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!
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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 >>
Eligibility and Claim Status Operating Rules Update
January 1, 2013 is rapidly approaching. This is the date by which HIPAA covered entities must implement the Department of Health and Human Services (HHS) Eligibility and Claim Status Operating Rules mandated under the Affordable Care Act. The Eligibility and Claim Status Operating Rules that HHS adopted by regulation in 2011 comprise the majority of those required for CAQH CORE’s voluntary Phase I and II certification. Emdeon became CORE Phase II certified in 2010, so Emdeon was in a strong position of readiness when HHS adopted these operating rules.
Emdeon has completed a thorough gap analysis in order to be ready by the compliance date. We are now concluding our remediation of any identified gaps.
Trading Partner Support
Emdeon dedicated to help our clients complete this important transition successfully. We have already initiated testing with health plans that are ready to test their operating rule conformance.
In addition, we are actively engaging health plans who utilize our Eligibility and Claim Status Hosted Data Services (HDS). These health plans must:
• Migrate to version 3 of HDS if they are not on that version already; migration efforts for clients on prior versions are actively underway.
• Provide the proper data content in their eligibility files. (There are no data content requirements for the Claim Status transaction)
HIPAA Simplified
Our HIPAA Simplified website, www.hipaasimplified.com, remains the primary resource for information regarding the operating rules and other HIPAA and ACA regulations.
On the Operating Rules pages, you will find the newly updated Operating Rules Playbook. This publication is full of valuable information, including our operating rule program management structure, roles and responsibilities, educational material on the rules themselves, and a new section specific to the upcoming ERA/EFT Operating Rules.
HIPAA Simplified is updated regularly, so check back often!
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Setting the Stage for Stage 2. Where We Are Now & What You Need to Know.
(Part 1 of 4)
Stage 2 of the Meaningful Use (MU) incentive program is being billed by some as “a giant leap in data exchange1.” The overriding goal of the program is to advance the secure exchange of information within our health system between all of a patient’s providers as well as the patients themselves —and that is a giant leap from where the system is currently, indeed. Of course, with every giant leap comes the chance for big missteps. That’s why the time is now to prepare for Stage 2 objectives and requirements.
The Biggest Challenges Revealed in Stage 1
According to a recent study published in the Journal of the American Informatics Association, the biggest challenge for hospitals participating in the MU program is Computerized Provider Order Entry (CPOE). Out of 2,475 hospitals in the study that intended to participate in MU, only 313 received incentive payments in 2011 during Stage 1. Half of those hospitals that didn’t meet Stage 1 requirements cited CPOE criteria as a top challenge. As we move to Stage 2, issues related to CPOE will remain as many hospitals are only beginning to adopt EHRs and build infrastructure to meet MU criteria.
For hospitals that were awarded incentive payments, giving patients access to their data in electronic form and generating numerator and denominator data for quality reporting directly from the Electronic Health Record (EHR) were reported to be the most significant challenges. The difficulty of providing electronic data to patients is very important to note and prepare for, as Stage 2 focuses on electronic patient communications and assigns heightened requirements to achieve program incentives.
According to Stage 2 Meaningful Use requirements final rule by Centers for Medicare & Medicaid Services (CMS), providers must achieve meaningful use under Stage 1 criteria before advancing to Stage 2. CMS has announced certain changes to Stage 1 CPOE; details may be found by clicking here.
What is different in Stage 2 as compared to Stage 1
In Stage 2, there are more core objectives for Eligible Professionals, Eligible Hospitals and Critical Access Hospitals (CAHs). Many Stage 1 core objectives have been merged or folded into other requirements. Eligible Professionals have 20 total objectives, including 17 core objectives and 3 (of 6) menu objectives. For Eligible Hospitals and CAHs, there are 19 total objectives comprised of 16 core objectives and 3 (of 6) menu objectives.
Here’s a quick look at core objectives that Eligible Professionals must report on, as well as the six menu objectives they may choose from.
Core Objectives
1. Computerized Provider Order Entry (CPOE)
a. Use CPOE for more than 60 percent of medication, 30 percent of laboratory, and 30 percent of radiology.
2. ePrescribing (eRx)
a. Use eRx for more than 50 percent.
3. Demographics
a. Record demographics for more than 80 percent.
4. Vital Signs
a. Record vital signs for more than 80 percent.
5. Smoking Status
a. Record smoking status for more than 80 percent.
6. Interventions
a. Implement 5 clinical decision support interventions + drug/drug and drug/allergy.
7. Labs
a. Incorporate lab results for more than 55 percent.
