QIO Change to CMS Inpatient Review Fact Sheet-July 2008 Signing of Physician Verbal Orders KDHE Center for Health and Environmental Statistics Birth Certificate Elements Medicare Publishes New Hospital Requirements Approved Medical Record Fees in Kansas - January 2008 Patient Status Code Quick Reference Patient Status Code 66 (Discharged/Transferred to a critical access hospital (CAH) Part A Modifier Manual CCHIT Awarded HHS Contract for Health IT Product Certification Patient Status Codes - On-line course Introduction of Health IT Bill Productivity Standards CRNA Opt-Out Letter Comprehensive Error Rate Testing Letter FAQs Issued On Use And Disclosure of PHI Copy Cost Formula to Determine Labor and Supplies Signing of Physician Verbal Orders - January 2008 According to Kansas Administrative Regulation 28-34-6a (g) (2), "A Practitioner may give verbal orders, including telephone orders, for medication or treatment to personnel who are qualified according to medical staff bylaws. The person entering these orders into the medical record shall sign and date the entry as soon as possible. These orders shall be authenticated by the prescribing or covering practitioner within 72 hours of the patient's discharge or 30 days, whichever occurs first." KDHE Center for Health and Environmental Statistics Birth Certificate Elements The KDHE Center for Health and Environmental Statistics has published findings of a review of selected elements from the birth certificate implemented in Kansas in 2005. The new birth certificate collects new data on perinatal health. It also contained revised fields. Implementation coincided with a new approach to calculating the month prenatal care began value. The report entitled "Selected Birth Outcome Findings from the Revised Birth Certificate, 2005, Kansas" provides insight for researchers who use birth certificate data to assess maternal and infant health. Click here to view the report on the KDHE Web site. MEDICARE PUBLISHES NEW HOSPITAL REQUIREMENTS November 2006 History and Physical Examinations, Authentication of Verbal Orders, Securing Medications, and Postanesthesia Evaluations Addressed The Centers for Medicare & Medicaid Services (CMS) published a final rule revising requirements in the hospital conditions of participation (CoPs) for completion of history and physical examinations, authentication of verbal orders, securing medications, and completion of post anesthesia evaluations.. The new rule addresses concerns of the health care community that the old regulations were outdated and unduly burdensome. "We always want to make sure that Medicare beneficiaries receive the best possible health care, and one important way to do that is to provide rules and guidelines that enable providers to operate smoothly and efficiently," said CMS Acting Administrator Leslie V. Norwalk, Esq. "We think these changes will better serve the health care industry as a whole." The requirements of the regulation are: History and Physical (H&P) examination. This requirement expands the timeframe for completion of the H&P and expands the number of permissible professional categories of individuals who may perform the H&P. Authentication of verbal orders. This regulation requires that all orders, including verbal orders, must be dated, timed, and authenticated by the prescribing practitioner with a temporary exception. For a five-year period beginning with the date of publication of the final rule, the regulation requires that all orders, including verbal orders, must be dated, timed, and authenticated promptly by the prescribing practitioner or another practitioner responsible for the care of the patient, even if the order did not originate with him or her. CMS believes this temporary revision to the authentication requirement will reduce burden and provide flexibility for hospitals until the advancement of health information technology is sufficient to allow the prescribing practitioner to authenticate his or her own orders promptly and efficiently. In the absence of a State law specifying the timeframe for authentication of verbal orders, verbal orders need to be authenticated within 48 hours. For the five-year period, verbal orders no longer need to be signed by the prescribing practitioner but can be authenticated by another practitioner responsible for the care of the patient. This responds to public comments, reduces burden, and provides flexibility for hospitals in meeting the requirements for authentication of verbal orders. Finally, this requirement clarifies and reinforces current regulations regarding minimizing the use of verbal orders, persons who may accept verbal orders, authentication of all orders for drugs and biologicals, and authentication of medical record entries. Security of Medications. This regulation requires that all drugs and biologicals be kept in secure areas, and locked when appropriate. This regulation addresses commenters concerns, maintains flexibility for hospitals in determining control of nonscheduled drugs and biologicals, and is more patient-focused and outcome-oriented. Postanesthesia evaluation. This requirement permits the postanesthesia evaluation for inpatients to be completed and documented by any individual qualified to administer anesthesia instead of only the individual who administered the anesthesia. This