ICD-10 impact, CMS redefines EHR , Con men and Health Care Act
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Health Management Technology News
November 11, 2013

In this issue:

Healthcare.gov chief resigns amid Web site glitches

HIMSS Analytics Honors, Atrius Health and its affiliate, Reliant Medical Group, with Stage 7

How will the transition to ICD-10 impact the revenue cycle?

CMS redefines certified EHR technology criteria for 2014

Con men prey on confusion over Health Care Act

Affordable Care Act

Healthcare.gov chief resigns amid Web site glitches

As bugs and glitches continue to plague Healthcare.gov, the man who oversaw the site's creation has said he's resigning. Tony Trenkle, chief information officer at the Centers for Medicare and Medicaid Services (CMS), sent an e-mail to co-workers on that said he will be leaving on November 15 "to take a position in the private sector."

Apparently, Trenkle's resignation isn't directly a result of the bungled Web site, but rather a management restructuring within the department, according to information sent to CNET by CMS.

"Given the importance of the I.T. portfolio here, we've moved quickly to fill this position with another internal staff member who had vast experience and knowledge of the I.T. issue," CMS Office of Communications director Julie Bataille said during a press call.

CMS' current director of the Office of Enterprise Management, Dave Nelson, has agreed to serve as the acting chief information officer upon Trenkle's departure.

Healthcare.gov is the Web site where US residents can buy health insurance, which is now mandatory under the Affordable Care Act. The site launched October 1 and the digital exchange has been plagued with problems and criticism ever since. Glitches have included site crashes, down time, erroneous data, and possible privacy violations.

This Web site forms one of the cornerstones of President Obama's domestic agenda, and there have already been plenty of hearings at the US Capitol determining who to pin the blame on within the administration. Obama himself deemed the glitches as unacceptable, saying last month that the online health insurance marketplace "has not lived up to the expectations of the American people."

Visit CNET for the story

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HIMSS Analytics Honors, Atrius Health and its affiliate, Reliant Medical Group, with Stage 7

HIMSS Analytics announced that Atrius Health and also separately its affiliate, Reliant Medical Group, in Worcester, MA, has received a Stage 7 Ambulatory Award. The award represents Atrius Health and Reliant Medical Group’s attainment of the highest level on the Electronic Medical Record Adoption Model (EMRAM), which is used to track EMR progress at hospitals and health systems.

Developed in 2011, the EMR Ambulatory Adoption Model provides a methodology for evaluating the progress and impact of electronic medical record systems for ambulatory facilities owned by hospitals in the HIMSS Analytics Database.Stage 7 represents the highest level of EMR adoption and indicates a health system’s advanced electronic patient record environment.

Through the second fiscal quarter of 2013, only 1.23 percent, of the more than 20,529 U.S. ambulatory clinics in the HIMSS Analytics Database, have received the Stage 7 Ambulatory Award.

"Atrius Health and Reliant Medical Group are grateful for this recognition from HIMSS and for HIMSS work in developing the thoughtful and comprehensive framework for the assessment,” said Dan Moriarty, chief information officer for Atrius Health. “Achieving high value IT requires that a broad and deep team receive leadership support and be in strategic synergy with the goals of the organization. At Atrius Health, we feel fortunate to have the informatics, analytics, engineering and project management teams that work effectively together -- and great collaboration with clinical leadership -- to keep all of our efforts pointed in the right direction."

“I am proud of the Reliant Medical Group physicians, staff, and IT team for their achievement,” noted Dr. Larry Garber, medical director for informatics, Reliant Medical Group. “This dual recognition reinforces why Reliant joined Atrius Health -- we clearly share the same values about the importance of IT in supporting our patients.”

Visit HIMSS for the full story

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How will the transition to ICD-10 impact the revenue cycle?

Oct. 1, 2014, is an example of how one cog in the revenue cycle can impact the entire wheel. Some are already referring to ICD-10 as the healthcare industry’s version of Y2K. In the context of the revenue cycle, ICD-9 to ICD-10 shows that reimbursement isn’t solely the responsibility of the accounts receivable. While healthcare organizations need to engage their payers to ensure a smooth transition, they must similarly engage their physicians and coders in knowing how valuable their roles are in ensuring that bills get paid.

