Medical Business Journal Volume 3 Issue 2 Feb/March 2012

MEDICAL BUSINESS JOURNAL Feb/March 2012 Issue 2 Volume 3

The Monthly Newsletter for the Informed Healthcare Professional

The Medical Management Institute moved to the Preston Ridge Medical Campus in Alpharetta, Georgia

In this Issue 2........................................................................................................Facebook/Twitter iPad Winner 2......................................................................................................................Contribute to the MBJ 2.....................................................................................................Upcoming CoderWeek in Atlanta 3..........................................................................................................................CMS News Updates New POS Rule Stage 2 for Providers Adopting EHR Records ICD-9 versus ICD-10 Version 5010 Enforcement Extended 4..................................................In Honor of Women’s History Month: The Evolution of Nursing 6..........................................................................................................................Affordable Care Act 6......................................................................................................................Payment Cuts Delayed 7.........................................................................Is Your Goal to Work Remotely? Take These Steps 8.................................................................................................................Join us on Learner Nation

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THE MEDICAL BUSINESS JOURNAL Feb/March 2012

Medical Management Institute Updates Facebook, MBJ, and CoderWeek Medical Business Journal Boost your resume!

The Medical Business Journal is MMI’s monthly newsletter to help keep our members informed in the healthcare industry. We would like to extend to our loyal students and alumni a fantastic opportunity to contribute to this nationally-distributed newsletter! If you are interested in contributing articles, job postings, or need ad space, contact us for details. We are always looking for a new perspective, story, or update. Reach us at mbj@mmiclasses.com or by phone at 866-892-2765, extension 240. We look forward to hearing from you!

MMI is on Facebook and Twitter It “pays” to be involved!

Through Facebook and Twitter, MMI has been supplying helpful resources, proving updates on upcoming seasonal courses, and recently, an iPad drawing. To participate, all you had to do was “Like” or comment on the MMI fan page, and you would be placed into the drawing. On March 1st, Tammy Corbetta, RMC, who has been a member of the Medical Management Institute since 2004 was pulled as the winner of the iPad2 [pictured above]!

To be a part of our next promotional event, stay tuned to our Facebook page at www.facebook.com/ MMIfan, or on twitter @MMIclasses. We look forward to going social with you!

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Tammy Corbetta, RMC, who has been a member of the Medical Management Institute since 2004, was pulled as the winner of the iPad2! To be a part of our next promotional event, stay tuned to our Facebook page at www.facebook.com/MMIfan.

Upcoming Bootcamp CoderWeek in Greater Atlanta The Medical Management Institute is proud to announce a CoderWeek coming up in June in the greater Atlanta area. It will be held at Preston Ridge Medical Campus in Alpharetta [pictured below], where MMI recently moved. The week will consist of 3 days dedicated to CPC Prep, followed by a two day introduction to ICD-10. You can learn more about the dates and pricing through updates on the MMI Facebook page, or you can call for more details at 866-892-2765, extension 214.

CMS Announced a New POS Rule If you are in a radiology practice, you need to be aware of a new place of service (POS) rule that CMS recently announced. According to MLN Matters MM7631, the new rule states that when you report POS for your physician, it should reflect the "setting in which the beneficiary received the face-to-face service." As there are exceptions to the rule, read it in its entirety and pay attention to the details of each section.

Effective Date: April 1, 2012 Implementation Date: April 2, 2012 [Source: codingnews.inhealthcare.com]

CMS Announces Stage 2 for Providers Adopting EHR Records Although Stage 2 meaningful use will bring stricter reporting requirements in regards to electronic health records (EHR), the benefits outweigh the effort. According to the AAPC, there will be improved interoperability and vendor responses to specialty-specific provisions. As quoted from Health and Human Services Secretary Kathleen Sebelius, “We know that broader adoption of electronic health records can save our health care system money, save time for doctors and hospitals, and save lives…We have seen great success and momentum as we’ve taken the first steps toward adoption of this critical technology.

As we move into the next stage, we are encouraging even more providers to participate and support more coordinated, patient-centered care.”

Hospitals and eligible health care professionals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it in a meaningful way. According to HHS.gov, meaningful use is advancing in 3 ways: • Stage 1 (which began in 2011 and remains the starting point for all providers): “meaningful use” consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.

• Stage 2 (to be implemented in 2014 under the proposed rule): “meaningful use” includes new standards such as online access for patients to their health information, and electronic health information exchanges between providers.

• Stage 3 (expected to be implemented in 2016): “meaningful use” includes demonstrating that the quality of health care has been improved.

