AAPC - credentialing the business side of medicine

The Drummond Group Inc. (DGI), Austin, Texas, and the Certification Commission for Health Information Technology (CCHIT), Chicago, Ill., were named Aug. 30 by the Office of the National Coordinator for Health Information Technology (ONC) as the first technology review bodies that have been authorized to test and certify electronic health record (EHR) systems for compliance with the standards and certification criteria that were issued by the U.S. Department of Health and Human Services (HHS) earlier this year.

Announcement of these ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) means that EHR vendors can now begin to have their products certified as meeting criteria to support meaningful use—a key step in the national initiative to encourage adoption and effective use of EHRs by America’s health care providers.

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Core Clinical Quality Measures for Eligible Physicians (EPs)

To demonstrate meaningful use of electronic health records (EHRs) under the Final Rule, EPs must report six clinical quality measures. Of these, three are “core” quality measures, which include:

• Hypertension: Blood Pressure Measurement
• Preventive Care and Screening Measure Pair:
  • a. Tobacco Use Assessment
  • b. Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

If the provider is unable to report on one of these clinical measures because the provider sees no patients addressed by the measures, three “alternate core requirements” are available for reporting:

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old
• Childhood Immunization Status

Menu Clinical Quality Measures for EPs

In addition to three core quality measures, to demonstrate meaningful use an EP must report on any three additional quality measures, as selected from a list of 38 possible measures.

Breast Cancer Screening Description: Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer

Smoking and Tobacco Use Cessation, Medical Assistance:

• Advising smokers and tobacco users to quit
• Discussing smoking and tobacco use cessation medications
• Discussing smoking and tobacco use cessation strategies description

Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies Read more »

A recent article co-written by top government officials and published in the Annals of Internal Medicine touts the virtues of recent health reform legislation. Robert Kocher, M.D., National Economic Council, special assistant to the president for health care, Ezekiel J. Emanuel, M.D., special advisor on health policy, Office of Management and Budget, and White House Director of Health Reform Nancy-Ann M. DeParle, J.D., admit in the article, “The Affordable Care Act and the Future of Clinical Medicine: The Opportunities and Challenges,” that reform will weed out the inept, but those who are up to the challenge will reap the rewards of a superior health care system.

“To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change,” the authors write.

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DCS Healthcare, recovery audit contractor (RAC) for Region A, posted 11 newly approved audit issues on its website mid-August. Unlike its counterpart, CGI Federal, none of the new issues include medical necessity review. Nine of the new issues are for medical severity-diagnosis related groups (MS-DRGs), another also affects inpatient claims and another affects durable medical equipment (DME) suppliers.

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The Centers for Medicare & Medicaid Services (CMS) is changing the payment status indicator for CPT® code 90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use from “E” (not paid under the Outpatient Prospective Payment System (OPPS)) to “L” (not paid under OPPS; paid at reasonable cost; not subject to deductible or co-insurance) in the October 2010 Integrated Outpatient Code Editor (IOCE).

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The Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) posted updates Aug. 5 to the ICD-9-CM Official Guidelines for Coding and Reporting. These guidelines for diagnosis coding are effective Oct. 1.

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Under the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) is expanding Medicare coverage of evidence-based tobacco cessation counseling. Effective Jan. 1, 2011, any smoker covered by Medicare can receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner.

Current Medicare policy covers tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or for those who show signs or symptoms of such a disease.

“Today’s decision builds on the existing preventive services that are available to Medicare beneficiaries,” said CMS Administrator Don Berwick, M.D. “Giving older Americans and persons with disabilities who rely on Medicare the coverage they need for counseling treatments that can aid them in quitting will have a positive impact on their health and quality of life. As a result, all Medicare beneficiaries now have more help to avoid the painful—and often deadly—consequences of tobacco use.”

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Core Objectives and Measures

All core objectives must be met, unless an exception applies. Several objectives do not allow exceptions.

Core Objective: Use computerized physician order entry (CPOE) for medication orders directly entered by any licensed health care professional who can enter orders into the medical record per state, local and professional guidelines.

Measure: More than 30 percent of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (place of service 21 Inpatient hospital or 23 Emergency room – hospital) have at least one medication order entered using CPOE.

Core Objective: Implement drug/drug and drug/allergy interaction checks.

Measure: The EP/eligible hospital/CAH has enabled this functionality and has access to at least one internal or external formulary for the entire EHR reporting period.

Core Objective: Maintain an up-to-date problem list of current and active diagnoses.

Measure: More than 80 percent of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry, or an indication that no problems are known for the patient recorded as structured data. Read more »

The Centers for Medicare & Medicaid Services (CMS) is considering changes to the Medicare coverage policy for ventricular assist devices (VAD) as destination therapy in end-stage heart failure patients.

In a proposed decision memo dated Aug. 19, CMS proposes removing the requirement that patients must have a body size greater than 1.5 m² and raising the peak oxygen-consumption threshold from 12 mL/kg/min to 14 mL/kg/min.

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The Centers for Medicare & Medicaid Services (CMS) issued a reminder Aug. 24 to health care providers, health plans, clearinghouses, and vendors about the approaching compliance dates for the transition to the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic health care transaction standards. Beginning January 2011, entities covered under the Health Insurance Portability and Accountability Act (HIPAA) should be ready to test with their trading partners the functionality of the entities’ practice management and/or other related software featuring Version 5010 standards.

That date is right around the corner. Are you ready?

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