Providers beware: computerized physician order entry (CPOE) is set to create headaches for the healthcare community. In fact, the threshold requirements for providers to achieve Meaningful Use (MU) under Stage 2 have many concerned that they will encounter similar problems to the ones they experienced during Stage 1 attestation, just more of them.
CPOE is proving difficult for the entire industry. Research conducted by the University of Florida found that only 13 percent of hospitals that intended to participate in the incentive program received an incentive payment in 2011. Fifty percent of organizations that did not successfully attest reported that meeting CPOE was their primary challenge. The report also indicated that unlike some of the other Stage 1 criteria, CPOE presented a host of technological, cultural and organizational barriers that are expected to grow as the threshold requirements increase.1
According to CMS’s Stage 2 requirements for CPOE, eligible providers (EPs) must reach a 60 percent threshold for electronic medications, up from 30 percent with Stage 1. But as providers are well aware, that may be the easier measure to achieve. They are not looking forward to the criteria surrounding laboratory and radiology orders, which have been added as a core measure. EPs are required to reach a 30 percent threshold for both radiology and laboratory orders, with one exception: Any EP who writes fewer than 100 radiology or lab orders during the 90-day reporting period is exempt.
Perhaps the greatest challenge for physicians to overcome is the disruption that electronic orders are expected to have on workflow. While software developers will attempt to make it as easy as possible for providers to create electronic orders with multiple labs and radiology centers, the truth is that this electronic capability is simply not one that practitioners have typically dabbled in extensively. Providers can spend the remaining time in 2013 to familiarize themselves with their Electronic Healthcare Record’s (EHR) radiology and lab modules in readiness for Stage 2. And they should not be afraid to check with their vendors if they experience any difficulties on the road to MU compliance.
Challenges aside, providers should be encouraged by the fact that they can increase patient safety and ultimately streamline billing and claims activities with cleaner, more accurate electronic laboratory and radiology orders and results.
[1] Healthcare IT News. “CPOE biggest barrier to meaningful use, study finds.” September 28, 2012.
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Stage 2 CPOE: Challenges and Opportunities for Providers
Analytics Provides a Head Start for Participation in New Models of Care
Quality is king in healthcare, a fact that is best demonstrated in emerging coordinated care models that reward physicians who achieve positive clinical outcomes. There is no better way to realize high quality care delivery than with analytics designed to track practice performance. With meaningful information at their fingertips, providers can identify areas for improvement and optimization and create a solid foundation for moving forward. As more and more practices are looking to take advantage of incentives offered through participation in new models of care, benchmarking solutions are becoming widespread.
However, many physician offices still lack the tools necessary to help manage patient populations or easily modify administrative procedures. Fortunately for organizations ready to make the leap, there are powerful analytics that help practices turn large amounts of raw clinical and financial data into useful information. Extracting data from patient records, physicians can gain insights into their performance on several clinical quality measures such as immunizations, cancer screenings or nutrition counseling provided for certain populations. And with technology to track their patients’ chronic diseases such as asthma or diabetes over time, physicians will be in a better position to offer preventative services and clinical interventions that lower overall healthcare costs.
With analytics that provide insights into their practice’s clinical performance, physicians also have the opportunity to drive additional practice revenue from emerging care delivery models that reward quality improvement, including patient-centered medical homes (PCMHs), accountable care organizations (ACOs) and the Centers for Medicare and Medicaid Services (CMS) Bundled Payments Initiative.
Practices that have successfully leveraged analytics tools to track performance and collaborate with diverse care teams are able to not only reap the benefits of financial incentives and improved outcomes, but they are also in a better position to participate in incentive programs such as the CMS Comprehensive Primary Care (CPC) initiative. The goal of the CPC is to foster collaboration between public and private payers and primary care physicians, creating a funding stream for resources that allow practices to better coordinate care1. Programs like the CPC give practices that are ahead of the curve access to additional funding and resources to better coordinate care for their patients.
As healthcare organizations move away from traditional fee-for-service payment arrangements and into quality-based, shared savings models, it has become evident that benchmarking data will be a vital tool for change. With an enhanced understanding of both clinical and financial performance, practices will be able to better coordinate care for all their patients, improving clinical outcomes at a lower cost.
1. http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/
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Setting the Table for Insurance Payers
Final article in a 4-part series designed to offer small practice providers tips on improving their administrative and clinical operations.
