Month: April 2013

PQRS..more than just letters in the alphabet!

In all the whorl wind of Meaningful Use Stages one and two, e-RX incentives (or penalties), ICD-10 implementation, there’s another “oldie but goodie” program for providers to participate in.  The program has been around for a few years, but did you know come 2015, you may be subject to another penalty (on top of everything else) for not participating in this program?

According to CMS- The Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. Beginning in 2015, the program also applies a payment adjustment to eligible professionals who do not satisfactorily report data on quality measures for covered professional services.

Planning to participate in 2013?  Here are some things you should know:

  • To earn the 2013 PQRS incentive payment and avoid the 2015 PQRS payment adjustment you need to collect your data from January 1 through December 31 of this year.
  • Decide if you are going to report through your EHR (you may have to discuss with your vendor if you can report through your EHR), or if you are going to report your measure on claims.
  • Become very familiar with the CMS website- http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS
  • Report on each eligible claim
  • Avoid including multiple dates of service and/or multiple rendering providers on the same claim – this will help eliminate diagnosis codes associated with other services being attributed to another provider’s services
  • For measures that require more than one code, ensure that all codes are captured on the claim
  • If your claim with the reporting codes on it was denied for payment the PQRS codes will not be included in the program analysis.
  • Check you remittance advice for remark code N365, which reads “This procedure code is not payable. It is for reporting/information purposes only.”
  • Review all diagnoses (if applicable) and CPT Service (encounter) codes for denominator inclusion in PQRS/eRx (i.e., claims that are denominator-eligible).

Participation this year in the program could earn you incentives of up to 1%.  Failure to report could land you a whopping 1.5% pay cut (in addition to all those other penalties from CMS).

Need to learn more?  Visit us on the web at www.sunrize.com.  CMS also has a new eHealth Website that has some useful information as well- http://www.cms.gov/ehealth.

Seven Value Propositions for Practice Choice

7 Value Propositions of McKesson Practice Choice

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1.      Lowers Cost of traditional EHR/PM Technology ·
         Avoid costly servers and IT staffing using a Web-based solution
         Learn, setup, & maintain one integrated solution
         Practice Management
         Health Records
         Patient Portal
         e-Prescribing
         Claims Engine including ERA, Electronic Eligibility Checking & Relay Health EDI.
         Low-hassle rolling upgrades always keeps your practice current and compliant
         Automatic backups & security
2.    Is Intuitive, Designed for the Small Independent Medical Office
         Be at ease with McKesson – a leading healthcare company that’s been in the EHR space for over 20 years
         Be confident in an built-from-the-ground up investment using Microsoft’s latest technology stack designed specifically for the independent practice
         Be efficient with our multiple role layout. We studied this space specifically, and laid out the software considerate of the many hats you wear during the day
         Learn easily and train new staff with integrated training videos, guides, and online help.
        Share best practices online chatting with other Choice practices like your own
3.       Protects Cash Flow
         Check patient eligibility real-time to guarantee reimbursement
         Ensure recommended procedures are performed to benefit patient health and encourage visit volume
         Improve collections by taking visit and account payments at check-in
         Embedded Claim/ERA services with auto-posting keeps cash moving
4.    Helps you Go Electronic without compromising Patient Care
         Avoid excessive clicking with single screen documentation that mimics paper
         Smart Notes design enables clinicians to pull and push data from the chart while you build the note
         Gain efficiency using natural terminology to search codes
         Care for patients with a powerful cross sectional chart summary
5.       Creates New Efficiencies with Technology
         Make patient care simpler via electronic prescriptions with clever interaction checking
         Maximize reimbursement with insurance-preferred labs automating when creating an order
         Save time eliminating paper lab results via an electronic connection
6.    Enhances Patient Touch
         Supplement patient-provider interaction with electronic messaging
         Give patients and their providers a consolidated health summary in-hand or electronically
         Quickly manage refill requests online
         Keep patients informed via patient education material summaries
7.       Gains Visibility to the Health of your Patient and Practice
         Speedily generate patient lists and reminders to communicate with the right audience
         Benchmark yourself against Meaningful Use performance and clinical quality measures
         Interrogate your financial health with comprehensive report generation

For additional information please visit our website at www.sunrize.com or call 502-538-4665.

Mandated Sequestration Payment Reductions Beginning for Medicare EHR Incentive Program

Incentive payments made through the Medicare Electronic Health Record (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011.

Incentive Payment Reduction

The American Taxpayer Relief Act of 2012 postponed sequestration for two

months. As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive

payments made to eligible professionals and eligible hospitals will be reduced by 2%.

Reduction Timing

This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction.

Please note: This reduction does not apply to Medicaid EHR incentive payments, which are exempt from the mandatory reductions.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

http://www.sunrize.com

Be prepared for changes to stage 1 meaningful use!

There are some changes coming in 2014 for all those meaningful users still in stage one.   While some of these changes are positive, there are a few that may come as a surprise-especially if a practice attested for the first time in 2013, and plan to do the second year of stage one in 2014.  Here are just a few things to be aware of:

  1. You can no longer count an exclusion toward the minimum 5 menu objectives.  In other words-there are 10 to choose from and a provider must be able to attest to 5 of those with no exclusions.
  2. Seeing patients ages 3 and over? You have to record blood pressure, height and weight on more than 50% of patients.  An EP can exclude his or herself, though if there is no relevance to the scope of practice.
  3. The capability to exchange key clinical information among providers of care and patient authorized entities electronically is no longer required starting in 2013.
  4. Providing patients with timely access to their health information within 4 business days has been changed in 2014 to being able to provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.  This will have to be reported for more than 50% of all unique patients.
  5. LOTS of changes with Clinical Quality Measures (CQM).  Prior to 2014, providers have 44 measures to choose from in which they had to report 6 total (3 core and 3 alternate).  Starting in 2014 and beyond a provider must report 9 measures (out of a total of 64).  Selected CQM’s must cover at least 3 of the National Quality Strategy domains.  For more information please refer to www.cms.gov/EHRincentiveprograms.

Providers who were early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 2014.  All other providers would meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in the third year.  This is regardless of the year you started to participate.

Looking forward to stage 2 of meaningful use?  Although you can’t begin to collect data for stage 2 meaningful use until 2014, there are a couple of things to have in place ideally before 2014.

The first thing is to establish a patient portal and become familiar with the workings of the portal.  Work out any changes to your workflow in order to become successful in establishing protocols for staff and for patients.  Make sure to give yourself plenty of time for marketing.

Another item for action would be to get with your lab (if you haven’t already done so), and make sure your EHR has a way to incorporate lab results as structured data.  This menu objective for stage 1 becomes a core objective for stage 2.  Creating this “bridge”, can take some time to do so the sooner the better.  Some labs are more backlogged than others and this could very well take up to 6 months to complete.

Any questions?  We’d be happy to help visit our website- www.sunrize.com or email me-  Kelly@sunrize.com.