The Certification Commission for Health Information Technology (CCHIT), Chicago, Ill. and the Drummond Group Inc. (DGI), Austin, Texas, were named today 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 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.

“Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers.  EHR vendors can begin immediately to get their products certified.” said David Blumenthal, M.D., national coordinator for Health Information Technology.  This is a crucial step because it ensures that certified EHR products will be available to support the achievement of the required meaningful use objectives, that these products will be aligned with one another on key standards, and that doctors and hospitals can invest with confidence in these certified systems.”

Applications for additional ONC-ATCBs are also under review.

Certification of EHRs is part of a broad initiative undertaken by Congress and President Obama under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009.  HITECH created new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions.

To qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of, certified EHR systems.  The law envisions that defined meaningful use requirements will help ensure that the patient and provider benefits of EHRs are realized.  Initial meaningful use criteria were defined in a final rule issued by the Centers for Medicare & Medicaid Services (CMS) on July 28.

In addition to the CMS rule, ONC also issued standards and certification criteria for EHRs on July 28, aimed at ensuring that EHR systems will support the specific tasks required under meaningful use.  Also, through regulations issued on June 24, ONC created a system by which technology review organizations could also qualify as ONC- ATCBs that will certify EHR products as meeting the requirements necessary for meaningful use.

With the initial two ONC-ATCBs now named, EHR vendors can apply to them for certification of their products.  By purchasing certified products, providers will have assurance that the products will support achievement of the meaningful use objectives.

“Multiple steps are underway to carry out the intent of Congress in supporting rapid and effective adoption of EHRs throughout our health care system,” Dr. Blumenthal said.  “The naming of initial ONC-ATCBs is one important step.  Actual certification of multiple vendors’ systems by the ONC-ATCBs is an important next step.  CMS is also working to create an online system for providers to register and attest for the EHR incentive programs. The first incentive payments are targeted to be made in May 2011.  Meanwhile, ONC is also carrying out new programs of technical assistance and training, especially for smaller hospitals and physician practices.”

Dr. Blumenthal said the Health IT initiative “is on an aggressive schedule to meet the urgent targets set by Congress and the President toward realizing the quality and safety improvements that we can achieve through health information technology.”

To learn more about the ONC-ATCBs named today visit www.cchit.org and www.drummondgroup.com.

For more information about the ONC certification programs visit http://healthit.hhs.gov/certification.

For more information about other HHS Recovery Act Health Information Technology funding and programs, visit http://www.hhs.gov/recovery/programs/index.html#Health.

Source: http://www.hhs.gov/news/press/2010pres/08/20100830d.html

The report indicates that the recently approved audits include 18 types of inpatient hospital claims and one type of durable medical equipment claim. The report did not announce specific issues or indicate which of the four RAC contractors were approved, but CMS did state that the new audit issues would be posted on the RAC Web sites, adding that contractors would begin to issue ADRs (Additional Documentation Requests) within the next two weeks.

Read more here.

Source: MHA News Now

Written by Ernie De Los Santos

The Region C RAC, Connolly Healthcare, posted 25 new DRG Validation Issues to their list of CMS-Approved audit issues, on Tuesday, March 16 plus another five (5) on Friday, March 19. Once again, Connolly has been approved for even more MS-DRGs with high Relative Weights (which equates to high dollar reimbursements) and high discharge volumes (which equates to large number of claims to potentially audit).

Four (4) of the newly approved issues are for MSDRGs with Relative Weights of better than 5.0.  Also, seven (7) of the 25 new issues are ranked (by number of discharges in FY09) in the top 100 DRGs nationwide. Connolly and the rest of the RACs are not allowed to choose their audit issues simply by virtue of a high reimbursement value, nor can they choose them by random selection. The RAC Statement of Work (SOW) is clear on this issue: the RAC must garner approval from CMS before they can begin widespread review of an issue. To earn that approval, they must present compelling evidence to CMS that suggests improper payments have been made, and that audits of those issues might return significant dollars to Medicare.

Nevertheless, this latest round of approval/postings seems to continue a pattern previously noted in Connolly’s February postings, and reported here on RAC Monitor and on Medical Coding Journal. Such approvals might suggest that Connolly is certainly able to gather sufficient evidence to pursue fairly large volumes of claims, as well as many of the highest paying DRGs.

If the rationale listed by Connolly in a recent Additional Documentation Request Letter (ADR) sent to a Georgia hospital is any indication, it would appear that Connolly has been able to make good use of evidence gathered during the RAC Demonstration. See a copy of the letter and our analysis of it here.

Virginia and West Virginia are still noteably absent from the list of states where Connolly is approved to review these issues. The 13 states affected by the new approved issues are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas.

The Additions to Connolly’s Approved Issues List

Below are the newly posted and approved audit issues for RAC Region C. For your convenience, we have added some data not found on the RAC pages: each DRG’s Relative Weight taken from the CMS documents, which can be found here.)

The list shown here has been sorted by Relative Weight, highest to lowest:
To see the complete original listings (on the RAC websites), visit this page.

Or, to find a more useful listing of all the RACs’ posted issues, visit  this page on eduTrax®.  (Registration required.)

