EHR and Health IT Consulting
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EHR and Health IT Consulting
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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Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline?

Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline? | EHR and Health IT Consulting | Scoop.it

As the ICD-10 implementation deadline drew closer, more lawmakers began attempting to develop a different type of transition period in which healthcare providers would not be penalized for reporting inaccurate ICD-10 codes. For example, HR 2247, the ICD-TEN Act, would create a “safe harbor” for providers in which they wouldn’t be denied reimbursement “due solely to the use of an unspecified or inaccurate sub-code.” 


The Coalition for ICD-10 states that the Centers for Medicare & Medicaid Services (CMS) has often accepted less specific codes under ICD-9 and, when the ICD-10 implementation deadline hits, the new reporting requirements will have no difference in level of specificity.


“CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition,” the Coalition for ICD-10 explains. “Furthermore, it would be inappropriate and a violation of coding rules to require a level of specificity that is not documented in the medical record. Indeed, CMS has made it abundantly clear that it would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.”


Essentially, the ICD-TEN Act was proposed due to physician fears that there may be a significant increase in the number of claim denials once the ICD-10 implementation deadline takes effect.

However, the latest CMS end-to-end testing results show that there is only a 2 percent denial rate of claims due to ICD-10 errors. This shows that the physician fears may be unfounded.


According to the Coalition for ICD-10, a “safe harbor” transition period is not necessary and the current status of the ICD-10 implementation deadline should take effect on October 1 as is.


Additionally, CMS released its acknowledgement testing results taking place between June 1 and June 5. CMS accepted a total of 90 percent of claims submitted across the nation during this time period.

While a 10 percent denial rate is significant, CMS holds that the majority of claim rejections were due to submission errors within the testing environment that won’t affect the processing of claims when real claims are submitted after the ICD-10 implementation deadline.


It is time for providers to be ready for the ICD-10 implementation deadline or else risk having their claims rejected once October 1 hits. Any provider who submits ICD-9 codes after the deadline risks having the claims returned to their facility, returned as unprocessable, or rejected, according to apamphlet from CMS.


“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) stated at the end of 2014. ““This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS.”

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CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent”

CMS Official on Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?


Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?

I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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Future of Health IT: “It’s Time to Build Something Magnificent”

Future of Health IT: “It’s Time to Build Something Magnificent” | EHR and Health IT Consulting | Scoop.it

When it comes to health IT policy mandates, provider organizations have long questioned what’s behind the rulemaking process, with many showing further concern regarding federal leaders’ expertise levels and their lack of willingness to change based on public opinion. At the Centers for Medicare & Medicaid Services (CMS), senior technical director of Medicaid health IT Jason McNamara pays no attention these criticisms. “Those types of comments are tied to the old 1970s and 1980s way of thinking about the government, which was slow and hard to move, which sort of like a battleship in the ocean, took time to change. That’s not part of the government I’m with now,” McNamara says.  


McNamara has a wide variety of skills and projects he works on at CMS, ranging from Medicaid electronic health record (EHR) incentive programs to meaningful use rule development to health information exchange (HIE) strategies to consulting on state health IT development under the state innovation model (SIM) grants. McNamara, who focuses on the Medicaid side at CMS, recently spoke with HCI Associate Editor Rajiv Leventhal further about the perception of the government in the health IT landscape, as well as current trends and challenges he’s seeing in the industry from a policy perspective. Below are excerpts from that interview.


Tell me about how you got involved with CMS and what your current role there is?


I work in the data systems group, and if you think about the data systems group, in the context of Medicaid, we essentially work on anything IT related as long as it touches the administration of a Medicaid program or Medicaid beneficiaries. So I like to loosely interpret that as the IT arm of Medicaid. I am a technologist by trade; I spent five years in the Marine Corps, and have trained in communications and technology. I set myself up for a public safety IT focus, which evolved into health IT over the years,  and 15 years later, here I am. I also did work as a consultant implementing EHRs, building proprietary systems for large hospital systems, eventually moving over to the Department of Defense (DoD) and Veterans Administration (VA), having worked on their clinical applications as well. I was clinical operations director for ALTA, the DoD EHR system. Then in 2012 with HITECH legislation coming down, I have been managing EHR incentive programs ever since.


What are your insider thoughts on the DoD EHR contract bid?

Well it’s needed, it’s time to modernize that infrastructure. If you look at the infrastructure that’s in place, it’s antiquated. Some of those legacy systems were developed in the 1970s and 80s. Clearly it’s time to change the way they’re deploying their clinical technologies. This proposal will give us an opportunity to modernize a much needed environment. I have to maintain vendor neutrality here, but folks know some of the largest vendors that have partnered to help develop interoperable solutions, and it’s good that they have come to the table here.


