AMA letter to CMS: Repeal ICD-10

Written by Jill Raykovicz

On Wednesday, the American Medical Association wrote a letter to the US Department of Health and Human Services calling for a repeal of the ICD-10 implementation, slated to be required by all covered entities October 1st, 2014.  AMA Executive Vice President and CEO, Dr. James L. Madara, reasoned ICD-10  “is not expected to improve the care physicians provide their patients and, in fact, could disrupt efforts to transition to new delivery models.”

Financial Burdens and Vendor Readiness

Dr. Madara voiced particular concern for smaller sized practices, where some estimates of the ICD-10 price tag could reach over $225,000, which, he writes, merely compounds other financial hardships such as costs to comply with Stage 2 Meaningful Use, overcoming any impending ePrescribe and PQRS penalties, as well as mitigating the 2 percent across-the-board sequestration cuts now pushed into 2023.

The letter released the results of a report by Nachimson Advisors, which revealed fewer than half (47 percent) of physicians say their practice management system vendor plans on delivering an ICD-10 software upgrade. Of those who are expecting an upgrade, 26 percent expect to receive it before April, 24 percent before July, 13 percent before October, and 1 percent after the October 1st deadline.  These timelines, the AMA argues, is insufficient to perform the necessary testing to ensure the software is working as intended.

Dr Madara also implored Medicare to conduct true end-to-end testing with at least 100 different physician practices of varying size and specialties.  Dr. Madara writes, “We believe end-to-end testing is essential for ensuring the health industry will not suffer massive disruptions in claims and payment processing and ultimately risk physicians’ ability to care for their patients.”

Advance Payment
 Options

Dr. Madara also appeals for an “Advance Payment” policy for the more serious cases that would jeapordize a provider’s ability to treat Medicare patients due to non-payment of services. This would apply to those services that have been submitted but not yet paid for date of service after October 1st, 2014, where the provider has already tried unsuccessfully to recoup payment from their contractor but is still weeks or months away from receiving reimbursement.  Dr. Madara reminds CMS a similar policy went into effect after the implementation of the National Provider Identifier (NPI) in 2008, and proposed the following parameters where advance payment would be afforded to providers:

1. When a physician has submitted claims but is having problems getting the claim paid to reach the contractor due to problems on the contractor’s end
2. When a physician has not been paid for at least 90 days
3. When they attest that at least 25 percent of their patients are Medicare and;
4. When they attest that at least 25 percent of their reimbursements are from Medicare.

Two-Year Implementation Grace Period

To battle the learning curve physicians and coders will experience as they gain a better understanding of the specificity required for ICD-10, Dr Madara proposes a two-year “implementation period” during which Medicare will not be allowed to deny payment based on the specificity of the ICD-10 code, and provide feedback to the physician on any coding concerns.  Medicare would also agree not to recoup payment due to lack of ICD-10 specificity during this grace period.

Conclusion

While the AMA confirms their commitment to the successful transtion to new payment and delivery models, and the adoption of technology to promote care coordination,  the letter concludes that  ICD-10 is “unlikely to improve the care physician provide to their patients and takes valuable resources away from implementing delivery reforms and health information technology”.

42,000 Impacted by Insurance Hard Drive Breach

A Wisconsin health insurance group has notified nearly 42,000 of its members that their protected health information may have been compromised following a HIPAA privacy breach.

Back in December, Unity Health Plans Insurance Corporation, which serves some 140,000 members, discovered a unencrypted portable computer hard drive containing health records of 41,437 individuals was missing from the University of Wisconsin-Madison School of Pharmacy. Officials say the school had this information as part of a benefits program evaluation.

Member names, dates of birth, name of prescription drugs and dates of service were contained on the device.

“(We’re) reviewing all our policies and trying to reeducate employees,” Jennifer Woomer Dinehart, spokesperson for Unity Health, told Healthcare IT News. Woomer Dinehart would not confirm or clarify what the company-wide encryption policy was.

“We are sorry this happened and want to provide pertinent information concerning the occurrence along with the steps we are taking to minimize any potential impact,” read a Jan. 30 company notice.

To date, out of the more than 80,000 HIPAA breach cases OCR has received since 2003, only 17 of them have resulted in fines thus far.

Just this past December, the five-hospital Riverside Health System in southeast Virginia announced that the PHI of nearly 1,000 patients had been compromised in a privacy breach that continued for four years. From September 2009 through October 2013, a former Riverside employee inappropriately accessed the Social Security numbers and electronic medical records of 919 patients. The breach wasn’t discovered until Nov. 1 following a random company audit.

