OIG Malnutrition Audits –
Time for CDI to Up Their Game
It’s Patient ID Day!
We need your help reaching out to the U.S. Senate today as they work to pass the Fiscal Year 2021 budget bills that still include a ban that stifles innovation around patient identification!
In July, the US House of Representatives adopted an amendment striking language in the House FY21 Labor, Health and Human Services, Education (Labor-HHS) Appropriations bill that prohibits the US Department of Health and Human Services (HHS) from using federal funds to promote or adopt a unique patient identifier. Striking this language will give HHS the ability to evaluate a range of patient identification solutions that protect patient privacy and are cost-effective, scalable, and secure.
As Congress continues to consider the fiscal year 2021 spending bills, we encourage you to contact your Senator to encourage them to remove this archaic ban from the Labor, Health and Human Services, Education, and Related Agencies Appropriations Act of 2021.
Have you taken AHIMA’s Naming Policy Pledge? Join your colleagues and peers who have already taken it since AHIMA20. Educate on patient identification and matching and advocate for your profession!
And… attend a free webinar next week on November 18th to learn more about the pledge and the naming policy details.
The 2020 AzHIMA Virtual Annual Meeting registration is open! The Annual Meeting Committee has planned a great virtual meeting with a wide variety of topics including a panel presentation on COVID-19 Affecting HIM Staff/Best Practices and a session on Information Blocking presented by Melissa Soliz. You will find that some sessions are being offered as live webinars on November 3rd and 4th while others are being prerecorded so that you can listen to them at a day and time that works best for you. Can’t make the live sessions on November 3rd and 4th? No problem – these sessions are also being recorded. The meeting topics, speakers, and registration link can be found by clicking here.
We hope you will join us for the first virtual AzHIMA Annual Meeting.
The AHIMA bylaw changes are coming up…. and we want to hear from our AzHIMA members before the voting takes place during the 2020 AHIMA House of Delegates on October 17, 2020!
The AzHIMA BOD will be hosting a Townhall on Tuesday, Oct 6th at 6 PM AZ Time. To join in the discussion, click here at 6 PM on Oct 6th.
Meeting #: 146 792 0056
Meeting Password: A4Bgpp2TCM8
Click here to review the bylaw amendments or view the summary below.
Article III-3.1: Article V-5.1: Article VII: 7.2, 7.7
Article IV Members, 4.8-4.12
Article VII House of Delegates, 7.1-7.2
Article IV Members, 4.2-4.5
As we are seeing as a result of the worldwide pandemic, accurate and timely health and patient data to ensure patient safety is more important than ever. Yet even though the ECRI Institute names patient misidentification one of the top ten threats to patient safety, a two decade-old appropriations rider has stifled innovation and industry progress in advancing a nationwide patient identification strategy.
COVID-19 is highlighting the urgent need to lift this archaic ban. Accurate identification of patients is one of the most difficult operational issues during a public health emergency. Ensuring the correct patient medical history is accurately matched to the patient is vital for COVID-19 diagnoses, future patient care, claims billing, patients’ long-term access to their complete health record, and tracking the long-term health effects of COVID-19. Furthermore, the nationwide response in coming months, including effective implementation of any large-scale immunization programs, hinges on accurate patient information.
Last year, there was broad support for removing the ban, and the US House of Representatives voted to remove the ban from its Labor-HHS appropriations bill, but unfortunately the ban is included once again in this year’s House bill. Our champions on the Hill, Rep. Bill Foster (D-IL) and Rep. Mike Kelly (R-PA) are introducing an amendment on the floor of the House to remove this ban.
AHIMA needs your help to reach out to your Members of Congress and urge them to vote for the Foster-Kelly amendment and remove section 510 from the FY2021 Labor-HHS appropriations bill. Your Representatives won’t take action without hearing from their constituents, and we cannot ensure the progress achieved so far on this issue will continue without our members’ engagement.
We anticipate that the vote on the amendment will happen tomorrow so we need your help today!