What are the biggest priorities right now for you at CMS?


We have been very focused on Affordable Care Act work; we spent a lot of time deploying that, and now we’re breathing easier and are more focused on modernizing our systems on the Medicaid side, moving them into a real-time, progressive, shared-service model across Medicaid states. We are also heavily focused on data, deploying systems both at the state and federal levels to help analyze the massive amounts of Medicaid data we have. That is huge for us over the next 12 months.  And then we are of course continuing to work on health IT an HIE, an area that has lot of area for growth both from a policy and deployment perspective.


Ideally, in a perfect world, what would be the role of the government in this industry?


It depends on the topic. If you look at the National Health Information Network (NHIN), that was an Office of the National Coordinator for Health Information Technology (ONC) program,  and they managed it 100 percent at the federal level. As time progressed, they changed that and it got run over to a non-profit, Healtheway, who has since taken it over. In that regard, the government was widely used as a kickstarter to deploy that program, which is now self-sustaining in the private market. So I think it was important to push that forward. We took a step back and let the market drive that, and it’s been successful.


 Standards are an interesting topic as to what role the government plays, and we’re still trying to figure that part out. There has been a lot of conversation around open source products, as we have been playing with this idea in the Medicaid space. But how do we administer those open source products? What is our role? We have started to dabble in that market, but how do we translate that back into the community and let them market-ize the platform?


Basically, there isn’t one answer to this question. Everyone would agree that government has an important role, and we have to figure out what that looks like in each separate scenario.


How would you respond to the criticism that federal leaders aren’t appropriately apt to make such impactful health IT policy decisions?

In our government, these are folks who are industry experts who gave up lucrative positions and high paying jobs to help do good. They come from the smartest universities such as Harvard and Johns Hopkins, they were CIOs in large hospitals, and data geeks form get go with three or four computer degrees. So I don’t see this in the world I live in. It is true that it’s difficult for policy makers to keep in touch with where the rubber meets the road. We have to understand the impacts of the policy decisions and how it translates, and we’re getting better at it. We are receptive to public reception and very perceptive into how folks see the program. I’m a technologist, I started by implementing EHRs, so when someone tells me I don’t know what I’m talking about with EHRs, it is offensive. The government is made up of people who want to do good and are here for good reasons. They are underpaid and overworked. I know colleagues that haven’t had a day off in two or three months. So I can’t really associate with those types of comments.

What did you think about the news that Karen DeSalvo is likely out at ONC, and what would you like to see from the next National Coordinator?


I think it's a logical step for her career and her success.  Karen is a dear friend and colleague and she is one who can just get things done. There's value in that mindset no matter where you are in the health system. I think the next coordinator will have to continue to push the community with health IT adoption and interoperability. More importantly, push agencies towards modernizing their various policies that have a direct or indirect impact in the use of technology.  In short, the last five years have been spent laying the foundation. It's time to build something magnificent. 


What are your biggest challenges and pain points right now at CMS?

The way we have done business in the last 30 years is significantly changing; helping become a change agent is a very sensitive thing around everything related to Medicaid. We are not your grandmother’s Medicaid program anymore—it’s a different environment and building that trust is something we’re very focused on. It will become more complicated and important as we liberate data and start to tell stories about our beneficiaries. We have begun to publish a lot of data, and then folks get access to it, analyze, and make connections. We need to make sure communications across systems is continual, that’s a big focal point for us.


With respect to EHRs, we are very mindful of providers who have never had technology in practice. They are a minority but they do exist, as a specific percent are struggling with that. So it’s a challenge considering that from a policy perspective. Also, from a federal perspective, figuring out what’s the value in what we pay for? The data systems group has a $5 billion IT portfolio across states, but what does that mean and how do we create an environment where we make taxpayers dollars most effective installing systems? That’s very complicated, especially when working with legacy systems.  


You help write the EHR certification criteria for the meaningful use program. Can you get into detail about what’s behind that?

We create an advisory group, which comes from the private sector—doctors and CIOs—not public servants.  That committee looks at the program, takes public comment, and has very intimate conversations about how it will look from a clinical and systems perspective, and how it will be deployed. So we take in recommendations, and sometimes the idea starts with a simple Word document. We’ll toss around ideas and end up with some direction. The committee acts as an objective filter for that. So once we do that, we make a notice for proposal.  


For the meaningful use program, we put that on the street and take public comment. We are required to respond back—most people don’t even know that. If there’s a policy objective or measure we use and there’s a lot of comment, we can go back, change it and finalize it. We take our process from the Hill, we interpret what we think they’re trying to achieve for regulation, and then we finalize that with our rulemaking process. Then we go forward and deploy the program. When we start to hear questions from provider groups or associations, we create a sub-regulatory guidance, which provides clarity to what we intended when people have difficulty interpreting things. And we can use riders to modify and make amendments as well.  


