CHIA is pleased to announce that as of January 1, 2018, our new address is:
5055 E. McKinley Ave, Fresno, CA 93727
Email addresses and phone & fax numbers will remain the same.
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Medicare Advantage Program: CMS-HCCs 101
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Provided are excerpts from the Jan/Feb CHIA Journal. CHIA members receive a mailed hard copy, and all CHIA and AHIMA members can
access the digital version online
to view, read, and enjoy now!
Medicare Advantage Program: CMS-HCCs 101
What HIM Professionals Need to Know
by Janet Franklin, RHIT, CCS, CCS-P
This article reviews the payment model used by the Centers for Medicare & Medicaid Services (CMS) to affect payment to Plans for their Medicare Advantage members. Risk-adjusted data validation (RADV) audits conducted annually by CMS to ensure accurate data submission will also be reviewed.
Medicare Advantage (MA), also referred to as Medicare Part C, is a risk adjusted plan offered to Medicare patients through a contracting Medicare Advantage Organization (MAO). Members (Medicare beneficiaries) who enroll in Part C must first have Medicare Part A & B. Payment to the MAO is based on the member’s risk score.
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For more information on this topic, purchase the
CHIA Webinar on Demand “Medicare Advantage HCCs and RADV Audits” presented by the article author at
California-HIA.org/webinars-demand
This on-demand presentation provides an in-depth review of the HCC risk adjustment model and includes information to enhance the participant’s understanding of the model. This presentation also provides a review of the CMS RADV audits on patients' medical records, including objectives, processes, impacts, and available appeal processes.
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2019 Medicare Advantage Part I Advance Notice – Risk Adjustment
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The Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data.
The 2019 Advance Notice is being published in two parts this year due to requirements in the 21st Century Cures Act, which mandated certain changes to the Part C risk adjustment model and a 60 day comment period for these changes. Changes to other payment methodologies proposed for the following calendar year that are typically contained in the Advance Notice only require a 30 day comment period and will be released in accordance with that statutory deadline. The payment policies for 2019, proposed in both in Part I and Part II of the Advance Notice, will be finalized in the annual Rate Announcement. To be assured consideration, comments on the proposals announced today should be submitted by March 2, 2018.
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Last Chance to Vote - Ballot Closes Friday, Jan 26 at 4pm
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CHIA Active, Emeritus, Graduate, and Honorary members are eligible to vote, and as a voting member, you elect the CHIA leaders who will lead the association over the next few years. When you participate and vote, you take part in influencing the strategic direction and leadership of CHIA.
The CHIA Nominating Committee asked each candidate to respond to an important association-related question. Their position statement responses are included in the
January/February CHIA Journal
. Each candidate’s response and health information backgrounds are also available online at
CaliforniaHIA.org/ballot18
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The CHIA Nominating Committee set a 20% voter goal for the 2018 CHIA Election. As of today, 10.57% of eligible CHIA members have voted - We're halfway there! CHIA wants all member voices to be heard and counted, so let's increase the voter turnout this year!
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OSHPD News: Patient Data Reporting Requirements Updates
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Notice provided by Robyn Strong
Staff Services Manager II, Patient Data Section, OSHPD;
Member, CHIA Committee Coding and Data Quality
A regulatory proposal that makes updates to the Office of Statewide Health Planning and Development (OSHPD) Patient Data Reporting Requirements was recently approved by the Office of Administrative Law. The reporting changes will be effective with discharges and encounters on and after January 1, 2019.
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Draft Trusted Exchange Framework Common Agreement
- Open for Comment
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Notice provided by Debi Primeau, MA, RHIA, FAHIMA
Member, CHIA Legislation and Advocacy Committee
While the HITECH Act stimulated significant electronic health record adoption and exchange of health information, interoperability remains a challenge. The 21st Century Cures Act’s focus on trusted exchange is an important next step toward advancing the establishment of an interoperable health system that:
- Empowers individuals to use their electronic health information to the fullest extent
- Enables provides and communities to deliver smart, safer, and more efficient care
- Promotes innovation at all levels
In collaboration with the National Institute of Standards and Technology (NIST), federal agencies, and industry stakeholders, the ONC is working to further advance the interoperability progress made to date and address the complex yet core tenet of interoperability—building and maintaining trust. On January 5, 2018, ONC has published the Draft Trusted Exchange Framework Common Agreement (TEFCA). The draft TEFCA contains two parts: Park A—Principles for Trusted Exchange and Part B—Minimum Required Terms and Conditions for Trusted Exchange. The comment period is now open for 45 days and ONC will review, analyze, and post on its website all public comments that are
received by 11:50pm ET on February 18, 2018.
