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The doctor will e-mail you now. And then see you later.

The doctor will e-mail you now. And then see you later. | EHR and Health IT Consulting | Scoop.it

When Ted Palen, a Kaiser Permanente researcher, started investigating what happens when doctors begin e-mailing with patients, he thought he would see the practice lighten workloads. Patients would get their questions answered remotely, with no need to turn up in person.


Palen just finished a five-year retrospective study of what happened when Kaiser Permanente in Colorado began allowing e-mail access to doctors in 2006. The outcome, as Palen notes in this week’s Journal of the American Medical Association, was “contrary to our expectations”: Online access to doctors was associated with more doctor visits, not fewer.

 

There was a big spike in visits and phone calls to doctors’ offices right when the new e-mail access, called MyHealthManager, came online. The graph displayed divides the Kaiser Permanente population into those who were using the online access program, and those who were not:


That initial spike did taper off with in a few months. Even a year later, however, those who utilized the online access to doctors still had higher rates of doctor visits per month

 

There are a few possible explanations of what is happening here. One that the researchers discuss is an issue of self-selection: Those who would sign up for the online health manager might be more inclined to take a greater role in managing their own health. “Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system,” the researchers write.


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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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Medicare's Big Data Dump Is Just That - A Dump

Medicare's Big Data Dump Is Just That - A Dump | EHR and Health IT Consulting | Scoop.it

Based on the headlines, many might think that the sole purpose of the Medicare data (released last week) was a scavenger hunt for the "Medicare Millionaires." There was certainly no shortage of headlines with that exact phrase. Medicare Millionaires Emerge in Data on Doctor Payments (Bloomberg) Medicare millionaires: Florida eye doc got $21 million from Medicare in 2012 (NY Daily News) Medicare millionaires: Who are the top paid doctors? (The Christian Science Monitor) Who are the Medicare millionaires? (MSNBC) Medicare millionaires (CNBC) Medicare millionaires emerge in data on physician payments (Providence Business News) 340 Texas doctors among Medicare's millionaires (Dallas News) First Data Detail in 33 Years Shows 4,000 Medicare Millionaires (MoneyNews)



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Curbside Consult with Dr. Jayne 4/7/14 | HIStalk

Curbside Consult with Dr. Jayne 4/7/14 | HIStalk | EHR and Health IT Consulting | Scoop.it

I renewed my battle today with Big University Medical Center in trying to get my information corrected on its patient portal. Unfortunately, my efforts were derailed by a much more sinister problem – basic office chaos.

Luckily I’m a nice, stable patient so I only have to visit Big University’s outpatient clinic once a year. They run chronically late. I’ve learned to always schedule the first appointment of the morning so I can have a chance to make it to my own office before noon. I make sure to arrive on time if not early because they tend to triple (if not quadruple) book appointments and I want to be the first of the cohort to be roomed. I also bring plenty of reading material so I don’t go out of my mind when I inevitably end up waiting.

I shared the elevator with a member of the office staff who was reviewing a printed patient appointment schedule (including names, appointment reasons, and dates of birth.) I’m not sure why anyone would need to take home a printed schedule since they have a big-time EHR system with remote access and plenty of redundancy and they definitely shouldn’t have been reviewing it openly in the elevator.

I hit the floor 15 minutes early (as instructed by my appointment reminder that came through the patient portal) only to find the doors locked and six patients standing in the hallway. The weather was decent, so bad roads or traffic weren’t a viable excuse. They finally opened the doors just a few minutes before my appointment time and all the patients hustled to the check-in desk.

Since the office doesn’t use sign-in sheets (purportedly for HIPAA purposes) they told everyone to sit down and they would call us up in appointment order. Most of the patients were retirees and began grumbling. While we were waiting, we were treated (via the open floor plan check-in desk) to one of the receptionists chatting about some birthday party she was invited to.

By now, it was past the first appointment time and we got to watch her start up her computer, stow her personal items, then walk away. 

My process improvement brain had engaged. I decided to do an impromptu time and motion study. She was gone four minutes and came back with an open cup of coffee. I know there are no OSHA requirements about coffee at a desk, but there ought to be some rules about open liquids and eating around computers. Not to mention that slurping coffee in front of patients is unprofessional. 

The first receptionist had checked in two patients and had called me up before the second one was ready to start working. The receptionist apologized about my wait. I mentioned that their reminders tell everyone to come early. She said she knew it was a problem and they’ve asked to have the message modified several times because they don’t open early. They didn’t have a printed patient information form to verify, but rather read all our demographics aloud and asked for verbal verification.

I felt bad asking her about my patient portal problem and spared her the long story. I simply asked if they had a help desk number I could try before I left the office since all the demographics are correct at the practices where I’m seen but are wrong on the portal. The only advice she could offer was to try the help feature from within the portal.

By this time, they had four patients checked in. It was 15 minutes after the first appointment time (assuming I was actually in the first slot as I had requested) and not a single patient had been called back by the clinical staff.

I was placed in an exam room with the door left open. While waiting for the patient care technician to start my visit, I was treated to conversations about other patients coming later in the day, various people walking back and forth chatting about their weekend activities, and a physician who normally doesn’t work at the satellite location who didn’t know what exam rooms he should work from or who his assistant would be. Not exactly a vote of confidence for patient privacy or engagement.

Last year my physician had used a scribe to document my visit in the EHR. I figured at least once they would try to blame the EHR for the delays. As they started my visit, I realized they wouldn’t be scapegoating the EHR – the office had gone back to paper. The tech started documenting my visit on a photocopied paper template. She did reference the electronic allergies documented in the EHR and re-documented them on paper, so score one for patient safety. She also reviewed the previous note input by the scribe as well as a “backup” paper note that apparently was documented during my last visit.

I let her know I wanted to talk about a new concern that popped up in the three months I waited for my appointment. She responded by letting me know my physician was no longer caring for “routine follow up” patients and I would have to find a new doctor if the new concern didn’t turn out to be anything serious. I’ve already been handed off multiple times within this practice, so I’m no stranger to starting over, but I thought the timing was poor.

I finally saw the physician 45 minutes after my scheduled appointment. She remembered that I’m a member of the community teaching faculty for Big University and offered to keep me as a patient even though my new concern turned out to be nothing. I should probably feel grateful to not have to change physicians again, but I think I’m going to anyway. Their office is a mess and I get aggravated every time I go. Simple things like a) cutting the personal chatter while there are multiple patients waiting; b) being vigilant about behavior when the practice has an open floor plan; and c) manifesting obvious “hustle” when you know you’re late opening would go a long way towards reducing that aggravation.

Now they’re not using EHR any more, so my data isn’t available to share with other physicians. There’s not an advantage of staying there vs. finding a physician at one of the other institutions in town. If my records are going to be in silos, it doesn’t really matter if the silos are 20 miles apart or right next door. The clinic always posts a loss and blames it on the number of Medicaid and charity patients they see, but after several years of this routine, I’m fairly convinced that poor management has as much to do with it as patient mix.

I’ve never received a patient satisfaction survey from this location, but hope I get one today. I’ve got some choice recommendations to share with them, although I don’t think it will make much of a difference. It doesn’t matter how much we spend on IT or whether the systems have outstanding usability if we can’t get back to the basics and actually manage our offices, whether they’re academic clinics, private practices, or hospital outpatient departments.

Making sure that IT functions support our mission by synchronizing automated reminder messages with actual office practice, having help desk support for patient-facing systems, and ensuring staff come in early enough to turn their computers on before they start assisting patients are a must as well. There are numerous stressors on all our healthcare systems and personnel. We have to come up with ways to fix them.