As you are aware, the 2020 AzHIMA Annual Meeting was originally scheduled for June 2020 and then rescheduled to November 3-4, 2020 due to the COVID-19 situation.
The AzHIMA Board of Directors has continued to evaluate the every-changing COVID-19 pandemic, the possible resurgence of contagious cases in the Fall of 2020, and its effects on the rescheduled meeting. After extensive discussion and consideration, we have decided to change to a virtual meeting format instead of an in-person format. We feel it is the safest path to protect the health of our attendees, speakers, and exhibitors.
Even though the in-person meeting has been canceled, we know members are still in need of continuing education hours to maintain their credentials. Therefore, AzHIMA will be working with presenters to record their session and will offer these as on-demand sessions so that members (and nonmembers) can purchase and view the recorded educational sessions at a day and time that fits into their schedule. More details about the on-demand sessions will be available soon!
Things You Need To Know:
– A new registration process for the on-demand sessions will be available in the near future.
– Your hotel reservation for the in-person Annual Meeting will be canceled.
Click here to contact us with any questions you may have.
This is a challenging time for all of us, as we brace for uncertain times during this COVID19 pandemic. Keeping you, our families, our community, and our patients safe is of great importance to AzHIMA. There have been long days and nights for many, and there will be more uncertain days to come. I am sincerely appreciative for your continued dedication and commitment to the health information profession. AzHIMA will be making the necessary changes to our upcoming conference and education sessions to promote a safe environment and will follow all CDC recommendations concerning decreasing group gatherings and travel.
The priority for all of us is to do our part in the control of this wide-spread, deadly virus. Here are some simple ways you could assist in this fight:
I would like to thank everyone for their cooperation and continued support as we coordinate these necessary changes. It is important that we move forward with a positive focus and compassion for one another. We are in this together, we will overcome this together, and we will be stronger for having experienced it. We pray for everyone’s perseverance, health and wellbeing.
We will see you in the Fall!
As you may know, today is AHIMA’s Virtual Hill Day–a day for all health information professionals to advocate on behalf of the profession. I encourage you to head over to AHIMA’s Action Center (click here) to contact your elected officials in Congress to tell them about the issues that matter to this profession.
We’ve created two engagements that focus on the issues that are critical to the profession and that are active issues before the US Congress: patient identification and the modernization of health information laws to help stem the tide of opioid misuse. You can find direct links to these engagements and additional information about the issues here:
AHIMA’s social media manager will be posting and tweeting about AHIMA’s Virtual Hill Day throughout the day. I encourage you to share, post, and re-tweet these messages throughout the day to inspire others to let their voice be heard.
It doesn’t take more than a few moments. Even during these times of great uncertainty it is important to let your elected officials know about the issues that matter to you as a profession and can have an impact on your daily life.
Thank you for all that you do for the profession and AHIMA.
Lauren Riplinger, JD
Vice President, Policy & Government Affairs
CAHIIM accreditation supports competencies and job marketability for graduates and undergraduates. It allows for recruitment opportunities through the online accredited Program Directory. Eligibility for a variety of services, certifications, scholarships, stipends, and other resources are also supported through the Member professional associations – The American Health Information Management Association (AHIMA) and the American Medical Informatics Association (AMIA).
CAHIIM-Accredited programs are kept current with industry standards through its workshops, newsletters, website updates and much more.
Click here for more information.
AHIMA is looking for strategic, innovative, dedicated members to be considered for one of our five elected roles in 2021.
View the opportunities for the AHIMA President/Chair-elect, Board of Directors, CEE members, CCHIIM Commissioners, and Speaker-elect of the House of Delegates on the AHIMA website.
Select the Elected Positions tab from the top toolbar to review each description. The application for each position is posted on Engage’s Volunteer Center.
Questions? Feel free to contact firstname.lastname@example.org.
In June, the US House of Representatives adopted an amendment striking language in the House FY20 Labor, Health and Human Services, Education (Labor-HHS) Appropriations bill that prohibits the US Department of Health and Human Services (HHS) from using federal funds to promulgate or adopt a unique patient identifier. Striking this language will give HHS the ability to evaluate a range of patient identification solutions that protect patient privacy and are cost-effective, scalable, and secure.
