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Reports from Delegates to the 2003 AHIMA National Convention

Presentation: ICD-9-CM to ICD-10-CM

Speaker: Anita Hazelwood, MLS, FAHIMA, RHIA

Reviewed by: Jackie Moczygemba, MBA, RHIA, CCS

Synopsis:

This was an educational session to explore the transition issues and challenges in moving from ICD-9-CM to ICD-10-CM. Main objectives of the session included a discussion of uses of coded data, examination of HIPAA in relation to code sets, a brief comparison of ICD-9-CM to ICD-10-CM, a review of steps necessary to implement ICD-10-CM and a determination of individuals who will be affected by a change to ICD-10-CM. In addition, the speaker gave a broad overview of the structure and format of ICD-10-CM and analyzed major code changes between the two classifications.

Key Points:

• There are many problems with the current ICD-9-CM coding system which include: running out of numbers to use, insufficient clinical specificity, exchange of meaningful data with other parties, and ineffective monitoring of resources.
• Coded data has many more uses than in the past
• ICD-10-CM codes are alphanumeric and include all letters except "U'
• ICD-9-CM's V and E codes are now incorporated into the main classification in ICD-10-CM
• Codes in ICD-10-CM can be a maximum of seven characters as opposed to five in ICD-9-CM
• Now is the time to look at various issues regarding implementation of ICD-10-CM in the US such as the extensive training that will be needed for coders, physicians, billing personnel and others.
• Information systems such as billing, decision support, encoding, abstracting, case mix and others need to be reviewed to see what impact the new coding system will have on work processes.

Presentation: Six Sigma: Debunking the Myths and Delivering the Goods

Speaker: Deb Newberry and Gary Floss

Reviewed by: Jackie Moczygemba, MBS, RHIA, CCS

Synopsis:

This was an education session to cover the basics of six sigma, what it is and why it is important to organizations. Six sigma is an enterprise-wide strategy for improving key financial and performance measures that is data driven with results-focused decisions. It is designed to create manufacturing, service and administrative processes that produce approximately 3.4 defects per million opportunities (DPMO). In addition, six sigma is a systems-focused methodology for aligning the organization around customer-focused goals.

Key Points:

• Six sigma is a strategy to accelerate improvements in processes, products and services that is tied to financial results.
• The first focus is on reducing process variation and then on improving the process capability.
• An important attribute to consider is designing the product or service to meet customer needs and process capability.
• Six sigma allows an organization to "keep score" with a combination of financial results and mathematical measurements.
  

Presentation: Sending Coders Home: Strategies to Improve the Bottom Line

Speaker: Beth Freidman, RHIT and Teresa Benavidez, RHIA

Reviewed by: Dana M. Choate, RHIA, CHP

Synopsis: (in 5 sentences or less)

This educational session detailed strategies for setting up coding from remote locations. The speakers discussed the benefits of moving in this direction. Additionally, the speakers shared a case study when Seton Healthcare System in Austin implemented on-line coding. Finally, the speakers shared some best practices for communicating this initiative in order to seek CFO's approval.

Key Points:

• Remote coding proved beneficial to the coder and the facility. Facility was able to recruit coders and lower accounts receivable. Coders have less distractions, increase productivity and the ability to earn more money.
• After implementation of remote coding there is a 28% increase in production and 25% decrease in accounts receivable.
• The presenters gave us tools to determine costs associated with sending coders home.
• Home coding helps cut outsourcing costs, improves cash flow and is a stepping stone into the electronic medical record.
• There are essentially two ways a facility can implement home coding (photocopying or electronic access to scanned images).
• Anyone interested in seeing a demo of on-line coding technology can review www.ewebcoding.com.
  

Presentation: Compliance and Enforcement of the Privacy Rule

Speaker: David Meyer, Department of Health and Human Services, Office for Civil Rights.

Reviewed by: Dana M. Choate, RHIA, CHP

Synopsis: (in 5 sentences or less)

This educational session focused on what the Office for Civil Rights has witnessed within the first six months of HIPAA implementation. Additionally, the speaker discussed how the Office for Civil Rights (OCR) is enforcing the privacy rule. Meyer spent some time discussing the types of complaints they have received. The audience had an opportunity to ask questions. Meyer clarified that covered entities must account for illegal or misguided disclosures. An AHIMA member voiced concerns that the Department of Health and Human Services needs to reconsider covered entities keeping up with accountings to state mandated reporting.

Key Points:

• Speaker stressed that HIPAA should not prohibit free-flow of treatment information. OCR has received complaints about the strict stance covered entities have taken in sharing treatment information.
• Meyer reported that since 04/14/03, they have received 2731 complaints, 600 of which have been resolved. Of the complaints, 95% are against providers.
• Complaints received involve access to medical records, covered entities breaching confidentiality, employees reporting they haven't been trained (whistleblowers) misdirected PHI and custodial complaints.
• Meyer stressed that the best way to keep OCR out of a facility is to have an effective complaint process.
• The OCR has not imposed any penalties as of 10/17/03. They have only audited one facility (in Texas) to determine HIPAA compliance.
• Meyer discussed that OCR really stresses voluntary compliance. If a complaint is received, OCR will work with covered entity to comply. They provide technical assistance to facility. Good faith effort to comply with HIPAA standards and resolve complaints goes a long way with OCR.