Have any creative ideas? Email me.

Email Dr. Jayne.



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What does it take to get beyond hype in health IT and focus on valuable, actionable, practical, relevant content?

What does it take to get beyond hype in health IT and focus on valuable, actionable, practical, relevant content? | EHR and Health IT Consulting | Scoop.it

My friend John Lynn was kind enough to cover the new HealthIMPACT Conference that I’m chairing in Houston on April 3 in his recent piece entitled “Getting Beyond the Health IT Cheerleaders, BS, and Hype Machine“. While the article was great, Beth Friedman’s comment was priceless:

What are the criteria to be considered part of the cheerleader squad? This PR agency wants to be sure we are providing valuable, actionable, [practical], relevant content….NOT HYPE! And we’re open to your guidance.

John gave her a great reply:

It’s interesting how in high school you always wanted to be a cheerleader, but in marketing you don’t want to be seen as the cheerleader;-)

I think your description describes what you need to do to avoid hype. You have to focus on what really matters to the customers. Provide value to the customer as opposed to trying to sale your product. A deep understanding of the domain will create a relationship where people trust your views and then can talk about what you’re doing to solve their problems which you understand deeply.

Since Beth posted a great question I wanted to do it justice by answering more specifically. By the way, we’ll be covering a lot similar material at the inaugural Health IT Marketing Conference taking place in Vegas on the 7th and 8th of April. Join us!

Health IT “Cheerleaders” in my mind are those that push technology without considering deep value, return on investment, return on assets, and productivity loss. The hype machine is built around technology when health IT “cheerleaders” focus more on the gadgetry itself rather than the value proposition. If content is built around workflows, workflow optimization, and those tasks within existing or new workflows that optimize patient care through the use of technology then that’s real value.

This morning a college student sent a great question around health IT related productivity loss:

I am currently working on a capstone project for my MBA and my team is required to address a set of challenges as well as opportunities. One of the challenges they seem to be concerned the most [about] is the reduction in productivity of the physicians during and after the implementation of the EHR platform (they are currently working on a paper-base workflow). Since EMR requires doctors to type in the information which eventually takes significantly larger amount of time compared to their traditional method of handwriting, they are asking about ideas what they should do.

I replied that this sounds like a great project – and promptly advised them to conduct an analysis on whether the concern or productivity loss is warranted. I suggested they do a current workflow analysis to figure out their efficiency of existing steps and how those steps would change after an EHR is installed. If such an analysis is not done, evidence-driven technology choices cannot be made.

For a great example of how to build content around clinical workflows, check out HRSA’s guidanceIt’s still surprising to me how many of us in the tech business suggest usage of technology without a deep understanding of workflow. Progress will come, and cheerleading will be reduced, when tech meets workflow in a measurable way.



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ICD-10 delay --I'm quoted in AIS Health

ICD-10 delay --I'm quoted in AIS Health | EHR and Health IT Consulting | Scoop.it

I was surprised –like many others– that the latest temporary “doc fix” bill also delayed the implementation of ICD-10 coding for a year or more. Everyone I know had expected the real deadline to be October of this year. We were told as much by CMS leader Marilyn Tavenner in her keynote address at #HIMSS14 in late February:

“There are no more delays and the system will go live on October 1. Let’s face it guys, we’ve delayed this several times and it’s time to move on.”

But she doesn’t run Congress and they decided to do their own thing.

AIS Health (Health Plans Are Not Happy After One-Year ICD-10 Delay Slipped Into ‘Doc-Fix’ Bill) asked me for my perspective on the delay:

David Williams, co-founder of the Health Business Group and MedPharma Partners consultancies and author of the Health Business blog, tells HPW that he thinks the consistent and public drumbeat of negative news that has come with the Affordable Care Act (ACA) rollout has something to do with the congressional action on ICD-10. “I think it actually ties into the challenges of the implementation of the ACA….People are wary of sudden switchovers after seeing the various delays in mandates of the ACA.”

If I had been lobbying for a delay (I wasn’t), I would have pointed to the disastrous launch of the federal –and some state– insurance exchanges under ObamaCare and said we don’t want to see something like that for ICD-10 in October, just before the elections. Delaying for a year or more will provide more time for testing, something the exchanges seemed to have skipped. I would also have pointed out that the administration has repeatedly pushed back deadlines, some at the last minute. That line of reasoning could have been persuasive to those on both sides of the aisle, and it’s my guess that such logic was employed.

Whoever paid their lobbyists to pursue this outcome must be pleased with their investment. I wonder if they’ll try for a further extension next year. If so, they’ll have to reveal themselves and face some strong counter lobbying by ICD-10 proponents, who won’t be caught sleeping twice.

photo credit: Chris Devers via photopin cc

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New Resources Available on 2014 Certified EHR Technology Hardship Exception | EHR Blog | AmericanEHR Partners

New Resources Available on 2014 Certified EHR Technology Hardship Exception | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it
Technical Dr. Inc.'s insight:
New Resources Available on 2014 Certified EHR Technology Hardship Exception

The following information was provided by the Centers for Medicare & Medicaid Services and is reproduced here in its entirety:

Eligible professionals and eligible hospitals that are unable to implement EHR technology certified to the 2014 edition criteria in time to successfully demonstrate meaningful use for the 2014 reporting year may be eligible for a hardship exception from the applicable Medicare payment adjustments. CMS has released additional guidance on the 2014 certified EHR technology (CEHRT) hardship exception for the Medicare EHR Incentive Program. Tipsheets for eligible professionals and eligible hospitals are now available.

Payment adjustments are applied in 2016 for the 2014 reporting year for providers who demonstrated meaningful use in a previous year.  New participants in the 2014 reporting year can also apply for an exception to the 2015 payment adjustment.

CMS is currently accepting hardship exception applications for the 2015 payment adjustment only. Hospitals need to apply by April 1 and eligible professionals by July 1.

Hospital Hardship Exception Deadline Approaching on April 1

Payment adjustments for eligible hospitals that have not successfully participated in the Medicare EHR Incentive Program will begin on October 1, 2014.

Hospitals that have never participated in the Medicare EHR Incentive Program can take action by April 1 and avoid the adjustment by:

  • Submitting a hardship exception application for experiencing circumstances that posted a significant barrier to achieving meaningful use
  • Beginning 90 days of meaningful use for the 2014 reporting year by April 1 and attesting by July 1

Hospitals that participated in 2011 or 2012, but did not successfully participate in 2013 due to circumstances that created barriers can also submit a hardship exception by April 1.

The application must be submitted electronically or postmarked no later than 11:59pm ET on April 1, 2014 to be considered. If approved, the exception is valid for one year.

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Kicking the SGR & ICD10 Can Down the Road | EHR Blog | AmericanEHR Partners

Kicking the SGR & ICD10 Can Down the Road | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

In case you missed it, Congress passed legislation this week to “patch” the Sustainable Growth Rate (SGR) formula and delay ICD10 for another year. The process used by the House to pass the bill (voice vote; no accountability) was the subject of several articles. Government HealthIT Editor Tom Sullivan called it the “dark side” of the bill. Ed Park, EVP/COO of athenahealth called the ICD-10 delay a “canary in a coal mine”. John Halamka asked some CIOs what they thought and the responses were mixed. Professional societies generally were not supportive of the Protecting Access to Medicare Act 2014 because the bipartisan, bicameral bill to replace the SGR was the closest Congress has gotten to eliminating the SGR after after 16 “patches”. Now, there’s a 17th patch. Here’s one blog post from ACP’s Bob Doherty, Senior Vice President of Governmental Affairs & Public Policy – and an April Fool’s jibe at the whole process. AAFP expressed disappointment as did the AMA. Politico reports that there are still ongoing efforts to work on a permanent solution to the SGR. For now, it just looks like kicking the can down the road…again.

