It's HIPAA, not HIPPA

Just for the record, it's HIPAA, not HIPPA. The actual legislation is called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), not the Health Information Patient Privacy Act (HIPPA). I can't tell you how many times I've seen the latter referred to. As a matter of fact, a colleague of mine once emailed a company after seeing HIPPA repeatedly displayed on their website. Once she educated them, they offered her a job!

Privacy and Security
It's true - when most of us think HIPAA, we think privacy of health information. And that's a huge part of it. We may even think, as coders, that we are only impacted by HIPAA when it comes to keeping the medical record information we read during the coding process confidential. But HIPAA is much bigger than keeping health information from falling into the wrong hands. The true intent of the law was the make sure people retained insurance coverage as they changed jobs. It includes several provisions for sharing data electronically and in order to enact this sharing of information, it was prudent that privacy and security provisions be built into the infrastructure of HIPAA.

As coders, we will likely be required to sign confidentiality agreements with employers. We will be subjected to criminal background checks and possibly credit checks. We will be forbidden from discussing that interesting ER case in the elevator. We won't be able to look up medical record information for friends and family. Well, I suppose you could, but make no mistake - there is very little to no tolerance for HIPAA violations. I've seen people dismissed immediately for violating patient confidentiality. I saw this most at a celebrity-frequented hospital where people tweeted or posted on Facebook when someone famous was admitted or they released specific protected health information (PHI). In this day and age, it's not uncommon for employers to have a social networking policy that addresses Facebook and Twitter.

And while privacy of PHI is a coder's concern, there are other provisions within HIPAA that impact us. I meet a lot of people who want to code so they can work from home. But setting up a home office as a coder means more than getting a computer and internet connection. Along with ensuring patient privacy comes security of PHI as well. The home workstation must be secure from breaches including hacking of computer systems and stolen computers. It's a natural concern when setting up a home office - who will have access to the work computer and if there are multiple people living in the household, what provisions are being taken to ensure that the workstation is secure? Some home coders may be subjected to a home evaluation by an employer to ensure the workspace is secure.

HIPAA-Defined Code Sets
Still not convinced that HIPAA impacts you greatly as a coder? How about the codes you use? Those are also intertwined into HIPAA legislation. Electronic exchange of information between two different parties requires specific transactions. For example, the submission of an insurance claim by a provider to a payer is one such HIPAA transaction. There is another for communication from the payer back to the provider about what was paid on each account. These HIPAA transactions require a common language between the parties. And that language is often codes. As such, HIPAA defines which code sets are approved for reporting diagnoses and procedures in order to ensure uniformity.

There are six code sets approved for various uses and time periods as defined by HIPAA:

• HCPCS (Healthcare Common Procedural Coding System, Level II)for ancillary services and procedures
• CPT-4 (Current Procedural Terminology) for hospital outpatient and physician services
• CDT (Current Dental Terminology) for dental services
• NDC (National Drug Codes) for over-the-counter and prescription medications
• ICD-9 (International Classification of Diseases, 9th Revision) for diagnoses and hospital inpatient procedures - currently used
• ICD-10 (International Classification of Diseases, 10th Revision) for diagnoses and hospital inpatient procedures - effective October 1, 2013

The HIPAA Version 5010 Standard
Most coders and coding students are aware of the massive effort currently under way to migrate from ICD-9 to ICD-10 in 2013. Many are not aware, though, of the updates to the HIPAA transactions that must occur in order to make ICD-10 data electronically exchangeable. We currently operate under the HIPAA version 4010 and as of January 1, 2012, we will use HIPAA version 5010. This upgrade includes many other updates besides those to get us ready for ICD-10. The impact of 5010 implementation is currently being felt by payers and providers as they gear up for testing these new transactions beginning in July. As of January 1 of next year, CMS will not accept any electronic data in the old format. And that means failure to comply will hold up claims submission and payment.

The 5010 upgrade is probably invisible to most coders in an organization. It's very much an information technology (IT) initiative and involves inventorying systems and working with vendors and payers to ensure everyone has updated to the 5010 standard. In addition to updating the number of bytes available to report ICD codes and allowing for alpha-numeric entry (instead of mostly numeric with ICD-9), it also includes updates to allow for reporting the present on admission indicator, eliminates the release of superfluous PHI for insurance certification and verification, and eliminates numerous other inefficiencies in reporting data electronically.

So keep an eye out for the acronym HIPAA - it will come into play a lot in your career as a coder. As for HIPPA, I still can't figure out what that is. There is no Health Information Patient Privacy Act, so as best as I can tell, a hippa is a baby hippo!

Back Away from the Keyboard...

