Hospital Information Systems

• Family medical history
• Existing conditions
• Allergies
• Medications
• Surgeries
• Hospital stays
• Labs tests and results
• Dental and vision records
• Religious information
• Immunization records
• Emergency contacts
• Living wills

The decision to stop recognizing Current Procedural Terminology® (CPT) codes 99241–99245 and 99251–99255 in the Medicare program as of January 1, 2010, took many by surprise. In justifying its decision, CMS cited a 2006 Office of Inspector General report that 75 percent of consultations were billed incorrectly.

Offsetting the elimination of those payments, the codes CMS directs physicians to use instead received modest increases in the work relative value units (wRVUs). The small boost to units associated with these E/M codes, espouses CMS, means the decision to eliminate payment for consults is budget neutral for the Medicare program.

CMS’ exclusion of consultation codes for Medicare patients will certainly affect physician revenue, especially if private payers follow suit. Physicians must also devise new strategies for coding and documentation to continue getting reimbursed for seeing these Medicare patients, or else just decline to see them at all.

Here are answers to common questions physicians are asking about the new Medicare consultation policy:

How do I code consults for Medicare patients? 
Use the appropriate E/M code. For a patient in the hospital, code from the series CPT 99221-99223 for the initial encounter and 99231-99233 for subsequent encounter(s).

Can I ask the patient to sign an Advance Beneficiary Notice (ABN), and collect directly from the patient? 
CMS no longer recognizes the consultation codes as valid, as opposed to non-covered; therefore, you cannot use an ABN and bill the Medicare patient.

If physicians are directed to use the initial hospital visit code, how is an admission identified? 
To report an admission for Medicare, append AI (“a” – “eye”), the principal physician of record, to the initial hospital care code (99221-99223) or initial nursing facility care code (99304-99306). The new modifier is informational only; no additional remuneration is provided.

How will I get paid when a referring physician requests my opinion? 
CMS directs physicians to use the appropriate E/M code and will reimburse the physician even when services are requested within a practice within given parameters: “Medicare may pay for an inpatient hospital visit or an office or other outpatient visit if one physician or qualified NPP in a group practice requests an evaluation and management service from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional’s knowledge.” Remember, this policy relates to Medicare, so you can continue using the consultation codes for non-Medicare patients.

Should physicians stop using consult codes altogether? 
It may be the easiest path from a process perspective but most payers, other than Medicare, continue to pay for consults. Because the payment differential is significant – consults pay up to 30 percent more than a visit code at the corresponding level – experts don’t advise dropping them altogether.

How do I handle Medicare as a secondary payer (MSP)? 
This may be the most confusing situation of all because CMS essentially authorizes you to change codes when it is the secondary payer. CMS instructs: “Bill the primary payer using a consultation code that is appropriate for the service, and then report the amount actually paid by the primary payer, along with an E/M code that is appropriate for the service [our emphasis], to Medicare for determination of whether a payment is due.” Develop processes for “crosswalking” codes on MSP claims, catching MSP claims before they are submitted to Medicare, and re-working any denied claims that miss your crosswalk process.

Does this policy change apply to Medicare Advantage plans? 
Medicare Advantage plans aren’t required to embrace the new payment policy, but some have. It’s important to check with the plans with which you participate.

Is it no longer necessary to send reports to referring physicians? 
Although it’s no longer necessary to follow CMS’ documentation rules specifically related to consults, CMS states: “…physicians should continue to follow appropriate medical documentation standards and communicate the results of an evaluation to the requesting physician.” Furthermore, one of the proposed “meaningful use” criteria for the HITECH Act’s electronic health record bonus program is: “Provide summary care record for each transition of care and referral”.

How can I get more information?
Review the MLN Matters 6740: Revisions to Consultation Services Payment Policy.

In jettisoning consultation codes for Medicare, CMS cited audits showing high levels of inappropriate consultation coding, physician confusion about its rules, and its own disagreements with the consultation coding guidance in the AMA’s CPT® Manual. The new day for consultation coding is here. Let’s see how it works.

Written by Elizabeth W. Woodcock, MBA, FACMPE, CPC of Woodcock & Associates.

Meaningful What? Stimulus What? Who's on first?  Can somebody explain this in 500 word or less?

Let me break down Meaningful Use as simply as I can.

• $19 billion have been allocated by the federal government to encourage the health care industry to adopt information technology (more specifically an Electronic Health Records System).
• To be eligible to get some of the $19 billion you must do 3 things

1. Be an eligible professional or hospital
2. Implement a certified EHR product between 2011 and 2014
3. Use it in a Meaningful Way

Okay, are you still with me?  Then let's go one level deeper. Let's make some assumptions:

• You are an eligible professional (doctors of medicine, etc.)
• You have or will have a certified EHR system.  (All vendors in the medical software industry will have to get their software certified (including CCHIT) or go out of business.  We are going to assume your system is or will be certified)

There are two types of incentive programs (The Medicare way or the Medicaid way).  You can pick either but you can't choose both at the same time!
 

• Medicare:  Physicians that treat Medicare patients can receive up to $44,000 payable over 5 years.