8. Patient List
a. Generate patient list by specific condition.
9. Preventive Reminders
a. Use Electronic Health Record (EHR) to identify and provide reminders for preventive/follow-up care for more than 10 percent of patients with two or more office visits in the last 2 years.
10. Patient Access
a. Provide online access to health information for more than 50 percent with more than five percent actually accessing.
11. Visit Summaries
a. Provide office visit summaries for more than 50 percent of office visits.
12. Education Resources
a. Use EHR to identify and provide education resources more than 10 percent.
13. Secure Messages
a. More than five percent of patients send secure messages to their Eligible Professionals (EP).
14. Prescription Reconciliation
a. Medication reconciliation at more than 50 percent of transitions of care.
15. Summary of Care
a. Provide summary of care document for more than 50 percent of transitions of care and referrals with 10 percent sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR.
16. Immunizations
a. Successful ongoing transmission of immunization data.
17. Security Analysis
a. Conduct or review security analysis and incorporate in risk management process.
Menu Objectives (select 3 of 6)
1. Imaging Results
a. More than 10 percent of imaging results are accessible through Certified EHR Technology.
2. Family History
a. Record family health history for more than 20 percent.
3. Syndromic Surveillance
a. Maintain successful ongoing transmission of syndromic surveillance data.
4. Cancer
a. Maintain successful ongoing transmission of cancer case information.
5. Specialized Registry
a. Maintain successful ongoing transmission of data to a specialized registry.
6. Progress Notes
a. Enter an electronic progress note for more than 30 percent of unique patients.
For even more details, view the CMS' Stage 2 Tipsheet by clicking here.
The Five Percent+ Factor: Focusing on Patient Engagement in Stage 2
Patient engagement—reciprocal communication between patients and providers—is a significant focus that everyone must be prepared for in Stage 2. To be eligible for incentives, providers must achieve the following patient action.
- More than five percent of patients must send secure messages to their eligible providers.
- More than five percent of patients must access their health information online.
For many Eligible Professionals, it may be quite daunting to evoke such engagement from over five percent of patients, as so many factors affect the transition to electronic information sharing. Technological, cultural and organizational barriers exist across communities nationwide. For example, CMS is introducing exclusions based on broadband availability by county, as some areas simply don’t have the Internet access necessary for five percent to take action even if they are willing to do so.
Timing for Stage 2
The final rule has been out since August 2012 and though there is an urgency for Stage 2, there is not the mad rush that surrounded Stage 1. Stage 2 test scripts have not yet been released in full from certification bodies and at this writing only three are out. Test scripts from vendors will be released in phases, with the launch of testing anticipated for December 2012 or January 2013.
For a complete look at Stage 2, visit CMS’ website by clicking here. There you’ll find tables, tipsheets and updates directly from CMS. In addition, continue to follow Emdeon for targeted announcements and interpretation of latest updates as it relates to your business. Emdeon will continuously guide you through Stage 2 so that you are prepared to offer expertise to your customers every step of the way.
Stay tuned for our next article in series, Planning for Certification and Strategies in Testing.
1. http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-stage-2/
2. http://www.fierceemr.com/story/cpoe-huge-stumbling-block-meaningful-use/2012-10-02?utm_source=rss&utm_medium=rss
3. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf
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From Politics to Practice
What we learned at MGMA. By Gene Boerger, V.P. of Professional Product Management at Emdeon
On the surface, the agenda for the 2012 MGMA Annual Conference (San Antonio, Oct. 21-24) contained few surprises: Education sessions focusing on ICD-10, ARRA, administrative simplification, Meaningful Use and ACOs.
What was unexpected, however, was the energy invested by the more than 3,000 people in attendance in transforming the politics of these issues into actionable strategies. Attendees and vendors alike were eager to convert the principles of reform into practice. We strategized with numerous provider groups to share how our expertise in care management, clinical information exchange and revenue optimization can transform industry concepts into real, workable scenarios. From our viewpoint, attendee interests fell into four major categories:
1. Solution engineering. We spoke with leaders at medical groups who recognize they need new solutions and new processes to achieve their objectives. Educational sessions, hallway discussions and vendor meetings centered on best practices and lessons learned. Attendees seemed to have a grasp of what they need and were tuned in to asking questions about how to get from here to there. Vendors were on the same wavelength. Countless meetings were held outside of exhibitor hours, where discussions about how to collaborate and integrate technologies to provide a more comprehensive whole abounded.
