MaHIMA Connect
Official Newsletter of MaHIMA
January 2010 (archived)
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In this issue:
- News from the Editor
- President's Message
- MaHIMA has a New Website!
- MaHIMA Honors Meredith Cameron with Donation
- Legislative Affairs Update: Dot Wagg Memorial Seminar & Award Presentations
- Is Tougher HIPAA Enforcement Finally Here?
- HITECH Act: What it Means to Electronic Medical Record Adoption & Release of Information Responsibilities
- HIM Innovation Award Winner - South Shore Hospital - Project Category: Fiscal Impact
- HIM Innovation Award Winner - Lawrence General Hospital - Project Category: Best Practice (Compliance)
- Call for Nominations
- Calling New MyPHR Presenters
- Education Notes - Fisher College
- Education Notes - Labourè College
- Education Notes - Bristol Community College
- Congratulations to Our Newly Credentialed
- Save the Dates for Upcoming MaHIMA Events
News from the Editori
Clare Carvel, M.Ed., RHIA, CCS
Happy New Year! As the new Editor, it is exciting to see positive changes taking place within the association, one of which is a new name for our newsletter. Connect was one of many that came about as a result of a Visioning Meeting held in October and attended by Board Members and the Communications Committee. Thanks to those who were present for their time and energy! It was agreed by that group to have MaHIMA members vote on the name, and Connect was the overwhelming winner. So, along with calendar year 2009, join me in bidding a fond farewell to the familiar name e-Channel and welcoming MaHIMA Connect!
In addition to a name change, other ideas brainstormed at that meeting were polled via survey. Respondents indicated they would like to see more “hot topics” and, to this end, Attorney Colin Zick from Foley Hoag, LLP, has agreed to contribute regular articles on legal issues impacting HIM. Also, Pat Rioux, RHIA, Application Specialist at eClinicalWorks, a manufacturer of EMR products, will keep us informed about technology trends, beginning with an article about the HITECH Act.
There are many definitions for the word “connect”, ranging from “establishing in relationship; joining” to “meeting for the transference of passengers”, as in airline flights that connect.
On a personal note, it brings to mind the security of knowing I have the ability to access needed resources. For example, when I click on Internet Explorer, this message appears in the toolbar: CONNECTING …
That tells me I’ll soon be checking e-mail, uploading photos, and researching anything I need or want to know on the Internet.
As our profession faces continuous challenges and opportunities such as the RAC, ICD-10, Red Flag Rules and others, MaHIMA Connect will be a dependable source for exchange of information among members, other associations and experts in the field, as well as updates on current topics and links to additional resources. I welcome your feedback and suggestions for future content.
As we start a new year together, what better name for our newsletter than MaHIMA Connect?
President's Message
ICD-10-CM and ICD-10-PCS
Implementation of new ICD-10 diagnoses and procedure codes will be effective October 1, 2013, and preparing for the transition to it from ICD-9 is a very large undertaking. Working for a health care provider, academic institution or a health plan, the project plan necessary to accomplish the transition from ICD-9 to ICD-10 takes careful planning and collaboration between finance, clinicians, IT, HIM and operational leaders.
A good overview of implementing ICD-10 is an executive briefing from the American Hospital Association “HIPAA Code Set Rule: ICD 10 Implementation”. If you are an AHA member, you can download copies of this resource at www.aha.org, click on "Issues" then "HIPAA".
The following ICD-10 sample timeline is from the North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA): http://www.nchica.org/hipaaresources/timeline.htm.
ICD-10 is ten times larger than ICD-9 with an overall greater specificity in code assignments. Other countries now live on ICD-10 report a 6-9 month production decrease for coders. No one is currently live on ICD-10 PCS (procedure coding system). ICD-10 Procedure Coding will be new for all. It is important to remember this is not solely an IT project. Coders and Physicians must undergo basic training in ICD-10 at least six months prior to October 1, 2013. Will the documentation contain enough detail to support the new system?
There will be a period of time where your systems need to support both ICD-9 and ICD-10 with payers and researchers trying to crosswalk ICD-9 to ICD-10 and back. Refer to the General Equivalence Mappings (GEM) by CMS. Similar to a foreign language, there isn’t always a one to one translation. You can go from ICD-9 to ICD-10 and have a list of codes; then go from ICD-10 back to ICD-9 and have additional codes.
In the Health Care Provider setting you need to begin a systems application inventory, listing each vendor, application name where ICD-9 codes are captured, stored, analyzed and reported. The current systems need to accommodate the expanded codes.
