Health Reform Brings Changes, More Work for HIM

Andrea Kraynak, March 25, 2010

After an eventful week on Capitol Hill, HIM directors are likely wondering how health reform will affect them. Understanding what is in the bill is an important first step to figuring out what is on the horizon. Only then can HIM directors begin to figure out how to manage those changes.

"It will be awhile until all of this is flushed out and there is a clearer picture for the impact on HIM or other healthcare professionals," says Darice Grzybowski, MA, RHIA, FAHIMA, president of HIMentors, LLC, in Westchester, IL. After all, many of the provisions don't go into effect until several years in the future.

While a few details are still being worked out regarding EHR-related legislation, Congress took care of most of that in ARRA's HITECH Act. However, new healthcare reform legislation does address the topic briefly.

According to the reform, HHS is responsible for studying and reporting back on ways to increase EHR use among smaller healthcare providers, including recommendations for further legislation to increase funding. The resulting report will also discuss possible higher reimbursement rates or incentives for small providers who use EHRs, as well as assist with training and education, and implementation assistance to the providers.

But while EHRs are not a big part of the new reform bill, the administrative simplification provision is, according to Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for the American Health Information Management Association in Washington, DC.

The provision should allow for easier and more timely updating of the HIPAA transaction code sets. The language would allow the HHS secretary to set up a process to update on a more regular basis, as well as issue a uniform guide for the use of the transactions, both of which should be positives, Rode says.

"The industry has already finalized 5060, and we're still trying to get to 5010," Rode says. "And the secretary's guide could presumably eliminate many of the variances in how we report data on claims."

However, these changes are unlikely to come sooner than the switch to HIPAA 5010, set to occur on January 1, 2012, as part of the preparation for the changeover to ICD-10, which goes into effect one year later.

But once the changes do occur, the industry will be able to keep up with HIPAA transaction code set changes much more easily, Rode says. "They could come annually after that, with minor changes each year, as opposed to huge switch as we are seeing when we move to 5010."

A few new provisions for Medicaid may look familiar. For example, a new provision mandates the use of National Correct Coding Initiative edits for Medicaid claims filed on or after October 1, 2010. In addition, the Act contains new provisions for the nonpayment of healthcare-acquired conditions for Medicaid claims for discharges as of January 1, 2010.

Andrea Kraynak

Andrea Kraynak, CPC, is senior managing editor of Medical Records Briefing and HIM Connection. She may be reached at


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