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Why Everyone Better Learn About ACOs | EMR and HIPAA

Why Everyone Better Learn About ACOs | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it
While I wasn't working in healthcare at the time, I've heard a number of doctors say that doctors missed out on being part of the HMO process. Their voice


While I wasn’t working in healthcare at the time, I’ve heard a number of doctors say that doctors missed out on being part of the HMO process. Their voice wasn’t part of the process and they suffered as a consequence of that decision. As I consider that idea, I wonder if doctors aren’t in the same position again with ACOs.


I was reminded of this as I was reading through this whitepaper called ACO & Collaborative Care – The Basics. The whitepaper digs into a number of good ACO discussions, but I was struck by one of the opening phrases:


Health reform IS REAL and NOT GOING away.

That struck me, because I think many doctors are just hoping that this shift to ACOs and value based reimbursement will just go away. Certainly some of this hope is founded since ACO is such a nebulous concept and we’re not sure how it’s going to be implemented. However, just because a concept isn’t totally defined doesn’t mean that it’s not going to be the future of healthcare. I assure you that this shift in reimbursement isn’t going anywhere.


The fact that ACO is a nebulous concept is exactly why doctors should get involved in the process of defining an ACO. When there’s uncertainty, there’s opportunity. The question is whether the opportunity is going to be taken by doctors or by someone else. Ideally all parties will be involved and there will be a give and take. However, I think currently physician voices are underrepresented and they’ll suffer for it.


One other thing that the ACO & Collaborative Care – The Basics whitepaper points out nicely is that you can’t just go out and buy an ACO. There’s no off the shelf ACO solution that will solve your problems. It’s not a software. It’s not a program. It’s not an organization. It’s likely going to include all of those things and that means that it takes some planning, coordination and collaboration. You’re not going to be ready for it if you’re not part of the ACO conversation.

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The Time Has Finally Come for MU, It Really Is Now or Never

The Time Has Finally Come for MU, It Really Is Now or Never | EHR and Health IT Consulting | Scoop.it

The healthcare industry has been talking about Meaningful Use (MU) for years now. The program started in 2011, but there were discussions and planning going on years before that. It’s become a ubiquitous topic in healthcare publications and blogs. So much so that many providers probably still think that they have time to decide if they are really going to attest or not.

The truth is that 2014 is last year to initiate participation for Medicare to receive incentive payments. To avoid the first adjustment of 1%, providers must attest for Stage 1, Year 1 no later than the third quarter of 2014 (July 1 – September 30, 2014). You can still start MU in future years to avoid additional penalties, but you won’t get any incentives and you will still have the 1% deduction on your Medicare Part B Claims starting in 2015. That penalty doesn’t go away if you start MU in 2015 or 2016.

What this means is that the estimated 40% of America’s physicians who don’t’ have an EHR and haven’t yet begun to attest for MU have a decision to make—now. And there are essentially three options:

  1. Choose an EHR and attest in 2014
  2. Accept the penalty (which increases each year)
  3. Request a hardship exception.

Here is what you need to know about each of these options so you can make the right choice for your practice.

Choose an EHR & Attest

Over $16 billion in incentives has been paid out to providers who have been attesting for MU. If you start in 2014, you’ll still get $24,000 over three years for your efforts. You’ll also avoid the penalties, which start with 1% in 2015 and increase each year for a minimum of three years. The larger your Medicare pool of patients, the more sense this makes financially.

If you are going to adopt an EHR now, be sure to choose the right solution for your needs. Many of the providers who have not yet implemented an EHR, are small practices (10 or fewer providers). According to a survey conducted in January by SK&A, the smaller the practice, the lower the adoption rate. Small, independent practices don’t have staff, time, or money to waste. So it has to be right the first time. Take these factors into consideration:

  1. Cost: There are now free and low cost EHRs that can offer almost any specialty the tools they need to reap the benefits of an EHR.
  2. Cloud-based and Mobile: Its 2014, don’t choose an EHR unless it offers anytime, anywhere access and true mobile connectivity.
  3. 2014 Edition Certified for MU: As of January 1, 2014, you need a 2014 Edition certified EHR to attest for MU. Only about 12% of complete EHRs have this certification, which narrows the field.
  4. Total Integration: You can get more from your EHR if it is fully integrated with your practice management and billing system. You can meet MU and streamline many other functions. As a bonus it can actually increase both charges and collections. A UBM white paper showed that the average increase in revenue was $33,000 per FTE provider per year!

Accept the Penalty

So you are thinking you’ll just take the penalty. This may be because you don’t serve Medicare patients or at least not that many. It could also be that you are planning to retire soon and don’t think you’ll be around in another couple of years. But consider this, with MU, PQRS, and eRx penalties, it reaches over 10% in total adjustments to your Medicare Part B claims in five years. If you do start seeing more Medicare patients (as your patients age) or you don’t retire, 10% is nothing to sneeze at. If you are a solo doc and you generate an average of $30,000 a month and about 30% of your patients have Medicare, that’s $10,000 a month. A 10% cut adds up to $12,000 a year. To make that up, you would have to conduct about 100-120 more patient visits a year (if your average visit reimbursement is around $100-150).

And here is something else to consider. Perhaps you are willing to take that hit, and you are sure that you don’t want to attest for MU. But does that mean you don’t need to implement an EHR? Not these days. Patient expectations are changing, and to stay competitive you need to meet those expectations. A study conducted by the Optum Instituteshowed that 62% of patients want to correspond with their physician online and 75% are willing to view their medical records online. Another survey conducted by Deloitte showed that two-thirds of patient would consider switching to a physician who offers secure access to medical records online. You need patients to stay in business so take their changing needs seriously or you may struggle to stay competitive in changing times.

Request a Hardship Exception

The first thing that needs to be said here is that not everyone can apply for a hardship exception. If you’d like to attest for MU, but need more time AND you meet one or more of the criteria, then you should definitely consider this option. This is a summary, check the CMS tipsheet to find out more:

  1. Your area lacks the necessary infrastructure (i.e., no broadband)
  2. You’re a new provider
  3. Natural disaster or other unforeseen barrier
  4. Lack of face-to-face interaction with patients
  5. Practice in multiple locations
  6. EHR vendor issues (i.e., your current vendor was unable to certify for 2014 edition)

For most providers who are practicing full time in a single location and have not yet chosen an EHR, these exceptions won’t apply. This leaves you with choices and one and two above. You will still need to decide if you want to attest or not.

If you are still on the fence, consider this… Beyond MU, practices are facing the ICD-10 transition and a changing reimbursement landscape with ongoing reform from of the Affordable Care Act (ACA). Technology can be a very effective tool to help you manage these changes and turn this set of challenges into an opportunity to optimize your practice and position your business for success no matter what comes your way.

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ICD-10 – Is Everyone Ready? – ICD-10 Tuesdays | EMR and HIPAA

ICD-10 – Is Everyone Ready? – ICD-10 Tuesdays | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

One of the biggest challenges to revenue a practice will face in 2014 is the move to ICD-10 on October 1, 2014. One of the biggest challenges with ICD-10 is that it impacts the entire healthcare ecosystem. This means that revenue flow could be impacted if any one part of the healthcare billing continuum isn’t ready.

