Health Reform Brings Changes, More Work for HIM

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.

The legislation will also have indirect effects on HIM departments—for example, the sheer volume of their work. That's a lot more coding, a lot more requests for information, a lot more insurance companies to deal with, a lot more transcription. In fact, it means a lot more of almost everything HIM staff members manage on a daily basis.

"Where there is more volume, there is more work," Grzybowski says. "So there will be an impact on resources needed, which is unfortunate given the labor shortage already in existence for HIM."

"Unfortunately, that problem will probably continue for a while," Rode says. "But hopefully as we move toward increased EHR capabilities, that may help. ICD-10 may also help to make coding easier and more accurate as well by eliminating vague codes."

And that could be very important as the bill contains provisions for additional fraud and abuse. Providers have seen in the past that when the government looks into reducing waste and abuse, HIM departments tend to see additional auditing activity. Grzybowski believes this will be no exception.

"An increased emphasis on conducting audits, both internal and external, will occur as greater volumes mandate greater need for quality checks and controls," she says. "In addition, many of these audits will provide for recapture of reimbursement from providers to help fund the enormous expenses, which accompany this reform bill."

But whether the additional funding set aside in the Act will translate into new auditors or just increased volume by those already in existence remains to be seen. However, the government may simply expand the programs it already has (e.g., Recovery Audit Contractors), Rode says. He also believes the government may focus on auditing for deliberate fraud, as opposed to, for example, abuse in the form of coding errors.

Regardless, HIM departments will need to update their processes and increase their efficiency to keep up with patient volume increases, according to Grzybowski. This includes using technology to improve workflow, and electronic document management systems.

"Use of consultative and interim staffing resources should also increase due to both the labor shortage and the increasing use of technology," she says. "Overall, change management skills will also be essential."

HIM directors may come to appreciate the Act's emphasis on quality and having good data, both of which highlight the HIM department's role in managing information.

And finally, the reform could bolster hospital bottom lines, formerly hindered by receivable problems when patients couldn't pay for their care. "It could well stabilize healthcare organizations, which will be a positive in the long run for everyone," Rode says.