Keeping Up on Health Information Technology

   By Kathy Lindstrom RHIT

Don’t understand the meaning of “meaningful use” or even where to begin to research it? Wondering what the standards are for Certification of Health IT? Then check out the Health Information Technology website: http://healthit.hhs.gov a website maintained by the Office of the National Coordinator for Health Information Technology (ONC) and the Agency for Healthcare Research and Quality (AHRQ).

The Office of the National Coordinator for Health Information Technology was created as part of the American Recovery and Reinvestment Act (ARRA) of 2009, and Dr. David Blumenthal was selected as the first Coordinator by President Obama’s administration. The ONC, part of the U.S. Department of Health and Human Services, is responsible for coordinating the nation’s efforts to implement and use health information technology and the electronic exchange of health information. AHRQ, also part of the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services (http://www.ahrq.gov/).

The intent of the healthit.hhs.gov website is to centralize to one website location and make transparent all the information and efforts regarding Health Information Technology. It’s intended to be a resource for consumers, providers and organizations (including other federal agencies).

Once on the website, you will see a “spotlight” box on the right hand side, which gives users easy built in bookmarks to top topics on the website, which include HITECH programs, Privacy and Security, Standards and Certification, and Meaningful Use. Additional pages provide information on the Health Information Technology Standards Panel and Historical Information.

Clicking on the Meaningful Use link brings you to pages of up to date documents, including National Proposed Rulemaking (NPRM) documents, CMS fact sheets, frequently asked questions and press releases. A quick review of the website shows that the 60 day comment period deadline provided by CMS was released on March 15, and that ONC has issued an Interim Final Rule (IFR), which can be accessed as an html or a pdf document. If you want to know more about where the origins of Meaninful Use came from, links are provided below to the HIT Policy Committee and the HIT Standards Committee, both of which provided recommendations for the initial criteria of Meaningful Use.

Also as part of the ARRA, CMS was authorized to provide incentives for professionals and hospitals to become “meaningful users” of health information technology. To qualify for incentive payments under the Medicare and Medicaid EHR Incentive Program eligible users are required by statute to use Certified EHR Technology. This means EHR and EHR modules must meet certain standards in order to be certified. Those standards are currently being drafted and will be issued in two waves, first as temporary certification, and later as a permanent certification program takes it place. Comments on the temporary program are accepted through 4/9/10. Comments on the permanent program will be accepted through 5/10/10. Additional information can also be found on this page, such as the slides the ONC used for their March town hall session and webinar, frequently asked questions and facts at a glance.

Dr. David Blumenthal and other members of the ONC team blog about the latest health IT ‘Buzz’. You can even follow the Buzz on your twitter account: http://healthit.hhs.gov/blog/onc/ A link is also provided to the Federal Advisory Committee blog, where summaries of the HIT Standards Committee and HIT Policy Committee can be found. http://healthit.hhs.gov/blog/faca/ Additional information, including workgroups and membership, for the Health IT Policy Committee can be found here and here for the HIT Standards Committee.

Diabetes Self-Management Training

Medicare covers diabetes outpatient self-management training when furnished by a certified provider who meets certain quality standards. A diabetes outpatient self-management training program includes education about self-monitoring of blood glucose, diet/ exercise, an insulin treatment plan developed specifically for the patient who is insulin-dependent, and motivation for patients to use the skills for self-management.

Beneficiaries Eligible for Coverage and Definition of Diabetes

Medicare Part B covers (not to exceed) 10 hours of initial training for a beneficiary who has been diagnosed with diabetes. Diabetes is defined as diabetes mellitus, a condition of abnormal glucose metabolism diagnosed using the following criteria:

• a fasting blood sugar greater than or equal to 126 mg/dL on two different occasions; or
• a two-hour post-glucose challenge greater than or equal to 200 mg/dL on two different occasions.

Diabetes self-management training may be covered by Medicare if the physician or qualified non-physician practitioner who is managing the beneficiary’s diabetes certifies that such services are needed. The order must also include a statement signed by the physician that the service is needed as well as the following:

• the number of initial or follow-up hours ordered (the physician can order less than 10 hours of training);
• the topics to be covered in training (initial training hours can be used for the full initial training program or specific areas such as nutrition or insulin training); and
• a determination that the beneficiary should receive individual or group training.

It is important to note that the provider of the service must maintain documentation in a file that includes the original order from the physician and any special conditions noted by the physician.

Frequency of Training-Initial Training

The initial year for DSMT is the 12 month period following the initial diagnosis. Medicare will cover initial training that meets the following conditions:

• is furnished to a beneficiary who has not previously received initial or follow-up training under HCPCS codes G0108 or G0109;
• is furnished within a continuous 12-month period;
• does not exceed a total of 10 hours (the 10 hours of training can be done in any combination of 1/2 hour increments);
• with the exception of 1 hour of individual training, training is usually furnished in a group setting, which can contain other patients besides Medicare beneficiaries; and
• one hour of individual training may be used for any part of the training including insulin training.

Follow-Up Training

Medicare covers follow-up training under the following conditions:

• no more than 2 hours individual or group training per beneficiary per year;
• group training consists of 2 to 20 individuals who need not all be Medicare beneficiaries;
• follow-up training for subsequent years is based on a 12 month calendar after completion of the full 10 hours of initial training;
• follow-up training is furnished in increments of no less than one-half hour; and
• the physician (or qualified non-physician practitioner) treating the beneficiary must document in the beneficiary's medical record that the beneficiary is a diabetic.

Coverage Requirements for Individual Training

Medicare covers training on an individual basis for a Medicare beneficiary under any of the following conditions:

• no group session is available within 2 months of the date the training is ordered;
• the beneficiary’s physician (or qualified non-physician practitioner) documents in the beneficiary’s medical record that the beneficiary has special needs resulting from conditions, such as severe vision, hearing or language limitations or other such special conditions as identified by the treating physician or non-physician practitioner, that will hinder effective participation in a group training session; or
• the physician orders additional insulin training.

The need for individual training must be identified by the physician or non-physician practitioner in the referral.

CPT codes for DSMT

Suppliers/providers who bill other Medicare services or items and who represent a DSMT program that is accredited as meeting quality standards can bill and receive payment for the DSMT program under the following HCPCS codes:

• G0108 Diabetes outpatient self-management training service, individual, per 30 minutes.
• G0109 Diabetes outpatient self-management training services, group session, (two or more), per 30 minutes.

2010 Medicare Payment Rates for DMST:

• G0108: per 30 minutes $23.45
• G0109: per 30 minutes $12.99

AMA Coding Guidance: