in slightly different ways,
depending on the review entity. For purposes of measuring the error rate,
the CERT Contractor will notify providers that claims have been selected for
CERT review via letter or telephone contact.
For prepay review, the FIs and MACs will suspend claims for
review and the FIs and MACs will then send out a request for supporting
documentation. Providers may use the claim inquiry screen in the Direct Data
Entry (DDE) system and verify the status of the claim. They may view the
narrative for the reason code that is applied to a suspended claim. The
narrative will provide the reason for the suspension. Hospitals submit
hardcopy medical records via mail.
For postpay review, the claim is already paid. An FI or MAC
performing postpay review will send a request for medical records to the
provider. The FIs or MACs will review the claim and make any adjustment
necessary to the claim based on the review. Hospitals submit hardcopy
medical records via mail.
Screening and Review: Most QIOs used a commercial screening
tool as a first-level indicator of the appropriateness of the services
billed, though they were not required to use a particular tool. FIs, MACs
and the CERT contractor are also required to use screening criteria in the
review of acute IPPS hospital and LTCH claims, though, as was true for the
QIOs, CMS is not mandating the use of a particular tool.
In addition to use of a screening tool, FIs, MACs, and the
CERT contractor will apply coverage, coding, and medical necessity
guidelines, utilizing clinical judgment in making payment determinations on
each claim, as the QIOs did.
Reviewers: Qualified clinicians, such as nurses and
therapists, will perform the reviews, consulting with physicians or other
specialists as needed. As is the case with all other Medicare claim types
reviewed by FIs, MACs, and the CERT contractor, there is no CMS requirement
that physicians be used to review each acute IPPS hospital and LTCH claim on
which an adjustment may be made.
Comparison Chart
Because of varying statutory requirements, there are some
differences in the claim review processes used by various review entities.
The following chart provides a comparison of the processes used by the QIOs,
CERT contractor, FIs, and MACs.
|
Side-by-Side Contractor Activity Comparison Chart
Issue |
QIOs (HPMP) |
CERT |
FIs/MACs |
|
Review selection |
Random |
Random |
Targeted to claims with suspected improper
payments. Initially, there may be some random review. |
|
When the claim is selected for review |
Postpayment: 3 months after discharge |
Postpayment: Medical record request letter sent ~
35 days after payment |
Prepayment: Shortly after the claim is submitted
or Post payment: Up to 4 years after payment |
|
Credentials of reviewers |
Qualified clinicians |
Qualified clinicians |
Qualified clinicians |
|
Level of physician involvement in review process
|
Review all claims where nonphysician reviewer
identifies a problem with the claim |
As needed for complex cases |
As needed for complex cases |
|
Use of coding experts |
Mandatory |
Mandatory |
Mandatory |
|
Distribution of Program for Evaluating Payment
Patterns Electronic Report (PEPPER |
Mandatory |
N/A |
Undetermined |
Optimal Transcription
TAT
By: Holly Woemmel, MA, RHIA and Barbara Bermudez, RHIT
Members of the committee responsible for creating the
“Transcription Turnaround Time for Common Document Types TAT4CDT”
With the ever changing healthcare environment, decrease in
number of qualified MTs and increasing demands from healthcare providers and
regulation agencies, it was necessary for the American Health Information
Management Association and Medical Transcription Industry Association
(AHIMA/MTIA) to form a Joint Task Force to recommend standards for
turnaround time (TAT) of transcribed reports on selected work types. The
research for TAT recommendations included current technology, workforce
realities, existing TAT guidelines from authorities such as the Joint
Commission (JC) and Centers for Medicare and Medicaid Services (CMS) and to
take in consideration patient safety issues and quality patient outcomes.
