OmniMD is a specialty based electronic medical records (EMR), Electronic Medical Document Management, medical transcription, prescription and scheduling solution.
The Ultimate Guide to Revised E&M Guidelines for Office and Other Outpatient Services in 2021
Centers for Medicare and Medicaid Services (CMS) has embraced the recommendations of the AMA in regards to Evaluation and Management (E&M). Starting January 1, 2021, these changes will be applicable for coding office and other outpatient services.
Reason
In 2017, CMS brought an initiative “Patients Over Paperwork” to streamline work, increase efficiency, improve patient experience, and reduce administrative burden.
The purpose of this initiative was to revise the existing and archaic E&M coding guidelines. According to CMS, increasing paperwork and reporting tools were the main bottlenecks that kept physicians and medical practices busy.
They were required to spend more time managing administrative tasks instead of caring for patients. It resulted in poor patient experience and monumental administrative tasks that added to the cost as physicians needed to hire additional staff and comply with the government rules and regulations.
What Changes Will Take Effect
History and Tests Removed as Mandatory Elements for Coding. These two components tend to delay clinical decision making and are time-consuming as the clinicians need to document this in the patients’ medical record.
Documents related to Medical Decision Making or Time
Physicians cannot use both these documentation methods for the same patient visit. They need to select either option for each patient visit.
Updated Time-Based Coding
Time is explained as “total time on the date of the encounter.” It includes time spent by authorized healthcare professionals and clinicians for in-person and other modes or non-face-to-face discussions with the patient.
Revised Coding for Prolonged Services
It should be used for time-based coding when the duration of the encounter exceeds the defined time for 99205 and 99215 in 15-minute increments.
Updated MDM Criteria
Using the present CMS Table of Risk as a standard guideline, the MDM elements for code selection were refined and clarified to avoid complexity and increase efficiency patient management.
Restructuring of RVUs and Charges
Considering the RVU guidelines from the AMA’s CPT/RUC Workgroup on E&M, CMS has stated that relative value for the codes is evaluated depending on the total duration spent by a physician from three days before patient’s visit through seven days following the visit as the standard work will be same irrespective of the time when it is completed.
Are You Getting Cardiology Billing Denials? 9 Tips to Prevent Leaking Revenue
Billing denials adversely affect the operational and financial efficiency of a healthcare practice resulting in higher administrative charges. According to a recent Healthcare Information and Management Systems Society (HIMSS) report, 76.1% of healthcare leaders say that denial is the biggest challenge.
By the time your claim gets denied, you have already spent not less than two weeks. Then to appeal a denied claim, you invest additional time, money, and resources. It also means a longer waiting period to receive reimbursements. Cardiology billing denial is no exception.
With more insurance companies imposing stricter eligibility criteria for claims submission, cardiologists find it increasingly difficult to receive reimbursements. Wondering why cardiology claims get denied? Some of the most common reasons for cardiology billing denials are:
Incorrect or incomplete documentation.
Illegible handwriting if claims are manually submitted.
Incorrect coding.
Missing modifiers, combination codes.
Preauthorization not obtained.
How to Prevent Cardiology Billing Denials
As outlined by the Medical Group Management Association (MGMA), a practice should achieve a 95% or higher clean claim rate. Interestingly, most practices struggle to achieve a clean rate above 75%. Now even for a small practice that files 2000 claims with a 10% denial rate, it comes to 200 denied claims! According to MGMA, reworking a claim costs $10-$25, translating into a considerable number for these 200 claims.
Given the complexity of these challenges, you should act fast and start with addressing the core issues. To help you understand where it could go wrong, we have shared nine tips. Following these will surely increase the clean claims ratio and prevent denials or audits.
1. Avoid Late Filing
In order to meet timely filing requirements, billers need to make sure their claims are acceptable. A claim can be rejected at any stage, and once it returns to your desk, half the time is gone. Note that your payer is only interested in entertaining your claim when submitted with the required elements necessary for processing and well before the deadline.
Familiarize yourself with the best practices that ensure timely filing of claims to avoid denials:
Always check payer-wise timely filing limits on claims submission.
File fresh claims daily.
Appeal denied or rejected claims before the deadline.
Use an electronic claim submission software to avoid late filing.
