Meaningful Use Update

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What’s in the Final Rules and How it Will Impact Your Practice

It’s no secret that the Meaningful Use criteria under the HITECH provisions of the American Recovery and Reinvestment Act (ARRA) requires healthcare providers to successfully exchange electronic clinical healthcare information, such as ePrescriptions, to receive incentives and avoid penalties in payments from Medicare and Medicaid. Eligible professionals who meet the criteria can receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years, starting in 2011. After receiving over 2,000 public comments, the Department of Health and Human Services issued a final set of rules that addressed a number of the concerns that had been expressed during the comment period. Although the final rules contain hundreds of pages of requirements, they do offer greater flexibility and are expected to accelerate the adoption of electronic medical records (EMRs) in physician practices across the country. Join us as we examine the final rules on Meaningful Use and how Emdeon can assist your practice in meeting those requirements.

Meaningful Use Requirements
To ensure that physicians are using EMRs to improve the quality of care and to exchange healthcare information with other providers and patients, the government has mandated that doctors meet certain requirements for Meaningful Use. There are three stages of Meaningful Use, which will have progressively more demanding requirements. Stage 1, covering 2011 and 2012, focuses on capturing information electronically in a coded format; using that data to track key conditions and coordinate care; implementing clinical decision support; and reporting quality measures. Stage 2, which will take effect in 2013, will require the use of EMRs for “continuous quality improvement” and more structured data exchange. And Stage 3, starting in 2015, will take all of these processes further, with an emphasis on decision support tools, patient self-management tools, and population health management, according to HHS. Non-hospital-based physicians are eligible for Medicare incentives if they can show Meaningful Use. For a doctor to be eligible for Medicaid incentives, at least 30 percent of his or her practice must consist of Medicaid patients (20 percent for pediatricians) and eligible professionals may receive EMR incentives from Medicare or Medicaid, but not through both programs.

Based on the final rule, eligible professionals must meet a set of 15 core objectives determined to be a starting point for Meaningful Use, as well as five additional objectives selected from a menu of 10 options, for at least a portion of their patients. This approach, which is different from the proposed set of 25 all-or-nothing criteria, is intended to give providers flexibility in meeting Meaningful Use. The final rule on Meaningful Use is available for download and includes program contact information for additional questions about these criteria.

Under the core objective list eligible professionals must use their EMRs to:

  1. Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines

  2. Implement drug-drug and drug-allergy interaction checks

  3. Generate and transmit permissible prescriptions electronically

  4. Record patient demographics (sex, race, ethnicity, date of birth)

  5. Record vital signs and chart changes (height, weight, blood pressure, body mass index growth charts for children)

  6. Maintain up-to-date problem list of current and active diagnoses

  7. Maintain active medication list

  8. Maintain active medication allergy list

  9. Record smoking status for patients 13 years of age or older

  10. Provide clinical summaries for patients for each office visit

  11. On request, provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies, and discharge summary and procedures)

  12. Implement capability to electronically exchange key clinical information among providers and patient-authorized entities

  13. Implement one clinical decision support rule and ability to track compliance with the rule

  14. Implement systems to protect privacy and security of patient data in the EHR

  15. Report clinical quality measures to CMS or States

Under the menu set of criteria, providers must implement five of the following 10 criteria:

  1. Implement drug formulary checks

  2. Incorporate clinical lab test results into EHRs as structured data

  3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach

  4. Use EHR technology to identify patient-specific education resources and provide them to the patient as needed

  5. Conduct medication reconciliation between care settings

  6. Provide summary of care record for patients referred or transitioned to another provider or setting

  7. Submit electronic immunization data to immunization registries or immunization information systems

  8. Submit electronic syndromic surveillance data to public health agencies

  9. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, medication allergies) within four business days of the information being available

  10. Send reminders to patients (per patient preference) for preventive and follow-up care

Notably, the Stage 1 criteria do not include documentation of visit notes in discrete categories. Many EMR products either lack this capability or offer very basic note-taking modules; so the government’s decision not to require it in Stage 1 will enable physicians to use these products to achieve meaningful use, if they meet other requirements. However, discrete documentation of notes may be required in Stage 2 or Stage 3.

Emdeon’s Meaningful Use Portal
Emdeon, which is the largest administrative network in healthcare and has extensive lab and pharmacy connectivity, offers an EMR Lite solution called the Emdeon Office Suite. This easy-to-use web-based application simplifies everyday administrative and clinical processes including eligibility and benefits verification, claims and payment management, patient billing and payment as well as clinical tools that can help providers meet Meaningful Use criteria. Emdeon Office Suite integrates these capabilities with hundreds of practice management systems so providers can link to their billing and scheduling system for patient demographic and insurance data. Lab results are imported directly into the EMR Lite satisfying an optional requirement of Meaningful Use. The Emdeon Office Suite can also be used as a “plug-in” product that supports bi-directional exchange of discrete data with conventional EMRs.

