EHR and Health IT Consulting
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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Medical Billing and Coding Trends for 2018

Medical Billing and Coding Trends for 2018 | EHR and Health IT Consulting | Scoop.it

According to the New York Times, disease-classification systems originated in 17th-century London to help doctors prevent the bubonic plague from spreading to populations that didn’t speak English.

 

French physician and statistician Jacques Bertillon (the 1890s) introduced the first medical coding system when he developed the Bertillon Classification of Causes of Death. In the 20th century, the codes encompassed not only causes of death but also the incidence of diseases.

 

These days, medical coding translates the content of a patient’s health records into a universal standard medical code so it can be billed properly. Let’s take a closer look at the landscape to see how things stand, and identify the medical billing and coding trends you should look for in 2018.

 

The medical billing and coding landscape

 

Between 2015 and 2020, Deloitte predicts worldwide spending on health care will increase anywhere from 2.4 to 7.5%. Despite this extra spending, many healthcare delivery organizations are facing increased operational costs, which are eating into their returns.

 

One source of increased operational costs is the ever-expanding complexity of medical billing. The same Times piece cites in-office earwax removal and vaccinations as examples; there exist unique codes for the method used as well as each injection. On top of that, not every payer uses the same coding system.

 

Administrative costs account for a full quarter of U.S. hospital spending; for comparison, those costs sit at 16% and 12% in England and Canada, respectively.

 

While medical billing and coding are ever-changing, there is the general movement toward efficiency. Here are three medical billing and coding trends you should be watching in the coming year; they’ll only get more important as 2018 gets underway

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Three trends to look for in 2018

 

1. Computer Assisted Coding (CAC)

 

  • Uses natural language processing (NLP) to read and interpret text-based clinical documentation from patient charts.
  • Identifies potentially relevant ICD-10-CM diagnoses, ICD-10-PCS and CPT procedures, and present on admission (POA) indicators to provide suggested codes and corresponding documentation for coders or CDI specialists to review and approve.

 

CAC software is proliferating, particularly for coding inpatient claims. According to a report available through Research and Markets, the global market for computer-assisted coding software is projected to reach $4.75 billion by 2022.

 

According to CareCloud, coding specialists are afraid that the CAC built into EHRs could replace their jobs within a decade. This concern, however, is likely overblown. CAC is a huge help to human coders. According to one study, CAC increased coder productivity by over 20% and reduced coding time by 22% relative to their peers who didn’t use CAC, all without reducing accuracy.

 

2. EHR alignment


Poor record keeping—from not capturing the chart data you need to code correctly to capturing the data but making it hard for a coder to find later—can lead to a variety of problems for reimbursement. Already, most providers spend too much time searching for the right diagnostic codes for their patients rather than looking at and listening to them.

 

If your EHR and medical billing software are integrated, especially if your medical billing offers CAC, the process can go much faster. For example, your software can offer coding suggestions at the point of documentation, making codes more accurate from the get-go.

 

When your EHR has integrated CAC, it can automatically populate patient demographic data into a bill instead of wasting time by requiring staff to re-enter it and introducing the opportunity for errors. Fewer errors increase your first-pass claim acceptance rate, can improve data abstraction, and offer more robust reporting than standalone EHR and billing and coding software.

 

This reporting can include a robust set of financial data, such as units billed per visit, days sales outstanding (DSO) to accounts receivable, net revenue per visit (NRV), staff productivity, referral numbers, appointment cancels, and no-shows.

 

3. Blockchain
In 2016 ONC called for white papers on how the blockchain can improve healthcare. Researchers submitted more than 70 papers, and ONC awarded 15 papers covering everything from precision medicine clinical trials and research to a decentralized blockchain-based record management prototype for EHRs.

 

“Blockchain is booming in clinical trials right now; it is a big favorite of the pharmaceutical sector,” Maria Palombini, director of emerging communities and initiatives development at the IEEE Standards Association, said. Palombini predicts that blockchain has an especially intriguing promise in EHRs.

 

In early 2017. EHR Intelligence’s Kate Monica wrote: “Blockchain is becoming increasingly common as a way to improve the standardization and security of health data.”

 

In September, HealthcareITNews published “Why blockchain could transform the very nature of EHRs.” And Bruce Broussard, CEO of Humana, described blockchain as the next big healthcare technology innovation.

 

There are three primary reasons EHRs should consider adopting blockchain data storage:

 

  • It can offer better privacy protections
  • It can make information exchange easier and more efficient
  • It can increase patient control over their data

 

With blockchain, it could be as simple as a patient giving their doctor a token to access their records. “Using blockchain technology to reconfigure EHRs makes sense,” Elizabeth G. Litten, partner and HIPAA privacy and security officer at Fox Rothschild, recently wrote.

