Author: kkmeeks

eClinicalWorks LLC to Pay $155 Million to Resolve Civil False Claims Act Allegations

eClinical Works has agreed to pay $155 million to resolve allegations the the EHR company misled consumers about the certification of it’s EHR technology and paid some customers kickbacks in return for positive promotion of it’s product, this is according to a press release by the Department of Justice May 31, 2017.

Since 2011, healthcare providers who used eClinical Works software and attested to satisfying the Meaningful Use objectives and measures received incentive payments through the Meaningful Use program. Had eClinical Works disclosed that its software did not meet the certification criteria, it would not have been certified and its customers would not have been eligible for incentive payments. In addition, requests for incentive payments that resulted from unlawful kickbacks constituted false claims.

eClinical Works paid unlawful remuneration to influential customers to recommend its product to prospective customer. Among other things, eClinical Works employed a “referral program” a “site visit program” and a “reference program”. Through its “referral program” eClinical Works paid current users as much as $500 for each provider they referred who executed a contract with eClinical Works. All of these programs violated the Anti-Kickback Statute and are included in the original complaint.

The company and its three founders — CEO Girish Navani, CMO Rajesh Dharampuriya, MD, and COO Mahesh Navani — will be responsible for paying $154.9 million to the federal government. One developer and two project managers are on the hook for a combined $80,000.

Under the settlement, the EHR company headquartered in central Massachusetts will enter into a five-year Corporate Integrity Agreement (CIA) with the Office of Inspector General (OIG), which includes a provision that eClinicalWorks “retain an Independent Software Quality Oversight Organization to assess ECW’s software quality control systems and provide written semi-annual reports to OIG and ECW documenting its reviews and recommendations.”

Customers of the EHR company will be able to obtain updated versions of eClinicalWorks at no cost or transfer their data to another EHR software free of charge.

 

Will your EHR stand up to the Rigors of MACRA?

 What is MACRA?

MACRA is the Medicare Access and CHIP Reauthorization Act. MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. It was signed into law on April 16, 2015 by President Obama.RIP MU

The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service. MACRA combines parts of the Physicians Quality Reporting System (PQRS), Value Based Modifier (VBM) and the Medicare Electronic Health Record Incentive Program (MU) into one single program called the Merit-Based Incentive Payment System or “MIPS”.

What is MIPS?

MIPS is the name of a new program that will determine Medicare payment adjustments and is an acronym for the Merit-Based Incentive Payment System. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.

The Composite Performance Score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Performance for MIPS started on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:

  • 50% for quality (PQRS/VBM)
  • 25% for Meaningful Use
  • 15% for clinical practice improvement
  • 10% for resource use

The points provided for each category will shift over time to place an increasing focus on more resource use.

MediTouch is MACRA-compliant and can support your success through the transition to the new payment model.

Our software will provide you with a MACRA-specific, real-time dashboard so that you can be aware (at any point of the reporting period) of how you’re performing in the three categories on which you will be reporting.  The new MACRA-ready functionality will also identify ways in which you can take action, per patient, to improve your score.

Three MIPS Performance Categories comprising our MACRA dashboard:

  • Quality (PQRS + VBM)
  • Advancing Care Information (Meaningful Use)
  • Clinical Practice Improvement Activities

Note: Resource Use (or Cost) will not require reporting. This will be calculated based on your claims.

Want to learn more?  Use the form below to schedule a demo or give us a call at

502-538-4665 to talk with a sales representative.

 

Can your current payment system store a card on file?

Most everyone likes the convenience of paying bills online.  It’s definitely my preference, since it seems most of the time I’m not home.  I am from the generation that is use to writing a check every month, and trying to remember to buy enough stamps, so I enjoy the convenience of going online and pay a bill with my credit card or setting up an auto payment to pull funds right from my checking account.  I like that I am emailed or sent a text of said funds have left my account-it’s just more convenient.  With my  Health Savings Account (HSA), I can also keep track of all my families medical expenses too and (again the word) conveniently pay with a debit card.

From a revenue standpoint in medical office, wouldn’t it be nice to give this convenience to your patients?  Especially for families like mine where there is college student making their own medical appointments (no way I am going to give him my debit card), or a spouse who can never remember to grab the HSA card from my wallet.

