CMSA Today - Issue 7, 2015 - (Page 6)

President's Letter The Essentiality of Standardized Coding Systems BY KATHLEEN FRASER, RN-BC, MSN, MHA, CCM, CRRN T his issue of CMSA Today will delve into health care coding and how it can and will impact case management. Each year in the United States health care insurers process more than five billion claims for payment. For Medicare and other health insurance programs to ensure these claims are processed in an orderly and consistent manner, standardized coding systems are essential. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made, republished, and updated annually by the American Medical Association (AMA). In 1996, the Health Care Finance Administration (HFCA, now known as the Centers for Medicare and Medicaid Services) established the National Correct Coding Initiative. Its intentions were twofold; the first was to create national codes for physicians so when they relocated they wouldn't constantly have to reapply for new provider numbers in their new area, and the second was to promote correct coding initiatives for all medical providers that led to incorrect payments and accusations of fraud. Though these standards are mainly for federal and state programs, they have been used by other insurance carriers as well. CMSA continues to work with Washington, D.C., lawmakers to provide coding for case management that actually will adhere to our Standards of Practice and make it applicable to actual case managers - not for unlicensed personnel that are deemed to be a "case manager" only for the use of billing purposes such as in a physician's office. The topic of coding, as well as all of the initiatives we continue to support and influence, came into play with our theme of Epic Transformation at our the 25th Annual CMSA Conference & Expo. We brought topics from the highest caliber of health care professionals and experienced first-hand the most up-and-coming innovations in case management. The networking is unsurpassed, and the rekindling of friendships helps ignite "CMSA continues to work with Washington, D.C., lawmakers to provide coding for case management that actually will adhere to our Standards of Practice and make it applicable to actual case managers." 6 CMSA TODAY Issue 7 * 2015 * DIGITAL the love and passion that brought us into case management originally. In our day-today work life we can become discouraged and feel isolated, yet coming to this annual event reignites that fire we need to continue the critical role we bring to health care. As Lou Holtz stated, "Ability is what you're capable of doing. Motivation determines what you do. Attitude determines how well you do it." We have the ability, but the most epic transformation I see at the conference year after year is the motivation we feel after each session along with changes in our attitudes. All of us get to places during the year where we are in need of an attitude adjustment to maintain our enthusiasm, not to mention our sanity. Everyone I spoke to, along with myself, left feeling motivated and energized with the positive attitude we need to maintain the successful outcomes we bring. And, with the free addition of a pre- and post-conference, CEUs (approximately 34 hours) were obtained. If you attended you know this, but if you were not able to, please join us in Long Beach, California, next year for our 2016 conference. Kathleen Fraser, RN-BC, MSN, MHA, CCM, CRRN President, CMSA National Board of Directors 2014-2016 Kathleen Fraser is the president of CMSA National, and a past president of Houston/Gulf Coast CMSA Chapter. She has over 35 years of nursing experience, and more than 21 years of case management experience with 20 years in workers' compensation. Fraser has worked in acute hospital, long-term care, and insurance managed care. She can be reached at

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2015

ICD-10 Implementation
Medicare Fee-for-Service Program
Revisiting “Ready or Not — Here Comes ICD-10!”

CMSA Today - Issue 7, 2015