CMS Guidance on Meaningful Use Objectives

Posted by Mindy Murphy
January 16, 2015

Source: CMS – EHR Incentive Programs

Review Updated Information on Reporting Menu Objectives

CMS has released updated guidance on the how eligible professionals should select menu objectives for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We encourage you to stay informed by taking a few minutes to review the information below.

Guidance on Reporting Menu Objectives
Eligible professionals participating in Stage 1 of the EHR Incentive Programs are required to report on a total of 5 meaningful use objectives from the menu set of 9 objectives. When selecting five objectives from the menu set, eligible professionals must choose at least one option from the public health menu set.

If an eligible professional is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the eligible professional should select and report on the public health menu objective he or she is able to meet.

If an eligible professional can be excluded from both public health menu objectives, the eligible professional may meet the menu requirement one of two ways:

  1. Claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set.
  2. Report on five menu objectives from outside the public health menu set

Eligible professionals participating in Stage 2 are required to report 3 meaningful use objectives from the menu set of 6.

We encourage eligible professionals to select menu objectives that are relevant to their scope of practice, and claim an exclusion for a menu objective only in cases where there are no remaining menu objectives for which they qualify or if there are no remaining menu objectives that are relevant to their scope of practice.

For example, we hope that eligible professionals will report on 5 measures, if there are 5 measures that are relevant to their scope of practice and for which they can report data, even if they qualify for exclusions in the other objectives.

The Registration and Attestation System may prompt an eligible professional to report on additional measures if he or she claims an exclusion. This is because starting in 2014, the exclusion criteria will no longer count as reporting a meaningful use objective from the menu set. An eligible professional must meet the measure criteria for the objectives or report on all of the menu set objectives through a combination of meeting the exclusions and meeting the measures.

However, some eligible professionals who elect option 1 above may be asked to report on non-public health measures when they claim that exclusion in the Attestation System. These providers should document this issue for their records, and then claim the exclusion for the remaining measures in order to allow the system to accept their attestation.

For More Information
For more information, read the updated FAQ. For additional resources, please visit the EHR website.

5 Ways to Increase Payer Reimbursements for Your Medical Practice

Posted by Mindy Murphy
January 14, 2015

Many medical practices are looking for ways to increase payer reimbursement as they adjust to the new health care industry landscape. You may have noticed that some of the latest trends (2013, 2014) have increased the financial pressures experienced by medical practices. The number of Medicaid patients has increased, but processing the claims for these patients is time consuming and Medicaid is known for rejecting claims at a higher-than-average rate. Higher deductibles and co-pays have also made the burden of collection more challenging.

The following are practical ways to increase payer reimbursements.

  1. Evaluate Your Situation

You will need to assess your payer reimbursements, looking for problem areas. This requires access to data and analytics, which can be best provided by practice management software or an EMR/EHR system tailored to your practice. At the very least, start with a spreadsheet comparing your top 10 payers and your 25 most common current procedural terminology (CPT) codes to see where you are losing money.

You will need to examine the data from the past couple years to identify where you can make improvements when it comes to reimbursements. Are you having problems with claims denial from a specific payer? Are there problems related to proper coding, or the performance of procedures that specific payers do not consider beneficial or necessary, and therefore are not covering?

  1. Address Internal Problems

Are the providers at your office administering services that aren’t covered? Are they coding improperly or in ways that are resulting in claim denials? Invest in software that checks procedures with policy coverage to limit claim denials. Also, make sure your staff is properly trained on optimal coding.

  1. Keep Current

It’s important to remain current with processing tools for record keeping, coding, billing and claims. If your software is outdated or no longer supported, you will need to invest in practice management software that communicates with payers and clearinghouses.

  1. Know Your Competition

Small practices don’t have much leverage with payers, since payers often say things like, “We know there are 75 other providers in your area who will take these patients if you don’t accept our reimbursement rates.” Find out how many competitors you really have, and keep track of your number of referrals, where they come from and what types of referrals you are getting. Keep data on which insurance plans they use.

Look for ways to prove your worth. If you have a reputation for quality service or are a unique practice that offers superior health care services, you need to find a way to document this so you have some sort of tangible proof to bring into payer negotiations. Survey patients and referral partners on satisfaction and quality of services provided, and collect and publish this information so you have some way to prove your worth in the market.

  1. Negotiate with Private Payers

You can negotiate better reimbursement rates from private payers if you can show your market worth and don’t just accept the first offer. Ask questions about changes in rates for specific codes.

Pay attention to contract expiration dates and make note of the deadlines for requested rate changes. Most payers want to set up evergreen contracts that renew automatically, making you think you can’t negotiate new rates. Read the fine print and find out when you need to initiate a meeting to renegotiate rates. Then ask for short term instead of long term contracts; it’s easier to ask for a small percentage increase in payments every year than to negotiate a 10 percent raise every six or seven years.

Look for areas of the contract to renegotiate that have previously been problematic. For example, you may need to ask for changes in the authorization for treatment process, or perhaps the amount of time allowed for appeal of a rejected claim. If your practice has lost money because of a specific problem, try to shore up against that problem when negotiating the terms of the contract.

Increasing Payer Reimbursements: How MediPro Inc. Can Help

If you want to keep up in this rapidly-changing industry, you need practice management software that will assess your office’s claims filing and processing for you. Talk to an expert at MediPro Inc. to find out what the best software is for this purpose. The payout will be well worth the investment.


