AMA Reminds Docs of Medicare E-Prescibing Deadline
The American Medical Association reminds physicians that they must report generation of at least 10 electronic prescriptions by June 30 to avoid reimbursement penalties under Medicare’s e-prescribing program.
The penalty is a 1.5 percent payment reduction for all Medicare claims filed in 2013. Physicians can apply for a hardship exemption but it must be done prior to the June 30 deadline. The application for exemption is available here.
AMA has additional information on Medicare e-prescribing reporting requirements here.
6 keys to small practice survival
New Orleans – John H. O’Neill Jr., DO, FACP, interacts with many physicians in his roles as vice chairman of the American College of Physicians (ACP) Medical Practice and Quality Committee and governor of the ACP Delaware chapter. Most doctors he encounters tell him they are passionate about what they do and want to remain in private practice, he says.
Physicians who prefer working in solo or small-practice arrangements appreciate the increased autonomy and control over the work environment that they have, as well as the close doctor-patient relationships compared with those in larger groups, O’Neill told those attending a session at the ACP’s annual meeting here.
And the healthcare system has a place for small practices, he adds. “This is America. A lot of our communities are served well by small practices, and by default, many of our communities have no other providers.”
But in an era of increasing malpractice insurance premiums, higher practice expenses, and reimbursement from payers not covering those expenses, how can smaller practices remain viable? Based on his ACP involvement and his experience practice with Bayview Internal Medicine Inc., in Middletown, Delaware, O’Neill offers the following advice:
- Analyze your top 10 charges/reimbursements by payer, including immunizations, then approach and negotiate with payers for better reimbursement. “As internists, our bread and butter is realty evaluation/management codes,” he says. Physicians can use their payer program participation as leverage, he says.
- Identify and micromanage your overhead using accounting software. “If you are going to manage your overhead, you have to know what it is,” O’Neill adds. Track expenses and determine which reports to generate and read.
- Pinpoint the procedures that best fit your practice, then track and optimize their use.
- Implement an electronic health record/practice management system to help you improve the care you provide and to optimize your billing and reporting. He recommends using the same vendor for both systems to ensure compatibility.
- Consider developing or becoming part of a Patient-Centered Medical Home (PCMH). “That’s where we’re heading,” O’Neill says. One major difference between current practices and PCMHs is that the latter includes one or more care coordinators who follow the patient inside and outside the practice.
- Think about using midlevel providers in your practice; they can generate additional revenue.
Section 179 at a glance – New for 2012
2012 Deduction Limit = $139,000
This is good on new and used equipment, as well as off-the-shelf software.
2012 Limit on equipment purchases = $560,000
This is the maximum amount that can be spent on equipment before the Section 179 Deduction available to your company begins to be reduced.
Bonus Depreciation = 50%
This is taken after the $560k limit in capital equipment purchases is reached. Note: Bonus Depreciation is available for new equipment only. Bonus Depreciation can also be taken by businesses that will have net operating losses in 2012.
The above is an overall, “simplified” view of the Section 179 Deduction for 2012. For more details on limits and qualifying equipment, as well as Section 179 Qualified Financing, please read the entire website (linked below) carefully.
Review Important Questions and Answers about Registration for the EHR Incentive Programs
After determining your eligibility for the Electronic Health Record (EHR) Incentive Programs, you should then register as early as possible for the Medicare and/or Medicaid program. CMS’ EHR Information Center is open to assist the EHR provider community with registration and other program-related inquiries.
The center can be reached at 1-888-734-6433 (primary number) or 888-734-6563 (TTY number) from 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays.
Here are a few of the Information Center’s most frequently asked questions about registration:
1. Question: What information should I have ready before I begin the registration process?
Answer: When you register, will you need:
- If you are registering as an eligible hospital or Medicare eligible professional, you will need an approved enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS). Medicaid eligible professionals are not required to be enrolled in PECOS.
- If you do not have a record in PECOS, you should still register for the Medicare and Medicaid EHR Incentive Programs. (Please note – your eligible hospital or Medicare eligible professional registration status will remain in an “issue pending” status until you have an active enrollment record in PECOS).
- A National Provider Identifier (NPI)
- A National Plan and Provider Enumeration System Identity and Access Management ID and password for the individual provider
- A Payee Tax Identification Number (if you are reassigning your benefits)
- A Payee NPI (if you are reassigning your benefits)
2. Question: Which option do I select when registering on behalf of an eligible professional in the Identity and Access Management System?
Answer: Click on “you are requesting to act on my behalf of the individual provider.”
3. Question: How can I check my registration status in the Registration and Attestation System?
Answer: Log in to the Registration and Attestation System and click the Status tab to view your registration information.
