Sandra Rowland, An Education Officer for the American Academy of Professional Codes (AAPC), spoke about electronic health records, coding, outsourcing of data entry, medical tourism and more.

With Electronic Health Records (EHR), Security is the biggest headache. There are 35 million people on Medicare. With job losses, many seniors are going on Medicare early. There are 1.5 billion claims per year, processing claims at the rate of 9,579 claims per minute.

American Recovery and Reinvestment Act --Funds have been allocated to health information technology. Important because of telemedicine. Incentives are provided for doctors who use electronic health records.

The CMS Web site has a section on telemedicine. She told of stroke victims who have cameras at home and being observed and attended by a nurse during their daily routines. The nurse checks on compliance with doctor's orders, nutrition and more. Hospitals are for the critically ill so other means of treatment have to be looked at.

Medical Tourism -- Receiving medical care outside the U.S. See the Medical Tourism Association. Costs of surgeries and other procedures can be much lower in other countries. Insurance companies are saving by sending patients overseas. Recuperative time is the reason. Some even pay for the transportation to other countries.

Joint Commission -- Accreditation agency for hospitalsaccreditations occur every 1-3 years. They look at various aspects of care to be sure that the hospital meets standards. They are accrediting foreign hospitals as well.

Health Information and Management Systems Society (HIMSS).

Electronic records have to be standardized. Medicare is providing incentives for physicians to keep them seeing seniors. Certified Electronic Health Record. In January, incentive program is beginning. Physicians need to use a certified EHR in a meaningful way. They have to serve at least 30% Medicaid patients to receive the Medicaid incentive and otherwise serve any number of Medicare patients. There is an incremental schedule for the incentive.

This is partly a response to cuts in Medicare and Medicaid payments by providing additional financial incentives to see Medicaid and Medicare patients.

Doctors are doing the coding -- E and M coding, evaluation and management coding.

American Medical Association -- Patients can find a way to see what is being charged.

CPT Codes -- Can go to CPT-RVU (Relative Value Unit) Search on the AMA site. Non-Facility is the doctor's payment, facility is the hospital payment.

Medicare is doing more audits and looking for error rates, accuracy of payments.

ICD-9 codes are used for diagnoses and CPT codes for procedures. The rest of the world is up to ICD-10 and working on ICD-11.

You can look up the meaning of codes online (www.findacode.com).

AAPC -- The site lists chapters of the coders in Continuing Education section. You can see the chapters in other countries that can be an indicator of the outsourcing that is occurring that can code procedures anywhere.

FORD in Brazil-Factory in Brazil. Workers are treated the same no matter where. Suppliers are closely integrated with assembly lines inside the factory. Extremely automated. Components are fed in a "just in time" manner. Very different method of assembling. Has own port for export. Claim is that the UAW won't allow building of factory at this time in US.

AAPC goal is to keep jobs in US. Partner with another person who has a different specialty. Technology is changing the practice of medicine. We need to keep educating our own people.

HL-7 -- International organization of health care scientists, professionals, etc. to create standards for the exchange of health information.

5010-standards for electronic claims. There is a timeline.

More information is available on the www.hl7.org site.