Saas Based EHR

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.

 

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.

Using templates in your EHR? Make sure they are updated for ICD-10!

The follow article, written by Cathie Wilde pertains to any EHR that is “template driven”.  As we approach (hopefully) adoption of ICD-10 codes, looking at how your templates are coded is one of those great first steps a practice can take to begin it’s transition to ICD-10.

 Published from ICD-10 monitor:
 “Templates can either enhance documentation necessary for coding and data quality, or they can hinder things by restricting options and failing to prompt physicians to document specific information. However, templates cannot be overlooked when it comes to ICD-10. This is particularly true if a hospital relies more heavily on templates to capture structured data. Many hospitals may use templates for certain diagnoses, orders, or visit types and allow physicians to dictate information for everything else.

Regardless of a hospital’s specific use of templates, one point remains clear: the templates must be updated to accommodate the details necessary for ICD-10. At a minimum, these details include laterality, specificity, and etiology. The number of physicians who could be using a specific template at any given time — or even over a short period of time — could be significant. If one template is not updated correctly to accommodate ICD-10, data quality and reimbursement could be compromised.

Health information management (HIM) directors cannot assume that electronic health record (EHR) vendors will handle this effectively and in a timely manner. Instead, take the following steps to ensure that all updates will be made:

1. Take an inventory of all current templates in use. Are some of these templates used more frequently than others? Can any of them be retired if not in use? Ask for input from coders — what information is typically missing from the templates? Can you add or revise this information during the ICD-10 update? Work with your EHR vendor to make these changes before tackling ICD-10 updates.

2. Form a committee to address ICD-10 template updates. This committee, which can be a subcommittee of the ICD-10 implementation committee, should include coders, clinical documentation improvement (CDI) specialists, a physician champion, and an EHR representative. Compile a list of all diagnoses and procedures that require greater specificity in ICD-10 and cross-check this list with any templates that are in use. Ensure that each and every reference to these diagnoses and procedures is updated to accommodate ICD-10 specificity and other requirements.

3. Tie your template update efforts to your query update efforts. As CDI specialists review queries to ensure the implementation of updates for ICD-10, they can easily use this information to review templates in light of ICD-10 changes. If templates ultimately capture all of the relevant information that coders need, a query may not even be necessary.

4. Review templates after updates have been made. Set a deadline for all template updates to be completed. Then manually review each template to ensure that updates have been entered correctly.

5. Educate physicians. Physicians don’t need template-specific training; however, let physicians know that the updated templates exist when performing specialty-specific ICD-10 training. Reiterate that the templates exist to make physicians’ jobs easier by prompting them to document what’s necessary and pertinent to ICD-10 in the most concise way.

Clinical areas for review

Consider focusing on the following templates that require new and more specific documentation in ICD-10:

Obstetrics-related templates

  • Specific trimester: The majority of codes in Chapter 15 (Pregnancy, Childbirth, and the Puerperium) feature a final character that indicates the trimester of the pregnancy. Assignment of this character is based on the provider’s documentation of the patient’s trimester during the admission/encounter. Templates should include the weeks of gestation at the time of admission and/or delivery.
  • Fetus identification: ICD-10 requires a seventh character to denote multiple gestations, when applicable. This character identifies the fetus for which the complication code applies. Templates should provide an option for this character.
  • Multiple gestation placenta status: ICD-10 features a combination code for multiple gestation and identification of the number of placentas and amniotic sacs. Templates should capture this information as well.

Trauma-related templates

  • Glascow coma scale: This scale denotes the degree of consciousness and is used commonly with head trauma cases. The score can function as an indicator for testing or treatment as well as predict the duration and outcome of the coma. Templates for head injuries should specifically include this information.
  • Gustilo classification: This classification applies to open fractures of the long bones, including the humerus, radius, ulna, femur, tibia, and fibula. The classification system groups open fractures into three main categories and three subcategories defined by these characteristics: mechanism of injury, extent of soft tissue damage, and degree of bone injury or involvement. Templates for open fractures should include this information.
  • Salter-Harris classification: This classification includes nine types of fractures that occur along the epiphyseal (growth) plates in bones that have not reached full maturity. With these types of fractures, plates are still open and filled with cartilaginous tissue. These fractures are common among children. Templates for these fractures should include information related to the Salter-Harris classification system.

Wound-related templates

  • Severity: In addition to specific location and etiology of non-pressure skin ulcers, ICD-10 also requires physicians to document the severity of the ulcer as follows:
    • Limited to breakdown of skin
    • With fat layer exposed
    • With necrosis of muscle
    • With necrosis of bone

Any and all wound templates should include these designations. Pressure ulcer templates should continue to include the stage of the ulcer.

Nutrition templates

  • Obesity: In addition to the current body mass index documentation on nutrition orders/templates for obesity, ICD-10 includes additional codes for obesity due to excess calories, drug-induced obesity, and morbid obesity with alveolar hypoventilation. Templates should be updated to include these designations. “

About the Author

Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.

How to Prepare For, Survive an EHR Meaningful Use Audit

Posted from AAFP News Now:

Use of the words “audit” and “Medicare” in the same sentence tend to make even the most seasoned physician uncomfortable. So when the news broke in March that CMS had added prepayment meaningful use (MU) audits to its ongoing postpayment audit process, some family physicians expressed concern.

Understanding that a little knowledge can go a long way toward alleviating anxiety, AAFP News Now recently spoke with a government expert about how physicians can prepare for MU audits associated with the Medicare Electronic Health Records (EHR) Incentive Program.