What has the Stage 3 feedback been like so far?


I think we are at a place where Stage 3 was an aggregate of comments that we have heard over the years. We have learned lot of lessons with Stage 1 and 2, and we are now seeing a much more simplified version. How is this connecting to other programs? It aims to simplify the administration process. Folks have been generally favorable—there have been some concerns about the details of the regulation, and we will publicize those as we start to finalize it. Stage 3 is a much needed policy change, generally speaking.


You have worked with a ton of EMR vendors in the past. How would you rate their willingness to be more open systems?


I think at the end of day, vendors are there for their customers. That means a few things: customers have to hold the vendors accountable, customers have to be knowledgeable, they have to know what they want, and they have to know what’s happening. Too often we see providers pointing fingers at vendors, but are you asking them the right questions and holding them to those standards? Chances are if you hold someone to a standard, he or she would like to perform to that standard.


I think vendors want to support their customers, do good by them, stay in business, and grow revenue, and the way to do that is to solve problems of customers. You can’t get answers to those problems unless you ask questions, though. The vendors are trying, some have built infrastructure around housing their data in an effort to move data within the context of their own systems. I think that’s okay for now. But when folks talk about restricting and closing access, that’s a problem for me. We meet with vendors regularly, people don’t realize that. If we’re hearing problems from providers over and over again we can go right to the executive leaders of those vendors to work those out.

If you had to give a message to the industry as they move forward in a challenging time, what would it be?


We have to keep asking questions and challenge the data. We have a data-saturated environment right now. There is a lot of noise around that data, but what does it all mean? A very important piece of all this, and this ties into interoperability, is the semantics of the data. Let’s keep challenging the data, keep asking questions, and if we have asked so many questions and challenged different pieces, then we have created this fog, but we could sift through that to find direction and truth. It’s not about you, me, a specific provider or vendor, it’s about the collective. What are we doing as the collective to move forward? Let’s have the conversation that way.


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What you don’t do in 2015 will cause 9% CMS penalties in 2017

What you don’t do in 2015 will cause 9% CMS penalties in 2017 | EHR and Health IT Consulting | Scoop.it
The initial notifications of Centers for Medicare & Medicaid Services (CMS) meaningful use (MU) penalties shocked many a health care provider. Years of incentive programs were initiated to stimulate the adoption and use of electronic health records, and many providers did not realize there was a backside to the incentives – penalties.

The full range of providers, from solo practitioners to large hospital systems, are now within the scope of the in-coming wave of penalties.

For Medicare Subsection (d) eligible hospitals that failed to become “meaningful users of certified technology” by October 1, 2014, the penalty will slash their Inpatient Prospective Payment System. As a direct result, critical access hospitals will experience a reduction to their “reasonable costs” payments.

That said, the largest potential smack down is reserved for the hundreds of thousands of providers in clinics and private practices. More than 250,000 eligible professionals were notified they would be penalized as of January 1, 2015 for not becoming meaningful users.

Here’s what is in store for this unsuspecting lot:

MU: Failing to achieve MU in 2014 will bring a 2% penalty beginning in 2016 with a 1% annual increase up to 5%.

Physician Quality Reporting System (PQRS): Non-participation brings a Medicare reimbursement reduction of 2.0% in 2016 based on 2014 data.

Value-Based Modifier(VBM): The VBM, which many providers are not aware of, is linked to PQRS. Beginning in 2016, eligible providers (EPs) in groups with 10 or more EPs will be subject to a penalty based on performance. In 2017, this will include all EPs, not just those in larger groups.

Taken together, this adds up to a 9% penalty in 2017 based on 2015 participation.
To avoid these penalties, immediately assess your current participation in the MU, PQRS, and VBM programs. If you are not on track you must take steps to mitigate your risk as soon as possible.
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ICD-10: CMS won't deny claims for first year

ICD-10: CMS won't deny claims for first year | EHR and Health IT Consulting | Scoop.it

In a surprise concession, the Centers for Medicare & Medicaid Services announced Monday that it would work with the American Medical Association on four steps designed to ease the transition to ICD-10.


Despite longtime disagreements on the topic, CMS will now adopt suggestions made by none other than the AMA with regard to the code set conversion. Those changes concern:


1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family," CMS officials wrote in a guidance document.


2. Quality reporting and other penalties. "For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."


3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.


4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, "to help receive and triage physician and provider issues." The center will also "identify and initiate"resolution of issues caused by the new code sets, officials added. 


"These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change," wrote Stack.


While AMA played a pivotal role in bringing about these CMS concessions, it was not the only party calling for a smoother conversion to the new code set.