Emdeon Office Suite will meet Meaningful Use criteria or we’ll give you your money back*.

Call us today to learn how our products can help you qualify for Meaningful Use incentives, accelerate your reimbursement, improve your productivity and simplify workflows in your office.


*Emdeon will meet Stage 1 Criteria for Meaningful Use of EHR Technology or we will refund up to six months of fees. Terms and conditions apply.

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It Pays to Give Patients Options

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Sign Up for Emdeon Patient Pay Online Before Year’s End and Get 90 Days FREE!

We’re sprucing up the Office with two innovative, patient-friendly solutions: Patient Pay Online and Patient Statements.

Emdeon Office Suite is already a versatile, spacious solution for providers like you. Every detail of this robust suite of applications—from eligibility and benefits verification and claims and payment management to ePrescribing, lab orders and results—is designed to meet providers’ unique needs by simplifying the business of healthcare. Of course, anything that helps providers manage the administrative side of healthcare provision is ultimately beneficial to patients as well; it’s a win-win.

Now we’re extending the Emdeon Office capabilities by integrating consumer-facing services. Patient Pay Online and Patient Statements are primarily focused on answering patients’ needs, but they’re sure to bear great results for your practice in the form of streamlined operations and a boosted bottom line. Once again, it’s a win-win.

Patient Pay Online
This application gives your patients a secure, self-service portal for making payments online. With easy, click-to-pay functionality and transparent account information available 24/7, patients are empowered with real-time data and spared the hassles of paper billing.

Your patient’s convenience equates to smoother compensation for you. As patients adopt Patient Pay Online, you’ll enjoy the pay-offs: improved cash flow, more timely compensation, reduced costs related to printed billing materials and less strain on your customer service and accounts receivable staff. Additionally, you’ll have access to deep reporting and analytics tools to effectively track payment information up to the minute, at any time.

Patient Statements
Patient Statements—now seamlessly integrated into Emdeon Office Suite—is your single-source for statement creation, processing, printing and mailing. In keeping with HFMA guidelines for Patient Friendly Billing®, Emdeon’s Patient Statements improves patient relations by offering the most accurate, clearly stated billing communications delivered in a timely, streamlined invoice processing.

This immensely practical solution alleviates the logistics of invoice processing and mailing for providers. Customizable statements are generated and diverted to Emdeon’s high volume mail site for processing and sending, while our Address Cleansing Services scrubs lists for accuracy. Patients receive prompt, easy-to-read and reliably accurate statements, and that leads to quicker, more complete provider compensation and better cash flow. Additionally, providers face fewer customer service calls and save time and money by transferring mailing operations to Emdeon.

The Pay-off: Get Emdeon Patient Pay Online FREE for 90 Days
If you’re already an Emdeon Office client, you can easily incorporate Patient Statements and Patient Pay Online into your daily practice. Sign up for Patient Pay Online by the end of the year, and we’ll waive our fee for 90 days.

To launch these versatile solutions simply call us at 866.369.8805 or visit us online to discover more about the new services of Emdeon Office Suite.

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HIPAA Simplified

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One of the major discussions this summer has revolved around the Errata for some of the HIPAA 5010 Implementation Guides (TR3s). X12N released the Errata for publication on August 5, and they are now being considered for adoption as a part of a standard by Centers for Medicare and Medicaid Services (CMS). Even though the Errata have not yet been adopted by the Department of Health and Human Services (HHS), many Covered Entities are nonetheless preparing to update their gap analyses accordingly if and when the Errata are adopted.

In simple terms, the Errata are supplemental information that contain modifications to some of the TR3s. Not only must senders adopt the Errata, but so also must receivers if they are to perform a successful exchange of information.

To help our clients with HIPAA readiness, Emdeon is publishing updated gap analyses for the transaction code sets to reflect the Errata once they are adopted by CMS. Like all of our other documentation on HIPAA Simplified, these updated gap analyses will be available to download for free. Visitors only need to type in their email addresses, and they’ll be able to pick from our vast library of documentation.

For visitors who search for new documentation on HIPAA Simplified, we have good news: we’re currently updating our Frequently Asked Questions (FAQ) to incorporate new questions we’ve answered since publishing the first FAQ.

Additionally, our Pharmacy team has been working on new NCPDP D.0 gap analyses. As always, we’ll update our Downloads page to highlight the new or updated documentation for quick access and easy download.