The goal of this project was to “outline significant
findings, contributors, impacts and provide recommendations that will create
a framework around which “buyers” and “sellers” of medical transcription
services can engage in dialogue and make informed purchasing and contracting
decisions related to documentation TATs”.[1] It was the Task Force’s
responsibility to really drive home the recommendations of TAT’s with the
ultimate goal to improve efficiencies in operations in the HIM department
and the patients they serve. The recommendations that came out of this task
force mainly focused on hospital’s needs, though, we believe that this could
also hold true in other settings such as large clinics.
The task force was charged with assessing the environment in
a number of ways. Survey data was obtained to measure and analyze current
conditions and established real-world practices from both the Health
Information Management (HIM) and Medical Transcription Service Organizations
(MTSO) management experiences. The main driver for the data collection came
from the hospital side of the healthcare industry business. In addition,
research and review of existing white papers, journals, articles, webs
search’s and other publications was performed, with information obtained
where available.
The increasing demand for medical
transcription of patient care documentation has been particularly notable
over the past 10 years. There are a number of reasons for the increasing
demand. The following are common, but this list is not all-inclusive:
-
An aging population
-
A trend away from handwritten reporting
-
Provider need for streamlined administrative tasks that
provide for more patient care time
-
Perceived greater efficiency
-
Ease and speed of dictating versus other methodologies
-
Correlation of improved accuracy and legibility to
transcribed reports
-
Belief that dictation allows clinicians to document a
more comprehensive report in greater detail
-
The need to integrate documentation with the EHR
Also, through the survey results
of the HIM Managers and MT/MTSO Managers, there were three main categories
that affected compliance with TAT standards. Those were the following:
-
Staffing
-
Changes in work volume
-
Transcription anomalies,
examples, mumbling, poor dictation, gaps and blanks in dictation and
technology issues.
The dilemma of keeping up with
the increasing demand has not been readily solved, and this continues to be
an obstacle, with increasing documentation volumes and the concurrent demand
for faster TATs both starkly juxtaposed against a critical workforce
shortage. There are as many reasons for the workforce shortage as there are
reasons for increasing documentation:
-
An aging workforce
-
Limited access to medical transcription training
-
Poor visibility of the profession to the general public
and potential workforce candidates
-
The long-term learning curve to reach a significant
level of expertise
-
Competition for workforce from other allied health
professions
-
Competition from other work-at-home professions
-
Declining compensation
The typical laws of supply and
demand have little correlation or evident application in medical
transcription. When demand is up, prices typically increase but demand for
low-cost transcription deliverables has resulted in a paradoxical
suppression of wages for those qualified to meet the demand. Pair that with
the decreasing number of qualified professionals to do the job, and you have
a significant economic conundrum. In reality, the price per unit (line,
report, minute, page, character, etc.) of medical transcription has
decreased significantly over the past 10 years, as have wages for the MT,
despite high demand (increased documentation needs) and low supply (critical
workforce shortage).
Based on the analysis of data secured, the task force used a
weighted average methodology to calculate the recommendations of TAT for the
common document types. The definition for TAT utilized in this white paper
is from the time dictation is completed until the time the report is
delivered, either by printed medium or electronically to a repository. The
basis of these recommendations included survey results and statistics
compiled from a number of significant MTSOs currently providing medical
transcription services to over 1200 clients nation-wide.
The following recommended TATs are based on these data.
Recommendations for TAT by major work types are as follows:
|
History & Physical |
8 hours |
|
Operative Report |
8 hours |
|
Discharge Summary |
24 hours |
|
Inpatient Progress Note |
8 hours |
|
Consult |
12 hours |
|
Radiology |
4 hours |
The task force closely studied and examined the research and
survey data as components and factors directly impacting TAT delivery. Based
on the development of new technologies, workforce realities, current
practices, implementation considerations, as well as the few existing
standards, the key discoveries due to the absence of a collection of such
important findings revealed the need to first establish these outcomes as
the state of the industry.