2. Enter Correct Patient Information
Most mistakes start with the patient registration process. Avoid entering incorrect patient data and always double-check their date of birth, name or spelling, subscriber number, and other important information before filing. As, managing patient files manually can be challenging and there are chances of misplacing them, you can use an EHR to manage patient information and health records easily, update real-time, and securely share with authorized users. It will also help you avoid repeated paperwork and chances of mistakes.
3. Minimize Coding Errors
Accurate coding is critical to achieving claim success. Cardiology practices often face various challenges, such as, entering incorrect or deleted codes, missing modifiers or combination codes, lacking specialty-specific coding experience, and under coding. As a result, claims are either denied or underpaid. Codes like 93880 (non-invasive cerebrovascular arterial study) can be billed twice a year only. 93297 and 93295 cannot be used in conjunction together. To minimize coding mistakes, refer to the latest CPT, HCPCS, and ICD-10 CM and PCS code books. Subscribe to the quarterly newsletter released by the American Heart Association (AHA) to stay informed about the recent updates and changes. Additionally, you should often check for updates with the CMS and local regulatory bodies.
4. Check Insurance Coverage
Whether you are rendering service to returning patients or registering new clients, it is necessary to verify the patient’s eligibility and benefits each time.
Pay attention to:
Pre-existing conditions.
Lifetime benefit cap.
Change of employer or insurance plans.
Whether your facility is listed as in network or out of network provider.
Cardiac tests and services are not covered under the plan.
5. Avoid Duplicate Filing
Beware of duplicate filing claims for the same individual, same visit, and same service. Consider periodic audits and remove duplicates. When appealing a denied claim, ensure the necessary corrections. Failing to comply with the rules and resubmitting claims without making proper changes will lead to your claim being denied on the ground of duplicate billing and may even lead to auditing.
6. Use Diagnoses and Signs/Symptoms Codes Judiciously
According to the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, Section I-B, healthcare practitioners are required to report confirmed diagnoses, if found, and not use signs/symptoms codes (2). The report indicates, “Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.”
7. Seek Pre-Authorization When Needed
Nearly 64% of physicians report it is difficult to determine which tests and procedures require pre-auth by insurers. Many cardiologists lose out on their claim(s) settlement failing to abide by the pre-auth requirements. Several cardiac procedures on the heart and pericardium like ‘pacemaker installation, ‘electrophysiologic’ and/or implantation of hemodynamic monitors, etc., require preauthorization. If you render services that fall under this criterion, verify with the insurance provider, and obtain a preauthorization.
8. Ensure Complete & Accurate Documentation
Incorrect documentation can cost your time, revenue, and put you at risk for denials and payer audits. As short-hand notes can be confusing and lack depth, you should ensure complete documentation and transcription. It will help you avoid unnecessary hassle and miscommunication with billers and coders. An Electronic Health Record and Practice Management System can efficiently help you achieve higher accuracy.
9. Optimize Revenue Cycle Management Software
Using an advanced revenue cycle management software can significantly reduce administrative errors and billing denials. For example, OmniMD comes with intuitive solutions for cardiologists, and specialty healthcare providers, such as it triggers alerts, generates automated predictive analysis to potential flag denials, offers preauthorization tracking module all in one place. Consider switching to an effective and efficient EHR and Revenue Cycle Management software to enhance your claims filing experience and minimize revenue cycle gaps.
Cardiology billing denial is both unnecessary and avoidable. With the best practices and effective revenue cycle management software, you can surely achieve a higher clean claim rate and prevent denials.
The business of running a medical practice is becoming more challenging every day. Second only to patient care, revenue cycle management is critical to building and maintaining a thriving medical practice. Many practices have discovered that outsourcing their medical billing process can provide the highest return on investment by improving cash flow, minimizing the administrative process, and reducing the office footprint. Here are 5 reasons why outsourcing medical billing may be right for your practice.
1. Gain More Control Over Medical Billing
Outsourcing medical billing does not mean you have to give up control of your revenue cycle process. Instead, the right medical billing partner should be able to give you a better view using a billing dashboard to give you and customized snapshot of where your practice is in the reimbursement and payment process. The best medical billing companies provide detailed reporting of claims status, revenue, copays collected and reimbursement turnaround. Your practice can gain even more control by not having to keep up with changing regulations and payer rules.
