Your Practice Might be Audited Next – How to Prepare

Because the Centers for Medicare and Medicaid Services has shelled out about $19 million of their $27 million budget in just three months, physicians should assume that they will be audited and make preparations so they are not caught off guard and the audit goes as smoothly as possible.

Audits have been occurring frequently across the country, so in order to prepare physicians should follow these seven strategies:

  1. Assume you will be audited - Make sure your office retains all documents auditors will ask for so you meet the specific requirements and have a solid foundation for responding to the audit.
  2. Handle the audit promptly - Complying with an audit means you will have to complete a long list of tasks to prove every transaction, which can be tedious, but it is crucial that you do not lash out at the auditor and respond to the audit request in 14 days or less.
  3. Physicians take charge - While you might want your practice manager to take control of the audit, make sure you, as the physician, are involved and know what is going on so nothing slips through the cracks. It is your business that is on the line.
  4. Avoid discrepancies - The main thing auditors look for are discrepancies between what was submitted during the attestation process and what was actually done. The audit will request a document list so make sure you provide all the documents needed and in a timely manner.
  5. Ensure EHR certification - Make sure you have certification from your vendors confirming the version of EHR system  you are using and if your system is upgraded that your certification didn’t change and if it did that you also upgrade that.
  6. Documentation - Above all, it is critical you have an auditable source for all data used for registering and attesting to meaningful use. This not only includes the data presented on the meaningful use reports generated by the EHR, but evidence of all ‘yes/no’ objectives.
  7. Complete a Security Risk Assessment - This is an area that trips up many physicians because even though it became mandatory for physician practices to implement HIPPA, it is something many are still unfamiliar with. Neglecting the risk assessment can not only place physicians at risk of paying back incentive money, but they also risk a penalty from the U.S. Department of Health and Human Service’s Office for Civil Rights

For more information on these strategies see the following article, published by Medical Economics – http://medicaleconomics.modernmedicine.com/medical-economics/news/meaningful-use-audits-seven-strategies-protect-your-practice?page=0,6&contextCategoryId=146

CCHIT Exits Certification Game

Top government endorsed certifying body Certification Commission for Health Information Technology (CCHIT) has announced that it will transition to an advisory role to healthcare vendors and providers, as it is no longer profitable in its current role. CCHIT will no longer certify or test EHR software for the first time since 2006. Instead, the CCHIT will focus on advising healthcare providers and health IT developers on the government’s requirements for certified EHR technology and how to comply with IT regulations. The CCHIT will also be developing new programs and policy guidance for providers and patients who use IT to transform healthcare.

The reason for the CCHIT ending relations with EHR testing and certification is economic. Running a certification organization requires investments in infrastructure and staff, but generates revenue only during periods when vendors are seeking certification. Most vendors didn’t start applying for certification until last September, but CCHIT has staff on payroll all year.

CCHIT has informed their current customers of the change and has suggested that they use ICSA Labs to maintain their certification or apply for new testing services. They will maintain their work with the Source, which offers ONC testing and certification preparation service.

For more information on this transition, published by Information Week, see the following link – http://www.informationweek.com/healthcare/policy-and-regulation/cchit-exits-ehr-certification-business/d/d-id/1113632.

CMS Patient Participation Survey Results

The Centers for Medicare & Medicaid Services (CMS) recently conducted a patient participation survey on incentive payments under the Meaningful Use program and polled participants in the following categories: Meaningful Use participation, eligible professionals, and eligible hospitals. The results show strong participation and success, with 436,000 eligible professionals and hospitals having registered for the Meaningful Use programs since it launched in 2011.

The results of each category are listed below.

Meaningful Use Participation:
• 436,000 eligible professionals and hospitals have registered for the Meaningful Use program
• 82% of eligible professionals have registered
• 93% of hospitals are participating

Eligible Professionals:
• 97% provided electronic copies of health information
• 97% kept an active patient medication list
• 96% maintained a medication allergy list
• 92% provided transition of care summaries
• 93% provided active medication reconciliation lists
• 83% kept clinical studies

Some eligible professionals struggled with some menu objectives, for example:
• 33% submitted data to immunization registries
• 6% submitted syndromic surveillance data

Eligible Hospitals:
• 98% maintained a medication allergy list
• 98% kept an active medication list
• 96% recorded patient demographics
• 95% recorded advance directives
• 95% included clinical lab results in EHR data
• 92% recorded vital signs
• 83% maintained a computerized provider order entry system

The least-adopted objectives for hospitals were:
• 8% medical reconciliation
• 12% providing lab data to public health agencies

For more information on Meditab’s Meaningful Use program, visit http://www.meditab.com/company/ehr-meaningful-use/mu-readiness-program/.

ICD-10 Is More Than Just a Coding Project

Contrary to the popular conception, ICD-10 is more about documentation than creating new codes. Physicians know the cardinal rule is that if it wasn’t documented, it didn’t happen. Specifically speaking about ICD-10, each code is built individually based on a patient’s visit to the physician from admission to discharge. It is important for every aspect to be documented because this information is passed from physicians, to nurses, to therapists, and to the insurance adjuster if the patient was in an accident. Details and specificity matter.