A technical fact sheet on CMS’s proposed rule is available at http://www.cms.gov/apps/media/fact_sheets.asp.

[Source: http://www.hhs.gov/news/press/2012pres/ 02/20120224a.html]

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ICD-9 Versus ICD-10 ICD-9 is over 30 years old, out of date, and is impractical for “...today’s treatment, reporting, and payment processes,” according to AMA. Learn about the key differences below: ICD-10-CM codes: • designated for use in documenting diagnoses in all clinical settings • will be replacing ICD-9-CM Vols. 1 and 2 • 3-7 characters in length, a total of 68,000 codes ICD-9-CM codes: • designated for use in documenting diagnoses • 3-5 digits in length, total over 14,000 codes ICD-10-PCS procedure codes: • will be used to report hospital inpatient procedures only • will be replacing ICD-9-CM Vol. 3 • 7 characters in length, totaling approximately 87,000 alphanumeric codes ICD-9-CM procedure codes: • 3-4 numbers in length, approximately 4,000 codes According to AMA, moving to ICD-10 will effect all physicians and will require "significant planning, training, software/system upgrades/replacements, as well as other necessary investments." It is easy to see why when you see the extended number of codes and the specific characteristics of each one. In order to use the ICD-10 codes, it is essential that the healthcare community begins utilizing the 5010 HIPAA transaction standards. More on this in following article.

[Source: http://www.ama-assn.org/ama/pub/physician-resources/ solutions-managing-your-practice/coding-billing-insurance/hipaahealthinsurance-portability-accountability-act/transaction-code-set-standards/ icd10-code-set.page ]

Version 5010 Enforcement has been Extended until June 30, 2012 On March 15, 2012, The Centers for Medicare and Medicaid Services' Office of E-Health Standards and Services (OESS) announced an additional three month extension, on top of a previous 3 month extension, on the Version 5010 enforcement discretion period for updated HIPAA transaction standards.

This means that covered entities are still urged to complete outstanding implementation activities, which according to CMS includes software installation, testing and training.

However, OESS is encouraging the industry to collaborate more closely on relevant action to accomplish the remaining problems.

[Source: https://www.cms.gov/ICD10/11a_Version_5010.asp ]

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

CMS News Updates

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

In Honor of Women’s History Month: The Evolution of Nursing

By Doris Weatherford, National Women’s History Museum representative and noted historian of women’s history

As caretakers of children, family and community, it was natural that women were the nurses, the caregivers, as human society evolved. Nursing may be the oldest known profession, as some nurses were paid for their services from the beginning. This was especially true of wet nurses, who nursed a baby when the mother died or could not nurse her child. A woman whose infant did not survive birth, or who was ready to wean her child, or who was capable of nursing more than one baby, would accept employment as a wet nurse, usually going to live in the home of her employer.

The home, in fact, was the center of health care, and for the first two centuries after European exploration of North America, all nursing was home nursing. Even when the nation’s first hospital began in Philadelphia in 1751, it was thought of primarily as an asylum or poorhouse; another century or more would pass before the public viewed hospitals as reputable and safe.

Perhaps the best known nurse at the time was Mary Ann Bickerdyke of Illinois. A middle-aged widow, her accidental career began when she delivered money raised by local charities to the giant, if temporary, hospitals that the Union built at the junction of the Mississippi and Ohio rivers. After witnessing suffering soldiers who had literally no one to care for them, she went on to be the only woman that General William T. Sherman allowed with his army. At the Tennessee battle of Lookout Mountain, she was the sole nurse for some two thousand men.

The Civil War gave enormous impetus to the building of hospitals and to the development of nursing as a credentialed profession. Initial wartime volunteers, however, often were seen as no different from “camp followers,” the women (sometimes mistresses and sometimes wives) who followed their soldier men. It was an era of sharp class definitions, and especially in the South, “respectable” women could not be seen in a military hospital.

In the Confederacy, the most prominent nurses were Captain Sally Tompkins and Phoebe Pember.

Tompkins was commissioned as an officer in the Confederate army so that she could have the power to commandeer supplies. She converted her Richmond mansion into Robertson Hospital and established a reputation for extraordinary quality: Tompkins’ hospital had by far the lowest death rate of any facility in the North or South, even though physicians sent their worst cases to her. Her staff of six—four of whom were black women still in slavery – treated more than 1,600 patients and lost only 73, an uncommonly low number in an era before germ theory was understood.