• Medicaid:  Physicians that treat Medicaid patients are eligible for up to $63,750 payable over 6 years

Are there strings attached?  Of course.  And the biggest string is called 'Meaningful Use'.  The Government isn't going to just give you some cash for buying or even implementing an EHR system.  You have to prove to them that you can use it in a meaningful way that improves patient health care.  And they plan to accomplish this string by outlining 25 objectives and ways to measure those objectives.  Most of the measurements are percentage based.  (For Example:   At least 50% of all clinical lab tests whose results are in a positive/negative or numerical format need to be recorded in the EHR as structured data.)

For a complete list of these objectives, I recommend that you check out CMS or contact Bradford-Scott.  One important note:  The Meaningful Use definition is still under a proposed state and can be commented on until March.

That's it.  That's the nutshell.  Oh, and there is one more catch.  Starting in 2015, those physicians who choose to not participate will receive a 1% reduction in their Medicare allowed charges.  This reduction will increase by 1% each year up to a maximum of 5%.

So the moral of the story is that if you have plans on implementing an EHR/EMR system don't wait.  If you begin using it in a meaningful way in 2011 you are going to get more incentive payments than implementing in 2014.  And if you don't implement by 2015 you  are going to lose Medicare reimbursements.

Do you need help on what to do next?  Whether you are cardiology, orthopedics, or family practice, contact Bradford-Scott and ask about our Sage Intergy EHR system and how it can help you prove your meaningful use and improve patient care.

(and I kept it under 500 words!)
 

• Phone support for medical billing system and electronic medical records software
• Phone support for hardware, including servers, printers, backups, etc.
• Training classes for new and existing medical claims software and EMR customers
• On-site implementation of Intergy by Sage and Intergy EHR by Sage
• EDI Enrollment for new and existing customers
• R&D for our medical office billing software and EHR software
• Interface work with hospital information systems, labs, and EMR systems
• Countless other things...including blogging!

The “red flags” rule is now scheduled to take effect on June 1, 2010, after another delay announced earlier by the Federal Trade Commission as it considers new legislation that would exempt small businesses, including medical practices, from compliance. The rule mandates the creation of identity theft prevention programs, and will apply to any organization that can be considered a creditor with “covered” accounts (i.e.-commercial accounts that involve multiple transactions). Most providers, many physician medical billing companies and some health plans are expected to comply.

The American Medical Association, American Academy of Family Physicians and other industry groups have weighed in against the rule, on the basis that physicians do not meet the definition of creditors. A completely sensible argument. But medical practices need to proactively engage in some agreed set of identity theft prevention practices.  Incidences of medical identity theft are increasing. Smaller medical practices (which account for nearly 80% of all U.S. practices) may be more vulnerable, as thieves could perceive them to be lower risk targets based on the assumption that they lack the sophisticated security procedures of hospitals or larger health care organizations.

Despite the widespread outcry from industry groups, the actual impact on a practice for complying with the red flag rule may be minimal. The new rule would simply buttress state privacy laws that already require health care organizations to respond to breaches of certain patient information. In addition, there is a great deal of overlap between the proposed FTC regulations and HIPAA, which applies to medical practices or other entities that are conducting electronic transactions. But you should still be vary aware of these red flags. You must be able to protect your patient medical records.

Here are some Red Flag identifiers:

• Suspicious documents. Has a new patient given you identification documents that look altered or forged? Is the photograph or physical description on the ID inconsistent with what the patient looks like? Did the patient give you other documentation inconsistent with what he or she has told you — for example, an inconsistent date of birth or a chronic medical condition not mentioned elsewhere? Under the Red Flags Rule, you may need to ask for additional information from that patient.
• Suspicious personally identifying information. If a patient gives you information that does not match what you have learned from other sources, it may be a red flag of identity theft. For example, if the patient gives you a home address, birth date, or Social Security number that does not match information on file or from the insurer then fraud could be afoot.
• Suspicious activities. Is mail returned repeatedly as undeliverable, even though the patient still shows up for appointments? Does a patient complain about receiving a bill for a service that he or she didn't  get? Is there an inconsistency between a physical examination or medical history reported by the patient and the treatment records? These questionable activities may be red flags of identity theft.
• Notices from victims of identity theft, law enforcement authorities, insurers, or others suggesting possible identity theft. Have you received word about identity theft from another source? Cooperation is key. Heed warnings from others that identity theft may be ongoing.
  
  
  If you’re covered by the Rule, your red flag program must:

1. Identify the kinds of red flags that are relevant to your practice
2. Explain your process for detecting them
3. Describe how you’ll respond to red flags to prevent and mitigate identity theft
4. Spell out how you’ll keep your program current.

At Bradford Scott Data Corporation our EMR systems and our medical practice billing software has several built in features that can help you protect your patients from identity theft. Please contact our sales team at : www.bradfordscott.com/medical.php

Medical practices concerned about compliance can learn more at:
http://www.ama-assn.org/ama/no-index/physician-resources/red-flags-rule.shtml
 

With public attention on the ARRA stimulus funds in recent months, physicians have been feeling the pressure to adopt electronic health records. The vision is that in the next couple of years, the technology will be advanced enough to exchange health data freely between systems. Yet there is some skepticism from many in the health care industry that the lack of infrastructure and data sharing standards means that the day of sharing patient records between providers, labs and hospitals is a lot further off than the current administration is hoping.