 

Originating Source

Skype With Patients? HIPAA Says “No Go”

Oklahoma medical board sanction against Thomas Trow, MD, sparked concern over the practices of telemedicine and telepsychiatry. Using Skype, Trow conducted online video appointments and prescribed controlled substances to a patient who ultimately succumbed to an overdose. Trow never saw the patient in person before prescribing the drugs. As a result, the Oklahoma medical board published a ruling on January 16 of this year, stating that telemedicine, “Technology must be HIPAA compliant.”

With growing excitement, doctors and patients are “seeing” each other online through a range of video chat technology platforms. In fact, healthcare innovation like telemedicine is vital to the changing landscape of patient demands and government-driven insurance. For many, the Oklahoma telemedicine ruling brings welcome clarification and an opportunity to educate providers about this new way of practicing HIPAA-compliant telemedicine.

“The last thing the U.S. healthcare system needs is to abandon the idea of telemedicine,” said Daniel Gilbert, president and CEO of CloudVisit Telemedicine. “The technology has tremendously positive implications for providers and patients. To lose out because of one platform — a platform that was never designed as a medical tool — would be real detriment.”

Since the Oklahoma ruling does not specifically cite any brand names, many physicians are left wondering, “Is Skype HIPAA compliant?” Skype’s privacy policy simply states that they, “will take appropriate organizational and technical measures to protect the personal data…” and owner, Microsoft Corp.’s Business Associate Agreement (BAA) explicitly omits Skype. To better understand Skype’s security, one must turn to the Health Insurance Portability and Accountability Act (HIPAA).

  • Telemedicine is a HIPAA-compliant method for patient appointments
  • Online video appointments must be conducted via a HIPAA-compliant telemedicine platform
  • Business Associate Agreement (BAA) must exist between the healthcare provider and the company responsible for the telemedicine technology
  • The BAA must guarantee the HIPAA compliance of all measures for security practices and data encryption
  • Providers must obtain informed patient consent prior to conducting online video appointments
  • In absence of a BAA and informed consent, Skype is not HIPAA compliant

“It’s important to keep in mind that Microsoft never intended Skype to be a medical tool,” reminds Gilbert. “Beyond significant HIPAA issues, Skype has many operational shortcomings. CloudVisit provides tools for scheduling and billing, plus treatment notes and more. Skype has none of these features.”

In fact, a search of the word “telemedicine” on the Skype website comes up empty. They do not claim to be HIPAA compliant, nor do they position themselves as a resource for the medical community.

As stated, healthcare practices and patients have a lot to gain from online video appointments. The right technology can be highly effective and appropriate for follow-up care, routine appointments, and mental health consultations once a provider-patient relationship is established in person.

CloudVisit Telemedicine provides a HIPAA-compliant telemedicine and telepsychiatry platform for scheduling, conducting, tracking, and billing online video appointments with patients. CloudVisit enters into a BAA with every client.

 

Originating Source

This 5-Minute Video Could Save Your Practice

Almost every business uses a multi-function copy machine that copies, scans, prints and possibly faxes information. What most people don’t realize is that many of these machines have hard drives that store all information that the machine has access to. Think of these machines as computers that store a digital record of every copy it makes, every document it scans and every page it prints.

Copying patient information

If your organization copies insurance explanation of benefits (EOBs), patient insurance cards or uses a multi-function printer to print out letters to patients, all that information could be sitting on the hard drive of your copier. If this information is not properly destroyed before you return the machine to a leasing company, recycle the machine, sell the machine or throw the machine out; all that patient information might cause a HIPAA data breach.

Watch this video!

The below video from CBS news gives valuable information about the risks of copy machines.

Note: Affinity Health Plan who is featured in the video, received a $1,215,780 HIPAA fine (that’s right… $1.2 MILLION) because of one copy machine that contained 344,579 records with protected health information (PHI)

[youtube id=”TCKr5WgVVN8″ width=”600″ height=”350″]

Independent Physicians Lag Behind with EHRs

Adoption and use of health IT increased significantly from 2009 to 2012, though there is a sizable gap between the adoption levels of large and small practices.

A study by The Commonwealth Fund measured changes in health IT use over that four-year period. The study found that the percentage of physicians able to electronically send prescriptions to pharmacies rose from 34% to 66% and electronic prescribing increased from 40% to 64% over that timeframe. Adoption of electronic records is where the difference between practice sizes was most pronounced: Only half of solo physicians use EMRs, while more than 90% of physicians in practices with 20 or more physicians do so.