For medical practices using BillFlash,there is a way to now set up auto draft payments for patients.  There are two ways to do this-with StoredPay and with PlanPay.

StoredPay

With StoredPay, you’re able to make the authorized payment and email a receipt rather than just sending another bill and waiting to get paid. Securely store a payment method that you can use later as agreed with your patient.

PlanPay

PlanPay payments are not associated with any single bill/statement but are simply part of a plan to pay off an established liability like a car loan payment would do. Create and automate payments for payment plans/agreements you make with your patients (ex, payoff $2,400 liability by making a $100/mo. payment on the 15th of each month for 24 months).

Best thing of all-it’s easy to get started!  

Simply give us a call or email at(502) 538-4665 or sales@sunrize.com

Don’t currently use BillFlash and want to learn more?  Visit our website to view product information and see a video on how BillFlash works or give us a call!

New PT CPT Codes for 2017

pt-with-patient

CPT® 2017 has a few expanded codes for physical therapy evaluations and follow-up exams.  These codes are in effect for dates of service starting January 1, 2017.

97001 to be replaced by three codes in 2017:

These new codes will add more specificity and details regarding the scope of the evaluation and states that it involves clinical decision-making of low/moderate/high complexity. The evaluation includes history to identify any factors that impact the plan of care; using standardized tests and measures to assess body structures and functions that may limit activity or restrict participation; and evaluation of the patient’s current status on presentation. The evaluation typically includes face-to-face time with the patient and/or family.

97161 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
97162 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
97163 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.

CPT® 2017 adds 97164 to replace 97002 (Physical therapy re-evaluation).

The new code adds more specificity and details regarding the scope of the evaluation, which includes history review and standardized tests (criteria established and agreed upon by a group of experts) and measures to assess body structure and function; a revised plan of care using standardized instrument and measurable functional outcome assessment tool; and typically involves 20 minutes of face-to-face time with patient and/or family.

Consider these to be the equivalent of E&M codes (99000) for Physical Therapy.  You should now consider these elements when coding for services:

  • Patient’s history
  • Examination results
  • Clinical decision-making
  • Development of the care plan

The level of the PT evaluation performed depends on the clinical decision-making and the patient’s severity, according to CPT® instruction. For reporting, PTs must demonstrate review of these body regions and body systems:

  • Defined body regions such as the head, neck, back, lower extremities, upper extremities, and trunk
  • Musculoskeletal systems, which include gross symmetry, range of motion, strength, height, and weight
  • Neuromuscular systems, which includes gross coordinated movement and motor function
  • Cardiovascular and pulmonary systems, which include heart and respiratory rates, blood pressure, and edema
  • Integumentary system, which means assessing the pliability, scar formation, color, and integrity of the skin

One other thing-make sure to sequence these codes before your modality CPT codes (those starting at 97010).

OT and AT have similar changes.  Look for those in a future post.

References:
CPT® 2017 Professional Edition, American Medical Association, pages 664-668
Federal Register, Vol. 81, No. 136, Pat. 46162, July 15, 2016, “Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other revisions to Part B for CY 2017; Medicare Advantage Pricing Data Release: Medicare Advantage and Part D Medicare Advantage Provider Network Requirements’; Expansion of Medicare Diabetes Prevention Program Model”
AAPC Healthcare Business Monthly, November 2016

 

Advancing Care Information and Improvement Activities-Q&A

shutterstock_498951139The Merit Based Incentive Program (aka MIPS) defines four categories of eligible clinician performance, contributing to an annual MIPS final score of up to 100 points (relative weights are indicated for the CY2017 performance year and associated CY2019 payment year):

  • Quality (60% for 2017)
  • Advancing Care Information (ACI, renamed from Meaningful Use) (25% for 2017)
  • Improvement Activities (CPIA) (15% for 2017)
  • Cost (0% for 2017, but will be weighted for 2018 and beyond)

On December 13, 2016 the Centers for Medicare & Medicaid Services (CMS), briefly discussed two of the four Merit-based Incentive Payment System (MIPS) categories: Advancing Care Information (ACI) and Improvement Activities. Most of the 90-minute session was reserved for questions and answers. Here are some of the questions your colleagues asked, with answers from CMS.