 If practices know that payers and government agencies are invested in coordinating these efforts, it will reassure physicians that they won’t be left alone to arrange dozens of interfaces with a myriad of other systems. In fact, the inability of some smaller practices to afford EHRs at all has been another issue that has troubled advocates of health care technology. The Medical Group Management Association (MGMA) voiced concern back in July that those practices without the purchasing power of larger medical groups would in effect be penalized for their inability to show meaningful use. This stumbling block to widespread EHR adoption may soon be removed if a  new proposed legislation to make smaller practices eligible for business loans to buy electronic health records is passed.

Let Bradford Scott Data Corporation tell you all about our EMR and practice management systems that even the small practices can afford.

There is still a long way to go, but perhaps these and other measures will give physicians  confidence that the current path of health care enhances the chance that they will spend more time treating patients and less time tracking down information.

You can contact bradfordscott.com/index.php for all your health care software solutions.
 

Is Your Practice Ready for the Red Flags Rule?

Like many of our customers, we strive to stay on the pulse of industry changes.  For me, reading up on health care trends is about more than staying in-the-know and being able to speak intelligently about the vast changes going on around us.  I try to stay current because our customers depend on it.   Today, I want to share with you my knowledge about an important industry game-changer, and explain what is included in your medical software system to  facilitate a smooth adoption of this new policy for every one of your customers. We know how important your patient medical records are to your practice.

What are some of the types of companies that must be Red Flags Compliant?

Starting June 1, 2010, the FTC will begin enforcing the Red Flags Rule. This law will require health care providers that are considered "creditors" to develop a written program to identify, detect, and respond to indicators or "red flags" of identity theft. If your organization allows deferred patient payments until services are rendered and insurance is collected, you are considered a "creditor" by the FTC, and the Red Flags Rule applies to you. In order to assist health care providers, the AMA has prepared a guidance document along with sample policies. 

Our EMR systems and practice management system has several built-in tools that facilitate adoption of your Red Flags Rule policy. These include:

• Patient "Dup Check" - Detect duplicate SSN or Last-First-DOB entries in your system.
• Patient Merge - Detect information similarities across all your patient accounts.
• Insurance Eligibility - Detect PHI that conflicts with insurance provider records.
• USPS statements Verification - Detect addresses that conflict with USPS database.
• Scanned images programs - Capture images of your patients driver's license and     insurance card.
• Patient Notes & account alerts - Flag an account in question and keep track of the investigation process.

As your medical office software provider, here at Bradford Scott data Corporation, we are dedicated to your success and we are committed to delivering quality solutions that keep you on the cutting edge of compliance.  Does your medical office billing software and EMR system cover all your needs to help you get ready for the Red Flag rule? Contact us for all of your Physician medical billing needs  bradfordscott.com/index.php

 

• Electronic Prescriptions
• Drug Interaction checks and prescription history
• Imaging of all paper forms as well as X-rays, ultrasounds, etc.
• Specific templates for OB GYN EMR, Cardiology EMR, Orthopedics EMR, Pediatrics EMR, Primary Care EMR and many others
• Can interface with medical claims software and hospital information systems
• Send requests and receive results from labs electronically

• Electronic prescriptions
• Intergy EHR by Sage version 5.5 is a CCHIT certified product consistently finishing atop EMR reviews
• Medical claims software with over 25 years of development
• Interfaces with hospital information systems
• Customizable for Pediatrics EMR, OB GYN EMR, Orthopedics EMR, Cardiology EMR, and many other specialties
• The best service and support in the Midwest

• 3 deaths
• 14 permanent disabilities
• 31 temporary disabilities
• 39 hospital admissions
• 34 emergency room visits
• 267 physician office visits

$1.2 billion in federal grants for EHR (electronic health records) was unveiled by the Obama administration August 20, 2009.  The message was delivered by Vice President, Joe Biden, "with electronic health records, we are making health care safer, we're making it more efficient, we're making you healthier and we're saving money along the way.  These are four necessities we need for health care in the 21st century."

Some of the $1.2 billion will go towards state initiatives to expand networks to allow for sharing the medical information, about half will go towards establishing 70 technology extension centers, and billions more will be for the doctors, hospitals and other providers. 

The goal is that electronic health records will make health care more efficient and cut duplicate tests, unneeded procedures, and harmful drug interactions.  Some studies have estimated that the use of this kind of electronic technology could save more than $77 billion per year.

Be sure to look into a CCHIT certified EHR when you're ready to move, backed with a local company that can be there when you need help!  Check out Bradford-Scott's service and support and remember that Sage Intergy EHR V5.5 is CCHIT 2008 certified!

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• If you are the first client to notify us, and they become a Bradford-Scott Data Corporation customer, we'll pay you $500!!
  
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