Posts Tagged Eligibility
Interoperability designated major component of “meaningful use”
Posted by Jim Denny in ARRA/Stimulus, Interoperability on January 5th, 2010
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:
Web portal pilot program is worthy – but not completely new
Posted by Leigh Ann Gerlach in Insurance, Web Portals on October 14th, 2009
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 »
Cost survey underscores the magnitude of revenue cycle management
Posted by Craig Bridge in Revenue Cycle Management on October 8th, 2009
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 »
Real and reasonable progress towards healthcare reform
Posted by Jim Denny in ARRA/Stimulus, EMR, Healthcare Reform, Interoperability on August 31st, 2009
The summer of 2009 will no doubt go down as one of the most stimulating in the history of healthcare. The specter of reform, technological interoperability and incentive/penalty programs generated lively – to say the least – debate.
But in the midst of the confusion and hyperbole (e.g., “death panels,” special-interest strangleholds, socialized medicine) real and reasonable progress has been seen in the areas of meaningful use and electronic health record (EHR) certification.
Significant strides were made in finalizing the definition of “meaningful use,” an ambiguous concept that had left the industry wondering how it could be applied as a benchmark to measure EMR effectiveness, as required by the American Recovery and Reinvestment Act (ARRA). By mid-summer the Office of the National Coordinator for Health Information Technology (ONC), after a period of public comment, zeroed in on a definition: that meaningful use “enable significant and measurable improvements in population health through a transformed health care delivery system.” It likewise set goals for providers to accomplish by 2011:
- Allowing patients to access their health records in a timely manner;
- Developing capabilities to exchange health information where possible;
- Implementing at least one clinical decision support rule for a specialty or clinical priority;
- Providing patients with electronic copies of discharge instructions and procedures;
- Submitting insurance claims electronically; and
- Verifying insurance eligibility electronically when possible. Read the rest of this entry »
Getting your hands on critical business intelligence
Posted by Ken Bradley in ARRA/Stimulus, Business Intelligence, EMR, Revenue Cycle Management on August 19th, 2009
The ARRA’s focus on physician adoption of EMR technology, with its emphasis on implementation deadlines and reimbursement incentives, has dominated headlines to date.
But just as important – if not more – is the legislation’s directive that healthcare providers select systems that promote clinical interoperability and data transfer.
Most physicians and practice managers who have made the transition to EMR will tell you their systems capture plenty of information – overwhelming amounts, in some cases. The problem lies not in collecting data, but in how effectively it is shared and ultimately used. Read the rest of this entry »