8 Signs Your Practice Management Software is Outdated

Posted by Mindy Murphy
January 7, 2015

Are you concerned that your practice management software is outdated? If so, you’re not alone. A 2014 survey conducted by Software Advice has concluded that 63 percent of the medical practices that are already using practice management software are looking to buy new software this year.

Not sure if it’s time to trade in your old software for new? The following signs will make it clear whether your old software is fine or if you need to make a switch.

  1. Your Software Can’t Handle Regulatory Compliance Requirements

Your medical practice needs to be prepared for the following regulation deadlines:

If your software isn’t current, it isn’t designed to handle these regulatory requirements. Check with your vendor about upgrades or new software. The initial investment will pay off in the long run.

  1. Your Software is No Longer Supported

If the software you are using is no longer supported, it’s a time bomb just waiting to go off. Don’t wait until the day it quits working to find a replacement. You will risk losing time, patients and even breaking regulations if you don’t act in a proactive manner.

  1. Your Staff Complains that the Software Makes Their Jobs Harder, Not Easier

A common problem with older software is that it is cumbersome to use. Ask your staff if the software:

    • Is difficult to learn how to use
    • Takes too many steps to accomplish simple tasks
    • Decreases productivity
    • Doesn’t match the office workflow (or worse yet, interrupts or disrupts office workflow)

Basically, you want to find out if your current software improves office efficiency and organization. If not, it’s time to take a look at the new options available.

  1. The Software Doesn’t Integrate with Other Software

If you’re trying to work with multiple software packages, you will find that integration becomes a problem. This is especially true if you’re using a custom practice management software, and now you’re trying to add electronic health records (EHR) that were made by a different company. You will probably find that you are best off if you ditch the legacy software and invest in a comprehensive suite that is built to handle all your needs.

  1. The Software is Glitchy

Do you have reboot often just to get it to work? Are you finding that certain functionalities aren’t working? Do pages take a long time to load?

If the software is unreliable or doesn’t perform as advertised, it’s time to get new software. You’re probably losing time and money every day and receiving complaints from frustrated staff members.

  1. The Software Doesn’t Provide a Patient Portal

Patients know about this feature, and they are coming to expect medical providers to use a patient portal. Patients want to be able to:

    • Refill prescriptions online, without having to call in
    • Get questions answered through email
    • Get test results and health recommendations electronically
    • Have access to their health information 24/7 in a secure medium

If you want to meet the expectations of your patients and remain current in healthcare technology, your office needs the enhanced communication tools provided through a patient portal. Learn more about patient portals here.

  1. The Software Doesn’t Offer Specialty-Specific Templates

If you are a specialty medical practice (i.e. a chiropractor or podiatrist), you need software that features customizable templates and is designed to fit the unique needs of your specialty. If you’ve been trying to use generic software, you’ll find it is very difficult to record information and bill claims without jumping through hoops and doing a lot of extra work.

Take a look at the difference a specialty-specific template can make and you’ll see why the investment pays for itself.

  1. The Software Lacks Specific Features or Functionality

Have you often wished your practice management software would perform a particular function? If your software is more than a couple years old, that desired feature or functionality is probably available in new software. You’ll be amazed at how far medical practice software has come in the past couple of years – the advancements have come fast and furious, especially as the government has dictated specific requirements through Meaningful Use. Make a list of desired features and talk to a MediPro Sales Consultant to discover new possibilities.

Interested in New Medical Practice Software? MediPro Inc. Can Help

Here at MediPro Inc., we offer the most current software in the industry. Use our live chat, shoot us an email or check out our videos to discover what the latest software can do for your medical practice.


New MLN Connects Video Slideshow

Posted by Mindy Murphy
December 17, 2014

The video slideshow from the 11/05/14 MLN Connects™ Call on Transitioning to ICD-10 is now available. The written transcript and audio recording are also available on the November 5 call web page.

You may also be interested in a new MLN Connects video slideshow on Coding for ICD-10-CM: More of the Basics, presented by Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA).

Upcoming MLN Connects Calls

The following educational conference calls are coming up. To register, visit MLN Connects Upcoming Calls:

  • Thursday, January 15: IRF PPS: New IRF-PAI Items Effective October 1, 2015
  • Wednesday, January 21: ESRD QIP Payment Year 2017 and 2018 Final Rule

New CMS MLN Connects ICD-10 Video

Posted by Mindy Murphy
December 11, 2014

Source: CMS News Updates

In this MLN Connects™ video on Coding for ICD-10-CM: More of the Basics, Sue Bowman from the American Health Information Management Association (AHIMA) and Nelly Leon-Chisen from the American Hospital Association (AHA) provide a basic introduction to ICD-10-CM coding. The objective of this video is to enhance viewers’ understanding of the characteristics and unique features of ICD-10-CM, as well as similarities and differences between ICD-9-CM and ICD-10-CM. The video covers:

  • How to assign a diagnosis code using ICD-10-CM
  • ICD-10-CM code structure
  • Coding process and examples: Combination codes, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause codes
  • Resources for coders

Keep Up to Date on ICD-10

Visit the Medicare Fee-For-Service Provider Resources web page for a complete list of MLN Connects videos on ICD-10. To receive announcements for MLN Connects videos and the latest Medicare program information, subscribe to the weekly MLN Connects Provider eNews.

Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow CMS on Twitter.

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