The 5010 mandate is the next generation of HIPAA transactions and code sets (electronic exchange of administrative and financial information between health care providers and health plans for patient care services). 5010 has an earlier compliance date (January 1, 2012) than ICD-10 as it serves as the foundation of electronic exchange.
Don’t forget your researchers and physician offices with standalone data bases currently collecting ICD-9 codes and reporting. These must also be incorporated in your application inventory. Industry analysts describe ICD-10 as possibly exceeding Y2K in cost and impact, further emphasizing why proper planning is so essential.
ICD-10-CM/PCS Myths & Facts:
Myth: Current Procedural Terminology (CPT) will be replaced by ICD-10-PCS
Fact: ICD-10-PCS will only be used for facility reporting of hospital inpatient procedures and will NOT affect the use of CPT.
Take advantage of the following AHIMA and MaHIMA resources in 2010:
AHIMA created a separate ICD-10 webpage with a long list of ICD-10 documents, FAQ’s, ICD Ten Newsletter and audio conferences at www.ahima.org/icd10/
MaHIMA ICD-10 educational plans for 2010 include:
- Transitioning to ICD-10 for Coders. MaHIMA Winter Meeting, Marlboro, January 29, 2010
- MaHIMA ICD-10 Summit, Dedham, March 31, 2010
- ICD-10 Presentations, 6 State Meeting, Manchester, NH, May 2-4, 2010
Happy New Year, MaHIMA members! Please remember to visit often our new website at www.mahima.org.
MaHIMA has a New Website!
Susan Pepple, Director, Communications
The new www.mahima.org is designed to quickly and easily inform you of MaHIMA’s many and diverse association activities. Details on upcoming educational sessions as well as legislative advocacy are all available here. Our resources tab offers links and materials on issues of interest to HIM professionals. In our member area, you will be able to do many things including update your membership information, look for a new job, and check out photos of recent MaHIMA meetings.
A new website is not an easy project. We wish to thank Jeanne Fernandes, our website editor, and Karen O’Donnell our website technical editor, for their extraordinary creativity, energy and follow-through. Thanks also to Marc Avila and his team at 3MediaWeb – they made the process easy. And final thanks to the many members of the Communications Committee and MaHIMA Board of Directors for their input and encouraging comments.
We hope you like your new website. MaHIMA welcomes your feedback and comments.
MaHIMA Honors Meredith Cameron with Donation
Karen O'Donnell, RHIA, Administrative Director
On December 20, 2009, MaHIMA lost one of its past presidents and long-time friend, Meredith Cameron, RHIA. Meredith passed away suddenly while visiting family in Washington, DC. She was the Director of Health Information at New England Baptist Hospital, a position she held for many years. She was also a past instructor and clinical coordinator for the Health Information Administration program at Northeastern University.
Meredith was an active member and board member of MaHIMA , serving first as a Delegate in 1977, then working her way up to be President in 1983-84, the same year that the Prospective Payment System was enacted and the AHIMA National Convention was held in Boston. She will be missed dearly by her many colleagues and students.
The MaHIMA Board of Directors has voted to honor Meredith by awarding ten $100 MaHIMA Certification Scholarships in her memory. The MaHIMA Certification Scholarship encourages HIM professionals by helping to defray the cost of certification examinations. Any member of Massachusetts HIMA who has taken and passed one of the AHIMA sponsored certification programs is eligible to apply. Information on the MaHIMA Scholarship is available here.
MaHIMA members are invited to join the board in honoring Meredith’s memory by contributing to the MaHIMA Certification Scholarship. You can make your tax-deductible memorial gift today by clicking here.
There will be a memorial service for Meredith at the First Religious Society Unitarian Church (27 School Street, Carlisle, MA 01741) on Saturday, January 9, 2010 at 11:00 am. All are welcome to attend.
Legislative Affairs Update: Dot Wagg Memorial Seminar & Awards Presentation
Karen Griffin, Director, Legislative Affairs & Advocacy
The Dot Wagg Memorial Seminar: "Next Steps in the Regulatory Environment" was held in Marlboro, MA on November 4, 2009. On behalf of the Legislative Affairs Committee, I would like to thank all those who attended as well as share with you some of the comments received indicative of the feedback.
“This was one of the most informative and interesting meetings I have attended! Thank you.”
“All topics were very pertinent, timely. The presenters were great, as was the networking. I am impressed with the quality of MaHIMA’s educational seminars.”