Although there is a notable variance in current TAT4CDT as
evidenced by the survey contributions, the commonality brought forth
throughout is the striking difference in the size and type of healthcare
facility where these TATs are in place. The needs and demands in TAT of
healthcare facilities vary and this is a major contributor that explains the
wide range of the TAT results. With these recommendations, one must remember
that if the TAT’s are decreased from what your organization is currently
utilizing, it may increase the cost of your transcription, whether it is
done in house or outsourced. The driver for cost would be increased
staffing to meet TAT’s, after hour pay for additional coverage or sending
additional overflow work to your transcription vendor. One would need to
make sure that they are looking at the cost/benefit ratio for their
organization
The race down the track to optimal transcription TAT
standards has lead to National TAT standards that will ultimately improve
efficiency in patient care, meet Joint Commission and other regulatory
agency expectations and strengthen the healthcare billing and revenue cycle
process.
The HPMP Ending
By: Patty Collier, RN, FMQAI
and Ferdinand Richards, MD, FMQAI
Transition of HPMP Out
of QIO Program
Effective August 1, 2008 with
the beginning of the the 9th Statement of Work, Quality
Improvement Organizations (QIOs)
will no longer be responsible for implementing the Hospital Payment
Monitoring Program (HPMP).
The purpose of HPMP was to
measure, monitor, and reduce the incidence of improper fee-for-service
inpatient acute care Medicare payments. QIOs will no longer be responsible
for these functions, and funding for QIO assistance related to these
responsibilities will cease. These responsibilities are being transferred to
other entities. Hospitals should be aware that support and education
provided by QIOs related to payment error reduction will no longer be
available. Hospitals may wish to contact the following organizations for
questions previously directed to QIOs related to compliance or payment error
reduction activities:
Many QIOs also distributed
quarterly hospital-specific comparative data reports (the Program for
Evaluating Payment Patterns Electronic Report, or PEPPER). Although not
required to do so, QIOs will be able to distribute PEPPERs through the
January 2009 data release; FMQAI will not be providing these reports to
hospitals. A metric for readmissions within 30 days has recently been added
to the PEPPERs to aid QIOs in efforts related to this 9th
Statement of Work area. It has not been determined at this time whether
PEPPERs will be generated after January 2009. The tools and resources posted
at
www.hpmpresources.org will be available through January 2009.
For error rate calculation, the
final sample under HPMP was selected in February 2008; October 2007
discharges were sampled. Sampling after this date was discontinued, as it is
not possible to utilize the samples toward the final error estimate that
HPMP will contribute, the agency estimate to be released in November 2008.
Inpatient records for calculating the national fee-for-service Medicare
error rate will be sampled under the Comprehensive Error Rate Testing (CERT)
program beginning in April 2008. More information on the CERT program is
located at
http://www.cms.hhs.gov/cert.
QIOs will continue to perform
other statutory and regulatory mandated review activity and quality
improvement as described in the 9th Statement of Work.
Even through HPMP will end at
the close of the 8th Statement of Work, FMQAI will still be under
contract with CMS to provide case review for the Beneficiary Protection
aspect of the 9th Statement of Work. In the 8th
Statement of Work, FMQAI completed over 17,000 case reviews, of which 1,100
(6%) were for HPMP. FMQAI will continue to perform a large number of
quality, utilization and coding reviews for the 9th Statement of
Work. As outlined above, however, the educational piece of this process will
no longer reside with FMQAI.
After evaluation of case review and HPMP data in the 8th
Statement of Work, FMQAI would like to share the following information:
PTCA, PCI, and AICD
Pacemaker Billing
As technology has progressed and the need for prolonged care
after these procedures has become less, FMQAI recommends that these elective
procedures be billed as outpatient.
Inpatient Only List
Please remember that Medicare
pays by the Federal Register Addendum E Inpatient only list that can be
found at:
http://www.cms.hhs.gov/apps/ama/license.aspfile=/HospitalOutpatientPPS/Downloads/CMS1392FC_Addendum_E.zip
HPMP SPECIAL PROJECTS
Case Management
Assignment Protocol
The latest version of CMAP is located on our website at
www.fmqai.com. CMS had promoted national attention to CMAP through the
ongoing consortium project with six QIOs and their respective hospitals.
