Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10). Final rule

This final rule will extend enhanced funding for Medicaid eligibility systems as part of a state's mechanized claims processing system, and will update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes will allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems.

Exemption of certain systems of records under the Privacy Act. Final rule

This final rule exempts four systems of records (SORs) from subsections (c)(3), (d)(1) through (d)(4), (e)(4)(G) and (H), and (f) of the Privacy Act pursuant to 5 U.S.C. 552a(k)(2): The Automated Survey Processing Environment (ASPEN) Complaint/ Incidents Tracking System (ACTS), HHS/CMS, System No. 09-70-0565; the Health Insurance Portability and Accountability Act (HIPAA) Information Tracking System (HITS), HHS/CMS, System No. 09-70-0544; the Organ Procurement Organizations System (OPOS), HHS/CMS, System No. 09-70- 0575; and the Fraud Investigation Database (FID), HHS/CMS, System No. 09-70-0527.

[Extraction of management information from the national quality assurance program]

BACKGROUND

Starting with clinically motivated projects, the national quality assurance program has established a legislative obligatory framework. Annual feedback of results is an important means of quality control.

MATERIAL AND METHODS

The annual reports cover quality-related information with high granularity. A synopsis for corporate management is missing, however. Therefore, the results of the University Clinics in Greifswald, Germany, have been analyzed and aggregated to support hospital management.

RESULTS

Strengths were identified by the ranking of results within the state for each quality indicator, weaknesses by the comparison with national reference values. The assessment was aggregated per clinical discipline and per category (indication, process, and outcome).

CONCLUSION

A composition of quality indicators was claimed multiple times. A coherent concept is still missing. The method presented establishes a plausible summary of strengths and weaknesses of a hospital from the point of view of the national quality assurance program. Nevertheless, further adaptation of the program is needed to better assist corporate management.

Patients' safety, privacy and effectiveness--a conflict of interests in health care information systems?

Information technology (IT) is finding its way into daily clinical work. IT is primarily seen as a tool for providing quality of service, cutting costs and promoting efficiency in every aspect of health care, but improvements for patients' safety are also a driving force. IT-solutions can be found both at an administrative and a clinical level, supporting everything from documentation, distribution and storing of patient data to workflows, monitoring and decision making. However, the increasing use of IT in health care raises questions. What is the impact on patients' rights and privacy? Does the law benefit IT-solutions in health care, or does it raise barriers for optimized use? Which interests does the law safeguard in the health care sector, and in the light of an increasing use of IT, do any of these identified interests collide? In conjunction with a governmental national project (InfoVU) during 2001-2004, the Swedish National Board of Health and Welfare (NBHW) had to address these issues and other legal aspects of IT use in health care. The agency's analysis was published in November 2005. The purpose of this article is to present some of the agency's conclusions on legal issues pertaining to the management and processing of patient data. It will show, from a Swedish legislative point of view, the need for a common information security strategy for health care information management as well as discussing other legislative issues in order to meet both the patients' and the health care provider's interests in an electronic environment.

[Twenty years' experience with the information system "biopsy" used in the work of a department of morbid anatomy]

The long-term use of the information system "Biopsy" has shown its efficiency in improving the organization of the department of morbid anatomy in a large hospital. Its advantages are the availability of materials and necessary information for the shortest period. The introduction of an electronic signature and the storage of signed documents are new real steps to the creation of paper-free technology, including the so-called electronic case history base. Automated exchange of orders for tests and their results not only reduces the time of their obtaining, but also lowers costs and enhances the efficiency of work pf a biopsy laboratory.

Anesthesia information management systems

Documentation is the last component of anesthesia patient management to be affected by technology. Anesthesia information management systems (AIMS) have been introduced in a limited number of practice sites. The automated systems provide unbiased reporting of most patient information. This results in improved patient care and possible medical legal advantages. AIMS also allow anesthesia departments to monitor their business related activity.

HIPAA strengthens business case for electronic report distribution systems

HIPAA may finally force healthcare organizations to make long-postponed decisions to increase the use of automation and technology for report distribution. For most, the direct benefits will far outweigh the costs.

Countdown to HIPAA compliance

As compliance deadlines for the Health Insurance Portability and Accountability Act close in, the author details specific actions that must be taken to ensure that covered entities are indeed compliant with all of the Act's provisions.

Addressing HIPAA across the continuum

HIPAA is an issue in hospitals across the nation, but what about other kinds of facilities--such as long-term care, behavioral health, or home care organizations? They, too, need to address HIPAA. We asked three HIM professionals who work in these settings to briefly address how HIPAA is changing the way they work.