On the one hand, ICD-10 requires clear communication with payers. This is where conversations about general equivalency mappings (GEMs) and diagnosis-related groups (DRG) become essential for healthcare organizations.

“We truly believe it’s going to be a problematic area if hospitals do not engage and understand how they are going to map and pay them under the DRG model,” says HRAA CEO and Chairman Andrea Clark. “If they do not engage in that conversation and October 2nd, 3rd, 4th, or 5th of 2014 comes along, they can be surprised at the amount of denials they may receive along with suspension of claims and not have a strategy in place to correct those problems.”

Visit EHR Intelligence for the report

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CMS redefines certified EHR technology criteria for 2014

In an announcement written by Robert Tagalicod, the Director of the Office of E-Health Standards and Services (OESS), the Department of Health & Human Services (HHS) has redefined certified EHR technology. While eligible professionals participating in Medicare & Medicaid EHR Incentive Programs still need to use certified EHR technology, this change will allow more flexibility for practices selecting the technology, and the ability for vendors to offer more need-specific EHR options.

By the 2011 Edition criteria, all participants needed to use a complete EHR, often leaving providers with unused or useless technology that did not help them fulfill Meaningful Use. Under the new HHS policy (the 2014 Edition criteria), practices may choose only the technology required to meet Stage 1 and Stage 2 requirements, giving room for customized EHR technology.

To help providers find practice-specific technology, the Office of the National Coordinator for Health Information Technology (ONC) offers a Certified Health IT Product List containing all certified EHR technology under both the 2011 and 2014 Edition criteria.

Visit EHR intelligence for the release

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Health Care Act

Con men prey on confusion over Health Care Act

With millions of Americans frustrated and bewildered by the trouble-prone federal website for health insurance, con men and unscrupulous marketers are seizing their chance. State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act.

Some level of fraud or abuse is predictable with any big government program, and administration officials expected a few bad actors to emerge. Attorney General Eric H. Holder Jr.; Kathleen Sebelius, the secretary of health and human services; Edith Ramirez, the chairwoman of the Federal Trade Commission; and other officials met at the White House in September to discuss possible pitfalls.

“With this changing health insurance landscape, there is a new opportunity for people to take advantage of our residents, and we’ve seen it starting already,” said Kate Abernathy, a spokeswoman at the Tennessee Department of Commerce and Insurance.

While it is difficult to quantify the problem, interviews with authorities in states including California, Florida, Illinois and New York suggest that fraud is a growing worry. Websites are particularly difficult to police.

“We are remaining vigilant, since we anticipated that the law was so complex that scam artists would take advantage of it,” said Tom Miller, the attorney general of Iowa. In New York and Illinois, attorneys general are investigating at least two firms that they suspect of fraud, according to people briefed on the matter. Since October, attorney general offices in 36 states have been holding conference calls about the emerging dangers every two weeks.

The most prevalent complaints involve older Americans. Under the law, people age 65 and over, who are on Medicare, do not need to buy supplemental coverage. Nonetheless, some marketers are pushing expensive add-on policies by falsely claiming that such coverage is required, state authorities say. Others are telling people that the law means they need new Medicare cards — not true. And still others are charging fees as high as $100 to “help” people navigate the new insurance landscape.

And then there are those who are creating websites that resemble state healthcare exchanges. Visitors to those websites, with addresses like NewHampshireHealthExchange.com, say they are inundated with pitches from private insurance agents unaffiliated with the government.

Authorities warn that in some cases the come-ons are merely a ruse to get people to divulge sensitive Medicare and banking information. The pitches usually come with a telephone call or knock at the door. Someone claiming to be a government official offers help or warns residents that their Medicare cards are about to expire. Then the hook is set.

“The scammers are deploying traditional Medicare cons but wrapping them in the Affordable Health Care Act,” said James Quiggle of Coalition Against Insurance Fraud, a Washington-based nonprofit.

Visit the New York Times for the article

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Continuing Education

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November 2013 HMT digital book

Industry News

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HIMSS Analytics honors three hospitals with Stage 7 Awards
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Former HHS deputy secretary to lead new healthcare initiative of large employers
HR Policy Association, representing the chief human resource officers of more than 350 of the largest...
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