Chest Pain Project
The Chest Pain Project has yielded great success in Florida
as well as Arizona, our partner QIO in the project. Both QIOs use the CMAP
as one of the interventions to decrease unnecessary chest pain admissions.
For more information on the original CMAP and Chest Pain projects, please
see the published versions in:
-
A Case Management Protocol, Reducing Unnecessary Medicare Admissions
in Florida. Lippincott’s Case Management. 2005 Mar-Apr;10(2):72-20.
-
Reducing Unnecessary Medicare Hospital Admissions for Chest Pain in
Arizona and Florida. Professional Case Management. 2008;13:74-84
HPMP ANNUAL REPORT
Sepsis
FMQAI data suggest that sepsis
is the number one most disagreed with high-weighted DRGs (HWDRG) as well as
the leading DRG contributing to the Florida HPMP payment error rate.
Complex Pneumonia 079 vs 089
Complete pneumonia continues to
be a focused concern as pointed out in the Florida PEPPER data as well as
demonstrated in HPMP analysis. Aspiration pneumonia was a more prominent
area of concern.
30-Day Readmits
PEPPER data as well as other audits have focused on 30-day
readmits as an area of potential recoupment of Medicare funds.
Physician Query Process
FMQAI supports the physician query process. Non-leading
queries, along with appropriate documentation in the medical record, tend to
reflect best practices.
FMQAI would like to thank all
of Florida’s Medicare hospitals that participated in HPMP in both the 7th
and 8th Statements of Work. It is because of hospitals’ support
that FMQAI completed HPMP for CMS with a grade of Excellent Pass.
Please do not hesitate to call
for any questions or concerns.
Patty Collier, RN,
813-354-9111, ext. 3539
Ferdinand Richards, MD,
813-354-9111, ext. 3120
Transition of Inpatient Hospital Record Reviews from QIO to FI/MAC
By Barbara
Flynn, RHIA, CCS
Florida Hospital Association
There has
been considerable discussion about the change in the scope of work for the
Quality Improvement Organizations (QIOs) and what would happen with current
reviews for inpatient medical necessity and coding. The attached ADVANCE
copy of a CMS fact sheet outlines the plans for transition from review by
the QIOs to the Medicare fiscal intermediaries and Medicare Administrative
Contractors. Please note that the review at the FI/MAC level could be pre-
or post-pay and the contractor must use targeted case review, based on data
analysis, to select records and issues for review. There could be some
random review early in the transition.
It is our
understanding that a CMS transmittal will be issued shortly on this change,
but we wanted to make sure you had the information that we have received as
early as possible.
If there are questions on the review changes, please do not
hesitate to contact either kathyr@fha.org or
barbaraf@fha.org
Self-Mastery: What Is It, Who’s Got It, And How Do We Increase It?
By:
Dr. Brian Higley
The Building Blocks, April 12th, 2007
“Self-Mastery” is a concept that
is repeatedly recommended as essential to leadership excellence. Our firm
recently polled over 80 individuals - from CEO’s at a Fortune 500 level to
high-functioning college students working at internships - on their opinions
of their own levels of Self-Mastery. We found some very interesting results
and wanted to share them in hopes of: (a) facilitating a robust conversation
about Self-Mastery and (b) helping individuals conceptualize what
Self-Mastery is, why it is so important, and how to move toward increasing
it.
What Did Participants Report?