2. Care Management. Discussions about new care and reimbursement models, such as accountable care organizations (ACOs) and other pay-for-performance arrangements, have progressed from the abstract (“these approaches will help us control costs and improve care”) to the concrete (“who needs to be involved and what precisely will they be doing?”). Attendees explored the structures needed for greater focus on care management, for example, and heightened levels of coordination among providers. These conversations also dug deep into alignments—particularly as they affect community physicians—with hospitals.
3. Data drivers. As quality measures become engrained in emerging reimbursement models, medical groups increasingly need advanced data collection, analysis and reporting capabilities to successfully participate in a pay-for-performance or ACO-type model. Attendees recognized that their EHRs must work harder and that health information exchange (lowercase) is crucial. With a traditional focus only on delivering care—and not necessarily measuring it—providers are now taking a crash course in what tools are available, how they need to be configured and what they can do with the data that’s produced.
4. Business success. Billing professional fees. Proper coding and revenue optimization. Preparing for (and passing) audits. Contract negotiations. Use of outsourcing and technology. Patient collections. All activities that impact the bottom line—with a plethora of “practice proven and time tested” solutions for the challenges many medical groups face—were widely discussed. To arm our providers with information to improve business success, Emdeon held several educational presentations aimed at increasing revenue while effectively managing operations. Attendees agreed these considerations were more important in 2012 than ever before because of the incentive and payment reduction programs payers have adopted.
Emdeon made its presence felt throughout the conference, joining more than 350 other companies on the trade show floor with a dynamic booth that hosted long-time customers and new prospects. Emdeon was joined by the American Academy of Family Physicians for a speaking engagement in the MGMA Innovation Center on Care Management, and Emdeon representatives also delivered a number of in-booth educational sessions on topics ranging from how to remove barriers to submitting clean electronic orders to revving up cash flow by accepting online payments.
Overall, the mood of MGMA seemed to be of anticipation, partly fueled by the impending presidential election. Many attendees seemed to be of the opinion that the trends spurred by healthcare reform legislation would continue—and that they are embracing and preparing for new directions.
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Preparing Your Practice for the Future: A Look Ahead to 2013
You don’t need to be told that the speed of change in healthcare continues to accelerate. From healthcare reform to Medicare reimbursements to technology deployments, you must be ready to move with a quick and effective response to any and all challenges that come your way. The reward? Clinical and financial viability, now and well into the future. Here’s a peek at some market and regulatory forces that you will likely confront in 2013:
The Way is Paved for PPACA
The Patient Protection and Affordable Care Act (PPACA) was passed, the U.S. Supreme Court ruled to uphold the law and the potential Republican reversal to healthcare reform legislation came up short in a bid for the White House. If they haven’t already, physicians should gear up big for changes. PPACA will increase access to care for the millions of Americans who have previously been unable to obtain medical insurance; the expansion of Medicaid alone is estimated to result in up to 15 million new enrollees during 2014i. It’s important for practices to routinely verify information for its Medicaid patients, and with the impending, significant growth in this population, it will be increasingly vital to confirm that patient information is accurate. Whether coverage is obtained through private companies or government programs such as Medicaid, small practices better be ready.
An Adjustment in Income?
As it stands now, physicians may face an adjustment of 27 percent or more in Medicare reimbursements in 2013ii. Congress did implement a temporary patch last year to keep 2012 rates stable, but has yet to apply a permanent fix and replace the current sustainable growth rate (SGR) reimbursement system with a more stable and predictable payment mechanism.
Increasing Quality Reporting Demands
With the release of the new Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) announced that providers who do not successfully participate in the Physician Quality Reporting System (PQRS) during the 2013 program year will be subject to a one and a half percent payment adjustment in 2015, and a two percent adjustment in subsequent yearsiii. On the flip side, eligible professionals (EPs) who satisfactorily report quality measure data will qualify for a half percent bonus in 2013. To help you avoid reimbursement adjustments, CMS has proposed two additional reporting options. The first is to satisfactorily report at least one PQRS measure or measures group via a claims, registry or EHR-based reporting mechanism. The second option allows you to utilize administrative claims-based reporting for related measures. Be aware, however, that if you elect one of these reporting options, you will not qualify for an incentive payment.
ePrescribing Actions
CMS continues to aggressively push ePrescribing. The goal of CMS’ ePrescribing Program is ultimately to increase patient safety through the reduction of medication errors and adverse drug events. Besides the improvement in efficiency that physicians gain through this program, there is also a financial benefit for being an early adopter. In 2013, the last year of the Medicare ePrescribing incentive system, you can receive a half percent financial bonus for conducting a portion of prescription orders electronically. Considering that you will be subject to a one and a half percent payment adjustment for noncompliance, those easy to use ePrescribing platforms are beginning to look pretty attractive.