 

Dave Watson, a chief operating officer at SSI Group (an RCM and analytics company), sees tremendous potential for the blockchain to improve revenue cycle management and claims processing.

 

By recording tests, results, medical billing, and payments in an immutable ledger, the blockchain could reduce fraud and even save money by decreasing the time and labor currently used to track that information through various systems.

 

On Medium, strategy, design, and development consultancy Sidebench wrote that the three areas where the blockchain could impact healthcare with the clearest path forward to providing significant ROI through cost savings are developing better health exchanges, protecting patients and practitioners through supply chain accountability, and reducing fraud in billing and claims.

 

Palombini’s “Holy Grail” is when patients own and control their own complete health histories, from the hospital, stays to outpatient visits to data from wearables. A blockchain is a tool that could help get us there. But it’s not the only way.

Technical Dr. Inc.'s insight:
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Getting the Most Out of Your EHR - Healthcare IT Consulting

Getting the Most Out of Your EHR - Healthcare IT Consulting | EHR and Health IT Consulting | Scoop.it

No matter how much your organization has invested in an EHR, there will always be opportunities to improve its performance—especially when considering the ways individuals interact with and are impacted by it. If you are interested in learning how to ensure your implementation goes well or to better leverage your current EHR, check out four popular blog posts about getting the most out of your system.

 

8 Best Practices for Building Better Relationships During EHR Implementation and Training
EHR implementations and training can be highly stressful for end-users, especially those in patient-facing roles. Minimizing that stress can result in more engaged training sessions and better long-term retention, which is why in this article an experienced principal trainer shares how to streamline these processes through relationship building.

 

EHR Training: How to Help Users End Frustration, Overcome Fear and Engage
EHR training should include more than technical skills instruction—it should instill in end-users confidence that they will be able to adapt to a new system (even if they forget a few details post-training). In this blog post, an experienced training consultant explains how to create an environment of positivity conducive to learning.

 

EHR Optimization as a Bridge to Population Management
Healthcare organizations already analyze patient data to identify savings opportunities, but what often goes overlooked is how the configuration and use of the EHR can make a significant impact on cost and care. This article examines how organizations maturing their population health and value-based care programs can use their existing technology to meet their goals.

 

Quality Reporting: What Your Healthcare Organization Needs to Know About Measure Selection and EHR Configuration
For healthcare organizations with limited resources, participation in pay-for-performance plans like MACRA’s Quality Payment Program (QPP) is challenging. They often lack the time and expertise to retool their EHR implementation to document new metrics and recognize when a measure has been met. In this post, we discuss important data management issues and the repercussions of waiting to address them.

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EHR and the Failure to Communicate

EHR and the Failure to Communicate | EHR and Health IT Consulting | Scoop.it

Clinical workflow in my early career included the ritual of phone messages. Every day, at least once and usually in the afternoon, I would sit with my clinic nurse and a pile of manila folders to discuss phone calls. Details were discussed, recommendations were made, triage assessments were cosigned and I would hold the charts of those patients needing a callback. The ritual began with the daily call to action, “Let’s do calls.”

EHR and the disruption of the nurse-doctor interaction

About 15 years ago when our first EHR, Logician (evolved as Centricity), came along the process of handling calls changed. It was Texas Children’s first venture into EHR and with it we began the long calculation of how electronic records fit our clinical flow.

My nurse at the time was a pediatric nurse with years of experience. Seasoned and crusty, her capacity for laser-sharp phone triage was impeccable. She was a stickler for tight documentation.

 

As we grew comfortable with Logician, the ritual of call review evolved. While we began doing calls around the screen, my nurse began to insist that our daily rendezvous was no longer necessary. “It's’ all in the message. Just read the message, Dr V,” she would crow from her cramped desk. “And the documentation is better. Trust me.” Despite my insistence, she ultimately became an unwilling partner in a clinical dance for two.

 

Our digital phone messages involved a back and forth of queries and replies through the EHR. Documentation was tight. But something was missing.

Not all media are created equal

When it comes to communication not all media are created equal. The assumption on the part of my nurse was that communication through the EHR was the same independent of how it was transmitted. A message, in the end, was just a message.

As it turns out, there are different ways for patients and health professionals to exchange information with one another. All bring different affordances to a human encounter.

 

  • In person (mano y mano)
  • Asynchronous text (Epic MyChart, email)
  • Synchronous text (Live texting)
  • video stream (Skype)
  • audio transmission (phone)
  • And there are lots more.

 

All represent ways for us to exchange health information. As I have written, different problems call for different media depending on the type of problem at hand. Text works well for simple problems. But the text isn’t always enough. A video is an overkill for simple issues. And as inconvenient as it may be for both the patient and the doctor, sometimes a patient needs to be seen, heard or touched in person.