For nearly two decades, innovation and industry progress has been stifled due to broad interpretation of this language included in Labor-HHS bills since FY1999. More than that, without the ability of clinicians to correctly connect a patient with their medical record, lives have been lost and medical errors have needlessly occurred. These are situations that could have been entirely avoidable had patients been able to have been accurately identified and matched with their records. This problem is so dire that one of the nation’s leading patient safety organizations, the ECRI Institute, named patient identification among the top ten threats to patient safety.
The absence of a consistent approach to accurately identifying patients has also resulted in significant costs to hospitals, health systems, physician practices, long-term post-acute care (LTPAC) facilities, and other providers, as well as hindered efforts to facilitate health information exchange. According to a 2016 study of healthcare executives, misidentification costs the average healthcare facility $17.4 million per year in denied claims and potential lost revenue. More importantly, there are patient safety implications when data is matched to the wrong patient and when essential data is lacking from a patient’s record due to identity issues. The 2016 National Patient Misidentification Report cites that 86 percent of respondents said they have witnessed or know of a medical error that was the result of patient misidentification.
Contact Congress today and urge them to strike this archaic ban from the Labor, Health and Human Services, Education, and Related Agencies Appropriations Act of 2020.
Over the last couple of days we have had some substantial movement on patient matching in the US House of Representatives.
Representatives Bill Foster (IL) and Mike Kelly (PA) introduced a bipartisan amendment this week that strikes section 510 from the Labor-HHS Education Appropriations which currently prohibits the U.S. Department of Health and Human Services from spending any federal dollars to promulgate or adopt a national patient identifier.
The amendment will likely come to the House floor for a vote tomorrow and we need your help. We are asking AHIMA members to contact their U.S. Representative today and tomorrow asking them to support the Foster-Kelly Amendment #3 to HR 2740, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 2020. AHIMA’s Advocacy Action Center has everything you need to email your U.S. Representative.
Here is the direct link to the engagement. Please feel free share this link via email, social media, etc. both far and wide.
If you have any questions or if we can be of any assistance, please let us know, we are happy to help. I will continue to keep you all updated as things progress!
Lauren Riplinger, JD
Senior Director, Federal Relations | Policy & Government Relations
AHIMA | American Health Information Management Association
1730 M Street, NW, Suite 502 | Washington, DC 20036
Phone: (202) 839-1218
Title 42 of the Code of Federal Regulations Part 2 (often referred to as 42 CFR Part 2, or simply “Part 2”) regulates the sharing of substance use disorder (SUD) records. Protecting patients’ confidentiality is of the utmost importance but the outdated nature of Part 2 has created barriers for providing the best care possible to individuals with SUD, often leaving clinicians unaware of risks from multiple drug interactions and co-existing medical problems.
In June, the House of Representatives passed HR 6082, the Overdose Prevention and Patient Safety Act by a vote of 357 to 57. The OPPS Act enables appropriate sharing of substance use disorder records by aligning Part 2 with HIPAA for purposes of treatment, payment, and operations. The bill also includes criminal, civil, and administrative protections for patients during legal proceedings and applies HIPAA penalties to the Part 2 program to ensure that patients can seek treatment without fear their information will be inappropriately shared.
The Senate is putting the finishing touches on its opioid legislation this week. We need you to take action and urge your US Senator to support Part 2 reform as part of the opioid package.
Call your US Senator to ask him or her to support Part 2 reform as part of the opioid package.
AHIMA’s Advocacy Action Center has everything you need to take action.
Your assistance is critical to getting Part 2 reform passed out of the US Senate!
To continue to align with AHIMA’s Strategic Objective, the focus of AzHIMA’s coding roundtable is to provide education to the members to continue to “prepare HIM professionals for the future” (AHIMA). It is the desire of AzHIMA to be a leader in this area. For us to reach this objective, we rely on membership input. We also rely on each other to learn and share ideas. One of the best ways to learn is to talk about what is known, as Benjamin Franklin said, “Tell me and I forget. Teach me and I remember. Involve me and I learn.” Consider becoming involved.
~Crystal Champaigne (email@example.com)
By Pam Hess, MA, RHIA, CCS, CDIP, CPC
AHIMA House of Delegates (HoD) Vote on Standards of Ethical Coding.
This October there was a proposed update to on the Standards of Ethical Coding. This is an important document that governs now medical coding from an ethical perspective. The 47 of the 52 Component State Association (CSA) delegates voted as follows: 150 for, 4 against, 2 abstained.
The updated document itself can be found on AHIMA Engage.
Because this document governs the practice of medical coding for all HIM practitioners, I would advise that each of you review it. Many of our newer HIM practitioners may not be aware of the existence of this document. It is up to us as a professional association member to share the information and make that we are all in compliance. The document explains the “expectations of professional conduct for coding professionals involved in diagnostic and/or procedural coding, data abstraction and related coding and/or data activities.” 1
To provide clarity within the document, the Standards include a list of definitions related to the practice of coding. The body of the document and primary content includes the Standards and Guidelines themselves. There are eleven standards with sub standards within each that explain the actions that a coding professional shall and shall not do:
Did you know?
Standard #1 requires that managers foster an environment that supports honest coding practices. 1 This means that each manager is responsible to ensure that coders know about the Standards and that an environment is created to allow for expression of concerns if there is a potential violation. This violation could be something as simple as using information from a previous encounter to code from when that is not acceptable per the guidelines. An exception to this might be within the HCC guidelines where CMS specifically allows the inclusion of inpatient, outpatient and professional fee records for HCC assignment where applicable to the current encounter.
Standard #4 requires that coding managers develop query policies within their scope of responsibility to include “Designing and adhering to policies regarding the circumstances when providers should be queried to promote complete and accurate coding and complete documentation, regardless of whether reimbursement will be affected.” 1 This means that queries should be submitted to ensure that the record reflects the actual diagnosis and treatment provided even if it does not result in a change in reimbursement. Standard #4 also speaks to the practice of unnecessary queries such as querying for a gram-negative pneumonia on each pneumonia case. 1
Standard #5 is especially important and it outlines the proper communication between coders or HIM/Coding Managers and the compliance department when there is any misrepresentation of codded data to “inappropriately increase reimbursement, justify medical necessity, improve publicly reported data, or qualify for insurance policy coverage benefits.” 1
These are just a few of the gems you will find in the Standards of Ethical Coding Document. It would be a good idea to go over this document with your coding staff to ensure that they are aware that they are governed by a professional practice outlined by our professional association AHIMA.
Happy reading! And we will see you next time.
Standards of Ethical Coding, December 5, 2016, http://bok.ahima.org/PdfView?oid=301963
Click here to read more
AHIMA is rolling out a new membership model. Learn more about the various membership types AHIMA offers and the costs and benefits associated with them. Instead of a one-size-fits-all approach to membership, each member will be empowered to select the AHIMA content, services, and products they most value.
Click here for more information.
Click here to read more
Take a look at our latest newsletter
View Digital Version
By: Deanna Matson, RHIA
HIM Healthcare Consultant
Have you ever sat and wondered how all the events that AzHIMA puts on throughout the year, year after year, get done? Have you ever wondered how the newsletter, the web page, the specialty meetings and the special events take shape? Have you ever thought that maybe, just maybe, you could contribute in some small, special, or significant way? If this sounds like you then now is the time to act.
As Deb Beisel-Denton stated to me recently “people think they have to be great speakers or be an expert on a subject to be involved, that is not true.” What AzHIMA needs most to keep the wheels turning and the education coming is for people to share what they enjoy and what they have a passion for.