We’re also excited to announce that Emdeon will be launching a new regulatory e-newsletter later this year, which we’ll use not only to communicate updates to HIPAA Simplified, but also to keep our clients up-to-date on industry news that will impact them. We’ll also use the e-newsletter to announce the publication of new documentation. Check HIPAA Simplified over the next few weeks as we share more information about how to stay in the loop concerning the ongoing transition to HIPAA 5010.

We’ll now be posting HIPAA Simplified updates and announcing new documentation on social networking websites. Follow Emdeon on Twitter, Facebook, and LinkedIn to stay up-to-date on news as it happens.

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A Quest to Improve Workflow Leads to Efficient Patient-Centered Care

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21st Century Family Practice’s revenue cycle management and workflows were not living up to the organization’s stated vision of efficiency through the use of technology. The practice’s lean staff lost precious hours each week being left on hold during phone-based eligibility verifications, tracking the status of claims, as well as dealing with denial management and handling paper-based processes— including billing. And the delays involved with receiving lost or denied claims notifications by mail were impeding the practice’s cash flow, as payments were often greatly delayed or ultimately converted to bad debt.

21st Century implemented Emdeon Office Suite to completely revamp the way the practice operates in all aspects of administrative/business functions, including the all-important billing process. The team found Emdeon’s applications were aligned with their goal to improve revenue cycle management by making processes more efficient. “We were looking for a single partner to provide all the functionalities of our office for claims and eligibility,” explains Harry Singh, Practice Administrator with 21st Century. “Emdeon is a one stop solution to provide all we need, plus additional services that are also now an essential part of our office.”

The goal of improving revenue management through better efficiency has been achieved. 21st Century’s overall cash flow is notably enhanced since the implementation of Emdeon Office Suite. Currently, 70% of total accounts are received within 0-30 days, up from just 30% before the Emdeon solutions were implemented. “The improvement in our total collections has come about as a result of submitting the claims on time and electronically, and also collecting them on time - with Emdeon solutions’ 360 degree approach,” states Singh.

This is a true success story, as the specific results and Harry Singh’s praise attests. The complete, compelling success story including details about challenges, goals and impressive outcomes can be found in the Emdeon Office Suite Case Study. Read all the stats and specifics about how Emdeon helped 21st Century Family Practice achieve:

- reduction of AR days
- staffing efficiencies
- improved cash flow
- strategies for long term success

You can experience your own Emdeon success story! Call us today at 866.369.8805 to find case study-worthy solutions for your business operations.

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New Payer Transactions

New payers on board with Emdeon. Take a look at the new list
New payers added recently:

• Advantica Benefits; Claims
• Alta Bates Medical Group; Claims
• American Family Medicare Supplemental; Claims
• AmeriChoice of New Jersey, Inc.; Claims
• ATA FL; Claims
• BCBS of LA; Claims
• Benefit & Risk Management Services; Claims
• Benefit Administrative Systems; ERA
• BCBS of Montana; ERA
• Coventry Health Care; ERA
• Empire Omnipro (BC NYC); ERA
• Employee Benefit Systems; Claims
• Employers Insurance Group; Claims
• Florida Health Care Plan; Claims
• Freedom First; Claims
• Healthtran; Claims
• Hometown Health Plan Nevada; ERA
• InterCare Health Plans Inc.; Claims
• JMH Medicare Advantage; Claims
• MAMSI Life and Health Insurance Co. (MLH); ERA
• MBA Benefit Administrators, Inc.; Claims
• MD Medicare Part A; ERA
• Medicaid Hawaii Waivers; Claims
• Medical Services Initiative; Claims
• Medicare Blue Private; Claims
• MetroPlus Health Plan; ERA
• Metropolitan Transit Athority; Claims
• MidCoast IPA; Claims
• National Health Insurance Company; ERA
• Nebraska Medicaid; ERA
• New Era Employee Welfare Benefit Plan Trust; ERA
• NHI Billing Services, Inc.; Claims
• North American Benefits Network (Cleveland, OH); Claims
• Optum Specialty Services / Americhoice of NJ; Claims
• PEHP (Public Employees Health Program); ERA
• Pennsylvania Medicaid; ERA
• Providence PPO; Claims
• Regence UT BCBS; ERA
• Regence UT BCBS FEP; ERA
• San Louis Obispo Select; Claims
• Sheffield, Olson, & McQueen, Inc; ERA
• Southwest Airlines; Claims
• SRS Hilton Worldwide, Inc; Claims
• SuperiorSTAR Pregnant Women; Claims
• Surency Life and Health; ERA
• The Beacon Mutal Insurance Co.; Claims
• Tower Life Insurance Co.; ERA

For a complete list of the payers in our network, visit our website at

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