Logical Observation Identifiers Names and Codes (LOINC) are a key component of electronic health records (EHRs) and work in concert with other clinical vocabularies in a variety of healthcare applications. AAPC’s Patricia S. Wilson, RT(R), CPC, PMP, recently published an article with Amy Sheide, RN, BSN, MPH, in the Journal of AHIMA, in which they expound on what medical coders need to know regarding LOINC.
“Although a coder probably will never see or ‘code’ with an actual LOINC code, it provides meaning to the information a coder uses every day,” the authors explain. “As a health records coder or other coding-related professional, understanding the purpose and use of LOINC adds value as organizations manage their electronic health data.
Read the full article.
April 16th, 2013
An EHR that meets meaningful use certification requirements may not necessarily be able to connect and exchange data with all the entities providers want it to. Experts are now advising doctors to consider what data exchange they plan to implement and make sure the EHR they use is capable of meeting those needs. American Medical News recently interviewed Dixon Davis, vice president of business development at AAPC Physician Services, on EHRs and meaningful use.
“The exchange requirements EHRs must meet to be certified for meaningful use are limited mostly to exchange between one organization and another, not across multiple settings,” Davis says. “Physicians will need to talk with the organizations with whom they plan to exchange data — including labs, other practices, hospitals and health information organizations — to find out what capabilities their systems must have.”
Read the full article.
November 29th, 2012
by Ronda Tews, CPC, CHC, CCS-P
Inadequate documentation is not new to coders, but as offices transition from paper to electronic health records (EHR) coders have a new opportunity to educate physicians when they say, “Oh, that’s documented, it’s just in a previous visit.”
The EHR must follow the same documentation requirements as the paper chart. It is not true that if the information is located “somewhere” in the EHR, that it may be counted toward the documentation requirements for any and all dates of service. The provider must reference within her note for that date of service if she has reviewed any information within the EHR to get credit for the information.
Here’s how Medicare carrier Wisconsin Physician Services (WPS) addresses this topic in a Q&A:
Q 17. This question pertains to an Electronic Medical Record (EMR.) We have always been taught that the progress note “stands alone.” When we are auditing physician’s notes to determine if they are billing the appropriate level of service, what parts of the EMR can be used toward their levels without requiring them to reference it? We are referring specially to Growth charts, Past, Family, & Social History, Medication Listings, Allergies, etc.
A 17. If the physician were not referencing previous material in the EMR, then the information would not be used in choosing the level of E/M service.
The old adage still applies to the EHR: If it’s not documented, it wasn’t done.
Templates are beneficial, but can create problems if documentation begins to look the same for each patient. The Office of Inspector General (OIG) has warned, “Documentation is considered cloned when each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries…. All documentation in the medical record must be specific to the patient and her/his situation at the time of the encounter.” This does not mean that providers cannot use templates, but appropriate changes need to be made to the template based on the patient being seen and the treatment provided.
And remember: The volume of documentation doesn’t determine coding, medical necessity does. National Medicare policy asserts, “It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed” (CMS Transmittal 178, Change Request 2321, May 14, 2004).
November 28th, 2012
Sometimes complex communication in a large practice mimics the Tower of Babel. When that happens, a solution may be adopting some enterprise architecture (EA) strategies of hospitals.
EA is strategic business planning used by an organization to uniformly align business and IT goals across the entire organization. It includes all aspects of implementing a technical strategy to reach a set goal typically related to new technology. Scaled down and adapted to the mid-sized or large physician group or practice, EA can prove a valuable tool during the chaos of implementation.
The process is often used to maximize the return of an investment and prevent waste within larger health care organizations such as hospitals, but is also an excellent tool for practice management. EA—required by the Office of Management and Budget (OMB) across all federal agencies—considers:
- Business Goals
- Business Processes
- IT Hardware
- Software Applications
- Data Management
The process of EA requires goal setting and project planning. It often incorporates the use of technical roadmaps, reference models, design patterns and blueprints, and change management systems. It is used by health care organizations migrating away from one or more systems to meet new goals or adopt newer technologies. Many large health care organizations have outdated “legacy systems” that are the result of the evolution of their business (e.g., technology added over many years, company mergers, etc.). EA is used to connect systems, primarily through interfaces, to achieve system interoperability. EA often is used to consider:
- Provision of Services
- Operational Management
- Billing and Other Business Management
- Human Factors (eg, training and certification)
- ANSI X.12
- Health Level 7 (most popular in medical clinics)
- Data Repositories
- Security Mechanisms
- Infrastructure Services
The goal is to enable the organization’s disparate software to communicate by using phases requiring dual systems, implement bridges to connect systems, or decide to replace systems altogether. Whichever process is defined by the EA, the ability to communicate across an organization provides timely access to accurate clinical, financial, and related information needed for operations. This allows practices and other health care systems to improve the quality and efficiency of the care they provide. It also allows them to more easily interact with outside entities, such as a Health Information Exchanges (HIE) or Affordable Care Organizations (ACOs).
There are different frameworks, methods, techniques, and tools used to achieve EA. The majority of large health care enterprises utilize the HL7 standards for communication of data between internal applications and other facilities. Whichever EA is used, the goal is to provide a comprehensive framework to manage and align an organization’s Information Technology (IT) assets, people, operations and projects with its operational characteristics. EA defines how information and technology will support the business operations and provide benefit for the business.
November 26th, 2012
With the Centers for Medicare & Medicaid Services (CMS) predicting the number of affordable care organizations (ACOs) will double to 300 by the end of 2012, it is time to start thinking about what you and your providers need to do to become Medicare ACO partners.
How does a Medicare ACO function and how will it potentially affect your office?
Born of the Affordable Care Act, Medicare ACOs are made up of a group of Medicare providers and suppliers. Under the ACO, the providers and suppliers agree to band together, coordinating care, documentation, and billing for patients, improving quality and cost savings in the process. Providers, payers, and newly established groups have applied to CMS for approval to start an ACO, which if approved must operate for at least three years.
An ACO’s quality performance is evaluated in five areas: care coordination, patient safety, preventive health, patient/caregiver experience, and at-risk population/frail elderly health.
CMS’ Medicare Shared Savings Program (MSSP) bases financial incentives to ACOs on successful cost reduction via care coordination. Under the MSSP, ACOs serve a minimum of 5,000 beneficiaries and must provide enough primary care physicians to easily serve the population. Before applying for MSSP status, an ACO must establish legal and governance structures, cooperative clinical and administrative systems and a shared savings distribution protocol.
Incentive payments are based on comparing an ACO’s annual incurred costs relative to CMS determined benchmarks and ACOs can choose to be reimbursed based on a “one sided” or “two sided” model. The one sided model allows the ACO to share a maximum of 50 percent for the first two years and savings or losses the third year. The two sided model allows a maximum of 60 percent sharing of savings and losses for all three years. Shared loss grows from 5 percent to 10 percent over the three year period.
A key to success is the communication of patient information, which adds a new perspective on current, interoperative electronic health record (EHR) systems. ACOs were ideated to encourage seamless treatment of patients by teams of providers from different entities and disciplines. Universally reliable documentation and classification of each patient may help providers meet incentives while providing improved quality of care.
If you are updating your EHR, investigate its ability to capture and communicate the information needed by other practices, physicians, and providers who may be joining your practice in a future ACO.
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