January 5th, 2010 Category: ARRA/Stimulus, Interoperability
Interoperability designated major component of “meaningful use”
Posted by Jim Denny
We now have our first look at the official shape “meaningful use” of electronic health record (EHR) technology will likely take – in the near future, at least. As many had anticipated, one of the principal underlying themes is interoperability.
The long-anticipated proposed rule defining meaningful use finally was released by the Centers for Medicare and Medicaid Services (CMS) on Dec. 30. On the same day, we also received the interim final rule setting initial EHR technology standards, implementation specifications and certification criteria from the Office of the National Coordinator for Health Information Technology (ONC). You can view draft copies of both rules at www.federalregister.gov/inspection.aspx.
As it turns out, CMS will define meaningful use objectives in three distinct stages. Providers who meet the criteria in each of the three stages may be eligible for thousands of dollars in incentive bonuses through the American Recovery and Reinvestment Act (ARRA). In this proposal, however, CMS has only defined the requirements for Stage 1, which focuses on:
December 9th, 2009 Category: Coding
Understand the new CPT resequencing initiative
Posted by Ken Bradley
Be aware that there’s a new icon next to some codes in the 2010 CPT manual. It’s the hash-mark symbol “#,” and it’s being used to designate code numbers that are out of numeric order – a completely new concept for the CPT code book.
It appears the American Medical Association (AMA) is unveiling a new strategy to help provide much-needed room for expansion. The association is calling it the CPT “resequencing initiative,” and explains it this way:
“Resequencing of CPT codes allows placement of related codes to an appropriate location regardless of the availability of code numbers for numerical placement. This initiative also allows the CPT code set to expand and grow as a HIPAA designated code set and demonstrates the capacity to respond to today’s health information technology (HIT) requirements.” Read the rest of this entry »
November 30th, 2009 Category: Audits, Legislation, Medicare
New legislative proposal magnifies the significance of clean claims
Posted by Bryan Koch
Medicare “waste” and “improper payments” are no strangers to the governmental spotlight. This time it shines on them in the form of legislation just introduced by Sen. Charles Grassley (R-IA) called the Fighting Medicare Payment Fraud Act of 2009.
This bill is one you may want to watch closely. The reason: it would allow payment delays of up to one year if the government suspects waste, fraud or abuse – essentially circumnavigating current prompt payment rules.
“Because of this prompt payment rule, the government puts itself in a position of having to pay and chase Medicare fraud, instead of working to prevent it in the first place,” Grassley says in a press release introducing the bill. So, Grassley proposes to “…give the Secretary of Health and Human Services authority to extend the time period in which payments must be made under the prompt payment rule if the Secretary determines there is a likelihood of fraud, waste or abuse. With this additional time, the Secretary would be required to conduct more detailed reviews of the claims in question to make sure they are supposed to be paid.” Read the rest of this entry »
November 23rd, 2009 Category: Health Information Technology, Integration, Interoperability
The difference between interoperability and integration
Posted by Ken Bradley
“What’s so hard about interoperability, anyway? Lots of hospitals and physician practices already have integrated practice management (PM) and electronic medical record (EMR) systems…” That’s the kind of comment heard quite often in this business, from all manner of intelligent, informed professionals.
Unfortunately, an important matter of semantics sometimes unwittingly leads us to heated debate or a dismissive, “They don’t know what they’re talking about!” attitude. It’s imperative to be aware that discussions of “interoperability” and “integration” can easily leave people talking apples and oranges without ever knowing it.
Here’s the reason: People from so many disparate backgrounds – technological, clinical, business, regulatory, governmental – all play a role in the current push to better automate healthcare. Everyone understands the generalities behind the idea of one HIT system “talking” to another, but most folks have no need to delve into nitty-gritty technical specifics. As a result, “interoperability” and “integration” have become broad-brush terms many of us use synonymously as a way to express the general concept of data connectivity. Read the rest of this entry »
November 20th, 2009 Category: EMR, Infrastructure, Practice Management System
Evaluating an EMR? Use the opportunity to assess your overarching technology solution
Posted by Jim Denny
The prospect of obtaining stimulus funding has, not surprisingly, created an environment of intense focus on EMRs. While that’s OK, I see a distinct limitation in looking at EMRs, practice management systems (PMS) and other applications as isolated pieces of hardware/software. Instead, I think the current atmosphere provides many practices the opportunity to step into completely new systems, with a completely new way of viewing the components.
Rather than contemplating an EMR purchase or PMS evaluation in the context of “what’s available,” consider how well these technologies will serve as your platform from which to custom-build, taking into account future needs as well as current.