“This was one of the best conferences I have attended over the last several years.”
I would also like to thank the presenters for their generosity and willingness to share their professional knowledge and experiences as part of this educational forum. The talented presenters earning such high regards from attendees included:
• Debra Mikels, Corporate Manager, Confidentiality, Partners Health Care System, speaking on Understanding & Implementing Privacy Requirements Associated with the HITECH Regulation
• Deborah Adair, MPH, MS, RHIA, Director, Health Information Management and Privacy Officer, Massachusetts General Hospital, speaking on Developing a State-Wide HIT Plan in Massachusetts
• Rick Hoover, Health Insurance/Provider Relations Specialist, CMS, speaking on the RAC Appeals Process
• Andrew Finnegan, Health Insurance/Provider Relations Specialist, CMS, speaking on The Next Phase: Zone Program Integrity Contractors (ZPIC)
• Brad Blake, Director, Information Technology, Boston Medical Center, speaking on How to Ensure HIPAA Privacy in an Email Oriented Industry
The Legislative Affairs Committee hopes to see you at our next educational event….the upcoming annual Beacon Hill Day is scheduled for Thursday, May 20, 2010 at the State House in Boston. Watch for upcoming details on the Legislative Affairs page of our website at www.mahima.org.
RECAP OF AWARDS PRESENTATIONS
In addition to hearing the outstanding speakers at the Dot Wagg Seminar, I had the pleasure of presenting both Luisa DiIeso, RHIA, CCS, and Nancy Stanton, RHIA, with the 2009 Health Information Management Advocacy Award. This is a new award, designed to acknowledge an individual’s continued pursuit and willingness to educate and promote legislative and regulatory initiatives that support the advancement of the HIM profession.
As part of the presentation, I shared Luisa’s and Nancy’s journeys in the HIM field and their accomplishments along the way. Of note, the initiative for which they received the Advocacy Award started with a perfectly logical concept that there should be consistency across the payer network with regard to reporting patient data. If you ask Luisa and Nancy, I'm sure they would say easier said than done.
Facing the challenges before them, they began to showcase the widespread inconsistencies and variations in the manner in which patient data was being reported to individual payers. Both Luisa and Nancy collectively pursued their charge by focusing on the disparities that existed between the payer requirements, while focusing on the importance of data quality and integrity vs. payer covered services. Their challenge was to face, head-on, the extensive code set discrepancies currently in existence.
Luisa and Nancy created a committee to begin documenting the variations between payer requirements and the official coding guidelines, while continuing to focus on the impact of data quality and integrity along with the claims processing component. Based on the results of their findings, they began to educate payers, state legislators, and other related parties about the challenges faced by HIM practitioners. Combining their knowledge and experience, along with Senator Karen Spilka and her legislative staff’s resources, they led a campaign to gain exposure at the state level. Educational presentations included the AHIMA National Convention, MaHIMA and MAPAM seminars, as well as various payer forums.
As a result of their diligent pursuit to promote a uniform method of reporting patient data, Senate Bill No. 2863 was approved on August 10, 2008 and included language that proposed new regulation requiring “..uniformity and consistency in the reporting of patient diagnostic information, patient care services and procedure information as it related to the submission and processing of health care claims...”, enacting Chapter 305 of the Acts of 2008. As of July 1, 2012, the law will require payers and providers to use recent and updated code sets for claims processing to promote uniformity and consistency in reporting data. Throughout this process, Luisa’s and Nancy’s navigation of the legislative process to incorporate this significant language into state law demonstrates the dedicated efforts of HIM Champions.
MaHIMA recognizes the critical roles both Luisa and Nancy played in bringing the payer and provider communities to the same table in order to reach practical solutions moving forward. Congratulations on being recipients of the 2009 HIM Advocacy Award!
Is Tougher HIPAA Enforcement Finally Here?
Colin J. Zick, Esq., Folley Hoag LLP
It has been well over a decade since the passage of HIPAA in 1996. HIPAA has caused many changes in the way the business of health care works, including going a long way to create the position of “health information professional.” One area where HIPAA has, as yet, had little impact has been in enforcement. The history of enforcement of HIPAA’s privacy and security rules has been slim and almost none. The changes in behavior that have occurred have been done out of a desire to follow the law, and not fear of prosecution or administrative action. What few enforcement actions have been undertaken have been in the context of criminal behavior that had little to do with health care and would have been prosecuted anyway, without HIPAA.