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Calling all coding professionals to join us in Garden Grove for CHIA's second annual Advanced Coding Workshop. Learn about the challenges coding professionals are facing. Tackle coding areas that may be an audit trigger. Work through the challenging areas in the general coding guidelines.
Two days of advanced PCS and CM coding is what is needed to advance ICD-10 knowledge to the next level. Day one will cover advanced PCS coding. Day two will cover advanced CM coding.
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San Diego Health IT Summit – February 1-2, 2018
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Omni San Diego Hotel | 8.5 CE credits available
CHIA is partnering with the San Diego Health IT Summit to offer complimentary passes to CHIA members.
Use code CHIACOMP when registering.
Join top executives, physicians, practice management and IT decision makers from North America’s leading provider organizations and physician practices in San Diego, CA for a two-day executive Health IT Summit. We've developed a concise program where leading healthcare thought leaders interact with their fellow executives and solution providers to discuss the latest strategies and tactics to address a wide range of issues and topics, including: data security, population health, data analytics, accountable care, telemedicine, and more. This exclusive, high-level program is a great opportunity to stay ahead of the challenges we all face and to network with other healthcare leaders and colleagues.
Learn more and see the full agenda.
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Legislative Alert: Medicare Claims Processing Largely Uninterrupted by Government Shutdown
MGMA Washington Connection; Jan 22, 2018
Congress failed to pass legislation to continue funding the government for Fiscal Year 2018 resulting in a federal government shutdown that began on Saturday. However, according to a Department of Health and Human Services (HHS) contingency plan, Medicare disruptions are not initially expected. HHS states that, “in the short term, the Medicare Program will continue largely without disruption during a lapse in appropriations.” States are expected to have funding for Medicaid through the second quarter, and the Centers for Medicare & Medicaid Services will continue to make payments to eligible states from the Children’s Health Insurance Program carryover balances. In addition, while key federal health insurance exchange activities and work done by the Medicare Innovation Center will continue, about half of the HHS workforce will be furloughed. MGMA will update members as budget negotiations continue.
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EHR Copy and Paste and Patient Safety
by Shannon M. Dean, MD for Patient Safety Network; January 2018
Although the ability to copy and paste text is a central benefit of computing in general, and electronic health records (EHRs) in particular, the widespread adoption of EHRs has led to concerns about how copy-and-paste functionality is being employed in health care. It has been 5 years since Hirschtick wrote a WebM&M commentary on a remarkable case that illustrates some of the problems associated with copy and paste.(1) In that case, the patient with an alleged history of "PE" (interpreted by the clinicians as pulmonary embolism) received an unnecessary CT scan to rule out a suspected "recurrence" of pulmonary embolus. As it happens, years earlier, the abbreviation "PE" had been used in the electronic note to indicate that the patient had had a physical examination, not a pulmonary embolism! In a vivid example of copy and paste, once the diagnosis of pulmonary embolism was mistakenly given to the patient, it lived on in the EHR. Unfortunately, Hirschtick's call to action at the time, along with those of others over the years (2,3), has not resulted in the kind of improvements in provider documentation that might prevent harm from copying and pasting.
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ONC Aims to Release Proposed Interoperability Rule in April
Rachel Z. Arndt for Modern Healthcare; Jan 18, 2018
The Office of the National Coordinator for Health Information Technology will release a proposed rule about interoperability and certification in April, the agency said Thursday.
The proposed rule would update the HITECH Act and meet some provisions of the 21st Century Cures Act, including details about certification for health IT developers, according to ONC's director of policy, Elise Sweeney Anthony, at the first meeting of the Health Information Technology Advisory Committee on Thursday.
The rule will also deal with how health information networks attest to using a trusted exchange framework and common agreement for exchanging data among themselves.
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Fine Tune Your Coding Productivity Metrics
Wednesday, January 31 - Live Webinar
Advanced ICD-10 Coding Workshop - Day 1 PCS
Friday, February 9 - Garden Grove
Advanced ICD-10 Coding Workshop - Day 2 CM
Saturday, February 10 - Garden Grove
A Respiratory System A&P and Coding Review
Wednesday, February 21 - Live Webinar
EHR Governance Symposium
Wednesday, March 14 - Thursday, March 15 - Long Beach
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