Now, on to the “meat and potatoes” of the poll: what did our poll
participants have to say about Self-Mastery? First of all, here were the
items we asked people to rate themselves on; these items represent the
factors that we have found to be most strongly associated with Self-Mastery
(with average scores of respondents - based on a 1-5 point scale - in
parenthesis):
-
I am conscious of the many opportunities to succeed that
lie within myself (average score: 4.42)
-
I am good at identifying and resolving the “hot button”
issues (topics that create anger, resentment, or doubt) within myself
(average score: 3.90)
-
I am skilled at increasing my positive thoughts and
emotions when I would like to do so (average score: 4.06)
-
I consistently identify and pursue the most meaningful
goals in my life (at work and outside the office) (average score: 3.67)
-
I find it easy to adjust my behaviors and thoughts to
fit my needs across many situations that require both the ability to
focus within myself and interact with others effectively (average score:
4)
-
I consistently structure my mind and organize my
environment to minimize stress and increase focus (average score: 3.52)
-
I consistently create plans that are likely to succeed
based on strategies that have proven to be successful in the past
(average score: 3.98)
-
My lifestyle is one that contributes to my energy,
focus, and effectiveness levels (average score: 3.80)
-
I am good at opening up enough free time for leisure and
using that time to refresh and re-energize myself (average score: 3.33)
-
I have solid influence over my thoughts, feelings, and
actions – even when dealing with unplanned-for challenges (average
score: 3.98)
As I looked over this data, my
mind went immediately to the top three scores and the bottom three scores on
this list. I thought a discussion about those scores - and how the results
of this poll relates to my experiences researching (in much more
scientifically rigorous ways than this poll) and attempting to facilitate
Self-Mastery levels in my clients - might be a good place to go next.
A. The Highest Scores.
The 3 highest scores above were on to what I call the “success” items (items
related to achieving goals) - items I’ve seen most high level leaders truly
excel in. Most leaders I interact with tend to be:
-
aware of the many opportunities to succeed in life (4.42 average in
this poll),
-
able bring about more positive emotions and thoughts
when needed (4.06), and
-
skilled at flexing to fit the needs of a situation or
environment (4.00).
These abilities are some of the
very reasons why leaders rise to their positions. No surprises here,
especially since we polled some of the more successful people we know.
B. The Lowest Scores.
The 3 lowest scores above were on what I call the “satisfaction” items
(items related to enjoying life). These scores were also not surprising to
me, as they continuously come up as some of the greatest Self-Mastery
challenges for most leaders that I’ve encountered over the past 10 years.
Even the best leaders often report:
-
struggling to prioritize their many goals (3.67 average in this poll),
-
wishing that their minds and environments were more focused (3.52),
and - perhaps most universally. . .
-
not having enough satisfying leisure time (3.33).
It’s been my experience that
these 3 items are all interconnected, with less ability to prioritize often
leading to less focus, which in turn leaves less time for satisfying
leisure.
C. How Do The Highest and
Lowest Scores Relate to Each Other? My experience with leaders has
led me to believe that many leaders allow their Self-Mastery strengths to
create Self-Mastery weaknesses. For example:
-
being able to “see opportunity everywhere” (a Self-Mastery strength),
as most outstanding leaders tend to be able to do, can also lead to a less
focused life (a Self-Mastery weakness); a life of chasing goals without a sense
of which ones are truly essential to what they want to get done.
-
being able to bring about positive thoughts and feelings when needed
can lead to ignoring the leisure activities that bring about these feelings more
naturally; most people who cannot influence their emotions absolutely need to
put aside leisure time, while those who can bring these feelings about
internally can more easily ignore leisure.
-
finally, flexibility can also contribute to “flexing” out of some of
the most meaningful goals in our lives - goals related to family, leisure, and
truly relaxing activities.
Balancing Success and
Satisfaction: How to Avoid Creating Self-Mastery Weaknesses Out of Your
Strengths. The most important way, I think, to avoid creating weaknesses
from strengths is not anything that you probably haven’t heard
before - but might be something that you haven’t actually done
on a regular basis: prioritizing opportunities and time and spending time to
structure you life for more focus and satisfaction while moving toward your
most critical goals.
