Friday, March 12th, 2010
Do you know where your cell phone is? If it falls in the wrong hands, and unsecured data is breached, you could conceivably be in violation of the Health Insurance Portability and Accountability Act (HIPAA).
The number of health care professionals who store patient data on laptops, USB memory sticks, and other portable electronic devices is growing, but some say data security is not.
Friday, March 12th, 2010
The Military Health System (MHS) set up a version of its Armed Forces Health Longitudinal Technology Application (AHLTA) electronic health record (EHR) system for use in the White House.
Monday, March 1st, 2010
Coders and their providers can bone up on coding, regulation, compliance, and billing while earning continuing education units (CEUs) and continuing medical education (CMEs) at AAPC’s 2010 National Conference in Nashville, Tenn. on June 6–9. This annual event draws thousands of attendees including doctors, medical coders, and office/practice managers to connect on the business side of health care. This is the first conference to be approved for 15.75 CME (AMA PRA Category 1™) credits.
Wednesday, February 17th, 2010
EMR documentation can create risky record keeping.
By Cheryl L. Toth
Documentation like the following is becoming more common as coding consultants audit practices that have moved to an electronic medical record (EMR):
“The overarching issue here is lack of visit template customization,” says Mary LeGrand, RN, MA, CPC, CCS-P, consultant with Chicago-based KarenZupko & Associates. “A critical component of EMR planning is customizing your visit templates—in addition to tailoring other elements of the system,” says LeGrand. “In most cases, you get little to no template customization help from the vendor. It’s up to a busy physician to do in his or her ‘spare time.’ And many practices fail to realize the importance of this step.” Read more »
Monday, February 15th, 2010
President Barack Obama’s $3.8 trillion 2011 budget, which he submitted to Congress on Feb. 1, includes $81.3 billion for the U.S. Department of Health and Human Services (HHS) to provide essential human services. A lion’s share will go to states to cover a six-month increase in Medicaid funding. Also included in the budget are funds for expanding health care fraud initiatives, primary care physician access, food and drug safety, biomedical research and more.
Monday, February 15th, 2010
Providers looking to claim a piece of the incentive pie for “meaningful use” of an electronic health record (EHR) system face a difficult decision—choosing EHR system software. Early adopters of the American Recovery and Reinvestment Act of 2009 (ARRA) provision stand to gain the most, but haste makes waste. Before your practice signs an agreement with a vendor, take time to read the fine print. There are certain things to watch out for.
The Centers for Medicare & Medicaid Services (CMS) has released two new Health Insurance Portability and Accountability Act (HIPAA) Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010. With compliance deadlines rapidly approaching, the time to prepare is now.
Monday, February 15th, 2010
The American Recovery and Reinvestment Act of 2009 (ARRA), or stimulus bill, provision that promotes health information technology (HIT) among providers created many unanswered questions. OK, so the bill provides $19 billion in incentives to “eligible professionals” who adopt a “certified” electronic health record (EHR) system in a ”meaningful” way before 2015. But who are these eligible professionals? What exactly quantifies a certified EHR system? And what, pray tell, is meaningful use?
Since the bill’s passage, many have tried to answer these questions. Read more »
Friday, February 12th, 2010
In February, 2009, Congress passed and President Obama signed the ARRA Act, mandating implementation of EMR systems meeting meaningful use requirements by 2015 for physician practices that bill Medicare claims. In the past year, I’ve spoken to many physicians that do not want to implement an EMR system and a handful of physicians that have un-installed their EMR system. The fact that so few physicians have currently installed EMR systems (estimated between 20-35 percent have installed), when almost all physicians are aware of them, tells me that many physicians don’t see the benefit vs. the cost. To counter that, the Federal Government will give up to $44,000 for each EMR system installed that meets meaningful use. In other words, the government will force physicians to purchase what many don’t want and then help them pay for it.
Our workshop in March on EMRs will help you and your practice deal with the EMR issues that have plagued us, and it will explain how to get the $44,000 from the government. It also educates coders on the inevitable shift in duties as healthcare becomes fully part of the digital age. The workshop was created by a physician that has been a director of coding, is now director of healthcare revenue cycle management and has gone through a large EMR installation. If you are frustrated with your current EMR or are contemplating one, I believe this is a workshop well worth attending.
Reed E. Pew, CEO
By Janice G. Jacobs, CPA, CPC, CCS
Electronic health records (EHRs) are electronic versions of a patient’s medical history as maintained by a physician or other health care provider. EHRs contain elements such as patient information, past medical, family and social history, clinical notes, prescriptions, and diagnostic testing results. These records are accessible to other health care providers and serve as a legal record of everything that happened to a patient during a specific encounter. EHR adoption is key to the current administration’s health strategy. If you are confused about what’s happening, here’s a primer.
The Centers for Medicare & Medicaid Services (CMS), Electronic Health Records, Overview (www.cms.hhs.gov/ehealthrecords/) says, “EHRs are the inevitable next step in the continued progress of health care that can strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care.”