The EHR and the subtle dimensions of the human experience

So when my nurse stopped talking to me about my understanding of what was happening with my kids fell off significantly. The notes were impeccable and the transmission instant. But something was missing.

 

So what was missing from the EHR? As it turns out in human exchange there are subtle elements that get lost in the type. There are critical bits of information during a phone exchange that get picked up by an experienced pediatric nurse. Often there are subtle contextual elements of a social situation that are never properly documented. Some of these things can’t be documented.

 

Sometimes these details only come to my attention when face-to-face with my staff. And there are things that come from the gut that we don’t share in the record.

 

Paper charts didn’t solve this problem with the EHR. Written messages are exactly the same. They just forced us to sit at a table because there was no way to send a paper message across the office and easily back again.

 

Humans are messy. They rarely fit the constraints of the technology we create. The dimensions of the human experience are rarely felt through typewritten messages. Consequently, the accurate exchange of information and documentation of human interaction is potentially more challenging than we think.

 

Communication through and around the electronic health record is an inevitable part of medical practice. But we have a long way to go with regard to capturing the subtle elements of human engagement.

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A prescription for EHRs and patient engagement 

A prescription for EHRs and patient engagement  | EHR and Health IT Consulting | Scoop.it

Most physician practices and hospitals in the U.S. have installed electronic health records. In a classic Field of Dreams scenario, we have made patients’ medical records digital, but people aren’t asking for them or accessing them en masse.

 

“How do we make it easier for patients to request and manage their own data?” asks a report from the Office of the National Coordinator for Healthcare IT-Improving the Health Records Request Process for Patients – Highlights from User Experience Research.

 

The ONC has been responsible for implementing the HITECH Act’s provisions, ensuring that healthcare providers have met meaningful use criteria for implementing EHRs, and then receiving the financial incentives embedded in the Act for meeting those provisions.

 

Now that the majority of healthcare providers in the U.S. have indeed purchased and implemented EHRs, it remains for patients, health consumers, and caregivers to take advantage of them. In my post on the EHR Field of Dreams effect, I highlighted research from the U.S. General Accountability Office that explored the question of how the Department of Health and Human Services should assess the effectiveness of efforts to enhance patient access to EHRs.

 

The ONC team conducted in-depth interviews with 17 patients to understand their health IT personae and personal workflows for accessing their personal medical records. The research also considered medical record release forms and information for 50 large U.S. health systems and hospitals, and interviewed “insiders” – healthcare stakeholders inside and outside of ONC – to assess how patients request access to medical records data and look for solutions to improve that process.

 

Why is it so important for people to access their medical records? By doing so, patients and caregivers can better manage and control their health and well-being, ONC notes, by preventing repeat tests, managing clinical numbers (like blood pressure for heart or glucose for diabetes), and sharing decision-making with doctors and other clinicians – together, the process of patient and health engagement, which boosts health outcomes for individuals and populations.

 

The general process of a patient requesting their health data works like this, illustrated by the patient journey of Melissa and Ava Crawford, a mother and toddler daughter portrayed in the ONC report:

  • A patient/consumer makes an initial inquiry
  • The consumer requests the records, which can be done via a paper authorization form (that is then completed and either mailed or faxed to a provider) or sent online via the portal. Sometimes a consumer must write a letter to request the provider.
  • The consumer waits for a response, which ONC calls “a bit of a black hole for consumers.” This can be as long as 30 days under the HIPAA law.
  • The health system receives and verifies the request, then verifies the patient identify and address.
  • Health systems then fulfill the records request, often a printed copy of the medical record that can be faxed or mailed, PDF files, or a computer disk – CD.

 

ONC conducted research into the consumer journey through this process to identify opportunities to improve the patient experience of requesting and receiving personal health information.

 

Health Populi’s Hot Points: Most Americans see their doctors entering medical information electronically, and most people say accessing all kinds of medical information is important, the Kaiser Family Foundation learned in a health tracking poll conducted in August 2016. However, there are big gaps in the information available to U.S. patients online, such as prescription drug histories and lab results – two very popularly demanded information categories. And through the consumer-patient demand lens, 1 in 2 U.S. adults said they had no need to access their health information online, as the chart from the KFF poll attests.

 

How to bridge the chasm between self-health IT, providers, and patients? The most effective patient engagement technologies are biometric measurement devices like WiFi scales and glucometers, apps, texting, and wearables – with portals ranking last – according to physicians and clinical leaders polled in a New England Journal of Medicine (NEJM) survey published earlier this month.

 

The top benefit of engaging patients with these technologies is to support people in their efforts to be healthy and to provide input to providers on how patients are doing when not in the clinic, this research found.