A lack of resources is one explanation why independent physicians and smaller practices aren’t turning to health IT solutions at the same rate as larger ones. Independent physicians’ responses to an athenahealth Inc. survey reflected this sentiment. Fewer than half of independent physicians not associated with hospitals felt the financial and care benefits of EHRs exceeded the costs, while greater than half of their employed peers felt the same.

Independent physicians’ unwillingness to take on major business costs (including those associated with EHRs) is likely contributing to the shrinking number of independent doctors in the U.S. Statistics from Accenture show the percentage of independents sunk from 57% in 2000 to just 39% in 2012. A large majority (87%) of doctors cited business costs and expenses as a top concern and a reason why they’d consider abandoning their independent status.

A data brief from the National Center of Health Statistics (NCHS) focused on physicians’ widespread use of EHR technology. The NCHS data showed that in 2013 78% of all office-based physicians were using some type of EHR, an increase from  18%  in 2001 — something Karen Desalvo, national coordinator for health IT, noted in a recent blog post. Meaningful use incentives are driving many providers to adopt EHR systems. The NCHS brief reported that 69% of physicians intend to participate in the Medicaid or Medicare EHR incentive programs, though only 13% of them had EHR systems in place to support 14 of the 17 stage 2 core objectives. Those statistics represent a fear of independent physicians — adopting an EHR system without qualifying for reimbursement payments.

ICD-10 – Not Just A Coder’s Problem

by Jill Raykovicz

The deadline to transition ICD-10 for all covered entities is October 1, 2014.   If that seems like a long way off, it isn’t.   In terms of actual work days[1], this timeframe is compressed to six months for medical and other healthcare practices to train staff, communicate with vendors, test software systems and claim files, and evaluate current processes to determine in what areas ICD-10 will affect day-to-day office functions.

IMPACT ON REIMBURSEMENT

If this sounds like a problem reserved for coders and billing staff, it isn’t.   CMS’  ICD-10 Implementation Guide for Physician Practices advises,  “Consider getting a line of credit to cover cash flow disruptions due to changing reimbursement models, delays in claims processing and re-processing, staff learning curve and long-term effects of the ICD-10 transition”[2]

Although  CPT and HCPC based reimbursements will not change with the ICD-10 transition, indirectly, fee-for-service payments may have a potential to be adversely affected for the following reasons:

  • Denials will increase because of  incomplete or inaccurate translation of payment rules in payer systems as they attempt to translate these rules from ICD-9 to ICD-10
  • Payments will be delayed because of challenges in claim processing in the ICD-10 environment.

Increased detail contained in ICD-10-CM means that the documentation required will change dramatically.   The level of severity, comorbidities, complications, sequalae, manifestations, and causes that characterize the patient’s condition increases within the ICD-10 coding guidelines.

 

PLANNING IS EVERYTHING

ICD-10 Coordination Manager

Every office should have an ICD-10 Coordination Manager. Depending on the size of the practice, this could be one person or a committee of persons responsible for communication and coordination with staff, providers, and vendors on key dates and project timelines for an ICD-10 pre and post go-live.

The Coordination Manager will also:

  • Coordinate training schedules and verify staff has attended and completed.
  • Set an ICD-10 project budget in terms of training and software upgrade  costs, coding books and guides, re-printing of encounter or referral forms with the new codes, if necessary, and other costs associated with ICD-10.
  • Determine if re-training is necessary, as we get closer to the October 2014 timeframe.  

He or she (or they) should ensure accurate coding decisions are being made, clinical documentation supports the new ICD-10 specificity requirements, and associated lags in productivity are identified and communicated.

Training

Speaking of training, although most ICD-10 literature advises staff and providers receive training no more than six to nine months from implementation, it is imperative to reserve slots now before classes fill up, or before less than desirable dates and times are the only ones left for either on-site training or off-site seminar.  Don’t wait to contact professional associations around the April 2014 timeframe to find out the on-site ICD-10 trainer’s only availability is the same week Suzie in the business office goes out for surgery.  Or, the only off-site workshop with any seats available is the week before Jane, your charge entry clerk, returns from maternity leave.  

Resources

CMS, the American Academy of Professional Coders (AAPC)American InformationManagement Association (AHIMA) and Workgroup for Electronic Data Interchange(WEDI) all have information on ICD-10 training and factors to success.

WEDI and CMS have partnered in taking a proactive approach to answer questions and concerns regarding the ICD-10 transition.  Organizations can submit questions, free of charge, to an online database.