Some women had the courage and common sense to defy decorum, though, especially in the North, where the US Sanitary Commission became the forerunner to the Red Cross. The best known of these women, of course, is Clara Barton—but her genius was in supply distribution and in development of systems for the missing and dead, not in nursing. Barton herself

Phoebe Levy Pember has become somewhat better known since the Post Office recently included her on a series of Civil War stamps. A young widow from a wealthy Jewish family based in Charleston and Atlanta, she went north to the Confederate capital of Richmond and eventually ran the world’s largest hospital. On an average day, Pember supervised the

Mary Anne Bickerdyke

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acknowledged that she actually nursed for only about six months of the four-year war and that other women did much more.

Phoebe Pember

The war thus led to greater respect for nurses, something that Congress acknowledged in 1892, when it belatedly passed a bill providing pensions to Civil War nurses. More important, the war served as the beginning of moving the profession from the home to the hospital and clinic. The result was an explosion of nursing schools in the late nineteenth century. Usually these schools were closely associated with a hospital, and nurses—all of whom were assumed to be female —lived and worked at the hospital.

Often called “sisters” (as British nurses still are), their lives were indeed similar to those of nuns. Forbidden to marry, they were cloistered in “nurses’ homes” on hospital grounds, where every aspect of life was strictly disciplined. Student nurses were not paid at all, and because too many hospitals valued this free labor over classroom and laboratory time, many spent their days scrubbing floors, doing laundry, and other menial tasks. Curricula improved, however, in part because of the development of a tradition with caps: each nursing school had a distinctive cap that women wore after graduation, and because her educational background was literally visible every day, schools soon raised standards so that their graduates would affirm their quality.

Richards went on to establish her own precedentsetting programs as superintendent of nursing at New York’s Bellevue Hospital and at Massachusetts General Hospital; she also set up the first nursing school in Japan.

Like most educational institutions at the time, these schools did not admit African Americans, and the informally trained black women who nursed during the Civil War seldom were able to obtain credentials.

The first credentialed black nurse was Mary Mahoney, who graduated in 1879 from Dr. Zakrewska’s nursing school in Boston. As segregation remained the rule far into the 20th century, Mahoney led the National Association of Colored Graduate Nurses, which began in 1908.

During the four decades between the Civil War and the beginning of the twentieth century, the image of nurses moved from being viewed as somewhat less than honorable to a respected profession. The next century would bring still more changes, and nurses of the 19th century would scarcely recognize the occupation as it is in the 21st century. They would, however, agree that a world of difference has occurred in the care of patients, and that has been an unmitigated good—achieved primarily by women.

As was indicated in NWHM’s last newsletter, there were more female physicians (and hospital administrators) during the 19th century than most people realize today—and some of these female physicians recognized the need for nurses and worked to professionalize the occupation. Dr. Marie Zakrewska founded a medical school for women in Boston that was affiliated with her New England Hospital for Women and Children in 1862, during the Civil War—and a decade later, in 1872, she began an associated nursing school that was the nation’s first.

Linda Richards was its first graduate and thus is known as America’s first professionally trained nurse.

About the National Women’s History Museum: The National Women's History Museum affirms the value of knowing Women's History, illuminates the role of women in transforming society and encourages all people, women and men, to participate in democratic dialogue about our future. At present, NWHM is an Online Museum (nwhm.org), working to get a permanent site at the National Mall in Washington, DC. Support is Critical To secure a prominent site in Washington, D.C., we will need the formal approval of several government agencies. The federal government, however, is not underwriting the cost of this museum with taxpayer dollars. Instead, the National Women’s History Museum will have to raise no less than $150 million to build this museum privately — through the support of the American people. Before approval is granted, we need to demonstrate to Congress that we have your support and we have the ability to raise our full budget for construction.

Linda Richards

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For other historical information, visit nwhm.org.

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

treatment of 15,000 patients, most of them cared for by nearly 300 slave women.

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

“Now, because of the health care law, they no longer have to live in fear of that [maxing out their health coverage] happening.”

Kathleen Sebelius, Secretary of the Department of Health and Human Services

Affordable Care Act Causes a Sigh of Relief for Millions of Americans

Temporary Delay of Medicare Physician Payment Cuts

Ends lifetime limits and gives coverage to minorities

Setting up for a bigger cut in 2013

Under The Affordable Care Act, 105 million Americans no longer need to worry about lifetime limits on healthcare benefits. While the majority of people never actually reach this limit, Americans with serious illnesses like cancer were seriously effected. The federal government has estimated that about 10 percent of cancer patients have previously reached that limit. However, according to Secretary Sebelius, "…now, because of the health care law, they no longer have to live in fear of that [maxing out their health coverage] happening."