The first key step every organization can take to prepare for the switch to ICD-10 is to do an audit of which systems, people, and processes will be impacted by the change. Second, you should evaluate the ICD-10 readiness of each system, people and process. Finally, you should make a plan for how you’ll ensure that each piece of the puzzle is ready for ICD-10.

Here’s a quick look at some of the places you’ll want to look when doing an audit of your ICD-10 readiness:
EHR Software
This is an obvious one. We all know that the EHR vendor needs to be ready for ICD-10. However, as John posted previously, Is Your EHR Ready for ICD-10, Not Just Say They’re Ready? it’s really easy for an EHR vendor to say they’ll be ready for ICD-10. At the core of being ready for ICD-10 is just being able to use a new code. Every EHR vendor will be able to enter the new code. Instead of asking if they are ready for ICD-10, you should ask your EHR vendor what interface they’ve created for you to be able to find the ICD-10 codes. You’ll want to get in and test this new interface for finding codes well before the ICD-10 deadline so they can make any changes to the software.

Providers
Every doctor I know understands they they’re going to have to be ready for ICD-10. They’ve heard about the expanded set of codes and how finding the right code is likely going to take extra time. What many doctors haven’t realized yet is that with increased coding specificity, the doctor’s documentation is going to have to change as well. Coding 101 is that the coding has to match the documentation. This will require every doctor to change the way they document their visit even if it’s only a small change.

Billing Software
This is another obvious one and many of the lessons mentioned above about EHR software apply to billing software. However, you’ll definitely want to make sure that your billing software is ready for ICD-10. Can you imagine the impact to your organization if they’re not ready? You might not think this is possible, but I’ve heard some billing software already announce that they’re not planning to revise their software for ICD-10.

Billers and Coders
This is the group that seems most prepared for ICD-10. Most people realize that the coders or billers in their organization need to be ready for ICD-10. Unfortunately for many organizations, that’s where they think all the ICD-10 preparation needs to happen. As this list shows, they are so wrong. However, if you haven’t invested in getting your billers and coders ready for ICD-10, then you better start doing so now. In some cases you may have an older coder that chooses to retire instead of learning ICD-10. Make sure you learn if this is the case now instead of October 1st.

Billing Company
It’s really hard to imagine a billing company not being ready for ICD-10. It’s a basic fundamental of them being a business. If they can’t do ICD-10 they’ll be out of business. However, it makes sense for you to check with them to see what they’ve done to prepare for ICD-10. You’re their customer and it never hurts to hold them accountable. If they don’t thank you up front, they’ll thank you on October 1st when they’re ready for the change.

Labs and Radiology
You’d think that these wouldn’t be that big of an issue since we’re just talking about a new code that gets sent to the lab or radiology. However, if they’re not expecting ICD-10 codes, your patients could run into issues. Plus, many of you have interfaces which send this information automatically. You’ll want to make sure that these interfaces can handle the new codes as well.

Payors
This is probably the most important one and also one of the most challenging. It is the most important, because if they’re not ready for ICD-10 that could mean that you stop getting paid. In many organizations, a hit to their cash flow could have serious ramifications. My guess is that some of you don’t think that this could ever really happen. I assure you that it could happen. Certainly they’ll eventually fix whatever issues they have and they’ll get rolling with ICD-10. Although, will it take them a week, a month, a couple months, to fix whatever issues they may be experiencing? Can you handle not getting paid for a week, month, or multiple months? The challenge is that there’s no simple way for you to know if the payors are indeed ready for ICD-10. The best advice I can offer is a famous statement, “The squeaky wheel gets greased.” Don’t be afraid to make some noise to make sure they’re ready.

Hospitals and HIE
Many vendors are starting to build interfaces with their hospital or an outside HIE (Health Information Exchange). If you have one of these interfaces, you’ll want to make sure that it can support the new ICD-10 codes. Don’t forget to check and test both sides of the interface for their ICD-10 readiness.

Other ICD-10 Readiness Advice
When assessing the readiness of the various entities listed above (and you will likely have others), it’s important that you ask the right questions to make sure you get the right answers. Much like when you’re evaluating between EHR vendors, you want to avoid asking Yes/No questions. For example, if you ask your EHR vendor, “Are you ready for ICD-10?” then you will quickly get a response of Yes. If instead you ask, “What have you done to get ready for ICD-10?” you will get a much more informative answer that helps you understand their true ICD-10 readiness.

Also, when doing your assessment of their readiness, don’t forget to also verify that they can handle ICD-9 for those situations where an organization still hasn’t moved to ICD-10. Yes, it’s crazy that some government organizations aren’t moving to ICD-10. However, it’s the stark reality, so make sure that when needed to you can still support ICD-9 as well.

In all of this, there’s a challenging balance between doing your training too early or too late. If you train your doctors on ICD-10 too early, then they’re likely to forget it by the time October 1st rolls around. However, if you wait until the ICD-10 deadline approaches, the resources for ICD-10 won’t be available. Can you imagine what it will be like to try and hire an ICD-10 coder or ICD-10 trainer in September?

Technical Dr. Inc.'s insight:

Did you know that Technical Doctor has an ICD-10 training tool for your practice?  Our web based application allows your staff to train at their own pace, and providers can train when they aren't seeing patients.  Contact inquiry@technicaldr.com or call 877-910-0004 to learn more!


- The Technical Doctor Team

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What is the future of computerized physician order entry? | EHRintelligence.com

What is the future of computerized physician order entry? | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

Earlier this year members of the Office of the National Coordinator for Health Information Technology (ONC) pointed to the abundance of published research demonstrating the positive influence of the EHR Incentive Programs and their meaningful use requirements on care quality, safety, and efficiency. One significant takeaway from this literature review was strong evidence supporting the favorable effects of computerized physician order entry (CPOE) on patient outcomes.


With CPOE a cornerstone of the EHR Incentive Programs and its role increasing in future stages of meaningful use, how is CPOE adoption going to evolve over time? That was one of the questions posted to Methodist Health System’s SVP and CMIO/Chief Quality Officer Sam Bagchi, MD, during a sitdown interview at Wolters Kluwer booth at HIMSS14 in Orlando.
In this second and final installment of a two-part CPOE Q&A, Bagchi describes what lies ahead for his health system as it moves forward with CPOE and looks to increase adoption and improve the functionality of this health IT tool. As he explains, getting physicians to adopt CPOE is a necessary first step, but it is only the beginning of an ongoing process of optimization.
What’s next for CPOE at Methodist Health System?

We’re seeing a lot of organizations, ourselves included, running into high-adoption CPOE projects because of various deadlines that are out there and initiatives that are related to this. As we look back, we see people sometimes unhappy with how the system works or how their content is organized.
Our key in the first phase is getting physicians into the system, comfortable with the content, and generally standardizing evidence-based elements. The key to the optimization phase is comparing similar content and refining our content so that we only have one heart failure order set and four heart failure order sets at hospitals, so that it’s easier to find what you need and that we can count on getting the right care to the right patient at the right time every time.
What kind of input are you getting from physicians and how do you turn feedback both positive and negative into CPOE improvements?

We take every complaint as a request for improvement. We take input from all the physicians. We set up email addresses and we have frontline staff out at the hospitals soliciting feedback. We use our training sessions as feedback sessions so we’re not just telling you how it is today is how it has to be but we want to know what you want to improve. We take that feedback to an integrated informatics IT change management meeting that happens once a week that didn’t exist last year and now exists so that we can organize our changes, be aware of our changes, and rapidly improve our current system.
How does this approach to soliciting feedback and rolling out enhancements also work to benefit the organization’s health IT systems and services?