This morning my alarm clock went off at 7:00am, just as it does on most work days. Like most anal-retentive coders, I have my morning routine, which includes the usual suspects like brushing teeth and shuffling into the kitchen for that all important initial cup of coffee. Once my breath is fresh and my eyelids are open, I flip on the computer and wallah! I'm at work for the day. My work day routine begins by scanning my work, Coder Coach, and client email accounts. Sometimes I venture onto the Coder Coach page on Facebook to see if anyone has posted anything. Maybe I send or receive an IM to or from a client or coworker. Maybe I actually pick up the phone and call someone (not terribly likely). But rarely, in my daily dealings as a remote coding consultant, does my work involve face-to-face communication with people. And frankly, I miss it.

Let me be clear. I love communicating through email. I have relationships with friends in other states solely based on email. I have trouble communicating with people who hate email. I have access to six email accounts, Facebook, Twitter, LinkedIn, and Yahoo IM on my iPhone. In other words, I am always virtually connected to just about any of my contacts at any given time. But there is no substitute for in person communication. And that's part of the reason why my Coder Coach events are not offered in an audio conference format.

I've been asked by several people from out of state to offer my Coder Coach events as webinars. Besides the fact that I have oodles of experience as a webinar presenter - for several years I presented 2-3 webinars per month - and I understand all too painfully well everything that could possibly go wrong with the technology aspect of the presentation (I know Murphy well!), I have no desire to feed into the increasing trend of discouraging face-to-face communication. And speaking of feeding, public speaking is one of my favorite things - it energizes me and feeds my desire to keep going with my career. Webinars just aren't the same. Frankly, my pets don't seem as enthused about learning coding as my human audiences (normally) do!

And it's not just the novices who want to network from afar. This new year means a lot of committee and board work for me. And even though my board meetings are offered in a conference call format, I try to attend the meetings in person. Two of the committees I work with have decided not to offer conference calls for their meetings because the chair persons are growing concerned about the lack of face-to-face networking among professionals. There are more opportunities to get educated remotely and that means that those face-to-face networking opportunities are more important than ever. Because if you're trying to break into the industry, look for a new job, or just (as my father used to say), "blow the stink off," you need to get away from your gadgets, get out of the house, and start talking to people.

So I encourage all of you to back away from the keyboard every now and then... that is, after you've researched online for the best local networking event. And get out and meet someone in person!

For local events near you, visit AHIMA's state component association web page at http://www.ahima.org/about/csa.aspx or the AAPC's local chapter finder web page at: http://www.aapc.com/localchapters/find-local-chapter.aspx.

Happy networking!

More From the Coder Coach

Need a Coder Coach fix between blog postings? I frequently post links to articles on Facebook and Twitter. On Facebook, search for the group "The Coder Coach" and on Twitter, look for @codercoach.

Even My Dad's on Facebook - Are You?

Like most people these days, I'm on Facebook. Actually, I maintain a couple of Facebook accounts: one personal and one professional. It's been fun to connect with people from my past and see what they're all up to. And I have to admit, when my brain gets a little fried, it's a quick and simple distraction to see if anyone has posted anything interesting or entertaining. For over a year now, I've tried to convince my parents that they need to get on Facebook so they can reconnect with people from their past. Even so, I was shocked the day I received a friend request from my father.

I'm not one of those people who is afraid to "friend" my parents. They're actually pretty cool and I get along well with them. Plus, I subscribe to the idea that if I'm uncomfortable having my father read it, I shouldn't be posting it on Facebook to begin with. But my dad has only recently become semi-tech savvy. I received my first email from him about a year ago. So getting a Facebook request from him was major. Mom's request came in soon after his and was a little less shocking because she's into gadgets and is one of the few people I actually text.

My point (and I do have one) is this: so many people tell me they don't do Facebook because it's too much work. These people are often people who are looking for jobs. And all I can think of is, if Facebook is too much work and you want to be a coder (and potentially code from home), you are looking into the wrong business.

Let me demonstrate. I have 7 email accounts in varying states of maintenance. One personal, one for my company, one for The Coder Coach, two for clients, and the rest are accounts that were set up for miscellaneous purposes and very few people have those email addresses. I have 2 Facebook accounts, a LinkedIn account, and a Twitter account - although I only tweet professional tidbits because I personally find it a bit ridiculous to let people know what I'm up to at every moment of the day. I also have an instant messenger (IM) account, which one of my clients uses for quick questions.

And that's just "social" media. I am able to VPN into 2 of my clients in order to access their systems, which consist of a logon to the VPN, a logon to their server, a logon to the electronic medical record (EMR), a logon to their coding system, and an encoder. I also have various online memberships (e.g., AHIMA, AAPC) that require passwords to access member-only information. And frequent flier and hotel point programs. I currently maintain over 100 passwords.

