A lot has been said in disfavor of electronic health records (EHR), but recent events may have naysayers changing their tune.
If not for EHR technology, Moore Medical Center, a satellite of the Norman Regional Health System, would be suffering more ways than one from the aftermath of a tornado that ripped through Moore, Okla., May 20.
The tornado ravaged the town of Moore, killing at least 24 people, including nine children, and demolishing thousands of homes and Plaza Towers Elementary School (CNN). The center, which provides the community with a host of health services, was left crippled as the tornado swept away much of its second floor. Patients had to be moved to its two Norman facilities.
Rebuilding will take time, but is not impossible. What would be impossible would be recovering all of the center’s medical records had they been in paper form only. This is something St. John’s Regional Medical Center in Joplin, Mo., can relate to only too well. Two years ago, a tornado thought nothing of the center’s inhabitants or their belongings, sweeping up everything in its path. Fortunately, everyone was evacuated in time. According to reports, however, paper charts and X-rays were strewn everywhere, and found in yards as far as 75 miles away. As luck would have it, St. John’s had just transitioned from paper to EHR, so all was not lost (HHS). Moore Medical Center’s medical records were also safely stored in a health information exchange (HIE), along with the rest of Norman Regional Health System’s records, backed up by the regional health information organization serving Oklahoma City, and stored in a Cerner Corp. data warehouse (ModernHealthcare).
An HIE is an organization that provides services to enable the electronic sharing of health-related information. According to HealthIT.gov, HIE benefits include:
· Provides a vehicle for improving quality and safety of patient care
· Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations
· Stimulates consumer education and patients’ involvement in their own health care
· Helps public health officials meet their commitment to the community
· Creates a potential loop for feedback between health-related research and actual practice
· Facilitates efficient deployment of emerging technology and health care services
· Provides the backbone of technical infrastructure for leverage by national and state-level initiatives
Adopting EHR technology is the first step toward developing a nationwide HIE—an overarching goal of the Obama administration. Accountable Care Organizations (ACO), bundled payments, and patient-centered medical homes are also steppingstones toward this endeavor.
To promote EHR implementation, eligible healthcare professionals and hospitals can qualify for Medicare or Medicaid incentive payments when they successfully attest to meaningful use of a certified EHR—and many have. According to the U.S. Department of Health & Human Services (HHS), progress is being made.
“We have reached a tipping point in adoption of electronic health records,” said HHS Secretary Kathleen Sebelius. “More than half of eligible professionals and 80 percent of eligible hospitals have adopted these systems ….” (HHS May 22 press release)
An eligible professional who qualified to receive his or her first payment in 2011 or 2012, and continues to do so through 2014, stands to earn up to $44,000. Those who begin successful attestation in 2013 can earn up to $39,000, and those who wait until 2014, which is the last year you can begin participation in the Medicare EHR Incentive Program, can earn up to $24,000. Starting in 2015, a 1 percent reduction will be imposed on payments to eligible professionals for every year they do not successfully adopt a certified EHR, for a maximum 5 percent reduction in 2020.
For the rest who haven’t implemented an EHR, the reasons for not doing so are many. Weighing heavily is the cost. Forty-four thousand dollars is a drop in the bucket compared to what EHR implementation costs, some say (The Morning Call). For Moore Medical Center, though, it was worth every penny.
The U.S. Department of Health & Human Services’ (HHS) Office of Inspector General (OIG) is cracking down on healthcare crooks and abusers. Its list of individuals excluded from caring for government-insurance patients is increasing, while information regarding exclusion has been updated.
The latest exclusion list, "List of Excluded Individuals and Entities (LEIE)," was released on May 14 and includes 51,729 individuals banned from treating Medicare and Medicaid patients—and the list is growing. On the same day as the release, according to ModernHealthcare.com, “a national fraud crackdown in eight cities rounded up another 89 people accused of crimes that could end with their exclusions.”
According to data from the Centers for Medicare & Medicaid Services’ (CMS) National Practitioner Data Bank, the number of individuals on the excluded list includes:
- Nursing-related workers – 27,000+
- Physicians - 6,900
- Chiropractors - 3,000
- Dentists - 2,200
- Pharmacists - 2,000
- Nursing home administrator - 1
These individuals’ crimes included anything from not paying medical student loans to submitting fraudulent claims, and from patient abuse to murder. Non-payment of student loans is the number one reason for being banned.
Exclusions usually last from five years to life. When an exclusion expires, the individual must reapply to the OIG to be accepted back into federal healthcare programs.
OIG says healthcare employers who care for Medicare patients should perform monthly checks of their entire payroll rosters to ensure they aren’t employing excluded criminals.
Know the Effects of Exclusions
OIG has updated a special advisory bulletin, which describes the effects of exclusion from federal health care programs. It also provides guidance on monetary liability for employing an excluded person and it recommends provider protocol for disclosing excluded individuals. You can find the “Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs” online.
When it comes to running an efficient billing department, the best tactic is simply, “don’t fall behind.” Handling charges and collecting payments on a timely basis is crucial to cash flow. Here are five quick tips to set you on the correct path.
1. Generate numbered super-bills/charge tickets from your appointment system, so that no billable encounters are missed.
2. Submit claims (electronic and hard copy) frequently—every day, if possible.
3. Post payments as soon as possible upon receiving the explanation of benefits (EOB). Account for reassignments and adjustments as payments are posted to the claims being paid. You want every paid claim to end with a $0 balance; otherwise, your ageing report will be inaccurate.
4. Scan EOBs for denials and—when a fix is possible—fix the claim immediately so that you can re-file the next billing day. Promptly working denials greatly improves cash flow.
5. Make the most of your reports:
• Check reports for rejected claims, daily, and work them immediately.
• Run a “claims not billed” report at least once per week, to identify pending claims. If any claims must be re-assigned, handle them promptly.
• Run an ageing reports every few days to determine which claims have not been paid. If necessary, call the payer to find the reason for the delay. If there are problems with the claim, fix them. Keep up with your patient billing, too; you may wish to use a collection agency, when necessary.
Practices may offer diagnostic ancillary services to increase revenue, or to provide more complete care for patients. Ancillary services fall into three broad categories:
- Diagnostic (e.g., X-ray or lab services)
- Therapeutic (e.g., physical therapy services)
- Custodial (e.g., nursing home or hospice services)