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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.

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.

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.

Tips for successful EHR Implementation

Successful EHR Implementation

By Chris Torregosa, Project coordinator

With all the government stimulus money made available to hospitals and clinics these days, many groups are purchasing and implementing an EHR system. Some implementations go smoothly and achieve their goals while others they struggle or stall due to inexperience and frustration with the selected system. Some tend to fall short due to limited resources or IT issues. In certain instances, many groups experience little or no success at all. These groups then begin to contemplate whether it is a problem with their staff learning the system, the workflow processes within the group, or simply the EHR system’s abilities to meet their requirements. Regardless of your group’s size, many implementation issues are common throughout. Like any new journey in life that requires a certain amount of knowledge, there is much to learn and many things that can go wrong without proper direction. Here are a few tips to help ensure a successful EHR implementation:

1) There is no “I” in the word “Team”.

Any football fan knows that any given play can’t be run on the field unless everyone is completing their assigned role. The quarterback can’t throw or handoff the ball unless his offensive line is providing the proper protection from the opposing defense. I can go on and on, but the point is that the sane team concept can and should be applied to an EHR implementation. Navigating through an EHR implementation is not solo task. Everyone from the receptionist to the biller, to the medical assistant, to the physician will play a role in the success of the implementation. Involvement from the stakeholders is essential to create buy in into the project and to identify any ways the EHR could fail.

Like any normal team, there needs to be leadership. In an implementation, a Physician champion should be elected. The role of the Physician champion is to provide good input and communication, and to be an energetic supporter and positive motivator throughout the project. He or she is responsible to keep driving the project forward despite any road blocks that lie ahead.

Lastly, like any good team, practice makes perfect. It is incumbent of the staff to learn and practice. The more and more you practice with the system, the more familiar and comfortable you will be. This will ease any anxiety and in turn provide confidence within the group.

2) Setting realistic goals and expectations.

Implementing an EHR is by no means an easy task. A successful implementation involves a great deal of planning long before you go live. One of the first tasks during the process is to create a realistic implementation timeline that everyone is comfortable with. It is important to be flexible and open to modifying the schedule if necessary. Also, remember that you don’t have to do everything at once. A phased-in, incremental approach is suggested so that users are not learning everything at once and become overwhelmed. Another important aspect of the implementation is staying focused throughout the project. Staying on schedule in the timeline is more about making the EHR implementation a priority.

3) Positivity despite challenges.

Many challenges and frustrations will present themselves during an implementation. It will create uncertainty and doubts as to whether these challenges can be overcome. It is important to stay positive and realize that there is no reason why these challenges can’t be overcome.

4) Consult with experts with EHR experience .

It is a tall order to successfully implement an EHR without prior experience. There are many aspects of an implementation that can be overlooked that may result in failure. Assistance from someone with experience in implementing EHR systems can make a difference towards the outcome of the implementation ….. Visit www.sunrize.com  or call 888-880-0384 to speak with one of our experts on implementation of an EHR.

What is ANSI 5010?

 

What is ANSI 5010? ANSI 5010 is the new version of HIPAA transaction standards that regulates the electronic transmission of healthcare transactions. The 5010 standards will replace the existing 4010/4010A1 version of HIPAA transactions and address many of the shortcomings in the current version, including the fact that 4010 does not support forthcoming ICD-10 coding.  
When must the transition to ANSI 5010 be completed?
 By January 1, 2012, practices will need to complete electronic transactions in an ANSI 5010-compliant format. These electronic transactions include claims, eligibility inquiries and remittance advices. Failure to comply may result in denied claims, slower payments and increased customer service issues.
What is the urgency to upgrade my practice management system? Significant changes have been made to Mc Kesson’s Medisoft® practice management systems to comply with the new ANSI 5010 standards. These changes affect the amount of data and the way data is stored in the systems as well as your practice workflow. If you are on an older version of the software, the implementation of the compliant versions will be more complex and time-consuming than previous upgrades. In addition, testing of the new ANSI 5010 standards has already begun. By upgrading now, you can take advantage of the testing period and ensure that your claims are compliant in advance of the deadline. 

  How can Sunrise help? 

Visit our websites, at www.sunrize.com and www.ppemr.com , to find out more about our limited-time offers.

Medisoft v17 and Practice Partner are our ANSI 5010-compliant releases. Medisoft v17 is currently available Don’t wait to start preparing.

 

Call us today at 888.880.0384 
 
or visit our website at www.sunrize.com

 

At Sunrise, we are here to help your practice transition to ANSI 5010.
 Medisoft v17 and Practice Partner are our ANSI 5010-compliant releases. Medisoft v17 is currently available Don’t wait to start preparing.