This might mean you could write an article of interest for the newsletter, you might like to create puzzles or word games. Perhaps you like to bake and you would be willing to provide baked goods for a Coding Roundtable meeting. Maybe you have a desire to speak at a meeting on a topic of special interest to the membership at large. Or perhaps you have a special interest in helping to plan a meeting or annual event or to assist with the association web presence. No matter what your skill level or area of interest there is a place where you can contribute.
We are always our own worst critics. We often talk ourselves out of offering our services because we feel they have no value. Or we think we are not an “expert”. We do not need to be experts to participate. We just need a desire, a starting point, and willingness coupled with action to participate. We also need the opportunity. AzHIMA can be your opportunity to have your turn.
I encourage you to consider how much value you take away from the AzHIMA web page, publications and web or face-to-face meetings because “someone else” took the time to contribute. These members are not always experts. But they do shine!
Have you had a turn? I encourage you today to take the action needed to begin on your path of contribution. We all have something to contribute which will allow us all to shine!
Lisa Hart, MPA, RHIA
Director of Physician Practice Coding
Banner University Medical Group
When it comes to using offshore resources, there are requirements that are not well known to many HIM professionals regarding the use of offshore contractors for Medicaid, Medicare or Tricare patients, even though the requirements are 8 years old.
The requirements created by the Centers for Medicare Services can be confusing because of the language used that they apply to Medicare Advantage Plans (Part C) and to Medicare Drug Plans (Part D). But if your organization has their own MAO or Drug Plan they know all about it and can be a good resource to help you understand the requirements and the attestation process. Click here to read more.
This an important PowerPoint presentation on External Cause Coding and State Edit Questions.
AzHIMA has arranged with Libman Education to provide their popular “Learn From Lynn Kuehn – ICD-10-PCS Quick Consult” webinar series at a discounted price $59 for the entire series! (normally $275). The series includes the following sections:
Quick Consult 1: Body Parts: What to do when you can’t find them
Quick Consult 2: The Mystery of the Anatomical Regions
Quick Consult 3: Devices: What qualifies?
Quick Consult 4: Devices, Devices, Devices and More Devices
Quick Consult 5: Secrets of Approaches
Quick Consult 6: Supplement: The Misunderstood Root Operation
Quick Consult 7: Revision vs. Remove and Re-Do
Quick Consult 8: Breast Reconstructions: Replacement vs. Transfer
Quick Consult 9: OB Revealed
To place your order, email the information requested below to: firstname.lastname@example.org,
or fax it to (978) 371-2671,
or call (207) 865-1181
Order your copy today! Please send:
Facility or employer:
It feels like the last few years we have been living and working toward the start of ICD10. Now, more than three months after go-live how well is everyone doing? From a coder standpoint, it seems that everyone took seriously the studying and training to set themselves up to make a successful transition. The payers were ready to accept the claims from providers and healthcare systems and IT had all our systems ready for the ICD10 codes. All in all, it has been a fairly smooth transition for most. The year delay we experienced from October 2014 to October 2015 allowed coders time to practice, IT had time to work through system issues and create more interfaces and providers had more time to work with CDI staff on documenting specificity.
As we enter 2016, what can we expect to see from ICD10? Now that we have joined the majority of the world healthcare systems on ICD10, the U.S. can begin to compare healthcare statistics in a more meaningful way, accurately compare and measure quality of healthcare across the globe as well as evaluate the outcome of new procedures and capture newly developing conditions that just wasn’t possible with ICD9. Within the United States, we will be better able to measure healthcare services and their outcomes through the specificity of ICD10 codes. The much more detail codes within PCS will help us track new technology used in our surgical arenas. Studying those outcomes will help to improve surgical techniques and spur on more innovative technologies. Research will get a boost from the specificity of codes as clinical outcomes will be more detailed.
It will be interesting to see what 2016 will hold for ICD10. We have been on a partial code freeze since October 2011. There have been limited code updates to capture new technologies and diseases since 2012, but again, that has been very limited. October 1, 2016 will see our first regular code release in five years.
One thing we know for sure, we can count on change being part of our coding lives as usual. And who knows – ICD11 could be just around the corner!
