Stage one MU

CMS Announces July 2015 Transition from IACS to EIDM

CMS 

The Centers for Medicare & Medicaid Services (CMS) would like to inform Physician Quality Reporting System (PQRS) participants and their staff to an important system update scheduled to be in place on July 13, 2015.


The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval, and receive a single user ID for accessing multiple CMS applications.


Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at  http://portal.cms.gov. Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.


Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM.


For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.

Using templates in your EHR? Make sure they are updated for ICD-10!

The follow article, written by Cathie Wilde pertains to any EHR that is “template driven”.  As we approach (hopefully) adoption of ICD-10 codes, looking at how your templates are coded is one of those great first steps a practice can take to begin it’s transition to ICD-10.

 Published from ICD-10 monitor:
 “Templates can either enhance documentation necessary for coding and data quality, or they can hinder things by restricting options and failing to prompt physicians to document specific information. However, templates cannot be overlooked when it comes to ICD-10. This is particularly true if a hospital relies more heavily on templates to capture structured data. Many hospitals may use templates for certain diagnoses, orders, or visit types and allow physicians to dictate information for everything else.

Regardless of a hospital’s specific use of templates, one point remains clear: the templates must be updated to accommodate the details necessary for ICD-10. At a minimum, these details include laterality, specificity, and etiology. The number of physicians who could be using a specific template at any given time — or even over a short period of time — could be significant. If one template is not updated correctly to accommodate ICD-10, data quality and reimbursement could be compromised.

Health information management (HIM) directors cannot assume that electronic health record (EHR) vendors will handle this effectively and in a timely manner. Instead, take the following steps to ensure that all updates will be made:

1. Take an inventory of all current templates in use. Are some of these templates used more frequently than others? Can any of them be retired if not in use? Ask for input from coders — what information is typically missing from the templates? Can you add or revise this information during the ICD-10 update? Work with your EHR vendor to make these changes before tackling ICD-10 updates.

2. Form a committee to address ICD-10 template updates. This committee, which can be a subcommittee of the ICD-10 implementation committee, should include coders, clinical documentation improvement (CDI) specialists, a physician champion, and an EHR representative. Compile a list of all diagnoses and procedures that require greater specificity in ICD-10 and cross-check this list with any templates that are in use. Ensure that each and every reference to these diagnoses and procedures is updated to accommodate ICD-10 specificity and other requirements.

3. Tie your template update efforts to your query update efforts. As CDI specialists review queries to ensure the implementation of updates for ICD-10, they can easily use this information to review templates in light of ICD-10 changes. If templates ultimately capture all of the relevant information that coders need, a query may not even be necessary.

4. Review templates after updates have been made. Set a deadline for all template updates to be completed. Then manually review each template to ensure that updates have been entered correctly.

5. Educate physicians. Physicians don’t need template-specific training; however, let physicians know that the updated templates exist when performing specialty-specific ICD-10 training. Reiterate that the templates exist to make physicians’ jobs easier by prompting them to document what’s necessary and pertinent to ICD-10 in the most concise way.

Clinical areas for review

Consider focusing on the following templates that require new and more specific documentation in ICD-10:

Obstetrics-related templates

  • Specific trimester: The majority of codes in Chapter 15 (Pregnancy, Childbirth, and the Puerperium) feature a final character that indicates the trimester of the pregnancy. Assignment of this character is based on the provider’s documentation of the patient’s trimester during the admission/encounter. Templates should include the weeks of gestation at the time of admission and/or delivery.
  • Fetus identification: ICD-10 requires a seventh character to denote multiple gestations, when applicable. This character identifies the fetus for which the complication code applies. Templates should provide an option for this character.
  • Multiple gestation placenta status: ICD-10 features a combination code for multiple gestation and identification of the number of placentas and amniotic sacs. Templates should capture this information as well.

Trauma-related templates

  • Glascow coma scale: This scale denotes the degree of consciousness and is used commonly with head trauma cases. The score can function as an indicator for testing or treatment as well as predict the duration and outcome of the coma. Templates for head injuries should specifically include this information.
  • Gustilo classification: This classification applies to open fractures of the long bones, including the humerus, radius, ulna, femur, tibia, and fibula. The classification system groups open fractures into three main categories and three subcategories defined by these characteristics: mechanism of injury, extent of soft tissue damage, and degree of bone injury or involvement. Templates for open fractures should include this information.
  • Salter-Harris classification: This classification includes nine types of fractures that occur along the epiphyseal (growth) plates in bones that have not reached full maturity. With these types of fractures, plates are still open and filled with cartilaginous tissue. These fractures are common among children. Templates for these fractures should include information related to the Salter-Harris classification system.

Wound-related templates

  • Severity: In addition to specific location and etiology of non-pressure skin ulcers, ICD-10 also requires physicians to document the severity of the ulcer as follows:
    • Limited to breakdown of skin
    • With fat layer exposed
    • With necrosis of muscle
    • With necrosis of bone

Any and all wound templates should include these designations. Pressure ulcer templates should continue to include the stage of the ulcer.

Nutrition templates

  • Obesity: In addition to the current body mass index documentation on nutrition orders/templates for obesity, ICD-10 includes additional codes for obesity due to excess calories, drug-induced obesity, and morbid obesity with alveolar hypoventilation. Templates should be updated to include these designations. “

About the Author

Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.

New EHR Attestation Deadline

New EHR Attestation Deadline for Eligible Professionals:
March 31, 2014

CMS is extending the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 11:59 pm ET on February 28, 2014 to 11:59 pm ET March 31, 2014.
In addition, CMS is offering assistance to eligible hospitals who may have experienced difficulty attesting to submit their attestation retroactively and avoid the 2015 payment adjustment.
This extension will allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment.
This extension does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including the electronic submission for the Physician Quality Reporting System EHR Incentive Program Pilot.

How to attest?
If you are an eligible professional, you may use the registration and attestation system to submit your attestation for meaningful use for the 2013 reporting year. You must attest prior by 11:59 pm ET on March 31, 2014 to meet the new 2013 program deadline.
If you are an eligible hospital, you may contact CMS for assistance submitting your attestation retroactively. You must contact CMS by 11:59 pm on March 15, 2014 in order to participate for the 2013 program year.

Resources
If you are an eligible professional working on your attestation for the 2013 reporting period, there are resources available to help you with the registration and attestation process.
Stage 1 Meaningful Use Calculator
Registration and Attestation User Guides
EHR Incentive Program Website
The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888-734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.

Tips
In addition, there are some simple steps you can take which will help to make the process easier for you:
• Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS
• Make sure to include a valid email address in your EHR program registration
• Consider logging on to use the attestation system during non-peak hours such as evenings and weekends
• Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data
• If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem
• If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.

Eligible Hospital Instructions:
1. Send the following information to EH2013Extension@Provider-Resources.com no later than 11:59 PM EST on 3/15/2014:
o CCN
o Hospital Name
o Contact Person Name
o Contact Person Email
o Contact Person Phone
2. Type “EH 2013 EXTENSION” in the subject line of the email note
3. Each Hospital must be identified in a separate email
CMS will contact the person that you designate in your request to provide additional instructions regarding the Eligible Hospital 2013 attestation submission.