EHR Deployment Progress
Better known as “Meaningful Use,” the EHR Incentive Program continues in 2013, with many physicians preparing for their 90-day reporting period that will enable them to prove they are meaningful users of the technology under Stage 1 requirements. While the reporting period for Stage 2 compliance has been pushed back until October 2014, you should take advantage of the additional time and prepare for rising Stage 2 qualification thresholds, including demonstrating that at least 50 percent of your prescriptions are completed through ePrescribing, up from the 40 percent required in Stage 1.
Requirement to Accept Electronic Payments
Expect 2013 to be a watershed year for participation in emerging Medicare payment initiatives that are driving the formation of accountable care organizations (ACOs), shared savings programs, bundled payment pilot projects and value-based payment modifiers. And if Meaningful Use is not enough of an incentive for you to ramp up your EHR deployment efforts, these new initiatives surely demand that you look closely at enabling solutions to access and utilize the data you need to improve care and reduce costs. Additionally, January 1, 2014, is the deadline by which all payments under Medicare must be conducted via electronic funds transfer (EFT). And, while providers will not be required to accept electronic payments from commercial health plans, all payers will be required to have the ability to facilitate these transactions.
To help small practices navigate healthcare reform, Emdeon Office Suite provides many tools to increase accuracy and efficiency while reducing interruptions in the revenue cycle. Online pre-registration, real-time eligibility and benefits verification, and claims and payment management, including the facilitation of electronic funds transfer, are some of the key services this technology offers. Emdeon also provides a convenient and cost-effective way for providers and pharmacies to exchange ePrescribing transactions through its Emdeon Clinical Exchange EHR Lite, an ONC-Certified EHRiv.
ihttp://www.medicaid.gov/AffordableCareAct/Provisions/Downloads/MedicaidEligibilityFinalRule_Regulatory-Impact-Analysis.pdf
iiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 15
iiiMedicare Physician Fee Schedule; http://www.beckersasc.com/media/CMSFinalRule2013MPFS.pdf; Page 1195
ivThis Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Emdeon Inc, 01/19/12, Emdeon Clinician 7.6, 0119201230701, NQF0064/PQRI128, NQF0041/PQRI110, NQF0024, NQF0028, NQF0038, NQF0059/PQRI1, NQF0064/PQRI2, NQF0061/PQRI3.
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Make it easy and convenient for patients to pay their healthcare bills
Part 2 of a 4-part series designed to offer small practice providers tips on improving their administrative and clinical operations.
Few people enjoy paying their bills—it’s just no fun to watch hard-earned money end up in someone else’s bank account.
No matter how well you take care of your patients, they’re just as hesitant to open their wallets. It stands to reason, then, that you need to make the process as painless and convenient as possible. Online portals can be the perfect solution. Consumers have grown accustomed to managing their affairs via the Web and expect this level of service in all areas of their lives—including healthcare.
The healthcare industry, however, has yet to make patient-facing, Web-based payment tools a universal option. Small practices must pay especially close attention to cash flow, so encouraging timely and accurate payment by bringing the process online is crucial.
Optimizing the online advantage begins well before a patient encounter. Web-based registrations tools, for example, allow patients to sign in prior to their arrival and the practice to capture important information. Patients are free to register at their convenience days before their appointment, instead of arriving at the doctor’s office early just to fill out paper forms. The practice benefits, as well, because it has access to legible, accurate information to streamline the claims and billing process.
Then, after the visit, patients can conveniently—and promptly—settle their accounts via the secure portal. Not only is cash flow improved, practices can reduce administrative expenses by removing some of the burden of collections from their office staff.
When introducing online capabilities to their patients, practices must promote the portal to ensure it’s used. A “multi-touch” campaign offers the best approach. Posters in the lobby, hallways and exam rooms can announce the new payment option. Registration and check-out staff should mention the availability of the portal and maybe even hand out postcards, refrigerator magnets or other tchotchkes. An additional reminder can be printed on billing statements still being mailed.
It’s important to promote the portal on the practice’s website, as well, preferably on the home page. This serves as a constant reminder for current patients and might attract individuals looking for a new doctor.
Other ways to encourage use of an online payment option include:
• ensuring the portal features easy-to-use instructions and simple navigation;
• making sure the portal displays contact information prominently in case patients need help; and
• assuring patients that the portal is secure and all private information is protected.