If you agree with this need but
do not actually perform this activity on a regular basis - you might want to
investigate why you don’t. I’ve been collecting reasons for not doing
what’s good for oneself for over 7 years now, so if you’d like to place a
reason for not “doing prioritization” in the comment section below, I’d like
to hear your view on this (I’ll bet you a dime that the most common reason
for this is something like “I don’t have the time” - do you owe me a
dime?). Below this section of this article is a link for those who are
curious about how we assist people with “doing” Self-Mastery.
Some Final Words. Thanks
to all who participated in our poll and to everyone who took the time to
read this article and/or provide us with comments about either the article
or the SBSS. We look forward to hearing more from you all about
Self-Mastery, and hope that this article added value to your day.
Jacksonville FHIMA Member Receives Health Care & Natural Sciences Award for
Excellence in Instruction
By: Dwan Thomas Flowers, MBA, RHIA, CCS
FHIMA President-elect 2007-2008
Eudelia Thomas, MS, RHIA, fondly known to all as “Skip,” received the 2008
Marcus E. Drewa Endowed Chair for Excellence in Instruction Supporting
Health Care & Natural Sciences Award. The award recognizes outstanding
contributions of a faculty member whose actions directly impact students
seeking healthcare careers. In order to be eligible for such an award, the
nominee must have proven service to the community in the area of healthcare
continuing education programs; demonstrated innovation in teaching,
recruitment and development of programs as well as proven service to the
nominee’s discipline.
Unequivocally, Skip meets all criteria. Skip has been
involved in the Health Information Management (HIM) field for over 25 years.
She has been committed to the advancement of the profession. She currently
serves as the Chair for the Health Information Management (AS degree) and
Medical Coding and Billing (Applied Technology diploma) programs at Florida
Community College of Jacksonville. She basically, single-handedly built the
program from its inception. The program has progressed over the years from
having approximately 12 enrollees to an all-time high of 30 potential,
simultaneous graduates. Her impressive energy and passion related to HIM are
unrivalled.
Skip is one of the more involved professionals. She
emphasizes to her students the importance of professional service via
volunteering and ongoing academic pursuits. She leads these students by
example and has been intimately involved in various volunteer roles for the
Northeast Florida HIM Association (NEFHIMA) as well as FHIMA. She has
served as President and Treasurer for NEFHIMA during multiple terms. She
has recently served as the Service Awards Chairperson for FHIMA.
One of the more noteworthy projects in which she is involved
includes the partnership between Mayo Clinic Jacksonville and FCCJ. The
community has a need for educated, credentialed HIM coding professionals,
and Mayo’s requirements for coding positions are strict, including a minimum
of an Associate level degree in a healthcare related field in conjunction
with the RHIA, RHIT or CCS credential. Not only is there a strong
recruitment presence from the pool of FCCJ’s new, HIM graduates but also
those existing Mayo employees that did not meet these requirement were given
a specified period to meet the requirements. During periods from 2004
through 2007, Skip made quarterly visits to Mayo Clinic to educate the
employees on how to enroll in HIM programs. There were also a few hands-on
sessions that allowed employees to enroll or register for their next classes
during these periods. Eventually, this resulted in the FCCJ classes being
offered on the Mayo campus when there was sufficient enrollment. This was a
win-win situation and further exhibits how she was willing to go above and
beyond to meet the mutual needs of the program and the community.
Skip is a highly visible educator in the allied health
arena. She has experience in text book knowledge, real world application and
professional affiliations. These qualities continue to make her a
sought-after individual for her expert opinions. With this mix of passion
for her students’ success and dedication to her profession, she proves an
excellent candidate for this recognition. Acknowledgment of a HIM
professional for an award of this stature is encouraging, refreshing and
attracts the type of attention that adds validity to the science of HIM.
We are proud of her accomplishments and congratulate her on
behalf of FHIMA!