HIPAA--a real world perspective

An effective and realistic approach to HIPAA compliance requires healthcare organizations to achieve a fundamental shift in attitude, awareness, habits and capabilities in the areas of privacy and security. They must create a sense of accountability among staff, and even patients, for the safeguarding of patient information. Only when this culture shift has occurred, along with the required technological advancements, can HIPAA compliance be realistically achieved. There is still ample time to create the organizational shift necessary, along with technological enhancements, to meet HIPAA requirements. Beyond compliance, HIPAA will benefit the healthcare industry by promoting administrative simplification--the original intention of the Act. And it will require the healthcare industry, in an abbreviated timeframe, to upgrade its level of sophistication in managing information. HIPAA certification springs from an organizational compliance method that has been underway in government for the past two decades. The HIPAA playbook is taken lock, stock and barrel from other Federal guidelines. HIPAA's legislative lineage includes the Healthcare Reform Act of 1993, Paperwork Reduction Act of 1980, Computer Security Act of 1987 and the Privacy Act of 1974. HIPAA means that public and private sector healthcare organizations are going to be required by law to adopt the same information-handling practices that have been in effect in the Federal government for years. That boils down to two things: Standardized formatting of data electronically exchanged between providers, payers and business partners (EDI) Federalization of security and privacy practices within private-sector healthcare information management The key to making HIPAA compliance achievable within a practical timeframe, as well as instituting the culture changes that go with enhanced privacy and security standards, is a process that is largely unfamiliar in the private sector, called administrative certification and accreditation. Certification is an organizational change-management methodology that drives accountability for security down to that level in the organization where it will concretely and tangibly get done. It is a comprehensive managerial assessment of the technical and non-technical security features and other safeguards of a system associated with its use and environment. The assessment seeks to establish and document the extent to which a particular system meets a set of specified security requirements. HIPAA accreditation occurs when all functional managers in an organization have completed reports of what they know they need to do in their areas. They submit that information to an executive official within the organization who functions as the accrediting official for the organization. Accreditation is the formal declaration that an information system is approved to operate in a particular security mode using a prescribed set of safeguards and should be strongly based on the solvable vulnerabilities and residual risks identified during certification. Institutionalizing a practical and formal HIPAA certification program is important to support business activities and can provide several benefits including increased communication within an organization.

Overview of executive order 13148: requirements for environmental management systems at federal facilities

In April 2000, the White House issued Executive Order 13148, Greening the Government Through Leadership in Environmental Management. This Order applies to all appropriate federal facilities that have operations which interact with the environment and includes a number of environmentally-related requirements. The most significant requirement is that all appropriate federal facilities must implement an Environmental Management System (EMS) by December 31, 2005. This Order affects federal laboratories, testing facilities, maintenance facilities, hospitals, and so forth across all federal departments and agencies.

Digital archives and communication highways in health care require a second look at the legal framework of the seventies

The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.

Medicaid program: computer matching and privacy protection for Medicaid eligibility--HCFA. Final rule

This final rule revises regulations concerning the income and eligibility verification system (IEVS) under the Medicaid program. It implements provisions of the Computer Matching and Privacy Protection Act of 1988 and the Computer Matching and Privacy Protection Amendments of 1990. These laws improve the oversight and procedures governing the disclosure of personal information used in computer matching programs and protect the privacy and due process rights of individuals whose records are exchanged by these programs.

Medicaid program; Medicaid Management Information System (MMIS) performance review; notification procedures for changes in requirements, performance standards, and reapproval conditions--HCFA. Final rule

This rule eliminates the requirement in the Medicaid regulations that HCFA meet certain Federal Register notification requirements for any changes in performance standards and other conditions for reapproval of State Medicaid Management Information Systems (MMISs), even if such Federal Register notice would not otherwise be required. An independent Federal Register publication requirement will remain in place with respect to changes in system requirements and other conditions for approval of MMISs. We believe that a revised process for notifying States and other concerned parties of changes in performance standards and other conditions of reapproval is appropriate and will facilitate the efficient issuance of revised MMIS review requirements and methodologies each year.

Beyond Adam Smith and Marcus Welby: how CPARS works. Part 2

Part 2 of this article details the workings of the Claims Pooling, Analysis and Reporting System (CPARS) piloted by the Lehigh Valley Coalition for "prudent purchasers" across Pennsylvania. Hardware, software, data storage and sample size are among the issues covered by the Coalition's President, who believes CPARS is an easy, cheap way for employers to get the reality-based data analysis they need to support a prudent purchaser strategy for containing health care costs.

Medicaid program; Medicaid Management Information System requirements for physician and supplier services--HCFA. Final notice

In this notice, we are informing Medicaid state agencies of two new system requirements for Medicaid Management Information Systems. These systems will be required to accept and use exclusively: (a) A common claim form for physicians, durable medical equipment suppliers, laboratories, chiropractors, and podiatrists (the current version of the Health Insurance Claim Form, HCFA-1500); and (b) A uniform procedure coding system (HCFA Common Procedure Coding System). The purpose of these requirements is to improve the efficiency and effectiveness of the Medicaid program and to reduce the paperwork burden by implementing a single claim form for providers to bill multiple third party payers.