2. Spend More Time with Patients
With an integrated outsources medical billing service, your staff can focus on patient care and the overall patient experience. Let the medical billing company scrub and manage claims, collect copays and deal with insurance companies. You can focus on practicing medicine to improve patient outcomes and the quality of care.
3. Improve Cashflow and Reimbursement
With an integrated revenue cycle process, your medical billing partner can ensure that claims are cleaner, patient co-copays are collected, and reimbursement turnaround time is maximized. No more resubmitting denied claims and supporting documentation. Your medical billing partner can manage the entire process faster and more efficiently to give a better cash flow.
4. Reduce the Office Footprint
Free up space in your medical office and reduce staffing expenses by outsourcing your entire billing department. Your practice will no longer have to manage costly software updates and hardware purchases. Eliminate billing staff turnaround and cut the payroll cost of having an inhouse medical billing team. Put your focus on hiring skilled and experienced patient care professionals instead of worrying about billing and coding. You can even reduce and make better use of every square foot of your medical office.
5. Minimize Stress
Keeping up with ever changing regulations, coding updates, fluctuating payer rules, and documenting quality measures can be a strain on your medical practice. This, in turn, can significantly impact reimbursement. The right outsourcing partner can carry the burden of ongoing training and education, software updates, and synchronizing data to maximized value-based payment models. No more agonizing calls with insurance companies tracking down unpaid or denied claims. Benefit from less burnout and better cash flow.
Given the many benefits, it makes good business sense to outsource medical billing. Of course, you need to find strong, efficient, and cost effecting outsourcing partner like OmniMD.
OmniMD Medical Billing Services can help you get paid faster, simplify billing workflow, reducing billing related expenses, and improving your cash flow through outstanding billing services.
7 Reasons to Find the Right Medical Billing Software
It is no secret that the right medical billing software deliver clean claims, increase the quality and accuracy of patient information, and ensure timely reimbursement. The best medical billing software can help health care providers and medical billing specialists improve patient experience, prevent mistakes, and facilitate better revenue cycle management.
These sophisticated tools should be equipped with functionalities that trigger alerts and flag concerns that require special attention for the highest accuracy.
Here are the top reasons to get the right medical billing solution:
1.Increase Accuracy and Data Quality
Accurate documentation of patient demographic data is essential to prevent denials and get you paid faster. Manual entry often leaves room for errors. Even the slightest mistake in spelling can increase the chances of inaccurate filing and may lead to denials and audits.
By opting for the right billing partner with advanced processes and technology, you can create the highest quality data in real-time and stay on top of accounts that need special attention.
Since many claims are denied due to exhausted pre-approvals or expired authorizations, you need medical billing software which can automatically trigger alerts to about claims that need reauthorization. This can ensure uninterrupted patient care and better management.
2. Improve Operational Efficiency
With state-of-the-art infrastructure, intuitively designed healthcare accounting software brings you comfort, clarity, and more control over your data. If you have a centralized platform where you can both update patient information and manage billing and claims, you can optimize clinical and operational workflow.
An intuitive medical billing solution can improve communication and let you visualize detailed analytics for better claims management and a faster billing process. You should also be able to access data virtually anytime, anywhere
3. Get Cleaner Claims
When a claim is approved and paid on its first submission, it is usually due to clean claims. Scrubbing claims is imperative for a to ensure higher and faster reimbursement. A claim should have no errors, to eliminate additional requests for information, and stop the change of rejection.
Top medical practices maintain a clean claims rate of 90% or more. With a medical billing solution designed for multidisciplinary collaboration, you can easily collect and share patient and financial data in less time.
By partnering with the right medical billing software company, you can ensure correct coding information, cleaner claims, and higher claims acceptance.
4. Get Paid Faster
Missed deadlines should be a thing of the past. With a smart medical billing software, you can set automatic reminders, so you can stay on top of administrative tasks.. Intelligent medical billing solutions can verify insurance eligibility before the patient is treated. It can reduce the need to call health insurance payers.
Medical practices can efficiently organize records, check eligibility, inspect codes, self-validate claims before submitting claims electronically. As you know how important it is to timely submit a claim with accuracy for faster payment, medical billing solutions ensure that you do just that.
5. Secure and Backup Your Data
Data privacy and security should be at the heart of medical billing solutions. You need medical billing software which is securely hosted on cloud-based servers, patient information and sensitive data are always encrypted across locations.
