Kathy is well known in the industry for her excellent auditing, data analysis skills as well as coding knowledge. She has experience in corporate and not-for-profit facilities as well as private coding /auditing companies.  Kathy has been instrumental in the creation of several auditing tools and excels in data analysis techniques. She serves on various committees within AHIMA, as well as state and local organizations. Kathy has presented at various health care industry organizations as well as published author on topics such as case mix analysis, and coding rule clarifications

Please join us in welcoming Kathy to her new role with our company.

You may contact Kathy at kathy.fennick@himoncall.com.

About H.I.M. ON CALL, Inc.

H.I.M. ON CALL, Inc., a full service Health Information Management and Revenue Cycle Management company with offices in Allentown, PA and Hato Rey, PR, provides professional consulting services to hospitals and healthcare organizations throughout the country.  H.I.M. ON CALL’s primary focus is the delivery of high quality/high volume coding and data quality services onsite as well as remote.  H.I.M. ON CALL also has a series of Web-based software and tools offered under its AvianceSuite of revenue-driven applications.

Contact Information

Joseph J. Gurrieri, VP & COO
H.I.M. ON CALL, Inc.
1033 Hamilton Street
Allentown, PA 18101

Telephone:  (610) 435-5724 x31
E-mail:  joe.gurrieri@himoncall.com
Company Website:   www.himoncall.com
Applications Website: www.aviancesuite.com

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• Breast Procedures
• Cardiovascular (Other)
• Nose, Mouth & Throat Disorders
• Endocrine, Nutritional & Metabolic Procedures
• Eye Disorders
• Female Reproductive System Disorders
• HIV Infections
• Infection (Other)
• Joint Procedures
• Male Reproductive System Disorders
• Musculoskeletal Disorders
• Musculoskeletal Fractures
• Skin Disorders
• Disorders Related to Injuries (Toxicity)

The issues apply to all states within Region D.  Region D includes Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Marianas.

The issues also include a statement that medical necessity is excluded from review at this time.

HealthDataInsights, Inc. (HDI), the Medicare recovery audit contractor (RAC) for Region D, recently posted new CMS approved audit issues for RAC review on its website.  The following issues were added to the list:

• OP Services Within 72 Hrs of Admit (Part A Outpatient)
• Acute Readmissions – No B4 (Part A Inpatient)
• Incorrect Patient Status – IRF (Part A Inpatient Rehabilitation Hospitals)
• Medically Unlikely Edits (Part A Outpatient, Part B, DME)

The above issues apply to all states within Region D. Region D includes Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Marianas.

Maryagnes comes to H.I.M. ON CALL from MedQuist where she was the Vice President of Coding Services for the past seven years.  Maryagnes has extensive health information experience including academia, systems management, strategic expertise, corporate and not-for-profit executive leadership. Through her dynamic, executive leadership, healthcare organizations and companies have benefited from her guidance and success in revenue and workflow efficiencies. As a result of her leadership and expertise, organization have improved performance initiatives and instituted cost effective services and products. Maryagnes has established herself as a leading change agent and subject matter expert in the Health Information Management (HIM) industry. She has written and presented for various national and state organizations and has been instrumental in the development of the remote coding vision throughout the (HIM) profession.  She serves on various committees within AHIMA, as well as state and local organizations

Please join us in welcoming Maryagnes to her new role with our company.

You may contact Maryagnes at maryagnes.marek@himoncall.com

About H.I.M. ON CALL, Inc.

H.I.M. ON CALL, Inc., a full service Health Information Management and Revenue Cycle Management company with offices in Allentown, PA and Hato Rey, PR, provides professional consulting services to hospitals and healthcare organizations throughout the country.  H.I.M. ON CALL’s primary focus is the delivery of high quality/high volume coding and data quality services onsite as well as remote.  H.I.M. ON CALL also has a series of Web-based software and tools offered under its AvianceSuite of revenue-driven applications.

