Practice Management System

• 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.

• Albany Obstetrics and Gynecology experienced 20% fewer missed appointments
• Patient information became increasingly more up to date
• Verifying coverage for patients reduced denied claims by as much as 70%
• The days in accounts receivable has been reduced to less than 30
• Phone nurses quickly accessed/updated information - relieving front desk congestion
• With EHR, paper charts aren't needed, saving over 3 hours per day in chart pulls
• Physicians are able to view patient information from outside the office

"It's invaluable that the physicians can look at patient records when they are on call, especially being able to see lab results,"

There has been a lot of belly aching about the recent snow storms that have hit the Midwest. Yes, snow storms do get old, but I remember what it was like growing up in the 70's and 80's with blizzards here in Indiana. In the more recent years our winters here in Indiana have been very mild compared with those of my childhood. And although I am in the Federal protected age group, I am not that old. I guess one thing that you can count on in Indiana is that there will be some snow storms each and every winter season.

• A call back within 29 minutes from when you have logged your call
• trained software and hardware support teams
• Our dedication to client satisfaction, every year we send our clients our customer satisfaction surveys and this year you rated us as a 9.52 on a 10 point scale.

• Electronic Eligibility (important in the high deductible world we now live in)
• Pre-collection of copays
• Advanced collection modules
• Clearinghouse integrations
• eStatments, eCollcetion Letters, etc.
• Claim Scrubbing
• Patient Portals via the web
• Image scanning
• and many more...

• It automates access to patient information
• Enables providers to make better decisions & provide better care
• Improves the accuracy of medical records
• Reduces the incidence of medical errors
• Reduces duplication of tests
• Reduces delays in treatments
• Health information is readily available
• Electronic prescriptions sent to pharmacy of your choice
• Prescriptions printed making them easier to read by you and the pharmacist
• Reduces the amount of paper in the office & in patient records
• It is an electronic version of a patients medical history, including medications, vital signs, past medical history immunizations, lab data, etc.
•  Electronic prescriptions and incentives for using it. Intergy EHR is part of Stimulus package. 
  For more information about our EHR please follow this link http://www.bradfordscott.com/med_prod_ehr.php

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.
 

An EHR is like a good pair of shoes – you want them to fit right or you are going to feel the pain. And let’s face it, selecting the right EMR system and practice management system for your practice is not an easy task – particularly for practitioners who may not have IT expertise. Plus, there are more than 400 vendors of EHR/EMR products on the market today. It’s important to exercise caution and perform a thorough due diligence, but where should you start?

Bradford Scott Data Corp believes we have an amazing product that will truly improve your practice’s efficiencies and profitability, and we only want you to buy our software if it’s the “right fit” for you. We’ve got the insight of 25+ years of experience in the field of health information technology. But don’t just take our word for it. We encourage you to check our personal Provider references and letters.

Now you are ready to start approaching vendors and looking for the practice management and EHR solution that best fits the needs of your practice. If the vendor does not suit you, cross them off your list and continue to the next vendor. And don’t forget to demo the software. Have a vendor representative walk you through how the software works, and ask lots of questions! Once you have a shortlist of vendors, consider the following and make your decision.

1. What is involved in product implementation?
2. Is the implementation process disruptive to your day-to-day operations?
3. What kind of training is available?
4. What is the response time if you have problems next week or next year?
5. How long has the company been around?
6. What are the hardware requirements – will it require you to buy new systems?
7. Who is responsible for data back-ups?
8. How will the data be securely stored to protect your patients’ privacy?
9. How often will the software/hardware need to be upgraded and what will this cost?
10. Is the solution scalable as your practice grows?

By now, you have a couple of vendors who are standing out from the rest. The functionality meets the needs of your practice and you are starting to get excited about how the new practice management software and EHR solution can help your practice. Now it’s time to get references and ask your peers what they think about the software. Here are some questions you can ask:

1. How smooth was the implementation?
2. How well was training conducted?
3. What do you like best about the software?
4. What do you like least about the software?

Hopefully this has helped to further narrow your selection. Remember that you get what you pay for and you shouldn’t waste your time on products that don’t meet the needs you identified at the beginning of the process. Focusing on cost first could rule out some of the best products and minimize your chance to find the best solution that maximizes your potential gains – giving you a shoe that just doesn’t fit.

Please contact us for more information: http://www.bradfordscott.com/medical.php

**Last week marked the opening of the 60-day window for public comment about the HHS’ meaningful use” rules.  Input from practitioners and other stakeholders will help to refine the final version, which is expected to be completed in Spring of 2010.

**Since the Health Information Technology Policy Committee’s July 2009 meeting, many practitioners have been feeling uneasy about moving forward with what could potentially be a large financial and human resource investment without more definite and final criteria defining meaningful use. The December 2009 updates do not significantly change the committee’s earlier direction. Variations are minor, and include the ability to implement drug-drug/drug-allergy checks, e-prescribe and check insurance availability electronically.

**While the clarifications are much welcomed, many providers (and some in the health information technology community) see a long road ahead in achieving meaningful use. The first step will be adoption, and providers are reticent to adopt unless they see the potential for a better work flow and improved outcomes for their patients.

**Providers,  now’s the time to weigh in. You can accept the government’s initial effort and be subservient to the criteria, whether they are realistic or within reach. Or, make sure that the seeds are planted now for you to eventually cultivate technologies that remove complexity, are user friendly and have the greatest impact on patient care.

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

 

• Billing reports - reports that are generated and sent back to the client to find out if a claim was accepted.
• Claims Tracker - website that clients have access to view claims acceptance at the payer.
• Electronic Remittance - electronic copies of the EOBs that clients can use to post to the system in a matter of minutes rather than hours of manually posting.
• ERA Manager - a website that clients have access to view copies of the EOBs.

Video on the progression of information technology, researched by Karl Fisch, Scott McLeod, and Jeff Bronman, remixed

1.  Identify the reason for your call.  Sounds simple BUT determining the  true "problem" is not as easy as it may sound.  The support TEAM at Bradfordscott are experts in the field.
2.  Advise the customer how you will help resolve the problem and give them a time line.  Stick to it!
3.  Followup with a STATUS, or if the problem is resolved, followup to see if they are happy with the resolution.

• Intergy - Our premiere Practice Management Software & EHR
• Enterprise Medical Software - Manage multiple practices through one data area
• Sage Intergy EHR V5.5 is CCHIT 2008 certified -  Latest Technology
• Customer Service - 2nd to NONE

You owe it to yourself to check out Bradfordscott Data Corporation.  Your physicians + Bradfordscott = SUCCESS