It also helps us deploy innovations or new elements of the enterprise EMR that we want to use and not wait two to three months to do it. We’re doing 50-60 changes a month based now on this process, and if you don’t listen and move quickly after you go live on a project like CPOE, your physicians that you have engaged so heavily to get there can sometimes get off the bus. So we’re trying to keep everybody on the bus.
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EHR Incentive Program Exceeds $22.5 Billion Payout Estimate

EHR Incentive Program Exceeds $22.5 Billion Payout Estimate | EHR and Health IT Consulting | Scoop.it

According to the latest figures from the Centers for Medicare and Medicaid Services, the EHR incentive program has exceeded its total estimated payout of $22.5 billion.


CMS states in the January report that it has paid out a total of $20.937 billion in EHR incentives, with payments of $5.371 billion in 2011, $9.667 billion in 2012, and $5.896 billion in 2013. But these payments do not include another $1.942 billion to eligible hospitals in fiscal year 2014 so far, bringing the total to-date amount the program has paid to $22.78 billion.


In the final rule published in July 2010, CMS estimated the total cost would be $27.4 billion under the “high scenario” over a 10-year timeframe. Yet the estimate was subsequently revised to $22.5 billion in 2012 due to “different assumed penetration rates based on more recent data and analysis, and revised assumptions as to the timing of payments in relation to when meaningful use is achieved based on the actual experience of the programs to date.”


Nevertheless, it now appears that the original “high scenario” might be the more accurate dollar estimate as to the amount that the EHR incentive program will ultimately pay out. Case in point: in its just released fiscal 2015 budget, the Department of Health and Human Services estimated "Medicare health information technology incentive payments" of $1.436 billion to hospitals and $710 million to eligible professionals, respectively, for a total of $2.15 billion next fiscal year. However, that number does not include Medicaid incentive payments, which also factor into the cost of the overall program.


Under the current timeline, 2016 is the last year to receive a Medicare EHR incentive payment and the last year to initiate participation in the Medicaid EHR incentive program, while 2021 is the last year to receive a Medicaid EHR incentive payment. However, the program’s timelines in recent months have been changed. Stage 3 doesn’t start until 2017, which likely would require revisions of the participation and incentive payment timelines.

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Hospitals in EMR buying frenzy | Healthcare IT News

Hospitals in EMR buying frenzy | Healthcare IT News | EHR and Health IT Consulting | Scoop.it

The electronic medical record market is poised for a competitive shakeup. As Stage 2 meaningful use demands more from hospitals, many current EMR platforms just aren't cutting it, and up to half of large hospitals are ditching their old systems for new, interoperable platforms with population health capabilities.

 

Two new reports, conducted by Black Book and KLAS Research, underscore the EMR market trends at hospitals with more than 200 beds. And the once ill-fated Allscripts has made a huge comeback this year, edging out a slight lead for top-ranked EMR inpatient vendor over three-time annual champion Epic Systems, according to Black Book researchers.

 

The reports find that from one-third to half of all large hospitals are looking to trade out their old EMRs by 2016, but, according to KLAS data, only 22 percent of those buying decisions may be up for grabs, as 34 percent of them have already officially selected a vendor, and the lion's share, 44 percent, are already strongly leading toward a certain vendor.

 

"Where the last round of EMR purchases was fueled by meaningful use requirements and enticing reimbursements, this next round is being fueled by concerns about outdated technology and health system consolidation," said report author Colin Buckley in a press statement. "This shift in focus will play a major factor in which EMRs are being considered."

 

Black Book data, which includes responses from 163 large hospitals -- which it defines as hospitals having more than 300 beds, highlights a growing percentage of provider dissatisfaction with current EMR systems, as some 32 percent of them are reevaluating their vendor's products and services, with 20 percent saying the reevaluation will likely lead to a replacement system. Vendors that have advanced population health capabilities are likely to come out on top, hospital officials point out.

 

"Top scoring (EMR) vendors that are attracting the available market share are looking for patient engagement tools, clinical decision support, quality measurement solutions, mobile capabilities, intelligent interoperability and financial analytics as part of their (EMR) compendium," said Doug Brown, managing partner of Black Book, in a March 10 press release. "This large hospital market segment has progressed beyond meaningful use driving purchasing decisions but is aggravated with the extraordinary delays, cost run-ups, extended implementations and glitches interrupting operations from first-choice EHRs."

 

Large hospitals are not the only ones considering making an EMR change. Medical practices are also updating and trading up their systems. Last year, some 23 percent of them said they would be switching out their current platform by the year's end, according to a winter 2013 Black Book report.

 

Stage 2 meaningful use requires that eligible hospitals meet 16 core objectives and three menu objectives -- up from 14 core and five menu objectives in Stage 1 -- many of which are still not fully understood by hospital officials.

 

"There's certainly a number of people who know what the requirements for Stage 2 are, but it's probably not as widespread as you might think," said Robert Anthony, deputy director of the health IT initiatives group at CMS' Office of E-Health Standards and Services, in an interview with Healthcare IT News earlier this year. "As we have gotten into Stage 2 and we've really gotten into implementation, as people are actually starting to do it or starting to think about doing it and planning for their workflow, it's like anything else: you read about it, and you think about it, but once you're actually putting it into practice, it's a different beast altogether."

 

There are six completely new core objectives in Stage 2, including recording electronic notes in patient records; test imaging results must be available through the EMR; record family health history as structured data; generate and transmit more than 10 percent of permissible discharge prescriptions electronically; provide structured electronic lab results to ambulatory providers.

Technical Dr. Inc.'s insight:

If you're in the market for a new EHR, Technical Doctor can help.  With almost 10 years of consultative experience, our strength lies in our agnostic approach to EHR.  We help you select the best one for your practice today and for the future.  Contact inquiry@technicaldr.com to learn more!


- The Technical Doctor Team

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Clinical Mobile Apps Lead To Speedy Data Turnaround

Clinical Mobile Apps Lead To Speedy Data Turnaround | EHR and Health IT Consulting | Scoop.it
Magazine Article | January 28, 2014
Clinical Mobile Apps Lead To Speedy Data Turnaround
To access this content, please Register or Sign In.

By Katie Wike, contributing writer

At Rockdale Medical Center, clinical mobile apps are accelerating the transmission of data among departments, meeting HIPAA requirements and pleasing physicians.

In 2012, Epocrates Research group found 34 percent of physicians used a tablet computer and 75 percent planned to buy one within a year. Eighty-one percent of those who owned a tablet owned an iPad. Tablets continue to gain popularity due to their unmatched mobility and ease of use. Despite the trend, connecting these mobile devices to existing EHR platforms in a way that meets HIPAA security requirements may prove to be a tricky task.

For Rockdale Medical Center (RMC) in Rockdale County, GA, the answer was a clinical mobile app already approved by the FDA as a diagnostic aid. Since 1954 RMC has made its mission to provide the best care possible for all the patients in the 138-bed acute care facility. The need for a means of transmitting patient data from the emergency department to the lab and at night with a smaller staff available spurred RMC’s search for a HIPAA-compliant datasharing technology.


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The causes of digital patient privacy loss in EHRs and other health IT systems

The causes of digital patient privacy loss in EHRs and other health IT systems | EHR and Health IT Consulting | Scoop.it

This past Friday I was invited by the Patient Privacy Rights (PPR) Foundation to lead a discussion about privacy and EHRs. The discussion, entitled “Fact vs. Fiction: Best Privacy Practices for EHRs in the Cloud,” addressed patient privacy concerns and potential solutions for doctors working with EHRs.