Additionally, such software provides high-quality, automatic data backup which prevents any possibility of data loss due to natural disaster or misplacement of files. The best part is you do not need technical expertise to use a billing software because they are designed to self-update.
6. Better Connect Your Practice
From collecting patient data to billing and tracking, verifying insurance benefits to seeking authorizations, healthcare accounting software should come with a robust set of tools to improve workflow and ensure proper billing.
Best practice is to integrate your billing software with an efficient EHR system. That way you get complete transparency and access to resources right at your fingertips.
With integrated software, you can access information from anywhere, easily update patient information accurately, enable electronic payments, analyze revenue data, and efficiently coordinate with other departments.
7. Improve Patient Experience
Medical billing software should work as a supportive system. It should efficiently handle the backend tasks so that you can spend more time providing care to your patients.
An integrated system can also help with scheduling follow up appointments and sending timely reminders to patients., You can manage check-in, verify insurance coverage, produce accurate bills, and send notifications when authorization is needed.
Choosing the best technology partner for medical billing is essential to give you actionable insights into clinical and operational data, simplify billing and tracking, and generate maximum ROI for your medical practice.
Denials can be a massive thorn in a practice’s side. Chasing claims and resolving denials can be a huge time suck for your billing staff. Today on the blog, we will share the top 10 most common denials for physician practices.
A patient who is either ineligible or has no or expired insurance coverage will result in a denied claim.
The most common mistake is missing critical information when the claim is submitted, e.g., missing service code, fields left blank, wrong plan code, etc. Due to sheer negligence, sometimes we make silly mistakes, like the birth year 1957 can be written mistakenly as 1975.
Anything in the basic patient demographics can be wrong, ranging from a patient’s nickname instead of a full name on the file, wrong DOB, and incorrect insurance ID can straightforwardly lead to a denial.
Often, we fail to check eligibility and do not call payers to determine the coverage requirements. The patient’s insurance policy determines what’s covered and what’s not.
At times, especially when diagnostic studies and complex procedures are performed, a pre-authorization (MRI, CT scans, etc.) or pre-certification as indicated must be obtained from the payer based on the patient’s plan, failing which would lead to denials and is one of the most common causes of denials.
Having the wrong insurance on file and submission to the wrong payer will lead to immediate rejection.
It is not uncommon for things to fall through the cracks—especially when you’re busy. There is a set time window following service for a claim to be reported to the payer. If you miss the train, the claim is bound to be denied. Similar is the case with appeal filing window limits for previously denied claims.
Each place of service has a two-digit code, and it is mandatory to specify where the service was performed (IPD, OPD, nursing home, ER) to get paid accurately.
Either knowingly or unknowingly, resubmitting an already submitted/approved claim is bound to be rejected and can be considered fraudulent.
Correct coding is essential for claims, so using the wrong CPT code, unmatched ICD-10 code, or wrong or no modifier, etc., can cause rejection. Also, coding is continuously evolving, and it can be easy to use and outdated code.
Now that we’ve identified the biggest culprits, you know what to watch out for and where it pays to tame time to check your work. OmniMD has created a Clean Claim Checklist to Reduce Denials to help in your claims process. Click here to download!
If denials are a concern for your practice, OmniMD would be happy to help. Click here to schedule a call.
OmniMD Health Information Exchange Solutions (OmniXChange)
OmniXChange provides secure application to application messaging for healthcare industry (Clinics, Hospital, EMR/EHR, Labs, Payers, etc):
Standards based messaging (HL7, EDI)
Secure data exchange ( SSL, FTPS / VPN)
Data validation on fly
Tracking of data (Audit trail)
Easy to use and maintain web based system
Dashboard
Robust, reliable and cost effective.
Secure Connectivity
OmniXChange provides secure connectivity (SSL based), based on FTPS, SFTP, FTP over VPN, TCPIP over VPN etc to outer systems like Clinic, Labs, Hospitals, Payers, Billing houses, EMR and PMS. OmniXChange is user and role based system to provide high level of security to information.
Hub and Spoke Model
OmniXchange uses the hub and spoke model – a system which makes transportation much more efficient by greatly simplifying a network of routes.
Robustness and Transparency
OmniXChange is built using robust development methodology and provides complete transparency to the user. We have used Intersystem Ensemble and Cache DB to achieve robustness and have customized the Ensemble Adapter in such a way that it can be managed easily and fulfill the entire requirement to get the transparency of the system.