It is not a stretch to say that payer relations are paramount to the success of your practice. And, fortunately, there are ways you can improve how the reimbursement process works with a handful of tactical strategies that will create a more inviting place setting for health plans, while keeping business courteous and retaining your position at the head of the table. Here are some tips for enhancing your payer relations:
Manage Contracts
It is important for small- and medium-size practice managers to know the policies and fee schedules of health plans to ensure they are being paid correctly. Most coders and billers are not aware of the agreed upon rates for procedures, or whether the contract is paid by relative value unit (RVU), flat rate or some other fee structure. Knowing contracts means you can ensure the practice is getting paid what it deserves and that codes, RVUs and prioritizations are aligned. And when the contract is up for renewal, don’t show up empty-handed. You will want to have concrete data at your fingertips that shows cost of services and profits from care provided to patients.
Track Payments
Denials eat up time and resources. The first step in finding a fix is to determine what types of denials you are getting most often from the top two or three payers, such as bundled services that were billed separately or incorrect codes, for example. By tracking these patterns, you can go back and change habits through education (physician documentation, coding errors, etc.) or decide if a denial was inappropriate and appeal the decision. If you disagree with a policy change or denial, bring it to the attention of your representative. If it needs to be escalated, contact the plan’s medical director. Whichever direction an issue takes, claims resolution takes time, so it’s a good idea to appoint a lead to chart, pull and review the documentation for the least amount of disruption.
Close the Communication Gap
When it comes to improving payer relations, there is no substitute for direct communication. Get to know your representative. Issues that are addressed quickly tend to remain manageable. Your health plan contact can answer questions quickly or put you in touch with resources that can help. Moreover, learn to speak the payer’s language. Delivering information on clinical outcomes, profitability and service volume will earn you respect, lay the groundwork for dialog and make clear the goals you want to achieve.
Having a solid understanding of the industry by being armed with data, whether to negotiate a contract or settle a dispute, and clearly communicating expectations and goals will keep the reimbursement process running smoothly. Likewise, these actions will set the table for future business and partnerships with payers.
Whether it’s arming your practice with claims rejection data or helping to improve the accuracy of your claims submission, Emdeon simplifies the everyday tasks of physician office staff, enabling you to create claims online or submit them through a practice management system. Our reporting and analytics dashboard allows you to track claims from submission to payment, identify and correct rejections, and be made aware of the top reasons for rejections so that future claims can be submitted accurately—and help you get paid faster.
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Let's get social. Join us, won't you?
Emdeon’s active in the social mediasphere, from sharing our innovative new solutions to listening to the feedback we receive from you on Emdeon products and services. We value our role as an important player in the industry, so we regularly post updates and offer valuable resources to keep you aware of the industry trends that matter to you, including healthcare reform, emerging technology, best practices and more.
From your computer or mobile device, you can also receive important Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. Or visit our YouTube channel to watch inspiring testimonials and insight product videos. Just click on the icons to the left to get social with Emdeon today!
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New Payer Transactions Added Recently
We have recently added the following payers:
• Health Alliance Medical Plans (HAMP) - ERA
• Mediture - Claims
• Medico Insurance Company - Claims
• Wellcare - Claims
• North American Benefits Network ((Cleveland, OH) - Claims
• Trellis Health Partners - Claims
• CNIC Health Solutions Inc. - Claims
• AmeriChoice of New Jersey, Inc. (Medicaid NJ) - Claims
• CareOregon, Inc. - Claims
• Blue Cross of Arkansas - ERA
• MED3000 CMS TITLE 19 REFORM - Claims
• Hawaii Medical Service Association (HMSA) - ERA
• Merchants Benefit Administration - Claims
• Cook Children STAR Plan - Claims
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
See the full list >>
Meaningful Use Stage 2: It’s Not too Early to Prepare for Attestation
By Michele Judge
With the first round of attestation for the Medicare and Medicaid EHR Incentive Program out of the way, healthcare providers are looking toward the next phase that commences in 2014. As expected, the second stage of MU will greet them with stricter documentation requirements. Rather than being dismayed, eligible professionals (EPs) and hospitals should utilize lessons learned in Stage 1 to prepare for a successful Stage 2 attestation.
To review, providers and hospitals will be required to report on more core objectives than in Stage 1. EPs will now attest to 20 total items, including 17 core objectives and three (of six) menu objectives. But as the industry found out from Stage 1, attestation is not straightforward. Reporting requirements are different for certain patient populations, which is the essence of numerators, denominators, thresholds and exclusions. This aspect proved to be among the most confusing for providers.