It is similar to when, as a teenager, I went to buy my first stereo system. I saved up, went to the store, and there they helped me design my own system to suit my listening style. Two speakers or four? Turntable or tape player? Headphones? The stereo store catered to my taste, my music, my needs – and I ended up with a system that was perfect for me. Read the rest of this entry »
October 30th, 2009 Category: Audits, EMR, Health Information Technology
Use technology to aid – not substitute for – self-audits
Posted by Ken Bradley
In this age of automation, it is tempting to rely on technology solutions to ease the burden of coding operations. And that’s OK; that’s the purpose behind the many extremely valuable coding and documentation tools available from many EMR applications.
However, I’d like to offer one caveat: Please don’t allow confidence in technology to detract from the value of self-audits. Technological aids don’t render coding and billing audits obsolete. As advantageous as some coding tools are, ongoing self-evaluation remains the single best way to ensure optimal coding practices – those that garner appropriate reimbursement while also protecting against payer investigations.
Take, for instance, evaluation and management visits (otherwise known as E/M services). They are the lifeblood of many practices, yet they still account for a significant portion of the errors found in Medicare’s Comprehensive Error Rate Testing (CERT) audits. Perhaps that accounts for certain E/M services remaining on the Office of Inspector General (OIG) Work Plan for 2010. Read the rest of this entry »
October 26th, 2009 Category: ICD-10
Collaborative partnerships vital for smooth conversion of HIPAA standards
Posted by Ken Bradley
A seamless transition. That’s the goal we all seek in the colossal dual conversion of our HIPAA 4010 X12 files to the new 5010 standard, and the ICD-9 to ICD-10 code sets. Somehow, with a tight timeline and crunched budgets, we must simultaneously pull off two technically challenging migrations – and do it all with minimal disruption to business operations. The task, at times, feels overwhelming.
As you research your options, however, I’d suggest that one important place to begin is with a candid assessment of your organizational partnerships. The Herculean effort needed to successfully transition these two critical data sets at the same time will require close collaboration with trustworthy and responsive partners, each working within a well-defined area of expertise.
Consider the ways you can leverage current business relationships to accomplish the task at hand. Obviously, you best understand your business processes. HIT vendors, by contrast, may be better suited to navigate the technological waters. We don’t each need to reinvent the wheel; we need to work together.
The changeover to the HIPAA 5010 electronic transaction standard must be completed by January 2012. The move to the ICD-10 code set must be accomplished by October 2013. With precious little room for waste – of time or resources – practices must augment their internal strengths with the strengths outside vendors can provide. Read the rest of this entry »
October 14th, 2009 Category: Insurance, Web Portals
Web portal pilot program is worthy – but not completely new
Posted by Leigh Ann Gerlach
There’s a little bit of buzz right now about a pilot program starting up next month that will employ a Web portal to streamline information flow between physician offices and health insurance companies. This pilot is set to begin in Ohio with the backing of America’s Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association (BCBSA), and several physician associations. A number of private payers have signaled their intention to participate.
Some of the goals of this initiative, according to a HealthLeaders Media article posted online last week, include providing a physician’s staff the ability to:
- quickly verify patient eligibility;
- easily identify benefit information (e.g., co-pays, co-insurance, deductibles);
- handle real-time referrals and preauthorizations; and
- submit and manage claims online. Read the rest of this entry »
October 8th, 2009 Category: Revenue Cycle Management
Cost survey underscores the magnitude of revenue cycle management
Posted by Craig Bridge
Perhaps it is just another survey confirming what we already know: That the tough economic times are taking a toll on medical practice revenue.
But perhaps not. Maybe there is something more we can garner from the release a few days ago of the Medical Group Management Association (MGMA) Cost Survey: 2009 Reports Based on 2008 Data.
According to the survey, multispecialty group practices saw a 1.9% decline in total medical revenue last year. Practices tried to counter the profit bleed by cutting overhead costs, but those reductions were not enough to cover shrinking revenue.
Other key survey indicators appear equally dismal:
- 9.9% drop in procedures performed;
- 11.3% decline in the number of patients seen over a two-year period;
- 13% rise in bad debt over that same two years.
You can read all of the details in the MGMA news release. But meanwhile, it’s imperative for us to ask what these numbers really indicate. What is the take-home message? That it is impossible to run a profitable medical practice in a bad economy? Read the rest of this entry »
October 7th, 2009 Category: Clearinghouses
HIStalk Reader’s Write: Fee-Based Clearinghouses Defy 80/20 Rule
Posted by Jim Denny
Earlier this week, HISTalk Reader’s Write featured a short article I wrote in response to Nick Revak’s comments “Healthcare Clearinghouses and the 80/20 Rule.” In his article, Mr. Revak states that providers should consider the “80/20” rule when establishing their EDI transaction strategy. My response introduces thoughts about alternatives to per-transaction fees, as well as the value Web-based clearinghouses can add to the process. Visit HISTalk to read my full commentary on the subject and provide your own perspective on the matter.