Shortly after HIPAA’s passage in 1996, and then again after the passage of the HIPAA privacy regulations in 2001, I warned clients that there would be enforcement coming. After a while, when no enforcement came, I stopped giving my warning. Is it time for me to go out on a limb again and say that health care providers need to be worried once more about HIPAA? I am not quite ready to go there yet, but there are some preliminary signs that the HIPAA enforcement environment is changing.
First and foremost in this regard, I note the recent decision of the Department of Health and Human Services to transfer the authority for enforcement of HIPAA’s security rules to the Office of Civil Rights. The Office of Civil Rights is certainly in a better position to undertake enforcement than CMS. The Office of Civil Rights has a field force of 275 investigators that have an annual budget of $40 million. They will need to justify that budget and the most visible way to do that is to bring enforcement actions and recover significant penalties. Nevertheless, $40 million does not go as far as it used to, and it certainly is not enough for a broad-based, nationwide enforcement initiative. Instead, I suspect we will start to see incrementally more enforcement actions, higher financial penalties and a few selected audits.
Also pushing HIPAA enforcement is the HITECH Act, which was passed in February 2009 and much of which will go into effect in February 2010. Through the HITECH Act, HIPAA business associates under HIPAA are now subject to almost the same regulations as HIPAA covered entities. Penalties for HIPAA violations also were increased, and the ability to enforce some rules has been extended to state attorneys general.
There is one additional factor in the enforcement environment that is little-noticed, but nevertheless very significant: the general public. Most HIPAA issues that have been addressed by government officials were brought to light after a consumer complaint. This is a model that is true in many other regulated areas: it is often the complaint that drives the enforcement action and the whistleblower who pushes to have a civil or criminal case filed. And consumer sensitivity to privacy and security issues is growing explosively. Along with this activity at the consumer level, we can expect a parallel increase in the number of HIPAA whistleblowers. My experience in the health care fraud arena suggests that consumer complaints and whistleblowers will be the two most significant factors leading to more enforcement activities.
So what is to be done? I am not yet ready to start crying wolf about HIPAA enforcement again. But I would suggest that the same techniques that you, your employer or institution use to ferret out complaints and whistleblowers in billing and claims matters can and should be applied to privacy and security issues. In particular, I recommend that exit interviews should be conducted with all departing employees, so that their concerns can be heard before they depart. A well-conducted interview can save an institution time, money and aggravation, and set it on a better course.
Colin J. Zick is a member of Foley Hoag LLP's Health Care and Litigation practice groups. He advises clients on a variety of matters, including HIPAA, patient confidentiality, patient care, fraud and abuse, OIG advisory opinions, compliance programs, reimbursement, and other health care related issues. Atty. Zick has served as a Committee Chair on the Boston Bar Association HIPAA Task Force, has participated in a variety of health care educational programs and is an advisor and frequent speaker for MaHIMA. Atty. Zick invites you to visit the Foley Hoag LLP's website blog, "Privacy, Security and the Law" at http://www.securityprivacyandthelaw.com/ for timely and informative discussion on cases impacting the HIM Profession and health care in general.
HITECH Act: What it Means to Electronic Medical Record Adoption and Release of Information Responsibilities
Pat Rioux, RHIT, eClinicalWorks
The HITECH Act (Health Information Technology for Economic and Clinical Health Act) was part of President Obama's 2009 economic stimulus package known as the American Recovery and Reinvestment Act (ARRA). HITECH legislation encourages the healthcare industry to adopt electronic medical records by offering financial incentives ($19.5 billion) to providers and hospitals. Along with the push to adopt electronic medical records are new, strong provisions to keep sensitive data private and secure.
According to HITECH, eligible professionals will receive incentive payments for the first five years (2011-2015) up to $44K for demonstrating a ‘meaningful use’ of certified electronic health record technology during the reporting period. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payments will be made after 2016.
Providers and hospitals will have to put programs into place, collect data accurately and use the date to improve care to qualify for the incentive funds. The Centers for Medicare and Medicaid Services (CMS) has an online resource with facts about the incentives. The chart below is the CMS timeline for the implementation plan.
Date |
Milestones of CMS Implementation Plan |
|
2009 |
|
|
2010 |
|
|
No sooner than October 2010 |
|
|
No sooner than January 2011 |
|
|
2011 - 2016 |
|
|
2011 – 2016 |
|
|
2011 - 2021 |
|
|
2015 and thereafter |
|
HITECH also mandates that good security practices be in place, encryption be used to protect data and audits be done to monitor compliance. In addition, new requirements for data breach notifications have been put into place by the Department of Health and Human Services (HHS) which includes notifying the media of security breaches that affect 500 or more patient records.