While we are all somewhat disturbed by the slow erosion of privacy in all aspects of our digital lives, the rather rapid loss of patient privacy around health data is especially unnerving because healthcare is so near and dear to us all. In order to make sure we provided some actionable intelligence during the PPR discussion, I started the talk off giving some of the reasons why we’re losing patient privacy in the hopes that it might foster innovators to think about ways of slowing down inevitable losses.

Here are some of the causes I mentioned on Friday, not in any particular order:

  • Most patients, even technically astute ones, don’t really understand the concept of digital privacy. Digital is a “cyber world” and not easy to picture so patients believe their data and privacy is protected when it may not be. I usually explain patient privacy in the digital world to non-techies using the analogy of curtains, doors, and windows. The digital health IT world of today is like walking into a patient’s room in a hospital in which it’s a large shared space with no curtains, no walls, no doors, etc. (even for bathrooms or showers!). In this imaginary world, every private conversation occurs so that others can hear it, all procedures are performed in front of others, etc. without the patient’s consent and their objections don’t even matter. If they can imagine that scenario, then patients will probably have a good idea about how digital privacy is conducted today — a big shared room where everyone sees and hears everything even over patients’ objections.
  • It’s faster and easier to create non-privacy-aware IT solutions than privacy-aware ones.  Having built dozens of HIPAA-compliant and highly secure enterprise health IT systems for decades, my anecdotal experience is that when it comes to features and functions vs. privacy, features win. Product designers, architects, and engineers talk the talk but given the difficulties of creating viable systems in a coordinated, integrated digital ecosystem it’s really hard to walk the privacy walk  Because digital privacy is so hard to describe even in simple single enterprise systems, the difficulty of describing and defining it across multiple integrated systems is often the reason for poor privacy features in modern systems.
  • It’s less expensive to create non-privacy-aware IT solutions. Because designing privacy into the software from the beginning is hard and requires expensive security resources to do so, we often see developers wait until the end of the process to consider privacy. Privacy can no more be added on top of an existing system than security can — either it’s built into the functionality or it’s just going to be missing. Because it’s cheaper to leave it out, it’s often left out.
  • The government is incentivizing and certifying functionality over privacy and security. All the meaningful use certification and testing steps are focused too much on prescribed functionality and not enough on data-centric privacy capabilities such as notifications, disclosure tracking, and compartmentalization. If privacy was important in EHRs then the NIST test plans would cover that. Privacy is difficult to define and even more difficult to implement so the testing process doesn’t focus on it at this time.
  • Business models that favor privacy loss tend to be more profitable. Data aggregation and homogenization, resale, secondary use, and related business models tend to be quite profitable. The only way they will remain profitable is to have easy and unfettered (low friction) ways of sharing and aggregating data. Because enhanced privacy through opt-in processes, disclosures, and notifications would end up reducing data sharing and potentially reducing revenues and profit, we see that privacy loss is going to happen with inevitable rise of EHRs.
  • Patients don’t really demand privacy from their providers or IT solutions in the same way they demand other things. We like to think that all patients demand digital privacy for their data. However, it’s rare for patients to choose physicians, health systems, or other care providers based on their privacy views. Even when privacy violations are found and punished, it’s uncommon for patients to switch to other providers.
  • Regulations like HIPAA have made is easy for privacy loss to occur. HIPAA has probably done more to harm privacy over the past decade than any other government regulations. More on this in a later post.

The only way to improve privacy across the digital spectrum is to realize that health providers need to conduct business in a tricky intermediary-driven health system with sometimes conflicting business goals like reduction of medical errors or lower cost (which can only come with more data sharing, not less). Digital patient privacy is important but there are many valid reasons why privacy is either hard or impossible to achieve in today’s environment. Unless we intelligently and honestly understand why we lose patient privacy we can’t really create novel and unique solutions to help curb the loss.

What do you think? What other causes of digital patient privacy loss would you add to my list above?



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Morning Headlines 4/10/14 | HIStalk

Morning Headlines 4/10/14 | HIStalk | EHR and Health IT Consulting | Scoop.it

DeSalvo proposes new direction for ONC

Speaking at a Health Information Policy Committee on Tuesday, Karen DeSalvo, MD, proposed dismantling the ONC’s existing HIT workgroups and forming new ones that would address: HIT strategic planning; Advanced health models and meaningful use; HIT implementation, usability and safety; and Interoperability and health information exchange. Paul Tang, vice-chair of the HITPC said, "This is a nice step-back point. Now that we’ve finished wrapping up our comments and advice on Stage 3, we will begin to look a lot toward how are we getting the value from meaningful use.”

Final Notice of Termination of OIG Advisory Opinion No. 11-18

The HHS’s Office of Inspector General has reversed its 2011 decision on the Federal anti-kickback statute as it applies to transmitting patient referrals through an unnamed ambulatory EHR vendor’s "trading partner" network. The OIG originally approved of the network, but has since decided that it creates a situation in which transaction fees may be financially influencing referral decisions.

Lincoln Health Center request gives county pause

In North Carolina, Lincoln Community Health Center is looking to local county commissioners to pick up half of the $2 million it will cost to implement Duke University’s Epic system. The county thinks that Duke, which is paying the other half, should be on the hook for more.



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GetWellNetwork CEO speaks about patient engagement

GetWellNetwork CEO speaks about patient engagement | EHR and Health IT Consulting | Scoop.it

Michael O’Neil, CEO of GetWellNetwork

Download: hbdew0010-david-e-williams-interviews-getwell-network-ceo-michael-oneil.m4a

Michael O’Neil had the misfortune to contract non-hodgkin’s lymphoma while in graduate school. His medical outcome was good but his experience as a patient was not. He founded GetWellNetwork (GWN) to provide an interactive patient engagement solution to help patients move from dependence to independence in the course of their care. The company’s solutions are found in 200 hospitals and are credited with lowering readmissions, increasing staff responsiveness, and increasing patient satisfaction with pain control.

I caught up with Michael at #HIMSS14 in Orlando and asked him to tell his story.



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Deadline for Medicare EPs to Attest Fast Approaching | EHR Blog | AmericanEHR Partners

Deadline for Medicare EPs to Attest Fast Approaching | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it
Deadline for Medicare EPs to Attest Fast Approaching

Reminder: Medicare Eligible Professionals Must Attest by March 31 at 11:59 pm ET to Receive 2013 Incentive
Providers should submit data as soon as possible and during non-peak hours to avoid system delays.

The last day eligible professionals can register and attest to demonstrating meaningful use for the 2013 reporting year of the Medicare EHR Incentive Program is March 31, 2014. Eligible professionals must successfully attest by 11:59 p.m. Eastern Daylight Time on March 31 to receive an incentive payment for 2013 participation.

Payment adjustments for eligible professionals will be applied beginning January 1, 2015, to Medicare participants that have not successfully demonstrated meaningful use. For more information, visit the payment adjustment tipsheet for eligible professionals. Providers must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment. Review important dates for the EHR Incentive Programs using this Interactive Timeline.

The above information was provided by CMS and is reproduced here in its entirety.

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Road to 10: Free Online Resource for Small Clinical Practices | EHR Blog | AmericanEHR Partners

Road to 10: Free Online Resource for Small Clinical Practices | EHR Blog | AmericanEHR Partners | EHR and Health IT Consulting | Scoop.it

Road to 10: Free Online Resource for Small Clinical Practices
CMS released Road to 10, a free online resource built with the help of physicians in small practices. Available on the Provider Resources page at cms.gov/ICD10, this tool is intended to help small medical practices jumpstart their ICD-10 transition.