As calendar year 2015 comes to a close and 2016 begins, be sure department leaders continue to assess CDI and coder productivity and proficiency with the new code set. To do this, conduct CDI/coder satisfaction surveys and compare previous assessments, and continue to provide additional educational sessions as needed based on those assessments. If you feel you need more advanced ICD-10 studies, consider joining our new AzHIMA study groups.
Many CDI teams will also be the frontline educators for physicians. The same concepts hold true. Continue to assess physician performance and identify target areas for education. Communicate with physicians about areas they struggle with and identify opportunities for additional education. Use a multi-discipline approach incorporating tips into physician newsletters, presenting targeted education during short PowerPoint presentations, craft tip sheets for top problem areas and develop work study groups.
Any education must incorporate the main rationale for ICD-10-CM/PCS: to ensure the successful capture of additional specificity regarding care and conditions treated in America today. At the most basic level, education should highlight documentation requirements associated with appropriate coding. Lack of specificity affects the entire healthcare process. CDI specialists, in their efforts, have a valuable role to play.
Debra Beisel Denton, RHIA, CCS, CCDS
AzHIMA Coding Roundtable Coordinator
Please visit AzHIMA Coding Roundtable to learn more.
Click on the graphic to download the PDF, provided by the AHIMA CDI Task Force.
We are introducing CDI Chat Topics on the Coding Roundtable page. Please take a moment to check it out here.
We are looking for Clinical Documentation Specialists (CDIP/CCDS) to share other tips for ICD-10 documentation opportunities they are learning with ICD-10-CM/PCS.
Please use the form below to share!
October 30, 2015
Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries
CMS Finalizes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Changes to the Two-Midnight Rule and Quality Reporting for 2016
The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates final rule with comment period (OPPS/ASC final rule) [CMS-1633-FC] on October 30, 2015.
The CY 2016 OPPS/ASC final rule updates Medicare payment policies and rates for hospital outpatient departments (HOPDs), ASCs, and partial hospitalization services provided by community mental health centers (CMHCs), and refinements to programs that encourage high-quality care in these outpatient settings. Approximately 4,000 hospitals and 60 CMHCs are paid under the OPPS, while approximately 5,300 ASCs are paid under the ASC payment system. The OPPS provides payment for most HOPD services, including partial hospitalization services furnished by HOPDs and CMHCs. OPPS payment amounts vary according to the Ambulatory Payment Classification (APC) group to which a service or procedure is assigned. The final rule also includes important changes to the Two Midnight Rule effective beginning in CY 2016. See the related fact sheet for detailed information.
Click here to read more: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-3.html
Fact Sheet: Two-Midnight Rule
In addition, On October 30, 2015, CMS released updates to the Two-Midnight rule regarding when inpatient admissions are appropriate for payment under Medicare Part A. These changes continue CMS’ long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries. These updates were included in the calendar year (CY) 2016 Hospital Outpatient Prospective Payment System (OPPS) final rule.
Click here to read more Two-Midnight Rule fact sheet:
THIS WEEK’S INDUSTRY & AHIMA NEWS
Important Interim Advice from NCHS on Excludes 1 Notes
We have received several questions regarding the interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another.
Answer: If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note. For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder. In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-.
Attending coding roundtables is an exciting way for coders and clinical documentation specialists (CDS) to keep up-to-date on coding education and participate in hands-on practice. Coding scenarios with answers will be provided for practice and discussion. These are “working” meetings and coders and CDS should come to the roundtable prepared to code and participate in discussion regarding the coding scenarios (we will have ICD-10 books available but only a limited number so if you have one – please bring it!).
Each coding roundtable will have one facilitator for inpatient scenarios and a facilitator for outpatient scenarios who will present the coding scenario and moderate discussion, drawing out comments and questions, taking notes, and encouraging participation from participants. At the conclusion, the moderator will solicit feedback as to whether the session was useful, how it can be improved, and gather suggestions for future discussion topics.
Please consider volunteering:
You can also:
Debra Beisel Denton, Chair
Susan Ishikawa, Co-Chair