IN CONCLUSIONExpect no more delays or movement of the October 1st, 2014 deadline.  Ready or not, here ICD-10 comes. Through planning, resource management, and effective leadership, medical and other healthcare practices can mitigate disruptions in cash flow as a result of ICD-10.


[1] Based on regular Monday through Friday office hours

[2] ICD Implementation Guide for Small and Medium Practices, p. 31

Physician Practice Consultants is led by Jill Raykovicz, MHA, CMPE, CPC.  Jill has over 15 years’ experience in physician practice management.  She has a strong passion for leveraging this experience and expertise within the private-practice setting, in order to assist independent practices struggling to keep up with changes in healthcare reform, pay-for-performance quality measures, and shrinking reimbursement from third party payers.

Jill holds a Master of Health Administration from Cornell University, is a board-certified medical practice executive (CMPE) through the American College of Medical Practice Executives, and is a Certified Professional Coder (CPC) with the American Association of Professional Coders.

She is also a member of the National Society of Certified Healthcare Business Consultants and the North Carolina Healthcare Information and Communication Alliance ICD-10 Taskforce.

Jill may be reached at jill@physician-practice-consultants.com

A Cloud Based EMR Does Not A Compliant Entity Make

Snake-oilRecently, a question came up that involved entities that said they are perfectly fine with HIPAA compliance because they use a cloud based EMR (or EHR) who takes care of all their HIPAA compliance for them.

A discussion ensued ending with the question:     This can’t really be true, can it?

I suppose someone could dream up some condition and try to argue it is true.  I, however, tend to follow the statistics.  The chances any group is able to have all the HIPAA compliance requirements handled by their cloud based software provider is so very tiny I will say it can not actually be true.  Yes, some vendors may tell you just that but the term snake oil salesman comes to mind……

Here is your check list of things your vendor must provide to take care of all your compliance for you.  If you actually do have a vendor with all this covered and documented, please let me know.  I am eager to get to know them and work with them.

Does your vendor….

  • Provide a complete and thorough Risk Analysis looking at everything you store in your office that could include PHI.
  • Know every record that comes in and out of your office and how it is managed?
  • Configure your network security and firewall?
  • Monitor you computer systems to confirm they have all their security updates and an active antivirus/malware system?
  • Provide documentation and reports that compliance activity is taking place and reviewing the results?
  • Confirm data you exchange with every single business associate you work with is secured and protected properly?
  • Confirm your Business Associate Agreements are properly in place with every entity that you have a BA relationship?
  • Perform due diligence with all your Business Associates?
  • Update your Notice of Privacy Practices (NPP) to make sure all cases your office should cover is included properly?
  • Confirm you post your updated NPP properly to meet the new requirements?
  • Create a complete disaster recovery and business continuity plan that covers all aspects of your operation being functional?
  • Complete a physical site security checklist and determine all your physical safeguards are adequate and properly documented?
  • Review your administrative safeguards to confirm they are adequate and meet the required and addressable elements properly with documentation of same?
  • Create and monitor a plan for disposal of all media and equipment that may contain PHI – like printers and copiers?
  • Create and document a breach response plan?
  • Create, monitor and execute a training plan for every member of your staff regarding HIPAA terms, requirements, acceptable uses and disclosures, how to identify a breach, what your own internal policies and procedures require for HIPAA and more?

Should I go on, because there is more?  For now, I will just leave it at that.

Don’t get me wrong.  There are a lot of HIPAA things, in the Security Rule especially, that you can outsource to your cloud software provider.  But, even those things don’t relieve you of responsibility.  It is up to you to make sure you document completely and audit regularly to make sure those functions like backup and recovery of the data they maintain, up-time guarantees,encryption at rest and in transit, password and user access controls, etc are actually working as required.

The wall of shame is full of CEs and BAs that thought someone else was taking care of their compliance.  You can’t just say someone else is doing it for me.  If you do, you probably need more training before making your final HIPAA decisions and, of course, detailed documentation of those decisions.   It really takes time and effort on every entity’s part to create their culture of compliance that is really required to make an honest stab at HIPAA compliance in your office.

All this is really a question any CE or BA should be asking themselves no matter who their vendor may be.  Do we have all these things covered?  If you don’t then you definitely need to consider getting some help.  There is a lot to do and you can’t just “mail in” your compliance requirements.

 

Re-posted with permission. Original post located here.

What is Reasonable and Appropriate for Your Specific Environment

These days we deal with resistance and denial towards HIPAA compliance. There are many reasons given for incomplete or ineffective compliance programs. We have heard everything from long rambling rants against the government, claims of not applicable to me and plenty of “we don’t have the _____” (fill in: time, money, resources) to explain away the compliance gaps.