final rule will ensure that CMS requirements are consistent with current standards of practice, to provide hospitals and practitioners greater flexibility in meeting the needs of patients, and to reduce unnecessary regulatory burden for hospitals. The final rule was published in the Federal Register on November 27, 2006. It will become effective January 26. To view the final rule, go to http://www.cms.hhs.gov/quarterlyproviderupdates/downloads/cms3122f.pdf on the CMS Website. CCHIT Awarded HHS Contract for Health IT Product Certification The Certification Commission for Healthcare Information Technology (CCHIT) announced yesterday that it has been awarded a contract by the US Department of Health and Human Services (HHS) to develop, create prototypes for, and evaluate the certification criteria and inspection process for electronic health records (EHRs). The base contract, totaling $7.5 million over a three-year period, will address three areas of certification: ambulatory EHRs, inpatient EHRs, and the infrastructure components through which they interoperate. An optional $1.2 million extension to continue refinement and assessment of the processes during a fourth year will be up for consideration as the base period is completed. Certification of EHRs and the infrastructures or networks through which they interoperate is expected to accelerate HIT adoption by: • Reducing the risk of EHR investment by providers and directing those investments toward products that have the necessary functionality to improve the quality, safety, and efficiency of care • Protecting the privacy of health information by ensuring adequate security standards within EHR products and network infrastructure • Ensuring the interoperability of EHRs through standards-based compatibility with the emerging national health information network (NHIN) architecture • Facilitating the availability of incentives for provider adoption of EHRs offered by healthcare purchasers and payers The Commission has already made significant progress toward certification readiness, publishing and accepting public comment on the first two versions of its work related to ambulatory EHR functionality, interoperability, security and reliability, and the certification process. On Sept. 7, CCHIT opened a 30-day public comment period for the newest work focused on use cases and certification process. The final version of the criteria and the process will be pilot tested with actual EHR products beginning in December 2005, and the first round of product certification is planned to be available by March 2006. CCHIT was founded in 2004 with seed funding from AHIMA, the Healthcare Information and Management Systems Society, and The National Alliance for Health Information Technology. More information on the CCHIT is available at http://www.cchit.org. Patient Status Codes - On-line course Click here for more information regarding patient status codes on-line course. Reps. Murphy and Kennedy Introduce Health IT Bill On May 11, Representatives Tim Murphy (R-PA) and Patrick Kennedy (D-RI) hosted a press conference with the unlikeliest of allies—Senator Hillary Rodham Clinton (D-NY) and former House Speaker Newt Gingrich—to announce the introduction of the 21st Century Health Information Act (HR 2234). The bill charges regional health information organizations (RHIOs) with convening healthcare stakeholders to develop: • Health information networks • Mechanisms for financing physician information technology implementation • Plans to use the new networks to improve patient safety and healthcare quality and efficiency Provisions in the legislation authorize various financing measures including grants and loans to RHIOs, increased Medicare payments for IT use, Medicaid matching for state contributions to approved IT plans, and narrow exceptions in the Stark and anti-kickback laws so hospitals can provide assistance to physicians with adopting IT. Other language addresses privacy, uniform design requirements for information networks, and interoperability and certification by addressing the Certification Commission for Health Information Technology (http://www.cchit.org/), of which AHIMA is a founding member. For additional information on this legislation, visit the Advocacy Action Center of the Advocacy Assistant at http://www.ahima.org/dc/aa. Comprehensive Error Rate Testing Letter Click here to view the CERT Letter FAQs ISSUED ON USE AND DISCLOSURE OF PHI On January 14, 2005, the Federal Office for Civil Rights ("OCR") published on its website long-awaited guidance regarding the use and disclosure of protected health information ("PHI") in the context of litigation. Although in some instances this guidance, in the form of answers to Frequently Asked Questions ("FAQs"), simply restates the applicable provision of the HIPAA Privacy Rule, in some cases the FAQs do provide important guidance for covered entities and their business associates on how and when PHI may be used and disclosed. Vinson & Elkins has prepared an analysis that provides an overview of the key points of these FAQs (http://www.hhs.gov/ocr/hipaa/), which may be viewed at http://www.velaw.com/pdf/resources/HCSA021005A.pdf. Reporters, Jason Pinkall, Houston, 713.758.4570 or jpinkall@velaw.com and Brenda Strama, Austin, 512.542.8544 or bstrama@velaw.com.