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The Centers for Medicare and Medicaid Services (CMS) has freed up $730 million in state grant funding to support states in implementing health IT projects and new payment and delivery models.
This new funding builds on what the agency spent in 2013 helping 25 states with its State Innovation Models program, which helped states implement accountable care organizations (ACOs), medical homes, bundled payment programs, and other initiatives, Health Data Management reported.
According to the CMS announcement, $700 million of the new funds have been designated to help support states joining the “Model Test” program for the first time. The other $30 million will be awarded to new participants, as well as states that have already received funding in 2013, to implement “Model Design” cooperatives.
The announcement also said that Model Test states could receive between $20 million and $100 million per state. To qualify, states must develop a clear health IT plan that includes:
- Data quality infrastructure to support care and payment
- Expanding coordination across the care continuum
- Patient engagement and transparency
States’ proposals to participate in the Model Design program must include strategies for the following areas:
- Plan for improving population health
- Healthcare delivery system transformation plan
- Payment and/or delivery service model
- Leveraging regulatory authority
- Health information technology
- Stakeholder engagement
Click here to read the CMS announcement in full.
Becoming certified is mandatory with some careers, while in others, it is recommended or simply considered voluntary. Even when it is not required, obtaining a certification can give a job seeker the edge with a prospective employer. For those who already have a job, it can increase the chance for promotion. Medical billers and coders sometimes wonder if getting a voluntary medical billing and coding certification is worthwhile.
First, a bit about certification, which is usually obtained after graduation from a formal educational program. Individuals must take and pass a certification exam to demonstrate that they meet a minimum competency level. Several organizations offer certifications in different areas of the medical billing and coding field. Most of them are professional membership-based societies and in nearly all cases, the certification is valued for a certain period, typically one year. To renew the certification, the individual must earn a specified number of continuing education units.
It is important to distinguish this voluntary certification process from a state-mandated licensing requirement. Currently, no U.S. state requires a license to practice as a medical biller or coder. Though certification is also not required, it helps people illustrate their commitment to this profession and increases potential income and advancement opportunities. By holding a certification, individuals have hard evidence that they possess the basic level of knowledge important to performing well within this career.
The American Medical Billing Association, AMBA, offers the Certified Medical Reimbursement Specialist (CMRS) certification. The required exam, which costs $325 plus the cost of AMBA membership, features 16 sections containing 700 questions. The questions cover medical terms, medical coding, insurance reimbursement, federal compliance, and claim appeals. To receive the CMRS designation, a person must score at least 85 percent on the exam.
Both the Certified Medical Billing Associate (CMBA) and Certified Healthcare Billing and Management Executive (CHBME) designations are offered by the Healthcare Billing and Management Association. These are designed for supervisors, managers, and executives in medical billing and coding. The American Health Information Management Association (AHIMA) offers the highest credentials in medical billing, RHIA and RHIT. RHIA, a Registered Health Information Administrator, manages medical records and other patient health information. An RHIT, Registered Health Information Technician, is an information technician who specializes in medical records and related computer systems and applications.
In the field of medical coding, certifications are offered by both AHIMA and the American Academy of Professional Coders (AAPC). Deciding which credentials to obtain requires determining the desired career path and which designations a relevant employer will prefer. AAPC certifications include Certified Professional Coder (CPC) and AHIMA certifications include Certified Coding Associate (CCA) and Certified Coding Specialist (CCS).
Whether individuals are medical billers or coders, their level of experience, type of employer, and other factors determine which type of medical billing and coding certification is appropriate. The good news is there are plenty of certifications to choose from and none of them are currently voluntary. People can spend time obtaining multiple certifications to give themselves a competitive edge for hiring, pay, and promotions.
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The Senate voted today to approve a bill that will delay the implementation of ICD-10-CM/PCS by at least one year. The bill now moves to President Obama, who is expected to sign it into law. The bill was passed 64-35 at 6:59 pm ET on Monday, March 31.
The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, mainly creates a temporary “fix” to the Medicare sustainable growth rate (SGR). A seven-line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set on October 1, 2014.
In a statement on the Senate vote, AHIMA officials said they will work to clarify outstanding questions raised by the delay and continue to work with government officials to implement ICD-10.