The Affordable Care Act has also helped young minority adults obtain health insurance. Allowing people to stay on their parents' insurance until the age of 26 has made it possible for over 1.3 million minorities to gain coverage. HHS Secretary Kathleen Sebelius has stated, "…because of the law, more and more young adults can breathe a little easier knowing they have health coverage."

Source: http://aspe.hhs.gov/health/reports/2012/ LifetimeLimits/ib.shtml

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March 1st was supposed to be the day that a 27.4% cut was to hit doctor pay, but under Part B it will be postponed until the beginning of next year. While Congress has eased the minds of physicians and providers, it is only another delay.

The Congressional Budget Office has stated that this means there will be an even larger cut in 2013 - an estimated 32%. In a statement before the congressional votes, Dr. Carmel said, "We are deeply disappointed that Congress chose to just do another patch…kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients." Dr. Carmel went on to point out that seniors and military families will be threatened again by a larger cut to come, unless action is taken immediately.

[Source: http://www.ama-assn.org/amednews/2012/02/13/ gvsg0217.htm ]

- Bobby Keene, Orientation & Recruiting Manager at the Medical Management Institute

Increasingly, medical coders are opting to work from home, or are at least considering it. Best guess estimates say 1 in 50 medical coders work outside of the office at least 2 days out of a week. But reliable information is hard to come by and the internet is filled with half-baked assumptions and misleading or out-dated information. So what are the steps you should take to working remotely in the medical billing and coding field?

The first step to working remotely is to research and make sure that it is right for you. While there are many advantages to working remotely, like the money you save on gas, having the luxury of never getting out of your sweats, and the extremely high forecast for future growth, there are disadvantages to consider as well. Remote coders, as a group, have no collective representation. Without unions and little personal connection to their employers, many remote coders have a bit of uneasiness with job security.

Working from home also lacks human interaction, which can really cause an extrovert to go stir-crazy.

There can even be tax issues to consider if you’re going to work as an independent contractor instead of a full- or part-time employee. Maybe you will be working for more than one physician; then you will have to make sure you understand how to manage separate databases for each office, and do proper bookkeeping to ensure that you can measure income received by each place you work for. You will also want to consider the hours and salary and make sure it will fit your lifestyle. On average, working remotely pays anywhere from $17-$35 per hour, or $3.50 $6.00 per chart.

After weighing all of the advantages and disadvantages, the next step is to make sure you market yourself correctly. This involves everything from networking and making yourself visible on job boards and healthcare blogs, to including the pertinent information on your resume. What employers are looking for in a resume is pretty simple: job experience and education. Most are looking for coders with at least 2.5 years of experience. As far as education, this is made evident through your credentials. Not only does this show that you are educated, but it clearly indicates that you are a dedicated individual constantly working to keep relevant and up-to-date in the healthcare industry.

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Now that you have marketed yourself appropriately, the next step is to be prepared for the interview. The employer is going to want to make sure that you are a self-motivated and goal-oriented worker who is aware of the ever-changing updates, but equally and if not more importantly, has technological savvy. If you feel uncomfortable with search-engines and IP addresses, then you need to invest some time in transitioning to the technological world that is the future of medical billing and coding.

Familiarize yourself with the internet by exploring job boards, involving yourself in social media, and even taking an online course. It’s not a matter of being an expert, but having the capacity to find the answers and resources if need be.

O ve r t h e n ex t t e n ye a r s, a s m e d i c a l organizations look for more ways to reduce spending, many suspect the remote coder job market will grow exponentially. The traditional coder won’t go away any time soon, of course. But with more internet connectivity, higher bandwidth, and lightning-fast online software apps, it is easy to see the remote coder taking a big piece of the future medical coding market.

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

Advice from MMI’s Orientation & Recruiting Manager Is your goal to work remotely? Take these steps to make it happen

Working from home Best guess estimates say 1 in 50 medical coders work outside of the office at least 2 days out of a week.

THE MEDICAL BUSINESS JOURNAL Feb/March 2012

Join the Medical Management Institute as we embrace an exciting new educational platform on Learner Nation!

All of the courses and certifications online now in one convenient location. For a limited time, complete any available certification course through Learner Nation and receive $200 back for completing a survey to help us continue to improve this revolutionary learning system!

To sign up or learn more, call the Medical Management Institute at 866-892-2765

THE MEDICAL BUSINESS JOURNAL The Medical Management Institute 3330 Preston Ridge Road, Suite 380 Alpharetta, GA 30005

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