Q: How is the ACI scored for hospital-based and non-facing patient clinicians who are part of a large multi-specialty reporting as a group?

A: That would depend on whether they choose to submit data, or not; they still have the option because they’re hospital-based. If they choose to participate, they will be scored as a group. The resulting update will apply to everybody in the group.

Q: When ACI is set to zero, to what category is the percentage applied?

A: The entire 25 points is moved to the Quality category, so instead of the Quality category being worth 60 points, it will be worth 85 points of the composite performance score (CPS).

Q: Will providers be submitting data through the same system for ACI and Improvement Activities as they did for the Electronic Health Record (EHR) Incentive Program?

A: No. There will be a new system for MIPS. However, if you are eligible to participate in the Medicaid EHR Incentive Program, you will need to attest through the same system as before.

Q: When reporting as a group, will nurse practitioners and physician assistants be excluded from ACI scoring if no data is submitted?

A: Yes. But if they are part of a group ,they will get the same update as everyone else in the group.

Q: Do eligible clinicians need to inform CMS in advance whether they will be attesting as an individual or a group? If so, how do they do that?

A: They don’t have to inform CMS; they just submit the data — unless they are reporting as a group through the CMS Web Interface or reporting Consumer Assessment of Healthcare Providers and Systems (CAHPS) data. Information on these protocols are forthcoming.

Q: For the test portion of Pick Your Pace, which allows for one improvement activity to receive credit, can we pick any activity or do we need to pick a high or medium activity?

A: You can pick a high or medium activity, but a medium activity will only give you have the points (7.5) toward your final score.

Q: If we do not use an EHR and cannot attest to ACI, do we have to attest or submit this fact anywhere?

A: No. Just don’t complete that part of the reporting requirements.

Q: The rule states that ACI performance for groups will be based on a group score. Does that mean the reports showing the numerator/denominator for each eligible clinician in the group have to be combined?

A: The attestation should be aggregate there is one submission — one numerator and denominator per measure — for the group. If the group is using multiple EHR technologies, you will have to sum the numerator/denominator for each measure across the different EHRs for the group.

Q: If you do group reporting, do you only need a “1” in the numerator for the entire group to get credit for the base score under ACI?

A: Yes.

Q: When will the specifics of the improvement activities be released? The working on the 90-plus activities are vague and open to interpretation.

A: We are not planning to issue more specific language around the activities for the transition year. We aren’t requiring any specific data to be submitted. What you see is on the Quality Payment Program (QPP) website is all that is required.

Q: Will the bonus payment be a one-time payment?

A: Whatever score you get in MIPS will be applied to your Physician Fee Schedule amount. The method for paying the added bonus for exceptional performers is still being worked out.

Q: What if your certified EHR technology (CEHRT) year changes mid year due to an upgrade and your submitting a full year of data?

A: You can submit a combination. Aggregate your data between the  two EHRs and submit the data for the ACI category as one submission. This is not the case for Quality reporting, however. You will need to work with a data aggression vendor to report electronic Clinical Quality Measures (eCQMs), in that case.

Q: Does MIPS reporting take the place of EHR reporting? Do we still have to use a qualified EHR or can we do claims-based reporting?

A: The data needs to come out of your EHR. For Quality measures, you’re no longer required to submit eCQMs to earn credit. In the Quality category, you could submit via claims and it wouldn’t count against you.

Q: Can you report as a group under MIPS if not all of your providers are using a CEHRT?

A: Yes.

Q: What type of documentation is required for improvement activities?

A: For improvement activities, we are not requiring documentation. But providers should retain copies of medical records, charts, reports, and any electronic records that are applicable and appropriate for up to 10 years after the conclusion of the performance period, in case of an audit.

See the whole presentation:

Holiday Hours-2016

 

 

eli_lights1

We wish you a Merry Christmas

and

A Happy New Year!

Our 2016 Holiday hours will be:

Monday, December 26th-CLOSED

Tuesday December 27th-OPEN Normal Hours

Wednesday December 28th- OPEN Normal Hours

Thursday December 29th-OPEN Normal Hours

Friday December 30th-CLOSED

Monday January 2nd-OPEN Normal Hours

 

 

Last Chance to get Medisoft V21 in 2016!

santawithwriting

Still waiting to upgrade your current Medisoft program?  Now is the time to order Medisoft V21 and still receive savings.  Especially at this time of the year-who doesn’t like to save money?