“On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “AHIMA will continue our work with various public sector organizations and agencies such as the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health IT, and the National Center for Health Statistics (NCHS) along with our industry partners such as the ICD-10 Coalition so that ICD-10 will realize its full potential to improve patient care and reduce costs. These are goals that AHIMA and other healthcare stakeholders and our government leaders all share.”
Since the transition to ICD-10 “remains inevitable and time-sensitive because of the potential risk to public health and the need to track, identify, and analyze new clinical services and treatments available for patients,” AHIMA said in a statement the organization will continue to lend technical assistance and training to stakeholders as they are forced to navigate the challenge of preparing for ICD-10 while still using ICD-9.
Thousands of AHIMA members and ICD-10 proponents contacted their congressional representatives and senators over the last week asking them to vote against the SGR bill and not delay ICD-10.
Congress Working Against SGR ‘Fix’ Deadline
Congress was working against a deadline of today, March 31, to reform or “fix” the SGR before it directly impacted physician payment. Without a fix to the SGR formula, Medicare physicians faced a 24 percent reimbursement cut beginning April 1. H.R. 4302, introduced by House Representative Joseph Pitts (R-PA), will replace the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015.
Physician groups, including the American Medical Association and a coalition of nearly 90 state and national medical societies, have come out against H.R. 4302 since it does not provide a long-term solution to the SGR issue. The insertion of the ICD-10 delay section into H.R. 4302 was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely.
The original House bill was negotiated at the senior leadership level and quickly pushed through the House on March 27 via a voice vote, where no roll call was taken, no votes were tallied, and with the majority of representatives still out on a previously called recess.
“There’s no integrity in what we’re getting ready to vote on,” remarked Senator Tom Coburn (R-OK) as he spoke against passage of the bill despite the pressing deadline. Drawing a comparison with the principles of medicine that you don’t treat symptoms but instead treat the disease, Coburn also noted that the continued passage of SGR patches represents a corruptible process that hides truth from the consumer and demonstrates a lack of transparency from Congress. Coburn also displayed a poster that he said characterized Congress’s current methods during his speech that read “Put Off Until Tomorrow What You Should Be Doing Today.”
On Monday Senate Finance Chairman Ron Wyden (D-OR) did introduce a new SGR bill, S. 2157, that did not include the ICD-10 delay provision and would have addressed not just a “fix” for SGR but wider reform. However, Sen. Jeff Sessions (R-AL) objected to voting on S. 2157 and instead proposed the Senate vote on S. 2122, a SGR reform bill introduced on March 12 and sponsored by Sen. Orrin Hatch (R-UT) that would also repeal the individual insurance mandate of the Accountable Care Act. This vote was also objected to by senators, who in the end voted on H.R. 4302 which put off larger SGR reform to the future and delayed ICD-10 for at least one year. This legislation will become the 17th patch of the SGR since 1997.
This is the second time ICD-10 implementation has been delayed. The original compliance date of October 1, 2013 was officially pushed back a year on September 5, 2012 by CMS, who noted in their ICD-10 delay final rule that “some provider groups have expressed strong concern about their ability to meet the October 1, 2013 compliance date and the serious claims payment issues that might ensue if they do not meet the date.”
But this recent legislative call for a delay likely came as a surprise to CMS. On February 27 CMS Administrator Marilyn Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”
Impact of Delay Wide Reaching, Next Steps Unclear
The impending delay of ICD-10 raises a vast slate of questions for coding professionals, provider administrators, education entities, and even the federal government. The focus will likely turn to CMS, who will need to provide the healthcare industry guidance on the exact new implementation deadline and how to move forward.
The delay of ICD-10 impacts much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October. The extent of the logistical challenges and costs associated with “dialing back” to ICD-9-CM are not yet fully understood, AHIMA officials said, but are expected to be extensive.
CMS has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay. This does not include the lost opportunity costs of failing to move to a more effective code set, AHIMA said.
Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices had begun moving into the final stages of costly and comprehensive transitions to the new code set—even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM/PCS Coordination and Maintenance Committee.
The delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.
The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification. ICD-10 proponents have called the new code set a more modern, robust, and precise coding system that is essential to fully realizing the benefits of recent investments in electronic health records and maximizing health information exchange.