HL7 Standard
Hospitals and other healthcare provider organizations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should communicate with each other (or “interface”) when they receive new information but not all do so. HL7 specifies a number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organizations to easily share clinical information. Theoretically, this ability to exchange information should help to minimize the tendency for medical care to be geographically isolated and highly variable.
OmniXChange supports HL7 messages from HL7 message version 2.1 to 2.6. OmniXChange is developed in such a way that it can validate partial, unknown message format, etc. OmniXChange supports HL7 Messages like ADT, SIU, DFT, ORM, ORU, VXU, VXQ etc., as well as CCD and CCR. OmniXChange provides complete tracking of all HL7 messages.
User / Role based system
In OmniXChange security, role-based access control is an approach to restricting system access to authorized users. This can be referred to as role-based security. Currently OmniXChange supports 3 user roles: 1) Administrator 2) Support 3) Clinical user / end client.
Technology
OmniXChange uses Intersystem Ensemble, Cache DB, Microsoft ASP.Net, IIS 7 and SSL for the security.
Lab Interface With
QuestEmpireMillenium
LabCorpSunriseEnzo
LencoShielSpectrum
CPLSinaiBostwick
Bio-ReferenceDoshiElab
DynacareLawrenceMedics
For more information please Contact us at (844) 666-4631 Email us at [email protected]
Practice Management Software by OmniMD allows the practice to manage all patients billing claims management & reporting seamlessly and efficiently.
Practice Management / Revenue Cycle Management
Today’s healthcare providers often need more than simple medical billing and collections. Practice Management can significantly affect the revenue and cash flow of a practice by reducing the number of rejected claims and automating claims submission.
Medical billing companies grapple with multiple providers and payers in an increasingly complex environment. An advancedPractice Management system can increase the biller’s efficiency and enable faster collections with fewer denials.
OmniMD’s Practice Management has unique features which enable you to:
Easily identify dramatic improvements in the efficiency of your billing and collections processes
Execute successful denial management to reduce denials and improve revenues
Efficiently manage outstanding claims through follow-up activity and generate more revenues
Reduce Total Accounts Receivable and AR Days
Reduce turn-around-time ratio from submission date to final claims resolution date
Reduce time spent to process payments and insurance carrier responses
Saves time in enrollment process for clearing houses and expedite your go-live time
OmniMD’s Practice Management offers full integration with any EHR, appointment system, and charge capture. It includes the functionality of a practice management system from eligibility verification and billing through claims status to payment posting. OmniMD’s Practice Management has advanced capabilities which improve the efficiency and effectiveness of practice.
OmniMD’s Practice Management unique features include:
Total workflow process, from first contact with patient through collections
Can create master patient record across locations or practices
Can see all the activity of a patient as a single record (cases)
Enterprise/Business/Practice user level associations, so a billing supervisor can manage follow-up across multiple practices, or a business manager can administer multiple practices
Flexible provider/group billing credentials setup, so a user can set up billing credentials for a provider at multiple locations, insurance companies and plans
Electronic claim submission through 4 major clearing houses available
Bulk payment posting
Claims can be grouped into different buckets for follow-up and maintain follow-up activities with history
Automated follow-up—No need to hunt for open claims and filter them no outstanding claim can be ignored by chance.
Document Management
Business Intelligence reporting
Contact us or mail us on [email protected] for a demonstration of this truly superior Practice Management system.
Cardiology-specific Electronic Health Records (EHR), Practice Management and Medical Billing Services solution to be demonstrated at American College of Cardiology (ACC) 65th Annual Scientific Session & Expo, Chicago, IL, from April 2-4, 2016.
OmniMD showcasing its Cardiology-specific cloud EHR, PM and Medical Billing Services at ACC 65th Annual Scientific Session & Expo, from April 2-4, 2016.
Workflow Efficiency Cuts Cardiology Electronic Charting Time to One-Fifth the Industry Average
Cardiology-specific Electronic Health Records (EHR), Practice Management and Medical Billing Services solution to be demonstrated at American College of Cardiology (ACC) 65th Annual Scientific Session & Expo, Chicago, IL, from April 2-4, 2016.