Call us today at 888-880-0384 to receive a customized quote for upgrading.

 

 

 

 

 

It’s the holiday season….time to spread the Flu!

santa-hat

With all the weather changes we have experienced in the south over the past few months, getting the flu has been the last thing on anyone’s mind.  80 degree temps here in Kentucky in November is unheard of!  We’ve all been taking advantage of getting out in the fresh air (flu?  what flu?).

Well, now we are experiencing our first “Arctic Blast” and my first trip to Kroger this week resulted in witnessing probably the most embarrassing thing we as parents experience….projectile vomiting from a child in the grocery store.  Okay, maybe not the most embarrassing thing in the world but one that certainly had me running for the hand sanitizer and masks (no-I didn’t stick around to help).

And yes, remembering that in fact, the flu season is upon us.

Guidelines for Billing Influenza Vaccines

Medicare pays for one seasonal influenza virus vaccination per influenza season (12 months do not have to pass). Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

Medicare will pay both administration fees when a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. Report ICD-10-CM diagnosis code Z23 Encounter for immunization when an individual receives both vaccines, but report separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines.

Medicare Payment Allowances for this flu season (8/1/2016-7/31/2017)

CPT® Code Payment Allowance
90630 Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use $20.343
90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use $37.383
90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use Pending
90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use Pending
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use $17.717
90657 Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6–35 months of age, for intramuscular use Pending
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use Pending
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use $42.722
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use $26.876
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use $40.613
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

*NOTE-Claims for this code must be held until 1/1/17

$22.936
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use $26.268
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use $19.032
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6–35 months of age, for intramuscular use $9.403
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use $17.835

 

HCPCS Level II Code Payment Allowance
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) $16.284
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) $16.284
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) Pending
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) Pending
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) Flu Vaccine Adult – Not Otherwise Classified: Payment allowance is to be determined by the local claims processing contractor.

The payment allowance for some codes is still pending. Check the CMS website periodically for updates.

Resources:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2016-12-08-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc468862699

 

 

CMS Announces July 2015 Transition from IACS to EIDM

CMS 

The Centers for Medicare & Medicaid Services (CMS) would like to inform Physician Quality Reporting System (PQRS) participants and their staff to an important system update scheduled to be in place on July 13, 2015.


The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval, and receive a single user ID for accessing multiple CMS applications.


Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at  http://portal.cms.gov. Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.


Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM.


For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.

CMS Announces Extension for EPs participating in PQRS via EHR and QCDR (QRDA III format)

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that the submission deadlines for the PQRS reporting methods below have been extended.  All other submission timeframes for other PQRS reporting methods remain the same.  The revised submission timeframes are:

Reporting Method Submission Period Submission Deadline Time

(All Times are Eastern)

EHR Direct or Data Submission Vendor that is certified EHR technology (CEHRT) 1/1/15 – 3/20/15 8:00 p.m.
Qualified clinical data registries (QCDRs) (using QRDA III format) reporting for PQRS and the clinical quality measure (CQM) component of meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 1/1/15 – 3/20/15 8:00 p.m.

An Individuals Authorized Access to CMS Computer Services (IACS) account with the “PQRS Submitter Role” is required for these PQRS data submission methods. Please see the IACS Quick Reference Guides for specifics.

PQRS provides an incentive payment to individual eligible professionals (EPs) and group practices that satisfactorily participate or satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (PFS) services. Additionally, those who do not meet the 2014 PQRS reporting requirements will be subject to a negative payment adjustment on all Medicare Part B PFS services rendered in 2016.

Note:  The deadline listed above does apply to Individual Eligible Professionals and Group Practices participating in other CMS programs such as the Medicare EHR Incentive Program and Comprehensive Primary Care Initiative that are utilizing the reporting methods listed above. Additionally, CMS has extended the deadline for EPs wishing to attest to meaningful use for the EHR reporting period in 2014 for the Medicare Electronic Health Record (EHR) Incentive Program to March 20, 2015. Please be on the lookout for a separate listserv with information regarding the attestation extension.

For questions, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time. Complete information about PQRS is available at  http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.