While today’s vote delayed ICD-10 implementation, AHIMA officials said they will continue working to ensure that another delay does not occur legislatively. Over the upcoming weeks, updates will be added to AHIMA’s Advocacy Assistant with instructions on how members can continue to advocate their members of Congress on behalf of ICD-10.
“As demands for quality healthcare data continue to increase, this delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions,” Thomas Gordon said. “It is truly unfortunate that Congress chose to embed language about delaying ICD-10 into legislation intended to address the need for an SGR fix in their effort to temporarily address the long outstanding and critically important physician payment issues.”
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Preliminary recommendations for stage 3 of the “meaningful use” EHR Incentive Program were released Tuesday by an Office of the National Coordinator for Health IT (ONC) workgroup.
The recommendations were presented by the Meaningful Use Workgroup during a meeting of the ONC Health IT Policy Committee, who reviewed and approved the recommendations, marking an important step toward the development of a final stage 3 rule.
The majority of the stage 3 measure recommendations are updates to objectives included in stage 2 meaningful use, with some enhanced with more difficult provisions in order to increase the expected benefit to healthcare improvement that comes with meeting the measures.
For example, currently in stage 2 meaningful use eligible professionals must give at least 50 percent of their patients the ability to view online, download, and transmit their health information within four business days of the information becoming available to the provider. Hospitals are required to provide access to 50 percent of patients within 36 hours of discharge. Both providers need to ensure more than five percent of patients actually view their records.
In the stage 3 recommendations, both eligible professionals and hospitals would only have 24 hours to give at least a majority of their patients the ability to view online, download, and transmit their health information—if that information was generated during the course of their visit. Labs and other types of information not generated during the course of the visit would need to be available within four business days. The workgroup recommended that the requirement for patients to actually view their information be removed in stage 3.
Also, the current stage 2 measure to record patient demographics in the medical record for more than 80 percent of unique patients seen during the reporting period has been enhanced. In stage 2, eligible hospitals must have an EHR that can record the preferred language, sex, race, ethnicity, date of birth, and date and preliminary cause of death in the event of mortality.
The stage 3 recommendations call for hospital EHRs to record this data as well as record:
- A patient’s preferred method of communication (i.e., e-mail, telephone, letter)
- Occupation and industry codes
- Sexual orientation or gender identity
- Disability status
New Measures Recommended
Several new measures were added to the recommended slate as well. One new measure, if inserted into the stage 3 meaningful use final rule, would have vast implications for health information management (HIM) professionals and their oversight of the medical record.
A new recommended menu item states that eligible professionals and hospitals must receive provider-requested, electronically submitted patient-generated health information through either structured questionnaires—such as screening questionnaires, medication adherence surveys, and intake forms—or secure messaging. The method of entering the information into the EHR would be at the discretion of the provider. Patient-generated information provided through mobile devices would also count toward the measure.
Currently many HIM professionals have debated the best way to safely integrate patient-generated information into their health record, while physicians have debated over whether or not they can trust such data as reliable.
Another new measure that has HIM implications is a proposed menu measure that calls on hospitals to send electronic notifications of significant healthcare events to a patient’s care team—such as their primary care provider, referring provider, or care coordinator—within four hours of the event. Significant events that would trigger a notification include:
- Arrival at an emergency department
- Admission to a hospital
- Discharge from an emergency department or hospital
Stage 3 Next Steps
The recommendations from the workgroup are just a first step before stage 3 is finalized. With the Health IT Policy Committee approving the recommendations March 11, it is expected that ONC and the Department of Health and Human Services (HHS) will issue a stage 3 meaningful use proposed rule in the fall. After collecting public comments on the proposed rule, ONC/HHS is expected to issue a final rule in early 2015. Stage 3 is currently slated to begin in 2017.
Before the final rule is determined, ONC will likely receive many comments from the public and adjust the recommendations of the workgroup, which has occurred in the past with both stages 1 and 2 of the program.
The public comments have already begun. On February 21, 24 members of the US House of Representatives sent a letter to ONC head Karen DeSalvo and Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner asking her to use the stage 3 meaningful use criteria to address a number of healthcare issues, including a call to reduce health disparities and embrace mobile health platforms. While ONC develops the meaningful use measures, CMS operates the program and issues incentive payments.
View the full stage 3 recommendations of the Health IT Policy Committee’s Meaningful Use Workgroup here.