To help clarify, objectives requiring a numerator and denominator are divided into two groups:
In the first group, the denominator is based on patients seen or admitted during the 90-day EHR reporting period, regardless of whether their records are maintained using certified EMR technology.
The second group of objectives consists of those that are not relevant to all patients. In this case, the denominator is based on actions related to individuals whose records are maintained using certified EMR technology. More information can be found in guides such as this one provided by CMS.
But it’s not only the complex rules that promise to trip up providers in Stage 2. Meeting the increased documentation requirements for radiology and laboratory orders in particular have many wondering if they will attest successfully. The reason? Up until now, the focus for EMR developers has been on usability and meeting Stage 1 requirements. Radiology and lab order documentation has not previously been a priority.
Providers must use 2013 to become familiar with their EMR’s radiology and lab modules. If they determine that limitations in the software will jeopardize their MU compliance chances, they can suggest that their vendors deliver a more functional solution. Physicians can also consider implementing third-party stand-alone technology or a module that can be embedded within their current EMR. Many products, such as Emdeon’s lab orders and results software, are Web based, greatly easing implementation.
Perhaps the greatest bit of advice for the provider community, however, is not to procrastinate. Many physicians waited until the last three months of the year to collect their data, only to find that they failed to meet core and menu set objectives. Rather than risk missing out on MU’s economic windfall, providers should choose a 90-day period early in the year for attestation, leaving ample time to adjust their data if they do not initially meet the appropriate criteria. Providers should also consider using CMS’ calculator at http://www.cms.gov/apps/ehr/, to test whether or not they would successfully demonstrate Meaningful Use.
With adequate foresight and planning, healthcare providers will greatly increase their chances for MU success. Companies like Emdeon are great resources, providing insights and continuously guiding physicians through the complex maze that is Meaningful Use.
Michele Judge is Senior Director of Clinical Services at Emdeon. She has over 20 years of experience in managing, deploying and developing computerized physician order entry solutions for laboratories, hospitals and pharmacies.
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Emdeon Awarded Exclusive Health and Human Services Contract to Define Process for Electronic Healthcare Transaction Standards
We are proud to announce that Emdeon has recently been awarded a contract to define the processes and tools needed to move electronic healthcare transaction standards to a new version. Under the contract, Emdeon will develop and execute an analytical methodology for the Centers for Medicare and Medicaid Services (CMS) to estimate the industry impact of moving to a new version of electronic transaction standards. The recommended process will be submitted prior to the standards development organization proposing adoption by the U.S. Department of Health and Human Services (HHS) to the National Committee on Vital and Health Statistics.
The purpose of the project is to define the activities when new HIPAA and ACA transaction standards are adopted to avoid the implementation issues that have been associated with revised transaction standards in the recent past. According to CMS, the intent of the project is to greatly reduce the likelihood of technical issues going undetected until after the standards are adopted and to eliminate the negative impacts such technical issues would have on the healthcare industry. Under the terms of the agreement, Emdeon will analyze the functionality, usability, interoperability and business usage of a sample of draft versions of HIPAA standards for the following healthcare transactions: claims, claim status, claim payment/remittance advice, eligibility and referral authorizations, as well as any new standard that HHS may consider for adoption during the term of the project.
"We are pleased to work with HHS on such a high-visibility project and lend our industry experience to help avoid costly implementation interruptions that could potentially save the healthcare industry millions of dollars," said Debbi Meisner, vice president of regulatory strategy for Emdeon. "As the single largest clinical, financial and administrative health information exchange in the U.S. healthcare system, Emdeon's extensive experience will enable us to identify and correct potential technical issues during all phases of the transition to a new version of the transaction standards."
For more information on this and other important industry news, check out the Emdeon Newsroom at http://emdeon.mediaroom.com/.
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So, what's all the fuss about ACOs?
Try as you might, it’s hard to ignore the buzz surrounding accountable care organizations (ACOs) these days. You’ll find articles about ACOs in nearly any publication you open and presentations on ACOs at nearly any conference you attend.
So—as Emily Litella of Saturday Night Live fame would say—what’s all this fuss about ACOs?
Shared savings, shared risk
When you sort through all of the rhetoric and regulation, an ACO is a network of doctors, hospitals and health plans that shares responsibility for providing care to patients. ACOs—both public and private networks—offer incentives for providers that cooperate and save money while meeting specific quality metrics. In other words, they get bonuses for keeping patients healthy and out of the hospital. On the other side of the coin, providers will be responsible for additional costs if they cannot effectively treat the patient.