Contact Information

Joseph J. Gurrieri, VP & COO
H.I.M. ON CALL, Inc.
1033 Hamilton Street
Allentown, PA 18101

Telephone:  (610) 435-5724 x31
E-mail:  joe.gurrieri@himoncall.com
Company Website:   www.himoncall.com
Applications Website: www.aviancesuite.com

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Specifically, CMS has expanded the policy on additional documentation request limits so that it now applies to reviews of all institutional claim types.  The limits announced in December 2009 applied only to requests for DRG validation purposes; the same methodology will now be used for reviews of all institutional claim types. CMS will post the limits for physicians, non-physicians practitioners and DMEPOS suppliers at a later date.

For more information, see the new document titled Additional Documentation Limits for FY2010 for Institutional Providers. Additional information on the RAC Program audits can be found at the CMS RAC webpage.

In this issue…

• HITECH
• RAC Update
• RACs Q&A’s
• January 2010 OPPS Update
• RAC Approved Issues
• CMS awards EHR funds

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1.  HealthDataInsights, Inc. (HDI), the Medicare recovery audit contractor (RAC) for Region D, recently posted new CMS approved audit issues for RAC review on its website.

HDI added 5 new CMS approved audit issues pertaining to Medicare Part B claims, which apply to all states within Region D. Region D includes Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming, Guam, American Samoa, and Northern Marianas.

The recent approved issues are:

• Clinical Social Worker (CSW) Services During Inpatient Stay
• NCCI Edits
• Hospice Related Services – B
• TC of Radiology
• Not a New Patient – Providers are only allowed to bill the CPT codes for New Patient visits if the patient has not received any professional services from the physician or physician group practice within the previous 3 years.

For more information refer to the HDI website.

2.  CGI, the Medicare recovery audit contractor (RAC) for Region B, recently updated its CMS approved audit issues for RAC review.

Specifically, CGI expanded its CMS approved audit issues for outpatient hospitals and professionals in all Region B states. Region B includes the states of Minnesota, Wisconsin, Michigan, Illinois, Indiana, Ohio and Kentucky.

The recent update to the CMS approved audit issues include:

• Intravenous Infusion Chemotherapy and Non-Chemotherapy – Excessive Units Reported
• Preadmission Testing
• Separately Paid Ambulance Service during Inpatient Hospitalization Review

CGI also added the issue of Hospital to Hospital Transfer for inpatient hospitals.

For more information, refer to the CGI’s website.

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.

Connolly Healthcare, the Medicare recovery audit contractor (RAC) for Region C, recently updated its CMS approved audit issues for RAC review.

Specifically, Connolly Healthcare recently posted at least 21 new CMS approved audit issues on its website for inpatient hospitals pertaining to DRG validation.

The issues affect providers in the states of Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

The issues are briefly described below:

• Other Vascular Procedures with MCC: MS-DRG 252
• Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with CC: MS-DRG 574
• Skin Graft and/or Debridement for Skin Ulcer or Cellulitis with MCC: MS-DRG 573
• Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC: MS-DRG 465
• Other Digestive System O.R. Procedures with MCC: MS-DRG 356
• Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with CC: MS-DRG 623
• Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC: MS-DRG 622
• Other Digestive System O.R. Procedures with CC: MS-DRG 357
• Other Hepatobiliary or Pancreas O.R. Procedures with MCC: MS-DRG 423
• Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 578
• Skin Graft and/or Debridement Except for Skin Ulcer or Cellulitis with MCC: MS-DRG 576
• Skin Graft and/or Debridement for Skin Ulcer or Cellulitis without CC/MCC: MS-DRG 575
• Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with CC: MS-DRG 464
• Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders with MCC: MS-DRG 463
• O.R. Procedure with Diagnoses of Other Contact with Health Services with CC: MS-DRG 940
• O.R. Procedure with Diagnoses of Other Contact with Health Services with MCC: MS-DRG 939
• Other Circulatory System O.R. Procedures: MS-DRG 264
• Cardiac Pacemaker Revision Except Device Replacement without CC/MCC: MS-DRG 262
• Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders without CC/MCC: MS-DRG 624
• Cardiac Pacemaker Revision Except Device Replacement with MCC: MS-DRG 260
• Upper Limb and Toe Amputation for Circulatory System Disorders with CC: MS-DRG 256

All of the above issues include a statement that medical necessity is excluded from review at this time.