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Inside this issue - April 9, 2015:

Changes Published by CMS

Two weeks ago the Centers for Medicare & Medicaid Services (CMS) published an update to the 2015 Hospital Outpatient Prospective Payment System that included two paragraphs that appear to change a longstanding CMS policy that required an inpatient admission order prior to every inpatient-only surgery. CMS seems to be saying that as of April 1, it is allowing the three-day window for outpatient services to be billed on the inpatient claim to extend to inpatient-only surgery. According to the update, the admission order may be obtained at any time of the day of the surgery or within the next three calendar days as long as the patient is still hospitalized. Read more in this RAC Monitor report.

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MedPAC Approves Recommendations Regarding RAC Program and Short Stay Policies

At its public meeting last week in Washington, D.C., the Medicare Payment Advisory Commission (MedPAC), a congressional advisory panel on Medicare payment and policy issues, considered a number of final policy recommendations that included revisions to the Recovery Audit Contractor (RAC) program and Medicare’s inpatient status policies.  Sources report that MedPAC voted unanimously to approve all recommendations, which will be included in MedPAC’s June 2015 Report to Congress.  More in this King & Spalding Report Â»

AHIMA Publishes CDI ICD-10 Documentation Tips

The AHIMA CDI Workgroup has published a white paper of CDI ICD-10 documentation tips that are now available for the healthcare industry. These tips focus on the language and/or wording that will garnish greater details and specificity of the coded data for a given diagnosis, condition, disease and/or surgical procedure. Two THIMA members, Kathy Hallock and Angie Comfort, serve on the Workgroup.    If you haven’t downloaded your copy, do so here. Kudos to the Workgroup and AHIMA – this is a great resource!

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AHIMA Past-President Angela Kennedy testifies before U.S. Senate HELP Committee Hearing

The Senate Health, Education, Labor, and Pensions (HELP) Committee, chaired by TN Senator Lamar Alexander, recently held a full Committee Hearing: America’s Health IT Transformation: Translating the Promise of Electronic Health Records into Better Care.    This is a very interesting hearing, and you will especially want to hear Gracie’s story as told by her mother, Angela Kennedy.
THIMA delegates met with HELP Committee staffers recently in Washington.   We were very impressed with the knowledge and dedication of the staff and Senator Alexander to the implementation of ICD-10 and improving health information technology and electronic health records. 

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Contribute to Comments on Stage 3 Meaningful Use

Help inform AHIMA's comments on the Stage 3 Meaningful Use Notice of Proposed Rulemaking (NPRM) and the 2015 CEHRT NPRM. We will focus on: Interoperability/transitions of care/patient matching; privacy protections; patient engagement; quality measures; existing and new standards and rules related to certified EHRs. Send your comments to by May 8.

CMS Offers Free ICD-10 Training for Physicians in TN

THIMA is pleased to again assist the Centers for Medicare & Medicaid Services (CMS) in offering free ICD-10 training:  Road to 10: A Small Physician Practice’s Route to ICD-10.  During the sessions, attendees will
  • Study the basics, differences, and benefits of ICD-10
  • Explore common codes, primers for clinical documentation, and clinical scenarios all broken out by specialty
  • Create a customized Action Plan, personalized by specialty and practice details
Registration is open for all six sessions being offered in Tennessee:   Memphis, Jackson, Dyersburg, Nashville, Clarksville, and Murfreesboro. 

Learn more.

CMS to Hold Payment on Physician Claims until April 11

The Centers for Medicare & Medicaid Services (CMS) announced that it will hold payment on claims until April 11. This move follows the delay in the Senate to act on the legislation aimed to eliminate the Sustainable Growth Rate (SGR). The House of Representatives passed the Medicare Access and CHIP Reauthorization Act, HR 2 on March 26.

The CMS announcement reads:

The negative 21% payment rate adjustment under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015. CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st. Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. As we stated in our recent email to physicians, CMS will provide more information about next steps by April 11, 2015.

Hopefully, the Senate will approve the legislation on their first day back in session. We will send further information as soon as it is available.

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Upcoming Meetings

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CAHIMA Meeting
April 16, 2015
Chattanooga, TN

THIMA/THA 2015 ICD-10 Boot Camp
May/June 2015
Nashville, TN

THIMA/THA 2015 ICD-10 Boot Camp
June/July 2015
Knoxville, TN


CDI for ICD-10 by Body System
April-August 2015

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