Other provisions on how providers handle use, disclosures, and requests for PHI or ePHI include:
- Minimum Necessary Standard: HHS must issue further guidance on the minimum necessary standard for releasing PHI.
- Patient’s Right to Accounting of Disclosures of PHI: HITECH broadens a patient’s right to receive an accounting of disclosures of his or her PHI. Providers with electronic health records must report all disclosures for purposes of treatment, payment or health care operations for a period of three years prior to the patient’s request. Providers must comply in 2011 or later, depending on when they first began using electronic medical records.
- Patient’s Right to Request Restrictions on Disclosures of PHI: Providers must agree to a requested restriction if: (1) the disclosure is to a health plan for purposes of carrying out payment or health care operations, and (2) the PHI pertains solely to a health care item or service for which the health care provider has been paid out-of-pocket in full.
- Patient’s Right to Access Electric Health Record: Providers using electronic medical records must provide a patient with a copy of such information in electronic format or, at the patient’s request, transmit the information directly to a person or entity designated by the patient. (A fee can be imposed provided that it takes into account only the labor costs incurred).
- Marketing Communications: Provider and Business Associates’ communications that are about a product or service are considered a health care operation if it is: (1) to describe a health-related product or service that is provided by, or included in a plan of benefits of, the covered entity; (2) for patient treatment; or (3) for case management, care coordination, or to recommend alternative treatments, therapies, health care providers, or settings of care. If payment is received for making the communication, it is considered a marketing communication.
Summary
The HITECH Act will spur the adoption of electronic medical records and greatly increase the admininstrative burden of hospitals and providers to meet requirements for how they handle use, disclosures, and requests for PHI or ePHI. HIM professionals will need to monitor the AHIMA, HHS, and CMS web sites for final rules and requirements as we determine the best practices relating to confidentiality, privacy and security in the new HITECH era.
Pat Rioux, RHIT, is employed by Westboro-based eClinicalWorks, a market leader in ambulatory electronic medical record solutions. Their CCHIT-certified EMR and practice management system is in use by more than 30,000 providers in all 50 states. Its Patient Portal allows patients and doctors to communicate easily, safely and securely over the Internet, and eClinicalWorks Electronic Health eXchange (eEHX) is the fabric behind clinical integration systems becoming community-wide projects. Beginning in this issue of MaHIMA Connect, Ms. Rioux will contribute regular articles on technology trends.
HIM Innovation Award Winner - South Shore Hospital
Project Category: Fiscal Impact
Joe Guglielmo, Director, Revenue Cycle & HIM, South Shore Hospital
South Shore Hospital Outpatient Coding Team – ED IV Charge Capture Initiative
In May of 2006, we began to see an increasing number of emergency department services for IV infusion that could not be billed because of incomplete or missing documentation. To bill for these services appropriately, CMS requires that all start and end times for IV infusion be clearly documented in the patient’s medical record. We conducted a review of emergency department services where IV products were administered, and found that based on the documentation that was available, only a small percentage of the infusion services provided in the ED were billable.
Jeanne Dugas, Outpatient Coding Manager at the time, began meeting with ED Administration to share the challenges the coders were facing in obtaining proper documentation for medication administration – specifically, documentation for IV infusion stop times. The group discussed past strategies and attempts to address the issue, as well as barriers the nurses were facing in completing their documentation. The documentation practice at the time called for both the nurse and the physician to utilize the same form to document medication orders and medication administration. The physician would often retain this form during the course of treatment, leaving the nurse to track down the physician and retrieve the form to document their administration of medications.
Several options were discussed and the group agreed that separating and redesigning the Medication Order/Administration Record would provide the best opportunity for success. The revised Medication Order/Administration Record was to be utilized by the physicians to order medications and IV’s, while the nurses would use the newly created IV Administration Record to document their administration of IV infusions. Having the two forms would give both the nurses and physicians better overall access to the medical record, allowing them to document their care more completely.
Working closely with the ED nurse educator, we piloted the two new forms. During this period, the outpatient charge capture team conducted daily reviews of cases in which IV infusions were administered. At the end of the pilot, they compiled and arranged their findings and developed an action plan. We met with each individual nurse, along with the nurse manager, to discuss the Summary of Findings, and developed a mutually agreed upon action plan.
