The American Health Information Management Association (AHIMA) 2012 convention, coming up next week in Chicago, suddenly became a much more interesting place – from a reporter’s view at least – after last weekend’s New York Times piece alleging EHR technology could lead to rampant fraud through upcoding. It was followed by U.S. HHS secretary Kathleen Sebelius’s letter to health care providers the next day warning about a coming fraud and abuse crackdown.
While that letter probably had nothing to do with the article – in fact, HHS has been taking heat all year for using claims data as the start of fraud and abuse sleuthing – the timing seemed too eerie to be completely coincidental. EHR incentives weren’t part of this round of fraud stories, but the adoption of EHRs and how they can be used to generate claims fraud, were.
And oh by the way, all the AHIMA members’ planning for ICD-10 implementation happening Oct. 1, 2013? Hold the phone. It’s been delayed a year.
Health information managers are caught in the middle of all this. The billing and coding departments they oversee house the key to detecting errant clinical data – accidental or intentionally upcoded – and the constant drumbeat of “accurate coding from accurate data” we hear at the annual convention will never be more important than at this critical intersection of ICD-9 and ICD-10, and paper-to-electronic migrations of data workflows.
Well, maybe it’s always been this important. But with so many external forces ratcheting up the pressure on AHIMA’s members – CMS watching for fraud, CIOs implementing new systems, compliance officers managing HIPAA and meaningful use policies, commercial and public payers demanding more data to justify claims, and of course the transition to ICD-10 that coders feel is like taking on a new foreign language while working full time – there will at least be some interesting things to talk about with attendees as we wander the aisles of McCormick Place, our news antennae up.