Presentation: Surviving Medicare Medical Review (LTC)

Speaker: Susan Coppola, RN, BS and Monica Baggio Torney, RHIA, CHP.

Reviewed by: Dana M. Choate, RHIA, CHP

Synopsis: (in 5 sentences or less)

This long-term care educational session focused on issues of a Medicare Medical Record Review process and tips for surviving a Medicare Audit. The speakers felt that HIM professionals play a key role by developing a system of documentation and billing services, trending and tracking review data and release of information expertise in the review process. It was interested to note that 95% of Medicare claims are paid without a medical record request.

Key Points:

• The speakers stressed the importance of demonstrating medically necessary services for residents. Medical necessity involves a physician order, a diagnosis and the resident's need for the procedure/treatment.
• The speakers stressed the need for proactive and reactive medical record reviews.
• The proactive review should be conducted to identify in consistencies in care, trends or patterns of care and high-risk resident conditions.
• When reviewing what to audit during chart review, the central element was legibility of documentation across multidisciplinary treatment teams.
• The speakers also shared "confessions of a Medicare review." They have 15 minutes to make a determination on the claim. They will immediately look for technical denial such as:
  • Lack of qualifying hospitalization
  • No SNF days left
  • Medicare certification incomplete
  • Lack of daily skilled documentation

Presentation: 2003 AHIMA House of Delegates

Reviewed by: Kimberly Suggs, MA, RHIA, CCS

Synopsis:

Participants in the 2003 AHIMA House of Delegates discussed issues ranging from CE requirements to membership dues to the future of education and ethical practices. The following outlines the key outcomes for the Sunday session:

New Standards for CE Maintenance

The House approved a proposal to changes the standards for maintenance of continuing education units for AHIMA credentials. The measure was developed to simplify the process of deciphering the maintenance requirements for professionals who hold multiple credentials.

The revised standards create two categories for purposes of continuing education maintenance: associate-based (RHIT, CCA, CCS, and CCS-P) and baccalaureate-based (RHIA, CHP, and CHPS). Members holding an associate-based credential need to take 20 continuing education units (CEUs) plus 10 CEUs for each additional credential held. Members holding a baccalaureate-based credential will need 30 CEUs plus 10 CEUs for each additional credential. For individuals holding many credentials, the new standards cap the CEU requirements at 60.

A motion proposed by the Oregon delegation to add an amendment related to applying CEU activity to multiple credentials was defeated.

Dues Adjustment Amendment Defeated

The House did not pass an amendment proposed to allow the AHIMA Board to authorize a cost of living adjustment to dues.

The amendment was designed to allow the Board to keep dues in line with expenses without large periodic increases. The adjustment by the Board could not have exceeded the prior year's official US cost of living index and the House would have to approve any increase above 8 percent.

The amendment required a two-thirds majority to pass. It failed to gain the two-thirds in an initial vote and also failed its bid in a re-vote situation. Because the amendment was defeated, a related motion by the California delegation was not considered.

New Committee Name

The House approved a bylaw amendment that changes the name of the Professional Conduct Committee to the Professional Ethics Committee. The change was suggested to keep AHIMA up to date in the nomenclature used by association leadership.

Independent Recognition for Accreditation

The House voted to approve a resolution addressing HIM academic program education and accreditation. The resolution states that AHIMA now believes that independent recognition by the Council for Higher Education and Accreditation (CHEA) will better serve the needs of HIM education.

This represents a change from the current process in which AHIMA makes recommendations on accrediting decisions to a different entity, the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

Presentation: HIM Futures

Speaker: Linda Kloss, RHIA, CAE, Executive Vice President and CEO, AHIMA

Reviewed by: Kimberly Suggs, MA, RHIA, CCS

Synopsis:

This session focused on how information has become the new commodity of healthcare and that health information is not the exclusive domain of HIM professionals anymore. Ms. Kloss' discussion also emphasized that timing is critical for HIM professionals to take advantage of opportunities to make a difference in changing healthcare. "What we do as a profession in the next 12 - 24 months will position our profession for the future".

Key Points:

· Our work on the forefront of HIPAA has paid off. Personal health information has greater protection today than it did six months ago. Although more remains to be done, the hard work of implementing HIPAA has paid off in terms of visibility for the profession.

· AHIMA has participated in standards development work since the early 1980's. Today the association continues this work.

• AHIMA is a founding member of the National Alliance for Health Information Technology, which has led efforts to get agreement from the industry on a uniform standard for bar coding products.
• AHIMA continues to be a strong voice in efforts to promote the benefits of transitioning to the ICD-10 coding system.
• This year, AHIMA members participated in the efforts of the industry group, The EHR Collaborative to gather feedback on the draft standard for an EHR developed by HL7 at the request of the Department of Health and Human Services.
• AHIMA members should work to be integral to the EHR planning process.
• AHIMA will be a cosponsor of the American Medical Informatics Association spring conference on the electronic health record.
• AHIMA launched www.MyPHR.com, a site intended to help consumers understand and manage their health information.
  • AHIMA members must embrace the e-HIM future and make e-HIM a personal mission. AHIMA members are poised to lead change, not just react to it. Our e-HIM initiative is intended to be a catalyst for change, beginning with a vision in which information is "electronic, person-centered, comprehensive, longitudinal, accessible, and credible".
  • "What could be a better time than when the focus of the nation is on electronic records to solve problems in the healthcare industry? We have a wonderful opportunity".
    

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