In March of 2007, we conducted a second review to determine if the changes made had resulted in any improvements. Our findings indicated that while we provided the ED nurses with monthly feedback and extensive education, we only realized a minimal increase in compliance from the previous audit.
We conducted additional education from August to December of 2007, implementing everything from educational posters, monthly emails and letters highlighting their progress, to placing neon stickers on every IV Administration Record form to remind the nurses to document their stop times. We were still not seeing any major improvements in their documentation. Linda Farretta, an outpatient coder, volunteered to physically relocate to the emergency department for part of the day and evening shifts to concurrently review IV administration records for completeness. As part of this 5-month pilot, she provided the nurses with concurrent feedback and follow-up for incomplete documentation. Initially, Linda did not know what to expect, unaware of the inner-workings of the often chaotic ED environment. Her presence in the ED was not well received, but she was persistent, patient, and enthusiastic about what she needed to accomplish, and was focused on establishing a rapport with the ED nurses, one relationship at a time. Her enthusiasm and can-do attitude was inspiring. Linda was instrumental in developing that vital bridge between the HIM coders and the ED nurses.
The results that followed were a significant validation of the team’s efforts and commitment to facilitate change. Compliance during her first two months in the ED increased substantially. Within 6 months, it was as high as 75%. It was at that point we realized the key to sustaining higher compliance was to have a permanent presence in the ED. Our lead outpatient coder, Sean Toal, took over for Linda and sustained the progress she had made with the nurses, while further increasing awareness and compliance.
Our long-term goal was to create a revenue integrity team of three coding associates to provide concurrent review of IV administration and to increase charge capture of supplies utilized in the Emergency Department. The group was responsible for concurrently rounding in the ED and presenting any deficient documentation directly to the ED nurse for review and completion. In August of 2008, we hired our first coding associate to concurrently capture charges in the ED for the first shift. In December, we hired two additional coding associates for the second and third shifts. By April of 2009, our target compliance rate was sustained.
The clear success of this initiative can be credited to the collaborative efforts of Jeanne Dugas, Vanda Metellus, and the entire outpatient coding team. Their positive approach and ongoing enthusiasm and dedication throughout the entire project were instrumental to their success as a group.
HIM Innovation Award Winner - Lawrence General Hospital
Project Category: Best Practice (Compliance)
Stephen P. Molloy, RHIA, Director, HIM, Lawrence General Hospital
Lawrence General Hospital HIM Department - Remote Authentication: A Pre-Electronic Signature Solution
Electronic signature has proven to be the long-awaited solution to the age-old problem of how to get physicians to authenticate their transcribed reports in a timely fashion, and is clearly the preferred method when that option is available.
But what about those hospitals that do not, as yet, offer electronic signature to their staff physicians? Those facilities may want to look into the Remote Authentication Program, a system that enables the physician to authenticate each report without having to come to the HIM Department.
The Challenge: When I came to Lawrence General Hospital over three years ago, the procedure for obtaining signatures on transcribed reports was cumbersome and ineffective. All unsigned reports were printed and mailed to the physicians at their offices for signature, a process that literally took days to complete. Once received, a few would dutifully sign each one and mail them back to us. Most, however, would set them aside and sign them when they got around to it, and some wouldn’t mail them back at all thinking that these were copies for their office records, or because they did not want to incur the postage expense.
Consequently, the number of unsigned reports was approaching 12,000 with no end in sight. The HIM Department was bursting at the seams with unsigned reports in incomplete medical records. Staff morale was poor, suspension of privileges for failure to complete records was not an option, and the total number of delinquent records was more than triple the maximum limit established by the Joint Commission.
The Solution: It was then that we decided to implement the Remote Authentication Program at Lawrence General. Of note, this program had already been successfully implemented at Caritas Holy Family Hospital. The system is based on the premise that each and every transcribed report is forwarded to the authoring physician immediately upon transcription via electronic transmission to the physician’s EMR, by fax or even by mail. Once the report is received, it is incumbent upon the physician to review and if necessary, edit the report and communicate the edits back to the HIM Department.