Road to 10 gives providers the capability to build ICD-10 action plans tailored for their practice needs. The tool is designed for use by small practices in primary care as well as all specialties. Road to 10’s resources include common ICD-9 and ICD-10 codes, clinical documentation primers, and clinical scenarios for:

  • Family practice
  • Internal medicine
  • Pediatrics
  • OB/GYN
  • Cardiology
  • Orthopedics

To learn more, visit the ICD-10 Provider Resources page.

The above is information from CMS .

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House Delays SGR Cuts, ICD-10 for a Year

House Delays SGR Cuts, ICD-10 for a Year | EHR and Health IT Consulting | Scoop.it

WASHINGTON -- The House of Representatives acted Thursday to delay for a year problems physicians were facing with two three-letter acronyms: ICD and SGR.

Lawmakers voted to delay the switch to the ICD-10 coding system until Oct. 1, 2015. The bill containing that provision alsodelays by 12 months pending reimbursement cuts under Medicare's sustainable growth rate (SGR) payment formula.

The legislation also delays a requirement for hospitals to comply with the "two-midnight" rule for inpatient reimbursement, and pushes back recovery audits of allegedly unnecessary claims until March 2015.

The measure was approved via voice vote under a suspension of normal House rules -- despite a great deal of opposition from Democrats.

The bill now moves on to the Senate, where Sen. Ron Wyden (D-Ore.), the newly appointed chair of the Senate Finance Committee, which oversees Medicare, is pushing for a permanent solution to the SGR. Washington lawmakers, while agreeing on a policy for an SGR resolution this spring, have been unable to find a way to pay for the bill.

Under the SGR formula, physician payments will drop by roughly 24% on April 1 unless the Senate passes the measure now being considered.

A long list of physician groups -- including the American Medical Association (AMA), the American College of Physicians, the American Academy of Family Physicians, and the Alliance of Specialty Medicine -- opposed the 12-month SGR patch, saying it would derail efforts to permanently kill the SGR.

The AMA questioned the political fortitude of those on Capitol Hill.

"There was bipartisan, bicameral support for reform this year, yet too many in Congress lacked the courage and wherewithal to permanently fix Medicare to improve care for patients and provide greater certainty for physician practices," AMA President Ardis Dee Hoven, MD, said in a statement.

With elections looming in November, organized medicine will likely have to start anew with its lobbying efforts under a new Congress next year.

Physician groups -- although they oppose the SGR patch -- have been pushing for help on ICD-10, which they received Thursday.

Groups like the AMA have been lobbying the Centers for Medicare and Medicaid Services (CMS) to delay the switch to the ICD-10 system to give physicians more time for the transition. But with CMS firmly against another delay, Congress stepped in to give an extra year.


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Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA

Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it
How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:


ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.


In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.


Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.


We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.


Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.


Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.


The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.


Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.


The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.


Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Medicare.gov Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.


Conclusion

These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.

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Why Everyone Better Learn About ACOs | EMR and HIPAA

Why Everyone Better Learn About ACOs | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

hile I wasn’t working in healthcare at the time, I’ve heard a number of doctors say that doctors missed out on being part of the HMO process. Their voice wasn’t part of the process and they suffered as a consequence of that decision. As I consider that idea, I wonder if doctors aren’t in the same position again with ACOs.

I was reminded of this as I was reading through this whitepaper called ACO & Collaborative Care – The Basics. The whitepaper digs into a number of good ACO discussions, but I was struck by one of the opening phrases:

Health reform IS REAL and NOT GOING away.

That struck me, because I think many doctors are just hoping that this shift to ACOs and value based reimbursement will just go away. Certainly some of this hope is founded since ACO is such a nebulous concept and we’re not sure how it’s going to be implemented. However, just because a concept isn’t totally defined doesn’t mean that it’s not going to be the future of healthcare. I assure you that this shift in reimbursement isn’t going anywhere.

The fact that ACO is a nebulous concept is exactly why doctors should get involved in the process of defining an ACO. When there’s uncertainty, there’s opportunity. The question is whether the opportunity is going to be taken by doctors or by someone else. Ideally all parties will be involved and there will be a give and take. However, I think currently physician voices are underrepresented and they’ll suffer for it.

One other thing that the ACO & Collaborative Care – The Basics whitepaper points out nicely is that you can’t just go out and buy an ACO. There’s no off the shelf ACO solution that will solve your problems. It’s not a software. It’s not a program. It’s not an organization. It’s likely going to include all of those things and that means that it takes some planning, coordination and collaboration. You’re not going to be ready for it if you’re not part of the ACO conversation.

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Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA

Surviving 2014: The Toughest Year in Healthcare | EMR and HIPAA | EHR and Health IT Consulting | Scoop.it

How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:

ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.

In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.

Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.

We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.

Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.

Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.

The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.

Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.

The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.

Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Medicare.gov Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.

Conclusion

These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.

Technical Dr. Inc.'s insight:

Technical Doctor is a leader in Healthcare IT solutions, and we can help you with HIPAA and Meaningful Use!  Contact inquiry@technicaldr.com or call 877-910-0004 to learn more. 


- The Technical Doctor Team

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U.S. Hospitals Triple Use of Electronic Health Records: Report - US News

U.S. Hospitals Triple Use of Electronic Health Records: Report - US News | EHR and Health IT Consulting | Scoop.it

System allows sharing of latest information on patients' test results, treatments and meds


HealthDay Reporter MONDAY, July 8 (HealthDay News) -- U.S. hospitals have made major progress in adopting electronic health records systems over the past three years, according to a new report.


The number of hospitals with a basic electronic health records (EHRs) system tripled from 2010 to 2012, with more than four of every 10 hospitals now equipped with the new health information technology, according to the report scheduled for Tuesday release by the Robert Wood Johnson Foundation.


"Given the size of our country, that's amazing progress in a very short time period," said report co-author Dr. Ashish Jha, an associate professor with the Harvard School of Public Health.


However, there is much more work to be done, the report indicates. These systems may have been adopted, but hospitals have not yet figured out how to use the new technology to improve patient safety and reduce health care costs.


For example, the study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards for exchanging that data with other providers to allow widespread physician access to a patient's records.


"The news here is mostly good, but we shouldn't declare victory yet," Jha said. "In other industries it takes about 10 years after technology is adopted to see real efficiencies. My hope is we'll see that more quickly in health care. We don't have 10 years to waste."


Researchers believe that three factors have combined to drive adoption of electronic health records -- society's increasing reliance on information technology, new federal funding to support purchase of EHR systems, and future penalties under the Affordable Care Act that will be assessed against providers who will not use EHRs.


"It's the right incentives at the right time," Jha said. "Doctors and hospitals have been thinking about buying electronic health records [systems] for some time. This is where our society is moving. But the finances have been a challenge. The federal incentives have been very well targeted. They were well designed to help push hospitals and doctors to adopt EHRs."


Jha added that penalties for failure to act on electronic health records should not be underestimated as a motivating factor. "They are signaling if you don't do it, a few years down the road we're going to start paying you less," he said. "That motivates people to say, 'whoa, I'd better get on board.'"


The report found that electronic health record adoption has increased throughout the American health care system. It's not just big hospitals in major metropolitan centers that are purchasing the new technology. The number of rural hospitals with an EHR system increased from about 10 percent to 33.5 percent between 2010 and 2012, while urban hospitals saw EHR adoption rates rise from 17 percent to nearly 48 percent.