Tarrytown, NY — March 23, 2016 — The widespread discontent among physicians, nurses and other healthcare providers with their electronic health record (EHR) options is finally being answered, at least for those who are practicing cardiology. Attendees to next month’s annual meeting of the American College of Cardiology in Chicago will be among the first to review the new cardiology-specific EHR from OmniMD™.
“A data-rich EHR doesn’t have to cost us time; in fact, with the OmniMD EHR, cardiologists save time and increase efficiency,” says Henry Borkowski, M.D., who consulted with OmniMD’s programming team during the development of the new release. Dr. Borkowski administers a large cardiology practice in Connecticut, and he has followed the evolution of medical record technology since its introduction.
“With any EHR, a physician should be able to capture history, order tests and update medications, then generate an accurate bill. With the OmniMD EHR, we can do all this in 45 seconds or less, thanks to intuitive cardiology-specific workflows. Even a new chart for a hospital or office visit goes faster: 90 seconds with OmniMD vs. the average eight minutes using another EHR,” says Dr. Borkowski.
Efficiency is further enhanced via device integration with the OmniMD EHR. It captures data feeds from a variety of devices, including electrocardiograms, pacemakers, echocardiograms, treadmills, cardioMEMS and exercise myocardial perfusion imaging. These data are integrated directly into a patient’s chart, thereby eliminating the need for redundant data entry.
“The EHR developed by our team, with guidance from Dr. Borkowski, represents a breakthrough for cardiologists. We look forward to sharing it in Chicago,” says Divan Da’ve, CEO of OmniMD. The company will be exhibiting in Booth #21109 at the 65th Annual Scientific Session & Expo of the American College of Cardiology (ACC) from April 2-4, 2016, in Chicago, IL.
About OmniMD™
In business since 1989, OmniMD is a division of Integrated Systems Management, Inc. The company is committed to providing affordable and comprehensive cloud-based EHR, practice management and billing solutions. For two years in a row, OmniMD has ranked in the “Fastest Growing” Inc. 500:5000 companies. Today, more than 12,000 healthcare professionals use OmniMD products and services. It is among the few companies to achieve all the major certifications required for top-ranked healthcare technology. The OmniMD EHR is an ONC-ACB Meaningful Use (MU) Stage 2 Certified EHR, ICD 10 compliant, Surescripts White Coat of Quality and EHNAC-certified solution. For more information, please visit http://www.omnimd.com.
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Blumenthal: NHIN, NHIN Direct Offer Paths to ‘Meaningful Use’
Last week, National Coordinator for Health IT David Blumenthal published an open letter touting the Nationwide Health Information Network as a model to help health care providers meet the “meaningful use” requirements of the 2009 federal economic stimulus package, Modern Healthcare reports. Under the stimulus package, health care providers who demonstrate meaningful use of electronic health records will qualify for Medicare and Medicaid incentive payments (Conn, Modern Healthcare, 5/17). Blumenthal wrote that NHIN is “not a network per se, but rather a set of standards, services, and policies that enable the Internet to be used for the secure exchange of health information to improve health and health care.” NHIN Direct He also acknowledged that some health care providers “may have simpler needs for information exchange, or perhaps less technically sophisticated capabilities.” He said such health care providers could benefit from NHIN Direct, which still is under development (Blumenthal letter, 5/14). NHIN Direct is a basic version of NHIN that offers health care providers open-source software to develop a network for the electronic transmission of health information (Modern Healthcare, 5/17). Blumenthal wrote that NHIN Direct “is meant to enhance, not replace, the capabilities offered by other means of exchange.” He added that the model could “complement existing NHIN exchange capabilities and strengthen our efforts toward comprehensive interoperability across the nation” (Blumenthal letter, 5/14). In addition, Blumenthal wrote that ONC is “on an aggressive timeline” to develop standards for NHIN Direct so health care providers can use the framework to qualify for incentive payments. He also called for greater public participation in the NHIN Direct project through blogs and a community wiki, which are available on the project’s website (Modern Healthcare, 5/17).
