Wiki Hospital will not update 2011 codes in computer!

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lsmft

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Help, our hospital is not updating our computer system to recognize the 2011 fiscal year code updates! It is not important to them. Obviously we cannot accurately code and we cannot hand load the new codes...the system will not allow it.

We have no HIS manager. How can the coding office convince the hospital management that this IS vital. We are very frustrated.
 
I know there is a transmittal from Medicare regarding the usage of the new codes that specifies the codes are to implemented on OCtober 1 with no grace period. You can go to the CMS website for this. I have never encountered this situation before, and I am stunned at the response from your administration. You need to keep trying, maybe the CEO or the Medical Director?
 
Yes it is hard to believe and it would seem a no brainer to update these codes. We also do not have the 2011 coding books either. The IS administrator just doesn't see the need for this. We have no HIS manager and no CEO, just an interim company running us.

I believe the claims will have to be denied and once they are maybe that will make them sit up and take notice.
 
Cms

Thank you, I have the list of codes and changes from the CMS site. There is nothing more we can do, very sad.
 
You do know in the guidelines it states that adherance to the guidelines is mandated under HIPAA and the code sets themselves are mandated under HIPAA. It just is unbelieveable that a management company would think along these lines. Afterall the diagnosis is the patient's.
 
Although you are with interim management and without HIMS leadership, your facility should still have a compliance officer. Along with a compliance program, I'd imagine there'd be hotline to support the reporting of potential compliance violations.

Since HIPAA does mandate code sets be kept current as part of the Uniform Data Set, this is a compliance issue. If you have a hotline or a compliance officer at hand, present the issue in a professional manner to this individual, who should carry enough weight and influence in the organization to effect change. The other option is to anonymously report this to compliance, in helping your hospital get with the program.

Other than that, and as already mentioned, just wait for payments, denials and host of other back-end work pile up and see if that gets leaderships' attentions. It's so unfortunate to see your management company ignoring the needs of your facility, especially at a time when most hospitals need to recoup as much money as possible to stay competitive.
 
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