HHS
Selects 12 States for Medicare EHR Incentive Project
Last week,
Health and Human Services (HHS) officials selected 12 states and communities to
participate in a five-year Medicare demonstration project that will provide
local physicians with financial incentives for using electronic health record (EHR)
systems. The project is designed to determine whether incentives can encourage
small and medium-sized physician practices to increase their use of EHRs.
Individual physicians could receive up to $58,000 over the five years, while
physician practices could receive up to $290,000.
The Centers for
Medicare and Medicaid Services (CMS) will evaluate the participating physicians
on whether they meet the program's benchmarks, and doctors who meet or exceed
the benchmarks will be eligible for the highest incentive payments, according to
HHS Secretary Mike Leavitt. In the first year, physicians will be judged on how
effectively they use EHRs and in the second year they will be required to report
on national quality measures. Click
here for more information.
ONC Commissions
Medical Identity Theft Assessment
The Office of
the National Coordinator for Health Information Technology (ONC) awarded an
approximately $450,000 contract to Booz Allen Hamilton to assess and evaluate
the scope of the medical identity theft problem in the US. National coordinator
for health information technology Robert Kolodner, MD, has noted that medical
identity theft stories are being documented at an increasing rate, bringing to
light serious financial, fraud, and patient care issues. ONC recognizes that
health IT is an important tool to combat the threat of medical identity theft.
Public and government input is being sought to better understand how health IT
can be utilized to prevent and detect medical identity theft as well as build
consumer trust in electronic health information exchange. ONC believes it is
imperative to obtain a more comprehensive understanding of this issue from a
variety of perspectives and to create an open forum for dialogue to work
proactively to address medical identity theft.
Three specific
deliverables corresponding with each of three phases will result from this
assessment.
A comprehensive
environmental scan of the medical identity theft problem in the US particularly
focusing on the intersection of health IT
A one-day town
hall meeting to enable healthcare experts to share knowledge and experience of
medical identity theft and how health IT can be utilized to prevent and detect
medical identity theft
A final report
and road map
To learn more, click
here.
Journal Rolls Out New Web Site
The Journal of AHIMA has rolled out a new Web site with a new look and
increased functionality. The site is a companion to the print journal, offering
additional material related to each month’s issue. Journal staff will
post bonus material, updates to published stories, and highlights of Web-only
material such as practice brief extras. The site is also a place to check for
new online-only material, such as updated practice briefs and links to resources
including sample policies and checklists. Visit the Journal of AHIMA
online at its new Web site at
http://journal.ahima.org.
Polls Now Open for AHIMA
Election
The AHIMA
Election is now under way so plan to vote and get the message out to your fellow
HIM professionals to cast their vote as well. Please note that the polls will
close on June 30 at 6 p.m. ET. (Please note that since the polls opened an
hour later than officially published, they will close an hour later on June 30
.) Remember that AHIMA members will only be able to cast their vote via the
AHIMA Web site. The June Journal of AHIMA includes each candidate’s brief
bio, job description, and photo on pages 73-77. The “Resources” section of the
AHIMA Community of Practice includes a detailed profile of the candidates and
their photo.
To access the
CoP, visit www.ahima.org and go to myAHIMA on the right side and enter your
AHIMA ID number (the seven-digit number on your membership card) and your
password. Once in myAHIMA, select the CoP logo to enter. (See “CoP News You
Can Use” in this e-alert for complete voting directions.) The summaries of the
discussion threads from the Candidate CoP are posted in the “Resources” section
of the AHIMA Community, under the category AHIMA Election–2008.
New HIM Marketplace Now
Available
AHIMA has
launched The HIM Marketplace, a new resource offering comprehensive access to
HIM industry service and product suppliers. This new product provides a
convenient way for customers and providers to interact with each other. Members
can visit the HIM Marketplace at
www.thehimmarketplace.com when researching HIM-industry product and service
providers. HIM industry suppliers are welcome to reserve their listings today.