Medical Mutual will offer incentives for e-prescribing
One of Ohio’s biggest health insurance companies is trying to convince doctors to forego their old-fashioned prescription pads more often. Cleveland-based Medical Mutual of Ohio is teaming up with its pharmacy benefits manager, Medco Health Solutions, for a pilot program that gives select doctors financial incentives to prescribe medications electronically. Medical Mutual is signing up 250 of its network physicians who order the highest volume of prescriptions for the health insurer’s enrollees but haven’t switched to electronic prescribing yet. The practice of ”ePrescribing” enables doctors to send their prescription orders through a secure connection from their computers to the pharmacy’s computer. ”Since the prescription is being sent electronically to the pharmacy, the member can get his or her prescription more quickly,” said Ed Byers, spokesman for Medical Mutual, which has about 1.6 million enrollees. By prescribing prescriptions electronically, doctors also can immediately see which drugs are covered and at what level for their patients. As a result, patients save money and the health insurer saves money ”because they see higher returns on generic dispensing and formulary adherence,” said David Fidler, director of ePrescribing for Medco Health Solutions. ”Everybody’s interests are aligned when you start talking about e-prescribing.” Dr. James Dom Dera, a physician with Ohio Family Practice Centers in Fairlawn, recently switched to electronic prescribing for many of his patients. ”It’s just much easier,” he said. ”I can click and prescribe much faster than I could ever hand-write or print or fax a prescription.” Dom Dera said he also likes the fact that electronic prescribing eliminates the risk of errors from misreading handwriting or improperly transcribing an order. Still, electronic prescriptions aren’t for everyone. At least for now, federal law forbids doctors from prescribing controlled substances electronically. And some patients who like to shop around for their medications still prefer to take a paper prescription with them, Dom Dera said. Medical Mutual’s pilot program started in March and continues through September. Medical Mutual and Medco declined to release details about the financial incentives they are providing to physicians who reach targets for number of prescriptions ordered electronically.
Using bar-code verification technology for medication administration can significantly reduce error rates and decrease the likelihood of adverse events, according to a newly published study in the New England Journal of Medicine. In the study funded by the Agency for Healthcare Research and Quality, researchers at Brigham and Women’s Hospital, Boston, examined data from several units in the hospital as they rolled out a staggered implementation of an electronic medication administration record, or eMAR, with bar-coding technology. The use of a bar-code eMAR was associated with a 27% decrease in timing errors, such as late or early medication administration, and a 41% drop in the rate of errors not related to timing, which include incorrect dosages and administration without an order. Also, researchers noted that the rate of potential adverse events associated with errors not related to timing fell from 3.1% to 1.6%—what they described as a nearly 51% relative reduction. Not surprisingly, use of a bar-code eMAR also eliminated transcription errors, which occurred at a rate of 6% on units that did not yet have the system in place. Bar-code eMAR systems allow nurses to receive medication orders electronically from a pharmacist or from a computerized physician order-entry system, and then use a bar-code scanner to verify medications at the patient’s bedside. The results of the study demonstrate that bar-coding can have a substantial effect on safety, according to Eric Poon, director of clinical informatics at Brigham and Women’s, and lead author of the study. Poon also expressed confidence that the observed improvements were due to the implementation of bar-code eMAR systems and not another factor. “We took measurements within a pretty small time frame, and the implementation was the main project we were doing at the hospital during that time period,” Poon said. Still unclear, however, is whether hospitals with limited resources should implement a CPOE or bar-code eMAR system, Poon said, adding that Brigham and Women’s has had a CPOE system in place for many years. The two systems catch different types of errors and complement one another, he said. For instance, a CPOE system is more likely to prevent errors related to incorrect judgment or insufficient clinical knowledge when choosing a treatment plan, while a bar-code eMAR usually catches errors associated with lapses in memory or mental slips, the study said. “If a hospital can only afford one, we need to know which one makes the most sense to implement first,” Poon said. “That question is still unanswered.”
