Model plan shows how to comply with payment regs

The American Health Information Management Association (AHIMA) in Chicago has a new model compliance plan designed to help health care organizations comply with the mix of laws, regulations, and policies that govern payment for health care services.

The model, which covers compliance issues from the health information management (HIM) perspective, identifies and explains the key elements compliance plans should contain, such as:

• a mission;
• code of conduct;
• methods of oversight;
• compliance policies and procedures;
• plans for training and education;
• procedures for enforcement;
• methods of solving and correcting problems that may arise.

Desirable skills listed

In addition, the model includes a description of the skills professionals who manage compliance programs should have. At the top of the list is extensive knowledge of what constitutes accurate clinical documentation in all types of health care settings.

Other characteristics include knowledge of billing and coding practices; the conventions, rules, and guidelines for multiple classification systems; and knowledge of reimbursement systems. According to the model, more generic skills — such as strong leadership, managerial, communication, presentation, and analytical skills — are important as well.

The model also includes a sample job description for an "HIM compliance specialist" and several sample audit tools and forms.

"Health Information Management Compliance: A Model Program for Healthcare Organizations" can be ordered by calling (800) 335-5535. The cost is $32 for AHIMA members and $40 for nonmembers.

The devil’s in the details

On Oct. 21, 1998, President Clinton signed the Omnibus Spending Bill into law. The measure included spending bills for these federal departments: Labor, Health and Human Services (HHS), and Education; Agriculture; Commerce, Justice, State; District of Columbia; Foreign Operations; Interior; Treasury and Postal Service; and Transportation. Here are details of the bill, as analyzed by the Joint Healthcare Information Technology Alliance, a recently established think tank.

• Prohibits the HHS secretary from promulgating or adopting standards providing for a unique health identifier (UHI) without first obtaining explicit congressional approval. Thus, two years after directing the secretary to create such a unique identifier, Cong ress has indicated it intends to review the issue again, and many observers anticipate the introduction of legislation next year that would repeal this provision of the Health Insurance Portability and Accountability Act of 1996. Earlier, the Clinton administration announced that no UHI would be implemented until comprehensive privacy legislation is passed by Congress.

• Includes substantial across-the-board funding for HHS (major increases for AIDS treatment, disease prevention, and biomedical research); hastens phase-in of full tax-deductibility of health insurance for the self-employed; and provides a fix for Medicare’s home health interim payment system.

• Includes the Internet Tax Freedom Act, which establishes a moratorium that no state or political subdivision may impose any of the following taxes from Oct. 1, 1998, and extending for three years from the date of enactment on Oct. 21: taxes on Internet access, unless such tax was generally imposed and actually enforced before Oct. 1, 1998; and multiple or discriminatory taxes on electronic commerce.

• Establishes an Advisory Commission on Electronic Commerce that will conduct a study of international, federal, state, and local taxation and tariff treatment of transactions using the Internet and a study of Internet access and other comparable intrastate, interstate, or international sales activities. The commission will report to Congress within 18 months reflecting the results of the study, including any recommendations for legislation.

• Provides $45 million for the Health Care Financing Administration transition to a single Part A and Part B processing system and year 2000 conversion requirements of external contractor systems.

• Provides $1 million for the National Bipartisan Commission on the Future of Medicare for fiscal year 1999.

HIMSS conference to be held in Atlanta

"Discover the Synergy," the 1999 Healthcare Information and Management Systems Society Conference & Exposition will be held Feb. 21-25 at the Georgia World Congress Center in Atlanta. More than 150 educational sessions are scheduled, with topics including year 2000 compliance, computer-based patient records, and the Internet and Intranet.

For details, call (877) 446-7799 or visit the organization’s Web site at