In order to maintain all these accounts and passwords, I have my main work laptop, laptops from some of my clients, and an iPhone. I also have a personal laptop, which gets turned on about once every 3 or 4 months because I can't stand to be on the computer when I'm not working. I run dual monitors on my desk so I can look at applications side by side. I have 2 phone numbers, a fax number, and 2 different ways to connect to the internet. In other words, I'm well connected - at least when all the computers are working properly.

I admit - this is extreme. For the typical coder working from home, though, there will be at least a computer and 1 or 2 huge monitors for reading EMR documentation (remember, paperless means no paper - everything is online) and the login credentials to get into a VPN, remote server, and whatever systems you'll be using. When something goes wrong or doesn't work properly, you are the first line of IT defense. You can't just get an IT guy over to your house right away.

So if you want to be a coder and work from home and you aren't on Facebook because it's "too complicated," think about either changing your reason for not being connected, get connected, or find a new career that doesn't involve computers. And try to filter what you tell a potential employer about your issues with technology. As medical records move to an electronic format, you will need to be more tech savvy. After all, if my dad can do it, so can you!

Coming Soon: Back in Full Force!

Wow, I've been gone a long time! Now that we are through the holidays and I am over my annual post holiday illness, stay tuned... I will be posting weekly posts beginning next week. I haven't forgotten about you!

Also, if you are in the Denver area, I am now on a schedule with our monthly events. I will be hosting events the fourth Tuesday of each month beginning January 26. Next Tuesday's topic is the second in a reimbursement series. This month's topic is hospital diagnosis-related groups (DRGs). Here are future topics:

• Tuesday, February 23 - Hospital Ambulatory Payment Classifications (APCs)
• Tuesday, March 23 - Introduction to Physician Reimbursement
• Tuesday, April 27 - Discussion Panel: Resumes and Interviewing

For information about locations and to get email notices, sign in to your Facebook account and join The Coder Coach group. It's free and this is the best and easiest way for me to get information about events out to the masses.

Tribute to a Mentor

I’ve been meaning to start a blog for novice coders and wanna-be coders for quite some time, but that initial blog topic has been elusive – at least until this week when I received the sad news that Deane Poore, RHIT, one of my coding mentors, recently passed away. And as I congregated with former coworkers to pay respects to our esteemed colleague, I found myself reminiscing about my career beginnings and all the people who had a hand in my development as a coding professional. There was my mother, Nancy Stanton, RHIT, who encouraged me to get an associate’s degree in health information management (HIM); there was Lila Mayer, RHIA, who gave me a chance as an outpatient coder after graduation even though I had no experience except for the limited coding I did under her supervision as an intern; Layne Poseley, RHIA, who checked all of my work for the first year of my employment and answered countless “why’s” and “how’s”; and there was Deane, a former teacher turned coder, whom Lila brought out of retirement to teach me inpatient coding. And those are just a few of the people who got me on the right track within my first few years in the industry. From there, I have been unknowingly passed from one mentor to another, never truly realizing that the time they spent with me was one of the greatest gifts I could ever receive.

Now, after working in the HIM and coding field for almost 15 years, I have come to appreciate the fact that the way I was trained in my first coding position is not the norm. Most hospitals do not have the time or resources to take a novice and groom him or her into a quality coder. Since I started coding in 1995, the world of hospital coding has seen a complete facelift with the introduction of a new and overhaul of an existing code-based reimbursement methodology, increased coding regulation, and more focus on coding compliance. There is also the added challenge of learning to use electronic medical records (EMRs) and ensure that HIPAA guidelines are being followed. Changes to the coding industry are happening at such a rapid rate these days that employers are finding it more and more difficult to train and mentor new coders.

Nationwide Coder Shortage

The problem is the industry needs more coders. There is a nationwide coding shortage and industry experts expect this demand to increase as the nation marches toward the October 1, 2013 deadline to implement ICD-10-CM/ICD-10-PCS. To existing coders, implementation of the new system is the equivalent of telling everyone in America that starting in 2013, we will no longer speak English and that Chinese will be the new language. Many current coders are threatening to retire or change careers rather than learn the new system. That means it is the prime time for new coders to enter the field and for once, the playing field will be level – new and experienced coders alike will need to learn the new coding system.

So now is a great time to become a coder, but what do you need to know? Which healthcare setting is the right one for you (doctor’s office, hospital, rehabilitation, etc.)? Which certifications are most widely recognized? Do you have to join an association to get a job? How much money will you make? Can you work from home? These are all questions I hear from wanna-be coders on a regular basis and I would like to help answer some of them and maybe point you in the right direction.

If you have specific questions about becoming a coder, let me know and be sure to check out my Coder Coach Facebook page for updates about upcoming networking and mentoring sessions: http://www.facebook.com/groups.php?ref=sb.