"We saw a tremendous amount of activity throughout all subtypes of hospitals," said co-author Catherine DesRoches, a senior scientist at Mathematica Policy Research. "The rate at which they are adopting has increased quite a bit."


The next step, in which health data is shared between providers, will be key to realizing the true potential of EHRs, DesRoches said.

For example, patient safety should improve when doctors will have automatic access to a person's health records, which allows them up-to-date information on medications prescribed, tests performed and treatments initiated.


"It also has the potential to help with costs," she said. "If you're a patient and you get to your appointment and the specialist can see all of the tests that have already been ordered, they're not going to order duplicate tests or ordering medications that might be contraindicated. The information's right there in the record."


While the United States lags on effective EHR sharing, the report found reason for optimism. More health care providers are participating in initiatives that ultimately will connect their own electronic records systems to community-wide information exchanges.

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HHS Spells Out Obama Budget's Impact

HHS Spells Out Obama Budget's Impact | EHR and Health IT Consulting | Scoop.it

The Obama administration's proposed fiscal 2015 budget calls for a 22 percent increase in funding for the office that oversees policies and standards for the HITECH Act's electronic health record incentive program and a 5 percent increase for the agency responsible for enforcing HIPAA compliance.


Obama's budget is a statement of the administration's spending priorities for the federal government. Ultimately, Congress must approve appropriation bills to fund the government. Fiscal 2015 begins on Oct. 1.

ONC FundingUnder Obama's budget proposal unveiled this week, the Department of Health and Human Services' Office of the National Coordinator for Health IT, which oversees the HITECH program, would have a budget of $75 million, up $14 million from the current year. Six additional full-time employees would be added, bringing ONC's headcount to 191.


The proposed ONC budget includes $27.2 million, or $8.5 million more than the current fiscal year, to fund development of standards supporting interoperable and secure health IT infrastructure. In addition, ONC's proposed budget includes $2.9 million for other privacy and security related activities, "ensuring that electronic health information is private and secure wherever it is transmitted, maintained, or received," says an additional ONC budget document, the Justification of Estimates for Appropriations Committee, released by HHS on March 7.


The extra money sought by ONC in fiscal 2015 would also help support a number of other efforts, including the creation of a new Health IT Safety Center, which in fiscal 2015 "will begin a robust collection and analysis of health IT-related adverse events, which will facilitate benchmark data on the types and frequencies of events," says an HHS "budget in brief" document. ONC is seeking $5 million to fund the new safety center in fiscal 2015.


The new center "will monitor and analyze data on patient-safety events, potentially unsafe conditions associated with health IT, and patient-safety events that could be prevented by health IT," the HHS document notes. ONC will work closely with the Agency for Healthcare Research and Quality, the Joint Commission, Food and Drug Administration and patient safety organizations on this effort, the HHS document notes.


The HHS document notes that in fiscal 2015, the FDA will continue to implement key new responsibilities authorized in the FDA Safety and Innovation Act.


The FDA has been collaborating over the last year with ONC and the Federal Communication Commission in developing a "risk-based regulatory framework" to address patient safety concerns around health IT, including potentially those involving cybersecurity issues (see Health IT: A Cybersecurity Framework).


An ONC spokesman says the new Health IT Safety Center "is part of our Safety Surveillance and Action Plan based on recommendations in the Institute of Medicine report," which in 2011 suggested the government and private sector improve transparency in the reporting of health IT safety incidents and enhance monitoring of health IT products. The new safety center will be aligned with the report on the FDA framework, "which we intend to release for comment in March," the ONC spokesman says.


OCR Funding


Meanwhile, under the proposed budget, the HHS Office for Civil Rights, which is responsible for HIPAA enforcement, would have a budget of $41 million, up $2 million from fiscal 2014. OCR would add 11 full-time staff members, increasing its workforce to 218 employees.

The funding increase will help support OCR's centralized case management operations and online complaint system, HHS notes. "The budget supports continued enforcement of the HIPAA security rule and OCR's expanded HIPAA responsibilities," the HHS document says. "OCR evaluates and ensures HIPAA and civil rights compliance through complaint investigations, compliance reviews, audits, resolution agreements, enforcement actions and monitoring, public education and technical assistance."


Among OCR's enforcement activities slated for 2014 is the resumption of HIPAA compliance audits, which have been on hiatus since the agency's pilot audit program wrapped up in 2012 (see HIPAA Audits a Step Closer to Resuming).


Unlike the pilot audits, which were conducted by the consulting firm, KPMG, the next wave of HIPAA audits will be performed by OCR's internal staff.


OCR officials recently confirmed the agency is taking the first steps to resuming the program. In a Feb. 24 notice in the Federal Register, OCR said it will survey "up to 1,200 HIPAA covered entities, including health plans, healthcare clearinghouses and certain healthcare providers, and business associates, to determine suitability for the OCR HIPAA audit program."


In fiscal 2013, OCR resolved more than 9,500 complaints of alleged HIPAA violations, and collected about $4 million in HIPAA settlements related to its enforcement activities, the HHS document notes. OCR projects that it will collect about $5.5 million from HIPAA settlements in fiscal 2014, which the agency will use to further fund its enforcement activities, according to the HHS document. Under HIPAA Omnibus, penalties for each HIPAA violation can range up to $1.5 million.

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EHR Incentive Audits - CMS Provides Additional Insight for 2014

EHR Incentive Audits - CMS Provides Additional Insight for 2014 | EHR and Health IT Consulting | Scoop.it

CMS this week (1/28/2014) sponsored a “2014 EHR Meaningful Use Webinar”. Covered during the session were the “usual suspects” that included meaningful use, timelines, and hardship exemptions for the upcoming potential fee adjustments. A few slides buried near the end of the presentation provided insight into the ongoing EHR incentive audits and appeals process. Here are a few facts I found most telling, along with my commentary.

  • “Post-payment audits began in July 2012, and will take place during the course of the EHR Incentive Programs.” Its not over until its over.
  • “CMS began pre-payment audits this year, starting with attestations submitted during and after January 2013.” I’ve been seeing more of these pre-payment audits. Also, seeing more “limited audits”.  
  • “5-10% of providers subject to pre/post-payment EHR incentive audits.” Affirmation of the wide net being cast. 
  • “If a provider continues to exhibit suspicious/anomalous data, could be subject to successive audits.” This had been suspected but now it is clear that an audit failure could make a provider more likely to be audited again.
  • “In order to ensure robust oversight, CMS will not be making the risk profile public”. CMS will not be providing any clues as to the logic behind the selection of those providers who are audited based on an established risk profile. 
  • “CMS cannot: Discuss issues or circumstances related to specific audits of actual providers (e.g., One of my providers failed the audit and shouldn’t have… ). Provide information regarding protocols used by audit contractor (e.g., What raises a “red flag” for auditors?, What information will auditors ask for? ,etc.). Resolve issues related to specific audits—Providers must use the appeals process if they believe they received an incorrect adverse audit finding.” It is obvious that after a failed audit many providers continue to attempt to communicate with the auditors for clarification or in hopes of reopening the audit. CMS is clearly stating that if a provider receives a negative determination, the only potential next step is the filing of an appeal. 
Technical Dr. Inc.'s insight:

You may be audited this year.  Is your practice compliant?  Get a HIPAA Risk Assessment done immediately and protect yourself!  Contact inquiry@technicaldr.com today to schedule yours!


- The Technical Doctor Team

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