I recently heard of a local long-term care hospital (LTCH, also known as LTACH) that was unwilling to accept military veterans who were cared for at her facility or any Veterans Affairs hospitals even though they would otherwise qualify for LTCH care. The reason the LTCH would not accept these patients was because they did not have a preceding visit in a “regular” hospital. What's the solution?
One year following the official implementation of ICD-10, the coding industry is beginning to report valid results regarding accuracy, productivity, and denial trends. While some of these facts and figures are self-reported by HIM directors and anecdotal in nature, other findings are grounded in hard, fast coding performance data. Such is the case with the results from Central Learning (www.centrallearning.com), a web-based system that electronically assesses coder knowledge using real medical record cases and expert-verified answer keys.
This article summarizes coder performance data as measured across 50 health systems and 300 coders as of June 30, 2016. It compares these findings with other industry reports and extrapolates key findings for HIM directors and revenue cycle executives. Since coding and diagnosis-related group (DRG) assignment are the major drivers behind health system revenue streams, consistent data analysis helps to ensure accurate coding and reimbursement.
According to Central Learning data, coding accuracy is slightly increasing after nine months under ICD-10 for both experienced coders and coders-in-training. While the industry overall still lags behind the 95% accuracy benchmark achieved in ICD-9, we're getting closer in all three major patient types: inpatient, outpatient, and emergency services.
Fifty health systems are represented in the data, providing a broad-based assessment. We compared coder accuracy from Q1 (January 1?March 31) with Q2 (April 1?June 30) to identify recent, timely trends in code quality. The figure on p. 13 lists the most current benchmark of our status through June 30, 2016.
One of the topics raising the most questions in case management today is related to the MOON notification requirement. Hospitals were struggling this summer to comply with the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which was signed by President Barack Obama August 6, requiring hospitals to provide a verbal and written notice of outpatient status to any patient in observation who has been in the hospital for more than 24 hours. Just prior to the August 6 implementation date, hospitals received word that the notification requirement would be delayed pending approval of modifications made to the government's notification form.
As OCR's auditors wrap up the final desk audit reports for phase two of the HIPAA audit program, many covered entities (CE) are breathing a little easier. Only 167 CEs were selected for desk audits in July. Audited CEs can expect to wait several months to see the final audit reports, although they will have the opportunity to review a draft version and submit comments that will be attached to the final report.
But phase two is far from over. Business associates (BA) will be selected for desk audits this fall—the first time these entities will be subject to OCR's HIPAA audits. And early next year, OCR will launch comprehensive on-site audits of both CEs and BAs.
Social media is everywhere—even inside the walls of hospitals. Staff may log into personal accounts during lunch breaks, and many organizations maintain official social media accounts; plus, of course, patients and visitors often rely on social media to keep in touch with friends and family. For many, social media is so much a part of their everyday routine that the benefits are almost too obvious to list. Yet the risks—including potential HIPAA violations—are often not as clear, and privacy and security officers need to stay aware of them.
Q: In our pharmacy dispensing system, we can enter free-form notes for certain records such as a patient record, prescription records, and physician records. This field is used to enter notes that are customer service?focused and not treatment- or payment-related in nature. Would these notes be considered PHI, and would record retention requirements apply to these notes?