Equally important is real-time documentation. Physicians must know when a patient’s status changes, they cannot wait until the nurses finish their shifts to update the patient’s chart. Medical necessity must be present, if not requests sent to physicians will increase. Clinical documentation improvement specialists will have to forward clarifications to physicians if information on the clinician’s note does not correspond with what the physician documented. Since the volume of queries overall is expected to increase, if documentation is not entered in real time, the information will become backlogged and the system will cave on itself.

Users of EHR systems also need to be able to perform in depth documentation for specificity. For example, a coder needs a thorough description of an injury to understand where the IV was inserted, why it was necessary for the IV, and the administered medication. All information about the injury is necessary for effective ICD-10 coding.

Meditab has various ICD1-10 coding resources available here- http://www.meditab.com/company/ICD-10-readiness/.

Are There Limits to Stage 2 Meaningful Use?

Unlike Stage 1 Meaningful Use, which puts the responsibility for success fully on the shoulders of hospitals and healthcare professionals, Stage 2 Meaningful Use requires more involvement from participants of the EHR Incentive Program to engage each other as well as their patients.

Because the next stage of meaningful use poses some challenges there has been much speculation about how the program will manage in the upcoming year.

Since Stage 2 is more interactive than Stage 1 it requires patients to view, transmit, and download their health information, which can prove to be challenging especially for older patients, and also puts a lot of responsibility on the patients to submit their information in a timely fashion. A solution to this would be to set up kiosks at physicians’ offices and assist patients in registering and walking them through the process. However, this will require a lot of time from the staff, which could prove to be problematic.

Another issue Stage 2 might encounter is that collecting the data elements and transmitting them will be challenging for those companies that are exempt from meaningful use. Providers won’t be able transmit the data because they might not have an EHR yet.

Healthcare professionals are optimistic that Stage 2 will succeed, but that it will be a difficult road with trials and errors before it is perfected.

Meditab offers a variety of resources to help clients successfully attest to Stage 2 Meaningful Use that can be accessed here – http://www.meditab.com/company/ehr-meaningful-use/mu-readiness-program

AMA 2014 Forecast is Action-Packed

In an article recently published in EHR Intelligence, the President of the American Medical Association (AMA), Ardis Dee Hoven MD, says the organization is gearing up for a very busy year ahead. The AMA faces some substantial challenges this year, mainly due to national issues, federal changes, the implementation of IDC-10, and the beginning for Stage 2 Meaningful Use.

Some of the issues that will affect the industry this year include the repeal of the Medicare sustainable growth rate, which will directly affect providers who are already concerned with the financial viability of hospitals and private practices.

One of the most significant changes to healthcare law in several decades, that will continue to affect the industry in many ways, is the approval of the Affordable Care Act. While the rollout was rocky and received backlash from the media, the end-goal for physicians is still in mind, which is to give healthcare access to millions of uninsured Americans. In addition to the changes inherent in the ACA, providers will also be facing new rules under the Sunshine Act, which will make financial transactions with drug and medical device manufacturers public.

This year, two significant IT projects will go into effect after being in the planning stages for several years: the next stage of the EHR Incentive Programs and the transition to ICD-10. 2014 will see the beginning of Stage 2 of Meaningful Use, and will also be the last year to avoid Medicare penalties for non-participation. The implementation of ICD-10 is not a popular initiative with the AMA, who has been working for years to prevent it from being put into practice, but despite the association’s disapproval, ICD-10 is slated to go ahead at the beginning of October.

It’s important to use the resources and tools presented to you to stay on top of these changes this year. Visit our website for resources on Meaningful Use readiness and on preparing for the ICD-10 transition.

Healthcare IT Industry Expected to Grow to $31.3 Billion by 2017

Good news for the healthcare IT industry – according to a recent study conducted by the research firm Markets and Markets, the North American health IT market will grow at a compound annual rate of 7.4% to reach a total value of $31.3 billion in 2017, compared to $21.9 billion in 2012. More specifically, the value of the US market, which accounts for nearly three quarters of North American HIT revenue, will rise to $22.6 billion in 2017 from $15.9 billion in 2012.

Among the major factors influencing this growth are Meaningful Use regulations. Other factors according to the study include “growing pressure to cut healthcare costs, growing demand to integrate healthcare systems, and high rate of return on investment while using healthcare systems.” An aging population, a rising demand for Computerized Physician Order Entry (CPOE) adoption, and the rising prevalence of chronic diseases will also increase the size of the market. It’s predicted that there will also be major growth in the areas of interoperability and information exchange. The increased use of mobile applications, big data, fraud and abuse issues, and security measures will all contribute to market growth as well.