Whenever a health care provider or a hospital plans to have a full fledged medical billing department with billing clerks, it is very essential to think twice and make sure to choose well experienced billing staff. Today fortunately, outsourcing the entire medical billing process is a cheaper option that is available. Quite often there have been instances when the in-house billing staff does not have the sufficient experience and does not possess the sufficient in-depth knowledge about coding. This will result in loss because claims cannot be made properly and may require rebilling. Moreover, instances of many scandals in this area of health sector have been rampant. Considering the various risks it is a must to outsource the medical billing to a trustworthy and reliable professional billing company. Before signing a contract for outsourcing of medical billing with a company a proper enquiry about the company and its history is essential. Also checkout the following information from the outsourcing company and see how good they are. * Do they provide reports? * What is their collection rate? * What is their specialty? * Do they use a HIPAA-compliant format? * Are they well staffed? * Do they code also? (not preferred) * What percentages are accounts receivable? * Do they follow up on delayed /denied claims? * Have they had face to face meetings with clients? Encounter forms are usually completed and sent to the billing company along with the insurance card, registration cards on a weekly or daily basis. Most of the medical billing companies have medical billing software to prepare the bill and then submit it for claims. Bills to Medicare and other bigger insurance companies are generally sent via a clearing house. Many companies use doctors to scan the encounter forms. How much does medical billing service cost for a physician? Billing companies charge doctors a percentage of what they collect and the rate depends on the doctor’s specialty. Specialists are charged lesser than the primary doctors because specialists mean lesser claim and bigger amount.
The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health IT is seeking patient perceptions of the delivery of healthcare through the use of an EHR. “Health IT experts agree that HITECH stimulus funds are likely to improve how physicians practice medicine for Medicare and Medicaid beneficiaries and, ultimately, for advancing patient-centered medical care for all Americans. However, there is an evidence gap about patients’ preferences and perceptions of delivery of health care services by providers who have adopted EHR systems in their practices,” the HHS’ May 14 notice in the Federal Register stated. According to the notice, the goal of the proposed Patient Perceptions of EHR study is to help policymakers understand how primary care practices’ use of EHRs affects consumers’ satisfaction with: * Their medical care, * Communication with their doctor * Coordination of care. “The research questions for the proposed study are motivated by a concern that patients may have negative experiences as practices begin to use EHRs,” the agency wrote. HHS plans to survey 840 patients about their opinion of their medical care when their primary care physicians use EHRs, according to the notice, which can be read here.
Study Shows E-Prescribing Significantly Reduces Prescription Errors
In a recent news that our Baltimore, Maryland Attorneys have been following, doctors are reportedly increasingly leaving behind paper when prescribing medications, and depending more and more on electronic prescriptions, or “e-prescriptions”—in an effort to avoid pharmacy misfills and medication errors, along with hard-to-read doctor handwriting, or even prescription fraud, as our attorneys reported on in our last blog. E-prescribing immediately sends the prescriptions to the pharmacy in a digital format through a secured Internet network, from a handheld device or from their computers. The doctor simply selects the drug from a computerized list, with other symbols indicating the best drug option, different dosages, and either generic or name-brand medicine, instead of hand-writing the prescription, which can lead to medication error. Some e-prescribing programs give symbols in the form of colored or smiling faces, delineating between cheapest, preferred, or less desirable drug options. According to the Wall Street Journal, the number of e-prescriptions almost tripled last year, from 68 million in the previous year, to 191 million in 2009. Surescripts, LLC, the company that handles the majority of the electronic communications in e-prescribing, reports that this represents 12% of the 1.63 billion original prescriptions, which excludes refills. The first three months of this year showed that one out of every five prescriptions is being filed electronically—a number that is rapidly growing, as nearly 25% of doctors based in offices already have the technology to e-prescribe. In a study published in the Journal of General Internal Medicine in February of this year, e-prescribing was found to reduce common hand-written prescriptions errors significantly, including pharmacy misfills containing the wrong dosage, or incorrect usage instructions that could lead to patient injury or even wrongful death. The study, “Electronic Prescribing Improves Medication Safety In Community-Based Office Practices, showed that when practices started using e-prescribing for a year, they reduced their error rate from 42.5% to 6.6% on average. Medical practices with doctors who continued to hand write prescriptions on paper, rose from a 38% error rate to 39%. E-prescribing can also contribute to prescription errors, for instance, if a doctor mistakenly presses the wrong key, or chooses the wrong form of the drug, like a pill form instead of liquid form for children. The Institute for Safe Medication Practices focuses on analyzing and reducing medication errors, and although they support electronic prescribing, they recommend that patients always ask for verbal clarification and guidance from their doctors, as well as printed out instructions before taking the medication, to avoid medication mistakes or personal injury. At Lebowitz and Mzhen LLC, our attorneys strive to make sure that pharmacy misfill victims and their loved ones receive the personal injury compensation they deserve. Call us today at 1-800-654-1949. More Doctors Are Prescribing Medicines Online, The Wall Street Journal, April 20, 1010