While some experts debate whether or not ACOs will completely replace the current fee-for-service approach, they predict that some flavor of ACO will gain prominence in the marketplace.
PCPs and smaller practices will be critical to ACO success
Smaller practices find themselves in a challenging situation. It’s likely that large provider groups (such as independent physician associations), hospitals, health systems and payers will drive the development of most ACOs. But they will be highly dependent upon “family docs,” primary care providers (PCPs) and small specialty practices to deliver the well care, preventive services and disease management critical to meeting the access/quality/cost conundrum.
New model requires technology, communication
It’s to your advantage to explore whether or not it would be beneficial to participate in an ACO. You’ll be asked to enter into contractual relationships with other providers in your service area, of course, as well as implement health information technology (HIT) solutions like electronic health records (EHRs) to facilitate data sharing and collaboration if you have not done so already.
It also means you’ll need to communicate with patients about your involvement. The Medicare Shared Savings Program mandates that PCPs tell patients they are part of an ACO—and when they’re referring these patients to hospitals or specialists within the network. Patients, of course, can select other providers if they prefer.
Yet another option: the Comprehensive Primary Care Initiative
Here’s another twist: the Centers for Medicare and Medicaid Services (CMS) has created a model similar to ACOs specifically for PCPs—the Comprehensive Primary Care Initiative, also funded by healthcare reform. Through the program Medicare will coordinate with private and state health plans to pay bonuses to PCPs who improve care coordination for their patients. Even better, Medicare will offer PCPs additional resources to participate in the program. After two years, Medicare will give participants a chance to share in any savings they generate.
Consider all your options
Without a doubt, there will be no shortage of options for you to consider. And you’ll be able to respond in whichever way you feel most appropriate for your practice.
There’s only one reaction your partners at Emdeon advise against: Don’t take your cue from Emily Litella and simply say, “Never mind.” These changes are coming—and PCPs and small practices will be right in the middle of any new model. You’d be wise to keep abreast of what is occurring on the national scale, as well as right in your own backyard.
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Good customer relations builds loyalty and encourages timely payment
Part 3 of a 4-part series designed to offer small practice providers tips on improving administrative and clinical operations.
A sure sign that you’re providing good customer service is that people want to do business with you. In healthcare, this means patients want to come back to receive their care from you.
But busy physician practices (in other words, all physician practices!) sometimes find it difficult to focus on customer relations. Office staff is typically pulled in many directions: answering the phones, tracking down medical records, checking eligibility and coverage, and so on. Employees are stretched thin and may neglect those little things (and, sometimes, big things) that make patients feel appreciated and truly cared for. It’s important not to let this slide. Patients’ experiences during the entire visit determine if they return for a next appointment, how (and if) they pay their bill, and whether or not they refer others to the practice.
A positive customer experience starts before patients ever step foot in your office, often with a visit to your website. These days, most consumers turn to the Internet when they need information. Your website can offer a treasure trove of detail about your practice: location and directions, policies, provider profiles, etc. And, increasingly, patients expect a secure portal so they can easily schedule an appointment, request a medication refill or ask a question.
Equally important, of course, is what happens when patients arrive. It seems obvious, but welcoming the patient to the practice is absolutely vital—and it is astonishing how often this simple gesture is overlooked. When you walk into any other business—a store, restaurant, etc.—the first thing you usually hear is “Welcome!” A doctor’s office should be no different. A warm greeting, accompanied by eye contact, immediately puts a patient at ease and establishes rapport.
Every member of office staff should be encouraged to build rapport with patients—communicating genuine concern and warmth. Besides checking how patients are feeling, for instance, they can also ask about work, the kids or a recent vacation. This human connection allows patients to see the staff as personable and trustworthy—much more than just “the receptionist” or “the nurse.”
Although it might be hard to believe, being direct and upfront about the cost of care also contributes to good customer relations. Clear communication about copayments and deductibles can help prevent unpleasant financial surprises down the line—which, not surprisingly, upset patients. They are more apt to pay their bills in full and on time if they are fully aware of policies and balances due.
Treating patients well builds loyalty; they trust and respect you. And this creates a sense of mutual responsibility—and an environment where patients are willing to fulfill their obligations to your practice. Besides providing excellent care, your objective is to win and keep patients. Every staff member, regardless of responsibility, should be trained and committed to delivering the best customer service possible.
