On-line Federal Register access offers help
On-line Federal Register access offers help
Point, point, click, click . . . oh, what a relief it is!
If you’ve suffered through years of pawing through stacks of Federal Register copies, trying to keep up to date with the latest Medicare reimbursement changes, you may now suffer less. If you’ve scrambled to look up past references and nearly pulled all your hair out when your subscription temporarily expired or your colleague fed it to the dog for breakfast worry no more.
Now there is a solution or several to tracking the latest news in federal regulations and proposals, thanks to the information highway. You can access the Federal Register, still the pre-eminent source of official Medicare regulation, via CD-ROM and the Internet.
"It’s a lot easier to access the information, and you don’t have giant volumes of paper sitting around," points out Sue Proffitt, RRA, CCS, director of classification and coding for the American Health Information Management Association (AHIMA). AHIMA is the Chicago-based professional organization of some 15,000 members who are medical record and health information experts in hospitals, physician practices, and insurance companies.
"The advantage of on-line Federal Register searches is you can get directly to the portion of information you are interested in," Proffitt points out. "With paper searches, you often have to read quite a bit of paper before you get to what you want," she says.
For example, ever heard of modifier -QP? That’s a new coding series related to documenting medical necessity for lab services, points out Rita Scichilone, RRA, a coding consultant with Professional Management Midwest in Omaha, NE, and coding advisor for Physician’s Payment Update. "I was able to plug in just the terms modifier QP’ and go right to the recent regulation describing it," Scichilone says. Legibility is another advantage, she says. "It sometimes is tough to read the fine print [of the paper version]."
Let your computer system do the walking
Also, Scichilone often can produce the relevant section of the regulation on short notice. "I might say to a practice administrator, No, I’m not making this up, and here it is in the Federal Register," which she can access on her computer. Large group practices often have the Federal Register available on line staffwide.
Despite its strengths, be aware of disadvantages, too, Proffitt and Scichilone warn. It can take a little bit of experience dealing with electronic searches to get comfortable with this medium.
Also, none of the Internet sites are perfect. HCFA’s home page, where you can access Federal Register material, is subject to technical problems, as is any other home page. Another difficulty: Often essential charts and tables get scrambled, although experts predict this will be resolved in the near future.
Keep in mind, too, that the type of content in the Federal Register whether on paper or in any electronic version is exactly the same, so reading and interpreting it still is no walk in the park. At least tapping into topics is a much easier task, thanks to CD-ROM editions and other electronic media. Proffitt notes another added benefit: As you cruise through the Internet, you’ll find links to information you’d never have thought of before.
If you want to venture further, start with the Dec. 18, 1996, Federal Register. HCFA officials lay out a valuable description of ways to track Medicare and Medicaid policies via numerous avenues. They also give an excellent review of overall Federal Register protocol types of regulatory notices, definitions and distinctions, and some idea of expected time table for the various notices.
Below are highlights of HCFA’s description, along with comments from PPU editors’ own experiences using these new technologies, as well as comments drawn from interviews with other Federal Register hounds:
• CD-ROM. By many people’s standards, this is by far the easiest and the most idea-responsive way to access the Federal Register. The CD-ROM version can be purchased from the Government Printing Office or the National Technical Information Service by using stock number 717-139-00000-3. (See related story on p. 44 for contact information.) The material in the disk is organized in this manner:
Titles XI, XVIII, and XIX of the Social Security laws (Medicare and Medicaid), as of Jan. 1, 1995, updated on a monthly basis;
HCFA-related regulations (updated daily);
HCFA manuals and monthly revisions (updated as released);
HCFA program memoranda (updated as released).
Appendices are not included because of difficulties in reading them in this media form. Officials are taking this concept back to the drawing board, and they expect to re-load once technical difficulties are resolved.
The beauty of this system is you can call up a topic, and it will immediately identify where you can find it mentioned throughout scores of Federal Register issuances. Not only is it quicker, it probably enables you to be more accurate and complete than you can be by using hard copy.
For instance, say you wanted to look up only "physician payment" or "Part B" or "conversion factor." The screen shows you where to type in those search words. You hit the "enter" key following the term you’ve entered, and the screen will chronologically list citations from the Federal Register. You press "enter" and you’ll get the full text of that citation, and you can print either the entire regulation or just the parts of it you mark by using your highlighter key.
If you’ve ever done an on-line literature search, you’ll see the Federal Register system is virtually identical to the user-friendly ones you find at nearly all public or university libraries. Even children’s on-line encyclopedias use the same point-and-click approach, only the Federal Register hasn’t included interactive video or audio enhancements.
Other options beyond CD-ROM offer ways to get the latest in Medicare and Medicaid regulations, including:
• Internet. The federal government’s on-line database for the Federal Register is updated by 6 a.m. each day it is published, which is virtually every weekday. It includes both text and graphics beginning with Vol. 59, No. 1, which is the Jan. 2, 1994, issue.
Access is free to the public for those who have Internet access. You can reach this database at http://www.access.gpo.gov/su_docs/. If you are asked for a password, log in the word "guest."
• Tried and true paper version. You may still prefer the traditional paper copies. As you probably are aware, regulations produced by every government agency for every program in the country are published in the general repository of the Federal Register. You’ll find plenty of pages devoted to Medicare, most of which are under the general heading of the Health Care Financing Administration.
In 1996, a rough measure of all the Federal Registers stacked one on top of the other came to about 25 feet high so be prepared with plenty of space if this is the medium of your choice. (You can obtain a subscription from the GPO at the address listed above.)
• 24x microfiche. If you rode a horse and buggy to school, you probably still remember this method of research! Tiny strips and large machinery usually are required. Most public libraries have this available, but it’s not very handy for most physician practices.
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