 

 

Five ways HIT will reduce the cost of health care

HIT presents many opportunities to improve healthcare delivery in America, from changing the way healthcare is financed to enhancing efficiency. Jerry Buchanan, account director, healthcare technology and services at eMids Technologies, shares five ways that health IT can cut healthcare costs in the long-term.

1. Improved standards of care

Analyzing data collected by electronic health records provides the best treatment methods, leading to a healthier population. “Whether this data is combined with financial data to analyze cost effectiveness or not… is tangential to the overall goal of knowing the best way to handle treatment for each individual patient,” Buchanan noted.

2. Increased patient involvement and collaboration

America’s health expenditure is in a large part due to chronic health issues. Chronic diseases brought on by poor lifestyle choices are difficult to handle, but health IT “provides a clear avenue for enterprising organizations to develop innovative disease management solutions to address the issue,” according to Buchanan. Data retrieved from EHRs could also be useful in determining ways to stem costs associated with chronic illness.

3. Putting information at the forefront

The healthcare industry is constantly changing, and that results in an overwhelming amount of information to distill and absorb. Health IT offers a way to bring that information to the forefront.

4. Focus on outcomes

“The coming tidal wave of electronic clinical data provides an opportunity to replace our outdated, volume-based, fee-for-service business model with one focused on the quality of the product,” Buchanan said.

5. Transparency to the patient

Health IT should be used as a tool to include the patient in his or her own care. “Our current system of financing healthcare leaves patients completely insulated from the cost of their care,” said Buchanan. “Until we find a means for patients to educate themselves and question services, quality and price, the market forces that can naturally contain rising healthcare costs will never have an opportunity to work.”

Beta release Notes for Medisoft version 17

Enhancement: Electronic Transaction Reporting

Medisoft® Version 17 (v17) includes four new reports to help you manage electronic transactions related to verifying your patients’ insurance eligibility and submitting claims to insurance providers.

The reports include:

  • Appointment Eligibility Analysis – Detail
  • Appointment Eligibility Analysis – Summary
  • Electronic Claims Analysis – Detail 
  • Electronic Claims Analysis – Summary  Each of these reports offers several filters for controlling the information that shows. In addition, several summary values appear on each report so that you can see the information at a glance.

Enhancement: Audit Reports

Medisoft v17 includes a feature that allows you to track the reporting and exporting of data when you generate audit reports. A new option on the Audit tab in Program Options allows you to turn this feature on or off. It is turned on by default. Certain reports or grids that are printed or saved to disk will be audited. Note: Previewed reports will not be audited.

The following types of information are included as part of the audit reports:

  • Data grids
  • Custom reports, including claims and statements

 When printed from either Transaction Entry or Statement Management, but not the Report menu or Report Designer, the audit reports include.

  • Medisoft reports
  • Office Hours data
  • Final Draft reports or data printed or saved to disk
  • Internal reports
  • Statements
  • Eligibility information

 Enhancement: BillFlash Integration

BillFlash integration applies to the Medisoft Advanced and Network Professional programs.

Medisoft now uses BillFlash to print and mail patient statements. With Medisoft v17, you can enroll in BillFlash directly from within Medisoft, as well as upload your statement files directly from Medisoft automatically. You can view and approve statement uploads to BillFlash by clicking links from within Medisoft. For more information on BillFlash and to learn how to enroll, go to http://www.BillFlash.com.

Within Medisoft, you can control several aspects of what prints on your statements, including which credit cards you accept, service messages you want to print, printing of account summaries and aging, and printing up to six messages to appear on statements. For more information, go to the Program Options – BillFlash tab.

Options on the Activities, BillFlash menu allow you to enroll with BillFlash, view and approve statements that have uploaded to BillFlash, see your account settings at http://www.BillFlash.com, and view reports such as the Disposition report. Each one of these menu options will open a different page on the BillFlash website.

The following windows in Medisoft have quick access to the eView page of the BillFlash website via a new View eStatements button. (In addition, when a patient is selected and Ctrl + F7 is clicked, the eView page will open for any statements for that patient.)

  • Patient List
  • New/Edit Case
  • Quick Ledger
  • Guarantor Ledger
  • Apply Payments (through Transaction Entry)
  • Collection List/Tickler
  • Edit Statements
  • Deposit List
  • Apply Payments
  • Transaction Entry (note that Calculate Totals has been moved.)

HIPAA X12 Version 5010 (ANSI 5010)

The following are changes made to Medisoft v17 to accommodate the upcoming change from the Health Insurance Portability and Accountability Act (HIPAA) American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010 (referred to as ANSI 5010), as well as the National Council for Prescription Drug Programs (NCPDP) version 5.1 to NCPDP version D.0.5010. ANSI 5010 and NCPDP version D.0.5010 are new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims and remittances. Covered entities, such as health plans, healthcare clearinghouses and healthcare providers, are required to conform to ANSI 5010 standards