4. Question: How do I re-submit my registration?
Answer: To re-submit a registration, you will need to:
- Login to the EHR Incentive Program Registration and Attestation System;
- Navigate to the Registration tab;
- Select the modify action for the registration;
- Select the Personal Information registration topic; and
- Save the updated payee information and submit the registration.
CMS provides helpful registration guides and resources on the Registration page of the EHR website. Additionally, FAQs about registration can be found on the FAQs page of the CMS website.
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.
Take steps now to avoid 2013 e-prescribing penalty
CMS is urging physicians to report on at least 10 electronic scripts (e-scripts) by June 30, 2012, to avoid the 2013 Medicare e-prescribing penalty that amounts to a 1.5 percent reduction from their Medicare Part B payments in 2013. Physicians can also file for a hardship exemption but must do so by June 30, 2012. The AMA has put together a tip sheet on the steps physicians can take to avoid the 2013 e-prescribing penalty.
165,592 Reasons to Implement an EHR Today!
Improved Coding
Down-coding and poor charge capture can both be improved through an EHR’s E&M Coder. A study by Medical Economics Magazine estimated that a physician who is regularly down-coding may be losing $40,000 to $50,000 annually. A study done by Partners Healthcare System found an increase of 1.5% to 5% in overall billing simply through improved charge capture.
Total Potential Savings: For our example we will use a conservative improvement rate of 2.5% to factor in a reduction in down-coding errors resulting in an increase in income of approximately $25,000 per year!
Transcription
By utilizing voice recognition capabilities that come stock in our EHRs, this can be a savings of $1,000 per month for using a transcription service at the industry standard.
Total Potential Savings: Total potential yearly savings are approximately $12,000 per year!
Chart Management
Chart Management costs can be reduced through lower chart creation costs, lower chart storage costs and fewer chart pulls. The cost to create a new chart is estimated at $2/chart and the cost to pull a chart is $5 according to a study done by Partners HealthCare Clinic.
Total Potential Savings: For this example we will assume that there are 50 chart pulls per day including the 60% average for non-visiting patients. We will use a lower estimate for the cost of each chart pull at $3 and assume that we will only reduce our chart pulls by 40% the first year and not be paperless for 3 years. For the cost in searching for missing charts, we will use a conservative estimate of 25 minutes per day in looking for misplaced charts. 240 days x 25 minutes = 100 hours per year x $10/hour for office staff = $1,000 per year!
Prescription Refills
A study done by Journal of Healthcare Information Management showed that the time spent doing an Rx refill can be reduced from 15 minutes to 3 minutes. At 7 refills per day, that would be a savings of 84 minutes per day.
Total Potential Savings: 84 minutes/day x the average patient visit of 15 minutes = 5.5 extra patient visits/day. At an average cost of Medicare reimbursement for Office Visit level 99213 as of *2011 being $68.97 = an extra $379.34/day or $1,896.68/week OR a whopping $98,592 per year!
Capitated Patient Cost Savings
According to a study published in The American Journal of Medicine, the benefits of clinical decision support resulting in the reduction of ADE’s, lab and radiology tests and the ability to offer alternative medications showed that a conservative estimate of $29,000 could be saved per year by year 2 of EHR implementation!
Grand Annual Total of Potential Savings EHR Can Bring: 165,592 per year!
Average annual cost of owning one of MediPro’s Solutions: $4,200 – $5,988 per year!
Now ask yourself: “Does it make sense to deny myself this potential savings? Even if realistically, I can save my practice 1/2 of the $165,592 savings per year, would this be a bad thing?”
Guidance on Troubleshooting Claims Submissions for Version 5010
Although the Version 5010 upgrade deadline was January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) recently extended their enforcement discretion period for the Version 5010 upgrade for all HIPAA covered entities for an additional three (3) months, through June 30, 2012. It’s important that all HIPAA covered entities continue to take the necessary steps to complete the upgrade to Version 5010 as soon as possible.
Recently, some providers have experienced issues with Version 5010 claims processing or payment. CMS has created a fact sheet that provides guidance to help providers troubleshoot some of the difficulties they are experiencing with claims submissions. The fact sheet contains information on:
- How to handle claims that have failed edits during the delivery process
- What providers can do if they have difficulty receiving information from clearinghouses and/or billing vendors
- Links to each of the Medicare-Administrative Contractor (MAC) websites, which include lists of their top 10 edits for Version 5010 claims
- Additional reasons why some providers may receive claims rejections
The MACs will continue to work closely with clearinghouses, billing vendors, and health care providers requiring assistance in submitting and receiving Version 5010 compliant transactions. If any entity is experiencing difficulty reaching a MAC, they should send a message describing their issue to ProviderFeedback@cms.hhs.gov with “5010 Extension” in the subject line.