Once per week, or at another interval depending upon the volume of reports, a summary is generated by either the transcription system or the deficiency management system. This report lists every report authored by Dr. X since the last time the summary report was printed. It also includes the patient’s name, MR #, Account #, report type, e.g., Discharge Summary, H&P, etc., and the date on which the report was transcribed. This summary report is known as the Remote Authentication Log. The HIM Incomplete Records Coordinator stamps a statement at the bottom of each Log sheet saying: “By my signature, I hereby affirm that I have reviewed the listed reports and wish to authenticate them”. The Log sheet is faxed to the physician’s office where the physician reviews the list, signs the Log, and faxes it back to the HIM Department. At this point, the Coordinator locates each authenticated report and on the line normally where the author would sign, stamps the following statement: “Reviewed and authenticated by”. If this is the final deficiency remaining on the record, it is considered complete at this time. Signed Remote Authentication Logs are retained for at least seven (7) years.
The Remote Authentication Program fulfills the requirements of The Joint Commission and the Conditions of Participation for authenticating transcribed reports.
Several key HIM staff were trained to administer the Program. Since many physicians on the medical staff at Lawrence General Hospital are also on the staff at Caritas Holy Family Hospital where Remote Authentication has been in place for over ten years, most of the physicians were familiar with it, and in fact, not only encouraged Lawrence General to adopt the program, they were instrumental in “talking-up” the program among their peers. The medical staff members like the program so much that 312 physicians voluntarily participate today.
Outcomes of System Implementation:
The number of delinquent reports needing just a signature was dramatically reduced and over time, has leveled off to between 300-400 reports at any given time.
Remote Authentication is not a form of and should not be confused with “auto-authentication”, which is specifically forbidden in the Interpretive Guidelines, because with Remote Authentication:
- the report has already been transcribed, and
- the physician must take a “specific action” to authenticate the report that he/she reviewed and verified in the office
Next steps: Remote Authentication has proven to be a highly successful interim step between handwritten signatures and electronic signatures. Lawrence General Hospital recently acquired the ability to administer a system of electronic signature. Certainly electronic signature is a useful tool in the HIM Department’s tool box, but it will be as successful as Remote Authentication only if it is at least as physician-friendly.
Currently we are evaluating a system whereby we can blend the Remote Authentication Program with the electronic signature system. Tentatively, we would accomplish this by continuing to send Remote Authentication Logs to physicians for signature. Upon receipt of the signed Log, the Incomplete Records Coordinator would electronically sign the document on the physician’s behalf and at his direction. In such cases an appropriate notation would be printed to the final report.
HIM Department Team members who are responsible for the success of the Remote Authentication Program at Lawrence General Hospital are:
Lisa Taylor, HIM Department Supervisor
Andrea Quimby, Incomplete Records Coordinator
Liz Tierney, Medical Records Clerk
Kyle Jackson, Medical Records Clerk
If you would like more information on the program, please contact Steve Molloy at stephen.p.molloy@lawrencegeneral.org.
Call for Nominations
Julie Irons, RHIA, Chairperson, Nominating Committee
Being involved with MaHIMA is a rewarding and exciting experience and just around the corner is an opportunity to run for next year’s election for President-Elect and Director of Communications!
If you or someone you know might consider running for one of these positions, please email Julie Irons, Nominating Committee Chairperson at jirons@quadramed.com. To review the Officer Responsibilities, click on the link below:
President-Elect
Director of Communications
The official Call for Nominations takes place in January for the spring election, so right now is a great time to think about this opportunity to serve as President-Elect or Director of Communications.
Calling New MyPHR Presenters
Marianne Garfi, RHIA, CCS-P, MA Community Education Coordinator, AHIMA MyPHR Campaign
Would you be willing to give a MyPHR presentation to an association or group to which you belong? Did you miss the training at the 6 State Meeting last May?
Join the free session to be held at the JFK Building on Thursday, February 4, 2010 from 2-4pm and earn 2 Privacy and Security CEUs, as well as learn to take the show on the road!
MaHIMA wants to make 2010 a year for the MyPHR campaign, and you can help make that happen! Email Marianne Garfi at garfi.marianne@dol.gov for more information and to register.
Education Notes: Fisher College
Patricia Parkes, RHIA, Program Director, HIT & Medical Coding
As we approach the end of the calendar year, Fisher College Health Information Technology and Medical Coding students look ahead to the spring term. Many students will graduate in May and begin their exciting careers in the HIM profession. Before they embark on this new adventure, however, they must complete their Professional Practice Experiences (a.k.a. “internships”).
At the last Fisher College HIT Program Advisory Committee, a suggestion was made (thank you, George Wilson!) to ask potential PPE sites to apply* to take a student intern. So here is some food for thought:
- Perhaps you have a special project that a student could work on. Some of our students already have experience working in an HIM department. By completing a project in another facility, they get exposure to another department and the department can benefit from their knowledge as well as having a new set of eyes looking at the project.
