OMG – Mental Health Compliance Key

Acronym Key for Behavioral Health Compliance

Trying to keep up with compliance for mental + behavioral health can be daunting, especially weeding through the barrage of commonly-used acronyms. Use our handy guide for definitions – and details to help you maintain compliance:

• ACO: Accountable Care Organizations are groups of doctors, hospitals, and other providers who collaborate to voluntarily give high quality and coordinated care to Medicare patients. Coordinated care strives to make sure patients get the right treatments at the correct time, while avoiding unnecessary duplicate services and protecting against medical error. Medicare offers several ACO programs.

• A/I/U: Adopt, Implement, Upgrade describes the first year of Medicaid Meaningful Use. A provider doesn’t have to actually use a certified EHR; they simply need to prove that 1) they have adopted, implemented or upgraded EMR, which can be as simple as presenting a receipt of purchase; and 2) at least 30% of their patient volume are Medicaid. This is calculated on a 90-day period from the previous year.

• APMs: Alternative Payment Models (sometimes called Advanced APMs, or AAPMs) is one path of MACRA, which goes into effect on January 1, 2017. The other path is MIPS; get details here.

• CHERT: Certified Electronic Health Record Technology is a technological application that has been certified according to CMS and ONC criteria for data stored in a structured format. Structured data allows patient information to be easily retrieved and transferred, and allows the provider to use the EHR in ways that can aid patient care. Providers participate in MU or MACRA through the use of CHERT.

• CHPL: the Certified Health Information Technology Product List provides a list of practice management software that has met the certification requirements of Meaningful Use (which vary by Edition).

• CMS: Centers for Medicare & Medicaid Services, part of HHS, administers and regulates the Medicaid and Medicare programs. They also set the standards for healthcare, including the reimbursement amounts for procedures and supplies, nationwide.

• CPT: Current Procedural Terminology codes describe the health care services provided and covers everything from surgery to standard diagnostic tests to mental health therapy sessions. See our CPT Resource Center for details about CPT code topics and how they relate to mental / behavioral health care.

• CQMs: Clinical Quality Measures are standards that help track and measure the quality of services provided within the healthcare systems. Both MU and PQRS utilize CQMs to evaluate data nationwide.

• DSM: The Diagnostic and Statistical Manual of Mental Disorders is the national standard of diagnosing mental and behavioral health. The DSM endorses many (but not all) ICD codes and provides guidelines to choosing ICD code(s) to diagnose according to current standards and up-to-date healthcare data. See how do DSM, ICD, and CPT interact for mental / behavioral health?

• EHR: Electronic Health Records are essentially an electronic version of patient / client charts. Just like paper charts, EHR is maintained over time and includes demographics, progress notes, diagnoses, medications, and anything else relevant to the client’s medical history and ongoing care. EHR provides more data than EMR.

• EMR: Electronic Medical Records contain standard medical and clinical data from one provider’s office. EHR (see above) spans more than one clinician’s office and provides more comprehensive data than EMR.

• EP: Eligible Professionals qualify to participate in the CMS MU program. See our Meaningful Use blog for details.

• HHS: US Department of Health & Human Services is a prominent governing body in US healthcare.

• HIE: Health Information Exchange allows health care professionals and clients to appropriately access and securely share medical information electronically across organizations within a region, community or hospital system. HIE may also describe the organization that facilities this exchange of information.

• HIMSS: Healthcare Information and Management Systems Society is a non-profit organization dedicated to providing leadership for the optimal use of HIT for the improvement of healthcare delivery. They host a well-attended annual conference that attracts healthcare providers from across the country.

• HIPAA: Health Insurance Portability and Accountability Act: *offers the ability to continue and transfer health insurance coverage for workers and their families when they change or lose jobs; *reduces health care fraud and abuse; *establishes nationwide standards for healthcare data; and *requires the confidential processing and protection of personal health information. See our HIPAA blog for more information.

• HIT: Health Information Technology supports the electronic management of healthcare data among consumers, clinicians, payers, and quality monitors. HIT includes EHR, EMR, PMS, HIE networks and the like.

• HITECH: Health Information Technology for Economic and Clinical Health is the federal law that created MU. It’s part of the American Recovery and Reinvestment Act of 2009 economic stimulus program.

• HPSA: Health Professional Shortage Areas may be categorized as having a shortage of primary medical care, dental, or mental health providers. They can be regions, population groups, or facilities.

• ICD: International Classification of Diseases is the globally recognized medical diagnostic tool established by the World Health Organization (WHO). The US completed adoption of ICD-10 in 2015.

• MACRA: Medicare Access and CHIP Reauthorization Act of 2015’s Quality Payment Program (QPP) replaces MU and incorporates PQRS for Medicare Part B providers. See how it affects mental health.

• MIPS: Merit-based Incentive Payment System is one path of the MACRA QPP.

• MU: Meaningful Use, part of the HITECH Act, is a CMS program that provides financial incentives to Medicaid and Medicare providers for adopting CHERT to improve patient care and streamline healthcare data. Get details about how MU affects mental health in our Meaningful Use Resource Center.

• NIST: National Institute of Standards and Technology is a measurement standards laboratory. Its goal is to hone industrial competitiveness and innovation.

• ONC: Office of the National Coordinator for Health Information Technology. ONC leads the adoption of health information technology (HIT) and the promotion of nationwide health information exchange (HIE) to improve health care.

• OCR: The Office for Civil Rights is the governing body that enforces HIPAA.

• PHI / PII: Protected Health Information – aka Personal Identifiable Information is personal data that is protected by HIPAA because it identifies a person receiving services: name, date of birth, etc.

• PMS: Practice Management Systems are software that aim to help manage the various aspects of a practice, such as invoicing, scheduling, running reports, staff management, document management, etc.

• PQRS: Physician Quality Reporting System started as voluntary reporting program for Medicare Part B clinicians. As of January 1st, 2017, it’s being incorporated into the MACRA Quality Payment Program.

• QP: Qualifying APM Participants: clinicians who qualify for the MACRA APM Quality Payment Program.

• QPP: Quality Payment Program: part of MACRA, the Quality Payment Program goes into effect on January 1, 2017 and replaces the “flawed” Sustainable Growth Rate formula. Providers can choose 2 tracks to follow: APMs or MIPS. See how MACRA and the QPP affect mental / behavioral health care providers.

For more information about compliance for mental + behavioral health care practices, including psychiatry and substance usage / abuse, see our Resource Centers. To see how PIMSY mental health EHR helps you maintain compliance, contact us: 877.334.8512, ext 1 – hello@pimsyemr.com