There is, however, one case that concerns me when we find it. A practice or business is given a standard list of HIPAA Security implementation recommendations. The problem is that the list of recommendations doesn’t always include a review of what is reasonable and appropriate for the specific environment. The result is a group frozen by fear, sticker shock or worse paying for services and equipment that may be overkill for them. The Security Rule explains in the General Rules section just what should be considered in determining what is reasonable and appropriate for a specific environment (emphasis added):

HHS recognizes that covered entities range from the smallest provider to the largest, multi-state health plan. Therefore the Security Rule is flexible and scalable to allow covered entities to analyze their own needs and implement solutions appropriate for their specific environments. What is appropriate for a particular covered entity will depend on the nature of the covered entity’s business, as well as the covered entity’s size and resources.

Therefore, when a covered entity is deciding which security measures to use, the Rule does not dictate those measures but requires the covered entity to consider:

Its size, complexity, and capabilities,

Its technical, hardware, and software infrastructure,

The costs of security measures, and

The likelihood and possible impact of potential risks to e-PHI.

No, this doesn’t mean you can decide you are so small and the rules are too complex to follow them at all. That is definitely not what reasonable and appropriate means in this context. What it does mean, though, is that you can determine how to implement the standards, both required and addressable, but apply these considerations to your implementation plans.

Our approach is to always define the environment before defining the plan. The Security Risk Analysis is first in the list of requirements for a reason. But, keep in mind, that even the tasks performed in the Risk Analysis should be confirmed as reasonable and appropriate for your specific environment.

 

Reposted with permission from: http://smallproviderhipaa.com/2013/10/31/what-is-reasonable-and-appropriate-for-your-specific-environment/

Microsoft Aims To Take On iPad In Health Care

 

When internist Nitin Patel called up Microsoft in May to rave about its Surface Pro tablet, Dennis Schmuland, the company’s head of health strategy for U.S. Health & Life Sciences, was taken aback. “I was surprised, because he was so excited,” says Schmuland. “We didn’t solicit this.”

Microsoft is elated by Patel’s call. While physicians’ use of tablets is widespread—72% according to Manhattan Research, more than half of the nearly 3,000 physicians it surveyed, used Apple iPad in the first quarter of 2013. Microsoft released Surface RT last year, and Surface Pro this past February. According to IDC, shipments of Surface amounted to 900,000 units in this year’s first quarter. It has a long way to catch up with the iPad, which commands nearly 40% of the tablet market. “We’re not getting any requests from doctors to build on it [Surface],” says Daniel Kivatinos, a founder of drchrono which provides an electronic health record specifically for the iPad. Also, a 128 GB Surface Pro retails for $999, versus $799 for an iPad.

Patel who doubles as a geek-in-chief at Palmetto Health, one of the largest hospital systems in South Carolina, tried the iPad. He disliked the wait to log into a patient’s chart, the small screen, and the lack of keyboard, among other things. On a Friday afternoon, he drove over to a Best Buy in Columbia, and bought Surface Pro, keeping the receipt. He didn’t return it. Patel was immediately impressed by its speed to access a patient’s chart, and its compatibility with Cerner electronic health record which Palmetto uses throughout its hospitals and clinics. Patel says he now sees two more patients per day as a result.

William Jennings, Palmetto’s medical informatics officer, was initially skeptical, but Surface won over other doctors. “We’re providing an environment where physicians pick what they want. We want technology to work for us not the other way around,” says Jennings. Palmetto just started a three to six month pilot with 30 physicians, including obstetricians and surgeons, who will use Surface on loan from Microsoft, in their every day practice. The goal is to measure patient and physician satisfaction, as well as impact on productivity, which typically drops when medical providers go digital.

“What Palmetto has proven is that you can run Windows 8 or 7, and have the full features of an electronic health record,” says Schmuland, not a lighter version usually offered on an iPad.  If so, that would address major complaints by untethering doctors from their desktops, and allowing them to interact more freely with their patients. He says Microsoft is talking to several electronic health record vendors, including Cerner, Epic, and Allscripts about developing applications.

Schmuland doesn’t know how many doctors are using Surface, but he’s starting to hear more anecdotes, such as Palmetto’s.  “This is an early wave indicator that Windows 8 is resonating with the industry,” he says.

Microsoft sent a crew to Columbia, South Carolina, to film doctors at Palmetto using Surface Pro. Check it out.

 

original published at: http://www.forbes.com/sites/zinamoukheiber/2013/07/01/microsoft-pins-its-hopes-on-tablets-in-health-care/