Make sure to take a look at the Version 5010 section of the ICD-10 website to find helpful fact sheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade.
Keep Up to Date on Version 5010 and ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!
Medicare e-Prescribing Penalty: Phone Lines Now Open
March 29, 2012: CMS has confirmed that the QualityNet Help Desk is now prepared to take calls from physicians on the Medicare ePrescribing penalty. We understand that physicians have already attempted in the past few weeks to contact the Help Desk to discuss their individual situation which resulted in a 2012 penalty, but in many cases were turned away. CMS has been working diligently with the Help Desk to ensure that a physician’s case is adequately reviewed. CMS wants physicians to know that the issues they are having are being examined.
As CMS has indicated late last week, although there is no formal appeals or review process for the ePrescribing penalty, they encourage physicians with questions or concerns about their penalty and/or hardship exemption request to contact CMS’ QualityNet Help Desk as soon as possible. CMS is handling all penalty and/or hardship exemption requests and any questions or concerns on a case-by-case basis.
Physicians should continue to contact the QualityNet Help Desk if they have issues relating to the ePrescribing penalty. If a physician has previously contacted the QualityNet Help Desk and their case has been resolved to their satisfaction, the physician does not need to contact the QualityNet Help Desk again.
The QualityNet Help Desk can be reached M-F; 7:00 am – 7:00 pm CMT at 866-288-8912 or via email at qnetsupport@sdps.org.
NOTE: If a physician continues to experience problems with the Help Desk, CMS is encouraging physicians to email their concerns directly to Medicare at eRx_hardship@cms.hhs.gov.
Ensure Your Success in the EHR Incentive Programs by Registering Early
CMS recommends that all eligible professionals (EPs) register as early as possible for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.
Registering does not mean you are required to participate. By registering early, however, you can make sure your information is completely up to date in all of the CMS systems and resolve any issues which might otherwise prevent you from participating in the EHR Incentive Programs. If you do not resolve registration problems, you will not be able to attest and could potentially miss out on a payment year.
Give yourself plenty of time and register today. For more information on registration in the EHR Incentive Programs, visit the Registration page of the EHR website.
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.
ICD-10 Delay: 7 Things Practices Can Do With the Extra Time
HealthData Management, March 12, 2012:
The Department of Health and Human Services recently confirmed its intent to push back the Oct. 1, 2013, ICD-10 compliance deadline for certain health care entities. However, HHS has not yet specified a new deadline or defined which entities will be covered by the change, and many physician practices are wondering if they should delay their transition or continue on as planned.
Regardless of when the deadline is or who it impacts, we recommend continuing to move forward on your ICD-10 preparation. As the industry learned from recent 5010 transition challenges, it’s never too early to prepare. Here are seven ways to take advantage of any extra time the delay provides:
- Conduct more thorough in-office analysis to identify each of the day-to-day processes and areas of the practice that will be impacted. For example, both clinical documentation and office superbills will need to be converted to include ICD-10 codes.
- Ensure there is a strong plan in place to train your billing and clinical staff in ICD-10 coding changes. At a recent AAPC Boot Camp on ICD-10, it took participants four hours to code 20 cases–and that was with the help of a teacher. Having the right type of training will help reduce coding times.
- Conduct time studies to identify how much extra time coding will take with ICD-10. The American Health Information Management Association estimates that, initially, it will take roughly twice as long for a coder to code under ICD-10. In addition, medical practices should expect a permanent 10 percent to 25 percent loss of coding productivity. Questions that need to be answered are how to keep up with your increased coding needs, and how will that financially impact the practice? Will the practice pay overtime, hire more coders or outsource some of the work?
- Check with business partners, vendors and software applications to see how they plan to handle the transition.
- Almost every policy and written office procedures that medical offices have mention coding. To maintain compliance requirements, these documents will need to be updated to reflect ICD-10 changes. The Office of Inspector General has developed guidelines to help practices develop internal controls and processes to assist with these changes.
- Review payer contracts, which may be based on older codes, and work with payers to update them for ICD-10. Don’t assume payers will do it for you.
- Establish a line of credit. The industry encouraged providers to do so with the 5010 transition, but many didn’t take this step and were caught off-guard by the revenue impact. The ICD-10 switch certainly will affect cash flow, and most lines of credit need to be in place for six months to a full year before funds become available.
In light of the proposed delay, many practices are tempted to take a break from ICD-10, but the items mentioned above take a long time to complete. Doing as much as possible to prepare a practice for ICD-10 now will save headaches as the deadline nears, and will ensure that practices continue to operate efficiently throughout the transition.