Healthcare IT

Keep yourself updated on healthcare news regarding practices and medical software. The new regulations and trends in the health industry and all that you need to know.

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No ICD-10 Penalty till 2017?

With the SGR repeal bill signed into law, the ICD-10 transition deadline of October 1 2015 is almost certain. However, an interesting recommendation surfaced last week during a hearing about HHS’ proposed 2016 budget.

Senator Bill Cassidy recommended that ICD-10 penalty be delayed for two years. This essentially means that CMS will continue accepting, processing and paying claims filed in ICD-9 even post October 1 for the next 2 years.

Secretary HHS Sylvia Burwell , countered by saying that many large payers and providers are ready and waiting for ICD-10 and that HHS is working to provide technical assistance and training to those organizations that are not at this point prepared.

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How can I safeguard my practice from Claim Denials?

Claim denials are the main reason behind the decreasing bottom line and low profit margins of many small, medium and large practices. Physicians put patients first in their practice, which is why providing quality care is their main priority. However it’s quite impossible for physicians to receive the ‘fair reimbursement’ for their services.
It is estimated that 20 to 30% of claims are denied by insurance companies on first submission. The main causes of these denials are errors made by the administrative and billing staff. Entry of incomplete or inaccurate information and failure to keep up with new billing regulations and insurance policies are the most common mistakes that lead to an increased claim denial rate. COO of RemitData, Brian Fugere, identified the five most common claim denials that affect practice revenue; duplicate claims, claims lacking information, eligibility expiration, claims uncovered by insurer and time limit expiration.
After identifying the problems, I got in touch with several renowned physicians and medical billers to find solutions for these problems. The three most effective techniques to reduce claim denials are

Claim Scrubber-CureMD

1. Making use of Claim Scrubber tools:

Claim scrubber is the latest technology being adopted by clearinghouse vendors for aiding billers in catching errors in claims prior to submission. Unlike Clean Claim Checks, A claim scrubber ensures that CPTs and ICDs are entered correctly in the claims. Other features of claim scrubbers include checking formats and validity of insurance policies, suggesting corrections for proper coding and providing quick results. Claim scrubber eliminates the need to manually check claims before their submission to insurance companies, and thus contribute in reducing denials by a large extent.

2. Keeping a Claim denial log

Claim denial logs can help billers in identifying claim error trends early, and react accordingly. These logs can be maintained both electronically or via paper. They should include important information like written documentation of insurance companies, date of submission and rejection, amount, reason of claim rejection or denial, and how effectively did the billing team of the practice handle the process. Physicians need to understand why their previous claims were denied so they can avoid such mistakes in the future.

3. Consider outsourcing billing

Errors on the biller’s part are responsible for more than half of all claim denials and rejections. The best alternative is to either assign each of your billers to one or two individual health plans, because of the difference of policies and reimbursement contracts among insurance companies. This can help the billers gain expertise in the plans they are assigned to. For small and medium practices, an even better alternative is to Outsource Medical Billing to a third party vendor. The reasons: they are up-to-date with billing regulations, healthcare policies, and upcoming major changes in the healthcare system like ICD-10.
After implementing these techniques at your practice, you will observe a significant reduction in the claim denials at your practice. Do let us know if the strategies made a difference to the billing revenues at your practice in the comments section below.

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Oncology specific EHR improves patient care

Electronic Health Records (EHRs) have been designed to drive more productivity at practices, while improving healthcare of patients. For a specialty practice, it is recommended that they adopt an EHR which is specific to their practice needs and workflow. Same goes for Oncology.

Oncologists have the option to adopt an Oncology EHR that can be purchased from the market after some careful research. Some vendors offer Oncology specific modules that can be integrated into a general EHR to make it practice specific. Others offer EHRs that have been specifically designed and developed for Oncologists from the scratch.

Oncology patients require complex treatments that stretch over a long period of time, resulting in extensive data recording and management. Generic EHRs do not offer Oncology specific modules to assist physicians to identify symptoms, apply procedures and treatment of the patients.

Some useful features

A suitable EHR for Oncologists should offer features that are integral to patients’ diagnosis and treatment, such as:

  • Calculation and administration of drug dosage during chemotherapy
  • Specific charts and diagrams to assist physician in diagnosis
  • Manage and follow-up clinical trials
  • Oncology specific provider note templates
  • Comprehensive library
  • Integrated charge capture for billing
  • E-Prescribing

How Oncologists benefit?

Specialty EHR acts as a support system for Oncologists that enables them to create most detailed medical record that result in timely and accurate diagnosis and treatment of patients. Oncologists can remain updated with patients’ conditions and modify medication and cancer treatment accordingly.

Specialty EHRs support Oncologists gives complete access to patients’ past and current medical records and library that prompts a timely calculation of the patient’s stage of cancer, as mentioned in the American Joint Committee of Cancer’s staging criteria (AJCC).

Some of the other benefits include the interoperability functionality that is extremely helpful to Oncologists. Most of the cancer patients have more than one physicians providing them treatment simultaneously. This is necessary for each physician to be aware of the medication and treatment provided to the patient, so that there is no clash that may be fatal for the patient.