Rob Anthony, deputy director of the Health IT Initiatives Group for CMS’ Office of E-Health Standards and Services, noted that as many as 10 percent of program participants would face an audit. “Keep in mind that the audits are both random and targeted,” said Anthony, so physicians shouldn’t assume they’ve made an error if they receive an e-mail audit notification from Figliozzi and Co., the certified public accountant firm selected by CMS to conduct the audits.

“We’re required to do due diligence on our end,” said Anthony, and that includes robust oversight of a government program that disperses taxpayer dollars in the form of physician bonuses that can total as much as $18,000. According to Anthony, the audit process is the same regardless of whether physicians are notified before or after they are issued a check for successfully meeting MU program requirements.

“The first thing we always tell people is that if you’ve entered accurate numbers (in the MU attestation process) and have the documentation to support that, then the audit is a really simple process for this program. You’re simply showing (auditors) supporting documentation,” said Anthony.

For the vast majority of people, the primary support document is the report generated by a certified EHR because it generally provides both the numerator and denominator values needed for MU attestation.

“It’s important to make sure the report specifies a time period and indicates that it is specific to you as a provider,” said Anthony. That’s as easy as including a National Provider Identifier, provider name or practice name.

Anthony noted that some certified EHRs provide a “snapshot in time,” meaning that the physician can go back to any 90-day period, and the system always shows the correct numerator and denominator values for that period. However, many EHRs don’t have that function and instead use what Anthony called a “rolling system” that changes the values of the numerators and denominators after the reporting period ends.

In that situation, he advised physicians to “save either a paper or an electronic copy of the report you used to attest so that when an auditor comes knocking and asking for supporting documentation, you can hand him a report that shows the numerator and denominator values that you entered (for attestation) rather than something that might have changed later down the line.”

A number of physicians also have had trouble complying with what Anthony called the “yes/no functionality issues” that require specific EHR functions — such as drug allergy interaction checks and clinical decision support — to be turned on during the entire reporting period.

“Some systems have an audit log that shows that you have functionality enabled for the entire reporting time, but many systems don’t,” said Anthony. If your system doesn’t, save one or more screen shots that are dated from the reporting period to which you are attesting.

One additional area that has snagged numerous physicians is the security risk analysis. “This doesn’t impose any additional requirements beyond what’s already required for a security risk analysis for your practice as part of HIPAA (the Health Insurance Portability and Accountability Act),” said Anthony. “The only difference is that we require it more frequently,” or every year for MU versus every two years for HIPAA purposes.

Anthony warned that a “generalized” security risk analysis wouldn’t meet the MU audit requirement. “You need something that shows it (an analysis) was done before the end of the reporting period and that shows it is specific to your certified EHR and your particular practice. Information that is dated and specific to you goes a long way for a lot of these requirements.”

Lastly, Anthony advised physicians to direct any audit questions to Figliozzi and Co., including requests for clarification about requested documents as well as requests for additional time to comply.

Anthony summed up how to make the audit process go smoothly: “If you’ve input the numbers correctly and accurately, and you have the documentation to show how you got there, the audit process is simple. You’re not generating new information.”

Additional resources can be found by clicking the following links:

CMS: EHR Incentive Program Supporting Documentation for Audits

CMS: Audit Overview Fact Sheet

CMS: Sample Audit Request Letter

 

 

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.

Practice Choice EHR

 

McKesson Practice Choice Web Image - Product Name (Color)

 

McKesson Practice Choice™ is a cost-effective Web-based electronic health record (EHR) and practice management (PM) solution inspired by small, physician practices just like yours.   Intuitive and efficient, McKesson Practice Choice does more than maintain records and protect cash flow; it has the power to improve the quality of your patient interactions.
When care is your priority and simplicity is your choice

With 20+ years developing PM and EHR technologies, McKesson understands the juggling act of the small, physician practice, and is committed to utilizing technology to make your life easier, flexible and more efficient. That’s why McKesson Practice Choice is more than an EHR product — it’s a comprehensive, full-practice solution.
Utilizing a SaaS (Software as a Service) model, McKesson Practice Choice allows physician practices to exchange data with other practices, patients, HIEs, hospitals, pharmacies, labs and payers. These connections help to streamline care coordination, to enhance patient care, and to position your practice for the future direction of healthcare.
One solution for your entire office

Simplify your administrative overhead and learning curve with just a single solution: choicepic

• Electronic Health Record (EHR)
• Practice Management (PM)
• Patient Portals
• Patient Health Maintenance Tracking
• e-Prescribing
• Claims Management

One Choice for Connecting Providers, Payers and Patients

Progress Notechoice2 Featuring Smart Note Technology

Spend less time charting and more time interacting with your patients, as everything you enter automatically flows data into all pertinent fields throughout a chart.

• Document on a single screen while pulling and pushing
data from anywhere in the patient’s chart.
• Search codes using natural terminology and view
cross-sectional chart summaries.
• Create a template that suits your note-taking preferences

Billing and Schedulingchoice3

Utilizing intuitive drag and drop technology and simple organiza

tio

n,

McKesson Practice Choice brings needed efficiencies to a busy front office.


Meaningful Use Dashboard and Reporting

From a single screen, gauge your progress in real time for both core and selected requirements, and gain an instant view of your practice’s performance. Also, customizable controls allow you to observe detailed performance levels of every member of your practice.

Need more information?  Call us at 888-880-0384 or visit us on the web at http://www.sunrize.com.