The market will continue to grow even after the Meaningful Use program has concluded for a number of reasons. Organizations will continue to mature in their use of EHRs and implement new ways of using them to optimize workflow, and there will be an increased demand for other kinds of health IT applications that can help healthcare providers take advantage of the data they’re now creating.

CMS’ Proposed Program Has Industry Experts Talking

Industry stakeholders and experts are continuing to share feedback about CMS’ decision to delay the implementation of Stage 2 and 3 of Meaningful Use. CMS’ proposed program would extend Stage 2 through 2016 and delay Stage 3 until 2017 for physicians and healthcare providers who have already completed at least two years of Stage 2. The final ruling on Stage 3 is expected to be released in 2015.

CHIME’s Reaction
Although the proposed implementation would give physicians and providers flexibility, the College of Healthcare Information Management Executives (CHIME) announced that the delay will not affect the start date for Stage 2 and it does not change initial requirements for Meaningful Use in 2014. Russell Branzell, CEO of CHIME, believes there will still be pressure to transition to ICD-10 and Stage 2 within the next year. The organization is working to shift reporting periods and increase flexibility for those working to comply with Meaningful Use.

HIMSS’ Reaction
After initially stating that they were “gratified” by the decision to extend Stage 2 of the meaningful use program by one year, the Healthcare Information and Management Systems Society (HIMSS) soon after said it will “call on the government to address the timeline and allow at least 18 months in which eligible hospitals and eligible providers can attest to meaningful use requirements for one quarter” (McCann, Healthcare IT News, 12/6).

To read the full article, visit ihealthbeat.org.

Maximize ROI As You Switch to ICD-10

Oct. 1, 2014 is D-Day for healthcare providers and facilities across the nation. That’s when the new ICD-10 billing codes go into effect in a major transition for the industry. You’re probably spending time and resources preparing, but do you know all of the benefits of ICD-10 so you can get a return on your investment?

Most healthcare professionals aren’t aware, according to a new survey by eHealth Initiative, conducted in partnership with the American Health Information Management Association. The national survey of 281 hospital executives, physicians and other professionals revealed a lack of communication around the issue. Among those surveyed, 69 percent were providers.

Most indicated that they had no specific goals to achieve a return on their investment, other than to facilitate claims processing. However, the switch to ICD-10 was intended to be much more than that. The purpose of ICD-10 is to expand the code set to improve the quality of care, research and surveillance with more accurate and specific data.

Some survey respondents said their goals were to focus on measurement of clinical outcomes, quality improvement and performance measurement. But for nearly a quarter of all respondents – including one-third of clinicians – the only goal was getting paid after ICD-10 goes into effect.

More Specific Superbills

One goal of ICD-10 should be to take advantage of more specific superbills, health IT experts say. With ICD-10, you have even more reason to create superbills of ICD-10 codes using General Equivalent Mappings (GEMS) to migrate from your existing superbills of ICD-9 codes.

Physicians need tools like superbills to help them create highly specific coding and documentation without being so time-consuming they diminish patient care or disrupt workflow. With IMS from Meditab Software, for example, you can create a superbill quickly and easily. IMS is a comprehensive EHR/Practice Management solution that can reduce billing errors and denials, and better manage cash flow. It even includes Medicare logic-rules engine and insurance eligibility verification to assure accuracy and completeness.

From 13,000 to 70,000+ Codes

You’ll need the more specific coding of ICD-10 for new payor systems. Currently, ICD-9 codes don’t reflect new services and technology in CMS payment systems, and they’re not specific enough for detailed diagnoses. ICD-9 is limited to a maximum of 13,000 codes, whereas ICD-10 will have more than 70,000. With ICD-9, finding the correct code is difficult and existing codes don’t allow comparison of costs and outcomes.

In short, ICD-10 will include more precise documentation of clinical care. The federal government hopes the new codes will help determine public health needs, identify trends, and spot bioterrorism and epidemics for the good of all Americans.

To learn more about multi-certified IMS Electronic Health Records and its integrated Practice Management system, visit www.meditab.com.

 

Tips for Successfully Surviving a Meaningful Use Audit

You might know that in order to ensure that doctors and professionals meet all the criteria required for the EHR Meaningful Use Program, CMS has authorized audits for pre-payment and post-payment. The selection process is both random and targeted, and will impact up to ten percent of the program participants. While the new addition might initially be unsettling, government expert, Rob Anthony, deputy director of the Health IT Initiatives Group for CMS” Office of E-Health Standards and Services, has several survival tips for participants:

  • Be sure to enter accurate numbers when you attest to meaningful use of an EHR.
  • Know that dated screen shots provide a good source of documentation.
  • Turn on, for the entire reporting period, EHR features that track functionality issues, such as drug interaction checks and clinical decision support.
  • Understand that the security risk analysis must be specific to the EHR and the practice and is required every year.
  • Direct all audit questions directly to Figliozzi and Co., the certified public accountant firm selected by CMS to conduct the audits, for faster response time.

For more information and tips, visit http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20130515ehrmuaudit.html