- If you have a job opening or will in the future, accepting a student intern will allow you to witness the student’s capabilities and see how he or she fits into your department with current employees.
- If you have a current employee who exhibits supervisory skills, having a student intern can allow your employee to act as a mentor and trainer for their own professional development.
- Having students learn what your employees do gives your employees a chance to show off their work and emphasize the importance of their job responsibilities.
All PPE objectives and hours do not need to be completed at one site. If you have a unit of your department that clearly demonstrates today’s best practices and you would like to share this with students, a student can attend your facility to learn about that particular HIM unit or function. It is also important to note that while we have traditionally focused on sending students to acute care facilities, students today benefit greatly from exposure to QIO’s, physician group practices, large clinics, consulting vendors and companies, software companies, insurance companies, veterinary practices, public health departments, and healthcare research organizations.
Please consider sharing your department and knowledge with future HIM professionals. If you are interested in having a Fisher College student intern, please contact me at pparkes@fisher.edu or (508) 699-6200. What better goal for the new year than to become an Academic Ambassador to the HIM profession!
*No formal application necessary – just send me an email or give me a call.
Education Notes: Labourè College
Nancy A. Entwistle, MPA, RHIT, CCS, ACE, Chairperson & Assistant Professor, Coding & HIT
The holiday season is a time for our students to spend time with loved ones and to recharge for our next semester. This semester was the first in which Labourè College integrated ICD-10 into the curriculum and incorporated its guidelines, rules, and structure into our current ICD-9-CM format.
Every semester, leading up to the fall 2012 semester, will include critical pieces of ICD-10 added to the existing format to guarantee our students will be the most knowledgeable on this material and will be able to provide support to existing work places with the ICD-10 comprehension learned at Labourè.
Labourè continues to provide the most current courses demanded by our industry and our students, upon graduation, will be able to fill those vital areas of need for the work place. I would like to thank MaHIMA and our industry leaders for the continued support shown to the college, by accepting students, training students and offering new and exciting ideas for better preparation of our students.
I hope everyone had a wonderful holiday season and look forward to an exciting 2010. I can be reached at (617) 296-8300 x4063 or via email at Nancy_Entwistle@laboure.edu.
Education Notes: Bristol Community College
Patricia Dent, MS, PT, Interim Director, HIT & Medical Coding Certificate Program
More information to follow! Contact Patricia Dent at (508) 678-2811 x2142 or email pdent@bristol.mass.edu for more information.
Congratulations to our Newly Credentialed
The following MaHIMA members earned an AHIMA credential in the last quarter of 2009:
Cindy Marchando, RHIT, CCS-P
Shellie Roney, CCA
Sylvia J. Walker, CCS
MaHIMA grants Certification Scholarships to any member of MaHIMA who has taken and passed one of the AHIMA sponsored certification programs.Information on the MaHIMA Certification Scholarship is available at www.mahima.org/member_certification_scholarship/.
Save the Dates for Upcoming MaHIMA Events
MaHIMA Winter Meeting & Coding Seminar
Friday, January 29, 2010
Marlboro Holiday Inn
Click here for agenda & registration information
MaHIMA ICD-10 Summit
Wednesday, March 31, 2010
Dedham Holiday Inn
Registration information available in February
6 New England State HIMA Annual Convention
Sun-Tues, May 2-4, 2010
Radisson Hotel - The Center of New Hampshire, Manchester, NH
Registration information available in late January
MaHIMA Beacon Hill Day & Legislative Seminar
Thursday, May 20, 2010
State House, Boston, MA
Registration information available in April
Check our Education Calendar at www.mahima.org for registration and up to date information on all our events.
MaHIMA Connect is a quarterly publication of the Massachusetts Health Information Management Association.
MaHIMA Connect Editorial Board
Editor in Chief
Clare Carvel, M.Ed., RHIA, CCS
clarecarvel@comcast.net
Presentations Editor
Lisa Cronin Smith
lisa.smith1@verizon.net
Technical Editor
Karen O'Donnell, RHIA
karen@mahima.org
Editorial Assistant
Sherry Palo, RHIA, CCS
palo@tiac.net
MaHIMA Central Office
PO Box 681
14 Morgan Way
Tyngsboro, MA 01879
Karen O'Donnell, RHIA
MaHIMA Administrative Director
Phone: 978-649-7517
Fax: 978-649-2730
Email: info@mahima.org
Website: www.mahima.org
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