Compliance Key for Mental Health
by Leigh-Ann Renz, 3/27/13
How do you maintain Mental/Behavioral Health Care Compliance?
Industry Acronym Guide
Trying to read about HIT (health information technology) and MU (Meaningful Use) can be challenging enough without having to decipher all of the various acronyms sprinkled throughout the literature. To help streamline your experience, we’ve created a handy-dandy Compliance Guide geared specifically to mental health professionals:
ACO: Accountable Care Organizations: groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Medicare offers several ACO programs.
ARRA: American Recovery and Reinvestment Act of 2009, part of the federal government’s economic stimulus program. This is the law that created MU as part of the federal government’s stimulus plan.
CAHs: critical access hospitals are qualified to participate in the HITECH / MU program
CMS: Centers for Medicare & Medicaid Services, the government body that oversees the MU program.
CPT: Current Procedural Technology codes are 5-digit codes maintained by the American Medical Association and used for medical billing, including psychotherapy and psychiatry. ICD is the code used to describe the condition or disease being treated, also known as the diagnosis. CPT is the code used to describe the treatment and diagnostic services provided for that diagnosis. The critical relationship between an ICD code and a CPT code is that the diagnosis supports the medical necessity of the treatment.
CQMs: Clinical Quality Measures: part of the MU program, these are tools that the CMS uses to measure and track the quality of healthcare services provided by EPs, CAHs, and EHs. These measures use a wide variety of data that are associated with a provider’s ability to deliver high-quality care or relate to long term goals for health care quality.
DSM: those of us in mental health know that this is not actually a HIT term, but since there is often confusion about the interaction between DSM, CPT and ICD codes, it’s included. Click here for more about the differences between these codes and how they work together for diagnosis & billing of mental health services.
EHs: eligible hospitals, facilities that qualify to participate in the HITECH / MU program
EHR: electronic health records, another name for EMR
EMR: electronic medical records, a computer software program that maintains your clients’ records in an electronic format instead of on paper
EPs: eligible professionals, meaning single providers that qualify to participate in the HITECH / MU program
HHS: the Department of Health and Human Services includes more than 300 programs covering a wide spectrum of services, including Medicare and Medicaid.
HIM: health information management, describes the broad realm of maintaining health information in all formats, including electronic and paper.
HIMSS: HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. They host a well-attended annual conference that draws health care professionals from around the country.
HIPAA: Health Insurance Portability and Accountability Act: enacted in 1996, Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.
HIT: health information technology: similar to HIM, this spans the ever-growing world of technologies available to manage health information.
HITECH: Health Information Technology for Economic and Clinical Health Act: part of the ARRA, this is the federal law that created the MU program.
ICD-9, ICD-10: International Statistical Classification of Diseases and Related Health Problems, a medical classification list by the World Health Organization (WHO). Although ICD are diagnosis codes, they must be used for billing in conjunction with CPT billing codes. Since 2003, ICD codes have been mandatory (per HIPAA) for third-party billing and reporting for all electronic transactions for billing and reimbursement.
MIPPA: Medicare Improvements for Patients and Providers Act of 2008, it makes changes in 3 key areas: 1) improvements to Medicare benefits, especially for low-income beneficiaries; 2) new policies to reduce racial and ethnic disparities among people with Medicare; and 3) reining in rapidly-growing and inefficient private Medicare Advantage plans.
MU: Meaningful Use, also often referred to as ONC-ATCB, ARRA and HITECH: a federal program that provides incentive money for doctors that demonstrate meaningful use of certified software. For mental health, this means that participation in the MU program is limited to professionals who prescribe medications and who participate in either Medicaid or Medicare programs. Get more information from our Meaningful Use Resource Center.
OCR: The Office for Civil Rights is the government body that enforces HIPAA.
Omnibus: not actually an acronym, but enough of a buzzword right now to warrant a definition: HIPAA Omnibus is a sweeping (563 page) amendment to HIPAA that affects HIPAA Privacy, Security, Breach Notification and Enforcement Rules. The Omnibus Rule is effective March 26, 2013, and compliance is required with respect to most provisions no later than September 23, 2013; it requires businesses to revise their notices of privacy practices (NPPs) by the September 23, 2013 compliance date.
ONC-ATCB: Authorized Testing and Certification Body that provides MU certified status (PIMSY Platinum 5.0 is ONC-ACTB Meaningful Use Certified).
PHI: protected health information, any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history. PHI must be kept private under HIPAA.
PII: personally identifiable information must be protected under HIPAA. Get the details on what’s PII and what’s not.
PPACA: Patient Protection and Affordable Care Act, also called Obamacare or the Affordable Care Act, is a significant government expansion and overhaul of the US healthcare system aimed primarily at decreasing the number of uninsured Americans and reducing overall costs of health care.
PQRI: Physician Quality Reporting Initiative. The recently-passed Patient Protection and Affordable Care Act (PPACA) will require mandatory PQRS reporting in 2015 (and into the future) and also changes the name from PQRI to the Physician Quality Reporting System (PQRS)
PQRS: Physician Quality Reporting System, was established as part of the Tax Relief and Health Care Act of 2006 (TRHCA). It started as a voluntary reporting program that provides a financial incentive for certain health care professionals, including psychologists, who participate in Medicare to submit data on specified quality measures to the Centers for Medicare and Medicaid Services (CMS).
TRHCA: Tax Relief and Health Care Act of 2006 includes a package of tax extenders, provisions affecting health savings accounts and other provisions in the United States.