Medicaid program; Medicaid Management Information Systems; conditions of approval and reapproval and procedures for reduction of Federal financial participation--HCFA. Final rule

This final rule provides the additional requirements to the conditions and procedures for initial approval and reapproval of Medicaid Management Information Systems (MMIS) that were added by section 1903(r) of the Social Security Act (as amended by section 901 of the Mental Health Systems Act of 1980, Pub. L. 96-398). These provisions are intended to improve States' MMIS, ensure efficient system operations, and make the procedures for detection of fraud, waste, and abuse more effective. In addition, this final rule specifies the procedures we follow in reducing the level of Federal financial participation in State administrative expenditures if a State fails to meet the conditions for initial operation, initial approval, or reapproval of an MMIS.

Privacy Act of 1974; report of new system--HCFA. Notice of new system of records

In accordance with the requirements of the Privacy Act of 1974, we are proposing to establish a new system of records, "Payments for Interns and Residents," HHS/HCFA/BPO No. 09-70-0524. We have provided background information about the proposed system in the "Supplementary Information" section below. HCFA invites public comments by March 18, 1985, with respect to routine uses of the system.

Medicaid program; Medicaid Management Information System; system requirements--HCFA. Final rule

In this notice, we are informing State Medicaid agencies of three new system requirements for Medicaid Management Information Systems. These systems will be required to accept: (a) and use exclusively a uniform diagnostic coding system (the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM)), wherever diagnostic coding is used; (b) And use exclusively a common claim form for inpatient and outpatient hospital billing (HCFA-1450); and (c) A uniform electronic billing format for institutional billing. The purpose of these requirements is to improve the efficiency and effectiveness of the Medicaid program; the second and third requirements will reduce the paperwork burden by implementing a single claim form and a single electronic billing format for providers to bill multiple third party payers.

Privacy Act of 1974; exempt record system--DHHS. Notice of proposed rulemaking

The Assistant Secretary for Personnel Administration, through the Office of Personnel systems Integrity of the Department of Health and Human Services, by separate Federal Register notice is proposing alteration in the system of records entitled. "Management Information System Efficiency Report (MISER), HHS/OS/ASPER/OPSI", 09-90-0095. The Department intends to exempt portions of this system from certain provisions of the Privacy Act, 5 U.S.C. 552a. The proposed exemption is authorized by subsection (k)(2) of the Privacy ect, which applies to investigative materials compiled for law enforcement purposes. The Offices of Personnel Systems Integrity (OPSI) is authorised to gather information for personnel, legal and regulatory enforcement purposes under Title 5 U.S.C., Chapter 12. In order to maintain the integrity of the OPSI process of merit system and prohibited personnel practice complaints investigations, and to ensure that the Office of Personnel Systems Integrity will be able to obtain access to complete and accurate information, the Department proposes to exempt from the notification, access, correction, and amendment provisions of the Privacy Act those portions of Management Information System Efficiency Report (MISER) which contain personal information that would identify either a confidential source or an individual other than the complainant or subject of an investigation.

Medicare and Medicaid programs; OMB control numbers for collections of information contained in HCFA regulations--HCFA. Final rules

In accordance with regulations published by the Office of Management and Budget (OMB) on March 31, 1983, implementing the provisions of the Paperwork Reduction Act of 1980, HCFA is displaying in 42 CFR Chapter IV, currently valid OMB control numbers for approved "collections of information" contained in HCFA regulations. As OMB notifies us of additional control numbers, we will add those numbers to the HCFA display in the Code.

Privacy Act of 1974; report of new system--HCFA. Notice of new system of records

In accordance with the requirements of the Privacy Act of 1974 we are proposing to establish a new system of records. National Long-term Care Survey Follow-up, HHS/HCFA/ORD, No. 09-70-0030. This system will provide a nationally valid data base on dependency among elderly persons, the services they use, and their resources for providing for their long-term care in their communities and in institutions. The data will be used for developing long-term care policies for those who will require such care.

Medicaid program; Medicaid Management Information System proposed system requirements--HCFA. Proposed notice

In this notice, we are proposing five new system requirements for Medicaid Management Information Systems. We propose that the systems be required to accept and use exclusively: (a) A uniform diagnostic coding system (the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)), wherever diagnostic coding is used; (b) A common claim form for hospital billing (HCFA-1450); (c) A uniform electronic billing format for institutional billing; (d) A common claim form for noninstitutional providers (the revised version of the Health Insurance Claim Form, HCFA-1500); and (e) A uniform procedure coding system (HCFA Common Procedure Coding System (HCPCS)). These requirements would improve the efficiency and effectiveness of the Medicaid program.

Medicaid program; Medicaid Management Information Systems; conditions of approval and reapproval and procedures for reduction of federal financial participation--Health Care Financing Administration. Proposed rule

This proposal adds to regulations new conditions and procedures for initial approval and for reapproval of Medicaid Management Information Systems (MMIS) to update the regulations to reflect additional requirements added by section 901 of the Mental Health Systems Act of 1980 (Pub. L. 96-398). The proposal specifies procedures for reducing the level of Federal financial participation in a State's administrative expenditures when a State fails to meet the conditions for initial operation, initial approval or reapproval of an MMIS. It also proposes procedures with respect to waivers of the conditions of approval and reapproval and to appeals of adverse decisions. These provisions are intended to improve States' MMIS, and to ensure efficient system operations, and to detect cases of fraud, waste, and abuse effectively.