Saturday, November 5, 2011

Currently I am producing several instructional video programs for a
Public Television Station and organizations.
The  presentations will cover;
Program 1:
CH1: HIPAA Overview
  1.1. Brief History of HIPAA
    1.2. Prior to HIPAA the Privacy Act of 1974
    1.3. The Beginnings of HIPAA through the help of Senators
         Edward Kennedy (D-Mass) and Nancy Kassebaum (R-Kan)
  1.2. HIPAA Privacy & Security
    2.1.  Titles (I,II,III,IV,V)
    2.2.  Administration Simplification
    2.3.  Privacy & Security Rules
    2.4.  Electronic Health Records
    2.5.  Definitions/Acronyms
    2.6.  Compliance Timelines (Deadlines for Level I/II compliance)
    2.7.  Penalties (Civil/Criminal)
    2.8.  Transaction Standards and Code Sets (X12/ICD)
    2.9.  HHS HIPAA Audits
    2.10. ICD-10 Implementation Benchmarks
    2.11. Project Schedule for Implementation
    2.12. Impact Assessment
    2.13. Go-Live Plan Activities
CH2: HIPAA ANSI ASC X12N Standards Overview
  2.1. Overview
  2.2. Structure (004010X0.. and 005010X2.. and 005010X2..E1/A1)
    2.1. Segments ISA, GS, ST, SE, GE, IEA
    2.2. Control Numbers, Transaction numbers, EDI Loops
    2.3. Key EDI transactions
      3.1. 837D/I/P,820,834,835,270,271,276,277,278,278
  2.3. ASC X12 hierarchy
    3.1.  Subcommittees
    3.2.  X12A Education
    3.3.  X12C Communications & Controls
    3.4.  X12F Finance
    3.5.  X12G Government
    3.6.  X12I Transportation
    3.7.  X12J Technical Assessment
    3.8.  X12K Purchasing
    3.9.  X12M Supply Chain
    3.10. X12N Insurance
    3.11. X12X Steering Committee
  2.4. X12N Task Groups
    4.1. TG1 Property and Casualty
    4.2. TG2 Health Care
    4.3. TG3 Business & Information Modeling
    4.4. TG4 Implementation Guides
    4.5. TG5 Life & Annuity
    4.6. TG7 Reinsurance
    4.7. TG8 Architecture
    4.8. TG9 EDIFACT
    4.9. TG11 Education
  2.5. TG2 Work Groups
    5.1.  WG1 Health Care Eligibility 270, 271, ICHEBI, ICHEBR
    5.2.  WG2 Health Care Claims 837
    5.3.  WG3 Claim Payments 835, 269
    5.4.  WG4 Enrollments And Premium Payments 820, 834
    5.5.  WG5 Claims Status 276, 277
    5.6.  WG9 Patient Information 275
    5.7.  WG10 Health Care Services Review 278
    5.8.  WG15 Provider Information 274
    5.9.  WG12 Interactive Health Care Claims IHCLME
    5.10. WG20 Insurance Transaction Acknowledgment
    5.11. WG21 HIPAA Implementation/Coordination
CH3: ICD 9-10 GEM Overview
  3.1. ICD-9-CM Volumes 1 and 2
  3.2. ICD-9-CM, Volume 3
  3.3. ICD-10-CM Volumes 1 and 2
  3.4. ICD Background
  3.5. ICD Version history
  3.6. ICD 9-10 CM/CPT Syntax differences, variations, entomologies
  3.7. ICD-11 versions planned for 2015
    7.1. A succinct version for use in primary care
    7.2. A detailed version for use in specialty settings
    7.3. An advanced version for use in research
  3.8. Implementation Benchmarks
    8.1. Providers
    8.2. Health Plans
    8.3. Project Schedule for Implementation
    8.4. Impact Assessment on technology, people, processes
    8.5. 10/1/2013 Go-Live Plan Preparation Activities
CH4: Overview of the: Boothill - Death Registry Manager©™
CH5: Overview of the: ICD-GEM Manager©™
CH6: Overview of the: ICD-GEM SuperBill©™

Program 2:
1. TITLE IV of The American Recovery and Reinvestment Act (ARRA)
1.1. The $44k/$64k incentives available for EMR usage
1.2. Penalties by 2015
2. $18,000 1st year and the following year's incentive will be $12,000,
   then $8,000, $4,000, and $2,000
3. After 2014, Medicare payments will be reduced by 1 percent for those
   practices which haven't adopted an EHR system, then 2 percent in 2016
   and 3 percent in 2017 and thereafter, barring hardship or changes to
   the regulation.  There is no Medicare incentive for those who are
   meaningfully using an EHR after 2014
  3.1. Up to 2% CMS incentive of increased payments for using e-Prescriptions
  3.2. e-Orders for Labs, Diagnostic Centers and Pharmacies
  3.3. Patient Payments by Credit Cards, Online, Checks and Monthly
       Recurring Charges - Automatically
  3.4. Smart Card and Biometric Identification for HIPAA Compliance
       for Patients and Staff
  3.5. Personal Health Records (PHR)
  3.6. Registration KIOSK, Workstations, Network Architecture,
       Tablet PCs, PDA EMR Integration, Security, Servers, Backup and
       Disaster Recovery
  3.7. Final Rule Definition of "Meaningful Use"

In 1983, as a Data Architect and Designer, Technical Business Analyst and Application
Programmer for the BCBS Association in Chicago, I designed and developed (and
"coined") the first Inter-Plan Data Reporting file structure and programs for
Invoice Reimbursement, Reconciliation and Consolidation process of claims.  This
design structure is known as IPDR.  Thus creating the first common file format &
data content standardization that allowed the "Blues" and other health care
payers in all states to communicate more efficiently with each other in a timely
manner.  During that time, the Health Care industry wanted administrative
simplification in one format, one guide for all.  My work for the BCBSA helped start
it all.  During that time the ICD-9-CM was the code standard for the WHO's
International Statistical Classification of Diseases and Related Health Problems,
9th revision CM code set.
In 1997, after the development of the BootHill - The Death Registry Manager occured.
I kept tracked of a HealthCare Provider's patient expiration records.  There were
four classes of patients tha that died: In-patients, Out-patients, Still Born, and Emergency.
The important and inspiring field (column) was the Cause-Of-Death (COD).
Originally Doctors and/or Administrators would enter in the COD description not compatable
with the prefailing ICD-9 codes.  This impacted every HealthCare process.
So when I became aware of the ICD-9 codes in 1997 I decided to use this opportunity to self-train.
I then designed the object oriented program/module, the RDBMS schemas and sub-schemas,
algorythms, the SQL code for the ICD-9-CM codes standardizing the ICD-9-CM COD.
It was at that time I began design and development of the ICD 9-10 CM GEM Manager.
I searched the internet thru AOL dial-up until I found ICD-10 codes on the CDC.gov's ftp site.
In 1999/2000, development of the only ICD 9-10 CM GEM Manager
(International Statistical Classification of Diseases and Related Health Problems,
9th revision CM code set to the 10th revision CM code set General Equivalence Mapping)
took place. The system was designed to be used by Health Care entities to
research and map the ICD-9/10 codes.  Migration of the application from each
years version took place starting in 2000 thru to the 2011 version. This was
necessary because the ICD codes have been changing each year with additions,
deletions, definition and relationship changes.  There are ICD-GEM versions for platforms:
  • Client/Server
  • ASP.NET WebForms
  • ASP.NET WinForms
  • ASP.NET WPF (PB/Visual Studio Windows Presentation Foundation)
  • Classic ASP/AJAX (basic LookUp/Query)

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