Emdeon offers a broad array of solutions to help small practices create a patient-friendly environment. With technology to automate insurance eligibility verification and online payment options that free staff to devote more time to customer service, we can help you achieve your goals.
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ePrescribing: worth the wait, but not worth waiting any longer
Physicians are a wary lot. When a new technology suddenly appears, they usually don’t jump in head first. Their reasoning is legitimate: Any disruption in their workflow could impact revenue, or worse, threaten patient safety and care delivery. In the same typically cautious fashion, they’ve watched electronic prescribing, or ePrescribing, emerge on the scene. Centers for Medicare and Medicaid Services’ (CMS) Medicare ePrescribing incentive system and Meaningful Use provisions that financially reward practitioners for utilizing advanced technologies to send medication orders have inspired many early adopters to hop onto the ePrescribing bandwagon. On the other hand, some have simply chosen to endure slight payment adjustments while delaying any major changes in their practices. What these more tentative providers have come to observe, however, is an easy-to-use technology that delivers significant efficiency, convenience and patient safety benefits with very little, if any, disturbance to practice patterns.
Creating a two-way communications platform between physicians and pharmacists, ePrescribing all but eliminates handwritten orders, saving time and reducing hassles for providers, pharmacists and even patients. ePrescribing applications can be configured to generate a log for the patient record, which allows practitioners to easily review a patient’s medication history, not only ensuring consistency, but also streamlining prescription refill requests.
As a more accurate method for generating and sending medication requests, ePrescribing also improves patient safety, thereby meeting one of the CMS’s primary goals of reducing medication errors and adverse drug events with automated solutions. In fact, many ePrescribing technologies include medication reconciliation modules that allow providers to verify prescription information at the point of care.
ePrescribing is becoming an important component of patient engagement programs, helping integrate individuals with the prescription process. When a physician submits an order, for example, the technology can automatically send an email, text or voice message to the patient confirming the order with details such as when it will be ready and where the individual can pick up their medications.
Providers can even participate in ePrescribing for controlled substances (EPCS), which was prohibited by the Drug Enforcement Administration (DEA) until just a few years ago for fear that it couldn’t be adequately protected. With additional security controls now in place, such as passwords, biometrics and secure tokens that fit smoothly within physician workflow, the DEA believes that EPCS creates a safer portal for prescribing and dispensing controlled substances than manual processes, protecting both doctors and pharmacies.
Ease of use, simple implementation and immediate benefits are three reasons why even the most technology-averse practices should consider ePrescribing over traditional methods. While it may seem painless to accept a two percent reimbursement adjustment, the long-term benefits and savings from an ePrescribing capability outweigh any short-term costs.
Emdeon Clinical Exchange EHR Lite, an EHR solution designed for small physician practices, allows users to conveniently and cost-effectively exchange electronic transactions. With its advanced features, Emdeon Clinical Exchange EHR Lite helps providers add efficiency to this important component of their practice, qualify for Meaningful Use incentives and avoid reimbursement adjustments that will continue to increase for those not taking part in an ePrescribing program. To learn more about the benefits of ePrescribing, visit www.emdeon.com.
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Let's get social. Join us, won't you?
Emdeon’s active in the social mediasphere, from sharing our innovative new solutions to listening to the feedback we receive from you on Emdeon products and services. We value our role as an important player in the industry, so we regularly post updates and offer valuable resources to keep you aware of the industry trends that matter to you, including healthcare reform, emerging technology, best practices and more.
From your computer or mobile device, you can also receive important Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. Or visit our YouTube channel to watch inspiring testimonials and insightful product videos. Just click on the icons to the left to get social with Emdeon today!
Read More >>
New Payer Transactions Added Recently
We have recently added the following payers:
• Health Alliance Medical Plans (HAMP) - ERA
• Mediture - Claims
• Medico Insurance Company - Claims
• Wellcare - Claims
• North American Benefits Network ((Cleveland, OH) - Claims
• Trellis Health Partners - Claims
• CNIC Health Solutions Inc. - Claims
• AmeriChoice of New Jersey, Inc. (Medicaid NJ) - Claims
• CareOregon, Inc. - Claims
• Blue Cross of Arkansas - ERA
• MED3000 CMS TITLE 19 REFORM - Claims
• Hawaii Medical Service Association (HMSA) - ERA
• Merchants Benefit Administration - Claims
• Cook Children STAR Plan - Claims
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
See the full list >>