New Article Posted to PHIM
Web Site
The latest
article posted to Perspectives in Health Information Management, “Record
Retention Practices among the Nation’s ‘Most Wired’ Hospitals,” examines health
record retention practices among HIM professionals in acute care general
hospitals in the United States. This second part of a two-part study examines
the relationship between researcher-assigned storage media profiles, retention
periods, and factors that influence record retention periods such as retention
of secondary data, vendor usage, and continued reliance on paper in environments
where EHRs exist. Author Laurie A. Rinehart-Thompson, JD, RHIA, CHP, used a
self-reporting survey instrument to collect data from randomly selected
hospitals. The results showed that HIM professionals exercise considerable
responsibility and give a great deal of input relating to the administration and
oversight of health record retention policies and the determination of record
retention periods. Click
here to view the complete article.
Remember a Loved One
with a Memorial Gift
The Foundation
of Research and Education (FORE) accepts contributions from AHIMA members in
many ways. For example, memorial gifts are accepted all year long. Contributions
can also be made in memory or in honor of colleagues, family, and friends. These
contributions are a thoughtful way to remember or recognize members while
supporting the FORE Merit Scholarship Program, which awarded 95 scholarships in
2007. To view a list of memorials, click
here.
Plan to Attend AHIMA’s
Summer Meetings
Plan ahead and
visit Chicago in July for summer meetings including the Community Education
Coordinator session (by invitation only), Summer Team Talks, Leadership
Conference, and the Coding Roundtable Summit. Join your colleagues for these
great meetings and receive continuing education units.
July 17—Education
Coordinator Session: (by invitation only)
July 18—Summer Team Talks
July 19–20—Leadership Conference
July 20—Coding Roundtable Summit
July 21-24—Executive Skills Institute (AHIMA Office)
All meetings will be
held at the Wyndham Hotel in Chicago, IL. You can register now for the meetings
online and find hotel information
here. Those who register for the meetings plus the Summer Team Talks
Reception online will receive an e-mail confirmation. The registration
deadline is July 13 and the hotel registration cut-off date is June 18. To
register for the Executive Skills Institute click
here.
CoP News
You Can Use - AHIMA Election Voting Guidelines
Voting in
AHIMA’s election via the Communities of Practice is easy and convenient. Follow
the instructions below to cast your vote.
Go to
www.ahima.org and select myAHIMA on the right side.
Enter your
AHIMA ID number (the seven digit number on your membership card). Make sure
you include all numbers, including leading zeros
Enter your
password. Please note that if you have never created an AHIMA password
online or otherwise updated your password with AHIMA, your default password is
your last name. If you are a long-time member of AHIMA and have changed your
last name (due to marriage, for example), your password may still be your last
name as originally provided to AHIMA. If you applied for membership online and
created your own password, use that password. If you have changed your password
through the profile, please use that password.
Select the
Enter myAHIMA button.
Click on the
Communities of Practice icon in myAHIMA. You will be taken to the CoP.
First-time users
will see the Terms and Conditions of use. You will need to click the Accept
button before you can enter the CoP for the first time.
You will see the
screen with a link to the National Election. Click on that to begin the voting
process.
Members Experience the
Benefits of ACE
The ACE (Action
Community for e-HIM Excellence) Challenge mobilizes a network of experts and
change agents by defining, preparing, engaging, mentoring, and recognizing those
working to transform HIM practice. Once you become an ACE member, you can track
your activities in a database AHIMA provides. If you are already an ACE member,
be sure to record your activities. To learn more about ACE and take the self
assessment, click
here.
AHIMA
Convention and Exhibit Registration Now Open
Plan now to join
us at the 80th AHIMA Convention and Exhibit October 11–16 in Seattle, WA.
Equip yourself to navigate challenges, meet today’s requirements, and prepare
for what’s next in the HIM profession. Registration and housing are now open.
AHIMA has secured the best hotel rates. Make your reservations before September
12. Click
here for details.
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