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5 Top Physician Concerns About Electronic Medical Records and Their Solution

Taken from the perspective of human development, the health IT industry has entered its teenage phase in which physicians have adopted Electronic Medical Record systems, but face difficulty in proper implementation and assimilating it in their practice workflow. Following are some barriers that physicians persistently face while using EMR.

High financial costs deter small practice physicians

The high initial cost of EMR implementation at a practice is a major hurdle in adopting the system. Combined with an uncertainty about profits or monetary benefits, physicians running small practices get reluctant to invest in technology. Studies have shown that implementation of electronic medical records in a small to medium sized practice may cost from $16,000 to $36,000 per physician.

Solution: Implementing an EMR system can be heavy on physicians’ pockets, but they can make it a profitable investment by changing their practice workflow according to the demands and functionality of the system. According to a research, physicians who have managed to successfully change their practice workflows and eliminate all paper-based processes have managed to earn $20,000 and more in benefits.

Another way small practices can cut down implementation costs is by adopting a cloud-based system. This way, physicians can access their records anywhere, while saving money and space for servers.

Consumes more time and effects patient satisfaction

During initial days of EMR implementation, physicians spent more time concentrating on learning the technology and recording patient data accurately. This consumes lot of their time, especially in the exam room, which may leave the patient feeling unattended or dissatisfied.

Solution: However, this problem can be solved by hiring an intern with excellent typing and computer skills, who can assist the physician in taking down patients’ data. Moreover, the staff should be trained in this technology so that the front desk staff records accurate demographic and insurance information of patients.

Lack of user-friendly technology

Researchers have found that most physicians would rely on word-of-mouth or go for the leading brand in the market to buy EMR for their practices. This does not guarantee a technology that will fulfill your practice demands and easy functionality.

Solution: Instead of battling with your EMR, go for the one that is easy to understand. The best way to avoid hassles of buying a difficult EMR is to research the market and get in touch with various vendors, test their software and then make a final decision.

Hurdles in electronic exchange of data

Most physicians have increased their workload in an attempt to save money. Your EMR will enable you to record clinical data of patients. However, billing and prescribing medication will still be carried out on paper, which disrupts the workflow of practices.

Solution: In order to make your workflow smooth and cut down on time, implement an integrated system – EMR and Practice Management – at your practice. While you can record patients’ clinical data with EMR, the PM will help your staff in billing process – enter accurate insurance information and ICD code, create and submit charge, and follow-up – which will reduce chances of medical error.

Change in attitude for successful EMR implementation

Advancement in health IT requires change in attitudes of physicians towards the use of technology. Although researchers come across physicians with a “can-do” attitude, who are ready to take up the challenge, but reservations about the future often hesitate them to take the first step.

Solution: Before taking the plunge, analyze your practice workflow, arrange your finances and other resources, and consult your staff and take them on board, and then adopt electronic medical record system for your practice. Keep your expectations realistic and most important, keep a backup plan.

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Incorrectly Coded E/M Claims and How Your EMR is Helping?

Electronic Medical Records (EMRs) have streamlined the storage, retrieval and modification of medical records. Additionally, EMR vendors flaunt that the systems lead to enhanced accuracy in evaluation and management (E/M) coding via features such as better charge capture, higher reimbursements and extensive insurance follow up.

However, despite EMRs generally having templates for coding or computer assisted coding (CAC), they were not initially built as coding instruments and have shown several problems with the process. Thus, there is always the doubt of fraudulent coding in these systems for which the Department of Health and Human Services’ Office of the Inspector General (OIG) is trying to devise solutions.

A report issued by the OIG in May revealed a loss of $6.7 billion in improper Medicare payments due to fifty-five percent of E/M service claims in 2010 being wrongly coded and/or lacking documentation.

The report highlighted that 32.3 billion for E/M services were paid by Medicare that year, which represented about 30 percent of 2010’s Part B payments. Additionally, in 2010, the OIG disclosed that the billing of higher level codes by physicians had risen, and this had caused higher payment levels for E/M services of all visit types from 2001 to 2010.

Moreover, the Centers for Medicare & Medicaid Services (CMS)disclosed that E/M claims were 50 percent more probable to be paid for as errors in contrast to other Part B services, adding that the highest amount of improper payments were due to insufficient documentation and faults in coding.

A medical record review by the CMS found that the $6.7 billion loss was 21 percent of Medicare payments for E/M services in 2010. They also revealed that 42 percent of claims for E/M services that year were incorrectly coded, while 19 percent lacked in documentation.

How your EMR is helping?

You can use your EMR to generate comparative billing reports for evaluation and management services in addition to yearly chart reviews to identify E/M issues.  Reviewing your notes also helps identify if your notes are clinically important and accurate.

Moreover, EMR tools help ensure that you are up coding when it is required and down coding when that is required. This helps overcome numerous potential errors.

Additionally, if you customize your EMR templates to make them increasingly practice-specific, and to represent your most regular patient types, you will encounter lesser errors. Moreover, you have the ability to select and fill out multiple fields which could save you a lot of time, but make sure you are alert as patients’ conditions vary.

In conclusion, an EMR system is not the only requisite to avoid inaccurate coding; you also need to pay attention while the entries are being made as many human errors will bypass the systems.