Examples of how EHRs can improve patient care include the following:
The government is uncovering and addressing implementation issues through a series of demonstration projects prior to the 2014 projected nationwide rollout. CMS is engaged in a five-year EHR demonstration project, which began on June 1, 2009 and is anticipated to continue through May 21, 2014 (found at CMS, Medicare Demonstrations, Details for Electronic Health Records Demonstration:www.cms.hhs.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1204776).
The goal of the demonstration is “to foster the implementation and adoption of EHRs and health information technology (HIT) more broadly as effective vehicles to improve the quality of care provided and transform the way medicine is practiced and delivered … The demonstration is designed to leverage the combined forces of private and public payers to drive physician practices to widespread adoption and use of EHRs,” (CMS, Medicare Demonstrations, Details for Electronic Health Records Demonstration). The demonstration provides incentives to participating primary care physician practices fulfilling established criteria and serves as an operational outline for practices across the country in relation to infrastructure, physician education, tracking and reporting quality measures, and community outreach.
In February 2009, President Obama signed the American Reinvestment and Recovery Act (ARRA, or stimulus act), which included the Health Information Technology for Economic and Clinical Health (HITECH) Act. HITECH includes more than $19 billion used to increase EHR use nationwide. Under the stimulus plan, physicians can qualify for $44,000 in Medicare incentives if they demonstrate “meaningful use” of an EHR starting in 2011. High-volume Medicaid providers can be eligible for up to $20,000 more in incentives, for a maximum incentive of $64,000. Physicians in health professional shortage areas (HPSA) are eligible for an additional 10 percent incentive.
Specific criteria must be met before a provider is eligible for stimulus payments. The two most important criteria require that (1) the EHR must be a “qualified” EHR and (2) the provider must demonstrate “meaningful use.”
To be considered qualified, an EHR must:
The definition of meaningful use is muddy and will be clarified further by the Health IT Policy Committee. Meaningful use most likely will involve consistent use of the EHR for prescribing, electronic exchange of health information between clinical organizations, and the submission of information on selected quality measures. A provider who purchases an EHR system but fails to use it would be disqualified from stimulus eligibility. Stimulus funds are distributed per provider number rather than to individual physicians; meaning, if a group of five doctors operating under one provider number purchases a qualified EHR system and demonstrates meaningful use, the practice will be eligible for up to $44,000. Each physician will not receive his or her own stimulus payment and the practice, as a whole, must demonstrate meaningful use. One physician acting as the champion in regard to technology, who spearheads the EHR project but is the only meaningful user of the EHR system, would not qualify the entire practice for the incentive.
Stimulus payments will be staggered over a five-year implementation period: $15,000 (year one), $12,000 (year two), $8,000 (year three), $4,000 (year four), $2,000 (year five), and $0 for subsequent years. To be eligible for the full amount, the EHR system must be up and running by Jan. 1, 2011 to demonstrate meaningful use by 2012, when incentive payments will begin. Practices that have adopted a qualified EHR system prior to Jan. 1, 2011 also will be eligible for the incentive payments. Meaningful users who have systems up and running in 2011 and 2012 will receive an increased first year payment of $18,000. Practices implementing a qualified EHR after 2011 will be eligible only for that year’s payments. For example, if a practice is up and running in 2011/2012, they will get year one’s payment and payments each subsequent year for five years. A practice that implements an EHR in 2013 will start receiving the reduced year two payment and receive payments each subsequent year for four years.
The biggest obstacle in implementing EHRs in private and group practices is cost. With the financial incentive program, expense should be less of an issue for physician practices to adopt a functional EHR. In an ongoing effort for full compliance, further negative incentives will be implemented after the demonstration project is over. Beginning in 2015, penalties (reduced fee schedule payments) will be assessed for providers that are not meaningful users of a qualified EHR system. The penalty will increase each subsequent year of noncompliance, to as much as 5 percent by 2018.
As a result, every practice should assess its specific needs for a qualified EHR system. It is imperative to work with the business office or central business office in cases of large group practices with many locations. The new EHR system will not provide return on investment if it does not interface with the existing billing and accounts receivable system. Practice managers and clinicians need to consult with the billing and accounts receivable (BAR) office about evaluating vendors to achieve optimal interoperability between systems and offices. Failure to include the front and back ends of the revenue cycle will result in significant cash flow problems during implementation.
Your physicians also will need sufficient preparation to become acclimated to a new system, so there will be limited impact on the number of patients seen in a day with no adverse effects on patient care quality. Careful planning is necessary to implement the EHR system gradually, starting with the clinical data first, and then moving to implementation of the billing system where encounter form data is entered. If care quality and billable hours are affected substantially because a physician is spending excessive time in front of a computer keying in data, there will be a negative return on investment.
Computerizing the nation’s health records as part of the economic stimulus plan has resulted in mixed emotions. Although providers agree that quality of patient care quality will increase with EHRs, they are faced with the challenges of implementation and orientation to a new system. With the topic of EHRs on the CMS agenda since the early 90s, it’s still a top priority as CMS moves forward with the EHR demonstration project as part of their value-driven health care initiative. As the President designates funds and resources to fulfill the goal of Americans having access to a secure, interoperable health record by 2014,analyzing your practice’s current capacity and resources for implementing EHR is critical to your five-year strategic plan.
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