One final note: Keep in mind that patients of all ages might use online tools. They should include the full-bodied features the younger generation has come to expect, but be simple enough so those less technology-savvy can navigate the process easily as well.
Emdeon’s Patient Pay Online Express is a patient-facing application designed to help small providers enjoy success with Web-based portals. As an example, Concord Integrated Health, a chiropractic medicine practice located in Concord, Massachusetts, was increasingly burdened by the conventional process for generating and sending patient statements. At the time, it was generating between 250 and 300 statements per month. Along with implementing an automated billing service, Concord Integrated Health began using the Emdeon Patient Pay Online Express solution to answer patient demand for Web-based payments. With individuals able to view billing amounts and pay their accounts online, at anytime, the amount and promptness of payments greatly increased. Dr. Jeff Robichaud, Chief of Concord Integrated Heath’s Chiropractic Medicine Department, summarizes that “by allowing patients to pay their bills online, we are seen as a practice that is providing the most up-to-date solution for them. Patient Pay Online drives patients to our website as well, so we can have a presence with them beyond the in-person office visit.”i
With a secure system accessible to patients 24 hours a day, seven days a week, the Emdeon Patient Pay Online Express solution improves collections and data accuracy, while offering patients greater convenience. Emdeon helps speed up the billing and payment cycle, improving finances, reducing staff time invested in administrative tasks and giving you more time to spend with patients.
Nothing will remove the sting of paying a medical bill completely, of course. But by reducing the hassle and offering an option that fits into the patient’s lifestyle, practices eliminate some resistance—resulting in timely payments and improved cash flow.
For more information on how Concord Integrated Health has experienced increased payments and patient satisfaction through the use of Emdeon’s Patient Pay Online Express, please click here.
(Note: Stay tuned for an in-depth look at other ways to improve customer relations to enhance patient billing and collections in the next issue of this newsletter.)
i “Emdeon Patient Billing & Payment Solutions: Efficient technology for reducing costs and accelerating patient payments,” Emdeon Business Services LLC, July 2011
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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/
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HHS Announces FINAL Rule for ICD-10 Compliance Date and HPID
Health and Human Services has announced a Final Rule that confirms the proposed extension of the ICD-10 compliance date to October 1, 2014.
The Final Rule also establishes a unique health plan identifier (HPID), as well as a unique identifier for other entities (OEID), and modifies the NPI Rule to include pharmacy prescribers.
The Final Rule establishes these important dates:
• Health plans, with the exception of small plans, must obtain an HPID by November 5, 2014
• Small health plans must obtain an HPID by November 5, 2015
• Covered entities must use HPIDs in the standard transactions on or after November 7, 2016
The changes to the NPI rule become effective May 6, 2013.
HIPAA Simplified Expanded to Include ICD-10, other upcoming HIPAA and ACA Regulations
Emdeon’s HIPAA Simplified website (www.hipaasimplified.com) has been expanded to address ICD-10, as well as other upcoming regulations enacted by HIPAA and the Patient Protection and Affordable Care Act of 2010 (ACA).
New Section added for ICD-10:
We have added a new section for ICD-10 that includes Emdeon Clearinghouse FAQ’s. Emdeon’s ICD-10 Program Playbook will also be published in the near future, offering our customers an in-depth look at Emdeon’s ICD-10 strategy. The playbook will include:
• An overview of ICD-10, important facts and key changes between ICD-9 and ICD-10
• Guiding principles and governance of our ICD-10 program
• Emdeon’s ICD-10 implementation timeline
• Plans for customer messaging and communications
• Information on trading partner testing
To access the ICD-10 page, click the ICD-10 link from the HIPAA Simplified home page. Alternately, you can go directly to the ICD-10 page using the URL http://www.emdeon.com/5010/icd10.php.
Operating Rules:
The Patient Protection and Affordable Care Act (ACA) of 2010 requires The Department of Health and Human Services (HHS) to adopt operating rules for the HIPAA transactions. The first of these regulations, concerning the health plan Eligibility/Benefit and Claim Status transactions was issued in July 2011, with a compliance date of January 1, 2013.
The Operating Rules page of HIPAA Simplified presents frequently asked questions about the regulation and Emdeon’s readiness to keep you updated regarding this important milestone.
As an industry leader, we are committed to helping our trading partners successfully navigate the HIPAA and ACA regulatory timeline. Emdeon intends for HIPAA Simplified to be an evolving site and valuable resource for our customers.
Bookmark HIPAA Simplified and check back often!
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