Some members of the U.S. Congress have publicly suggested a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that "a valid ICD-10 code will be required on all claims starting Oct. 1, 2015."


So as things stand today, providers have to use ICD-10 come October – but CMS will be more flexible about denials and payments than it has previously suggested it would be.

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EHR Incentive Programs Sparked Market to Reach $25 Billion

EHR Incentive Programs Sparked Market to Reach $25 Billion | EHR and Health IT Consulting | Scoop.it

The meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have brought forth an era of electronic data access for the healthcare industry. The EHR market has never been stronger and recent findings illustrate that fact. A report from Kalorama Information called EMR 2015: The Market for Electronic Medical Records states that the EHR market reached nearly $25 billion in 2014.


Some of the stimulants that led to this increase for the EHR market come from the payment penalties promised by the Centers for Medicare & Medicaid Services (CMS), the financial boosts assured under the EHR Incentive Programs, vendors upgrading systems, and the search for greater efficiency throughout the healthcare industry.

“There’s still a healthy and competitive market for EMR,” Bruce Carlson, Publisher of Kalorama Information, said in a public statement. “Expect growth this year and next at seven to eight percent and stable growth until 2019. Eventually, there will be market saturation but this is a bit of a way off, especially in emerging markets.”


Between 2012 and 2014, the EHR market grew by 10 percent due to system upgrades and EHR adoption across the healthcare sector. Kalorama predicts that this market will hit $35.2 billion over the next four years.


As more providers and hospitals continue to attest to Stage 2 and Stage 3 Meaningful Use requirements under the EHR Incentive Programs, EHR adoption and upgrades will continue to rise over the coming years. Additionally, the payment reductions stemming from the meaningful use regulations will push more healthcare providers to continue updating their systems and spending more funds on certified EHR technology.


The latest results from CMS show that, last year, more than 80 percent of doctors across the country have utilized an EHR system as compared to 57 percent in 2011. At this point in time, the federal government has distributed more than $28 billion among providers who have successfully attested to meaningful use requirements under the EHR Incentive Programs.


The Kalorama report also found that EHR adoption varies among different parts of the US and different age groups with younger physicians more likely to implement and utilize certified EHR technology. One out of two doctors report having EHR platforms that meet the federal criteria for having a basic system.


The report from Kalorama discusses a variety of issues within the health IT sphere and the stimulants behind the EHR market. These factors include the historic market growth since 2012, regulatory trends, international market sizing, and profiles of various EHR vendors. Additionally, the report covers the status of meaningful use requirements, incentives under the EHR Incentive Programs, and vendor pricing.


Currently, the healthcare IT market is very complex with a wide variety of developments stimulating its growth. From mergers, acquisitions, security developments, and the ICD-10 transition to BYOD, big data, and the rise in electronic prescribing, the health IT market is likely to continue growing and transforming over the coming years.


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CMS Releases Strategic Vision for Physician Quality Reporting Programs

CMS Releases Strategic Vision for Physician Quality Reporting Programs | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare and Medicaid Services (CMS) has released its strategic vision for physician quality reporting programs, describing a long-term vision for CMS’ physician quality reporting programs and a future for these programs to strive toward over the next several years.

According to CMS, this vision acknowledges the constraints and requirements of existing physician quality reporting programs, as well as the role quality measurement plays in CMS’ evolving approach to provider payment, which is moving from a purely fee-for-service (FFS) payment system to payment models that reward providers based on the quality and cost of care provided.


There are five principles that the federal agency believes will ensure that quality measurement and public reporting play a critical role in improving the healthcare delivered to millions of Americans:


  • Input from patients, caregivers, and healthcare professionals will guide the programs.
  • Feedback and data drives rapid cycle quality improvement.
  • Public reporting provides meaningful, transparent, and actionable information.
  • Quality reporting programs rely on an aligned measure portfolio.
  • Quality reporting and value-based purchasing program policies are aligned.


“CMS relies heavily on quality measurement and public reporting to facilitate the delivery of high quality care,” according to a blog post from Patrick Conway, M.D., principal deputy administrator and chief medical officer at CMS. “This strategic vision articulates how we will build upon our successful physician quality reporting programs to reach a future-state where quality measurement and public reporting are optimized to help achieve the CMS quality strategy’s goals and objectives, and therefore contribute to improved healthcare quality across the nation, including better care, smarter spending, and healthier people.”


According to the blog post, the strategic vision evolved out of the agency’s desire to plan for the future in how it administers the physician quality reporting system (PQRS), physician feedback/value-based payment modifier program, and other physician quality reporting programs. With passage of legislation ending the Sustainable Growth Rate (SGR) formula, key components of these physician programs will serve as the foundation for the Merit-based Incentive Payment System, Conway added.


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