Still No Medical Necessity Reviews

All of the above approved issues still include this caveat:

(At this time, Medical Necessity excluded from review).

We again remind everyone that Medical Necessity Reviews could be approved by CMS any day now, since the CMS RAC Review Phase-In Strategy allows for such audits to begin sometime in calendar 2010.

Stay tuned, as the situation unfolds.

About the Author

Ernie de los Santos is the chief information officer at eduTrax®. He joined the company at its inception and has been responsible for the creation, development and maintenance of the eduTrax® portals – a set of Web site devoted to providing knowledge, resources and compliance aids for U.S. healthcare professionals who are involved in revenue cycle management.

Contact the Author – ernie@edutrax.net

Credit: http://www.racmonitor.com/news/5-analysis/316-connolly-posts-30-drg-validation-issues.html?tmpl=component&print=1&page=

According to the proposed federal rules for “meaningful use” of EHRs and, in order to be eligible for federal Medicare or Medicaid bonus payments beginning in 2011, at least five rules for clinical decision support (CDS) should be implemented, in addition to keep up-to-date problem lists, write electronic prescriptions, have electronic drug interaction checking, incorporate data from test results into their electronic health records and keep patient vitals.

The updated rules contain several differences from earlier plans:

• Physician practices will only have to enter 80 percent of orders electronically, down from the 100 percent called for in recommendations issued last summer;
• The threshold for hospital use of computerized physician order entry is just 10 percent;
• For 2011 and 2012, hospitals would not have to be able to transmit orders electronically to pharmacies, labs or imaging centers; and
• Physicians will not have to record progress notes in the EHR.

ONCHIT’s interim final rule will take effect 30 days after publication in the Federal Register. More information is available at: HHS press release, CMS proposed rule on meaningful use of EHRs and the ONC interim final rule on standards and certification.

The Proposed Draft for Standard MS.01.01.01 (formerly MS.1.20) is available at the Joint Commission/Standards section at: www.jointcommission.org/Standards/FieldReviews/ms_01_01_01_comment.htm

In this regard, the Centers for Medicare & Medicaid Services CMS has instructed its contractors to hold claims for services paid under the Medicare Physician Fee Schedule (MPFS) for up to the first 10 business days of January (January 1 through January 15) for 2010 dates of service. This should have minimum impact on provider cash flow because, by law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt.  Meanwhile, all claims for services delivered on or before December 31, 2009, will be processed and paid under normal procedures.

The holding of claims allows Medicare contractors time to receive the new, updated payment files and perform necessary testing before paying claims at the new rates. CMS has instructed contractors to begin processing claims at the new rates no later than January 19, 2010.  Therefore, even absent a new update, most claims likely would not have been paid any sooner than January 19, 2010, given the aforementioned statutory 14-day payment floor.

The Medicaid Integrity Contractors (MICs) are organizations contracted by CMS with the responsibility of auditing individuals and organizations providing Medicaid services. The overall goal of the provider audits is to identify overpayments and to ultimately decrease the payment of inappropriate Medicaid claims. These contractors are firms CMS has chosen to carry out education, review and audit with the following Medicaid Integrity Program goals:

• Education MICs are responsible for educating providers, beneficiaries, and others on program integrity and quality of care issues.
• Review MICs analyze Medicaid providers’ claims data for evidence of atypical billing practices that could result in overpayments.
• Audit MICs conduct post-payment audits of Medicaid providers. The Audit MICs determine which providers to audit in part based on leads received from CMS, state agencies, or the Review MICs.

CMS has divided the country into five MIC jurisdictions, each of which encompasses two CMS regions. Contracts for Education MICs, Review MICs, and Audit MICs are awarded separately for each of the five MIC jurisdictions. The Audit MICs have commenced audits of Medicaid providers in most jurisdictions, and audits are anticipated to begin in the remaining jurisdictions by June 2010.

The audit process

All Medicaid providers are subject to MIC audits. Although Audit MICs, unlike RACs, are not paid on a contingency fee basis, Audit MICs are eligible for financial bonuses based on the effectiveness of their audits.

Review MICs perform post-payment reviews of Medicaid claims and then recommend selected providers to be audited by the Audit MICs. CMS is responsible for ensuring that investigations or other audits of these providers for similar Medicaid issues are not already underway by state Medicaid agencies, state or federal law enforcement, or Medicare contractors. Audit MICs can review

Medicaid claims as far back as permitted under the laws of the respective states that have paid the claims.

RACs vs. MICs

MICs have been termed “RACs for Medicaid,” but there are certainly differences between the programs. For example, the RAC lookback period is three years, but MICs base the length of time on individual state lookback guidelines. Similarly, the number of days a provider has to produce medical record copies for MICs is dependant on state rules, unlike with RACs, where providers have 45 days regardless of their location. In addition, MICs have no set medical request limits, while RACs max out at 200. Also, CMS will not reimburse providers for the cost of copying records, which is also different from the RAC program.

Unlike RACs, MICs are not paid by contingency fee, but rather through a sort of fee-for-service model. The dollars MICs recover aren’t tied to their compensation, according to CMS, although they will be eligible for bonuses based on how “effective and efficient” they are. In some cases MICs will do desk audits, and in other instances, auditors will come on-site to do the reviews.