 

My friend and collaborator Michael Millenson wrote in the BMJ in July about patient-centered care no longer being “enough.” In this era of technology-enabled healthcare, and rising consumerism among patients, three core principles must underpin the relationship between patient and provider:

  • Shared information
  • Shared engagement
  • Shared accountability.

 

Michael quotes Jay Katz from his book, The Silent World of Doctor and Patient, who talked 35 years ago about the concept of “caring custody.” Jay explained this as, “the idea of physicians’ Aesculapian authority over patients'” being replaced with “mutual trust.”

 

It is not enough to build and offer a technology “meant” for patients and people to use for their health and healthcare. Trust underpins all health engagement and must be designed and “baked” into the offering. Today, that trust is built as much on consumer retail experience (the last-best experience someone has had in their daily life, exemplified at this moment by Amazon) as in a new social health contract between providers and patients.

Technical Dr. Inc.'s insight:
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When Doctors Choose a Job Based on the EHR

When Doctors Choose a Job Based on the EHR | EHR and Health IT Consulting | Scoop.it

I recently had lunch with a young doctor new to our community. The conversation wandered on to how she settled on her new position and the EHR was identified as one of her key selection criteria. She heavily favored positions with institutions running EPIC.

 

Interesting, I thought. Because when I took my first job, the brand of manilla folder used in the patient chart played no role in my decision. Clearly, times have changed. And so have the doctors.

What does this tell us about doctors and technology?

 

Not everybody hates electronic health records. The generation that never felt paper has officially entered the clinical workforce. And despite the popular press and their drive to perpetuate anti-EHR sentiment, not everyone hates EHRs.

 

Our experiences are increasingly defined by our tools. The clinical tools that surround us go a long way in determining our quality of life. So the EHR is likely to shape how we view a position. I’m working on my second EHR system in a decade and my day-to-day life is very different.

 

Technology can draw or repel talent. The technology we use and the systems we choose are likely to impact the docs we recruit and the talent we retain. Hospital systems that use dated and/or dysfunctional EHR systems are likely to feel the impact at some point.

 

An isolated case you might think. But the truth is that millennial physicians see the world and the workplace through a very different lens.

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Benefits of EHR Systems - Benefits of Using EHR

Benefits of EHR Systems - Benefits of Using EHR | EHR and Health IT Consulting | Scoop.it

The Affordable Care Act (ACA) radically changed the healthcare landscape, and the rise of electronic health records (EHRs) as critical tools for delivery and continuity of care is one of its more involved outcomes. There are significant benefits of EHR systems for healthcare providers from small private practices to large hospitals and provider groups. To find the best EHR software for your business, make sure it provides these seven key benefits:

 

Meaningful Use

The ACA’s Meaningful Use mandates began to go into effect last year, and providers who aren’t caught up are losing money. The best EHR software is designed to help your practice meet Meaningful Use guidelines and prepare you for upcoming mandates in future stages. There are a number of EHR Incentive Programs that optimal EHR software will help you take advantage of so that you aren’t leaving money on the table.

Scalability

Third party EHR software can grow with your practice and be scaled up rapidly to include larger patient bases. And cloud-based EHRs can quickly integrate patient populations in the event that your practice chooses to join an accountable care organization or group practice.

Accessibility

Online EHRs are always accessible. Unlike EHRs stored on a single server in your office, you can access EHRs managed by a third party vendor from any location with an Internet connection. This allows you to improve collaboration with other health care providers, involve patients in management of their care and respond to patients’ concerns from anywhere.

Support

An EHR vendor who provides customer support around the clock can make your IT concerns disappear. They can also provide on site support that will significantly reduce your IT costs. Data migration, updates and patches are handled automatically so that you don’t even have to think about IT support.

Interoperability

EHRs that can interface with other systems allow your practice to optimize continuity of care. If your patients need to see specialists, manage chronic conditions such as diabetes or plan on transitioning to a home health care environment for recuperation or hospice, an EHR system that offers interoperability is critical.

Customization

Every practice is somewhat different, and EHR systems can be customized to meet your practice’s individual needs so that you get the best possible package. An EHR package that can be tailored to fit your practice’s workflow will make the transition virtually seamless.

Security

Protecting electronic health information is critical. One of the benefits of EHR systems is that they can make sure your practice is HIPAA-compliant and that your health records are protected. EHR companies that are compliant with IDC9/10, CPT and other EHR standards offer the highest security.

Adopting a robust EHR software platform isn’t just about maintaining compliance with Meaningful Use or even about ensuring the best delivery of care to your patients. It’s also about optimizing your practice’s ability to make smart business decisions based on patient data. This kind of business intelligence is critical to growing your practice and optimizing your bottom line.

Technical Dr. Inc.'s insight:

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inquiry@technicaldr.com or 877-910-0004
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