HITECH Act : Economic Stimulus for EMR Adoption

HITECH Act : Economic Stimulus for EMR Adoption

Nitin Chhoda reveals a few ways that the HITECH Act can help a private practice switch to an electronic medical records system using a limited budget.  He also shares the requirements needed so that the practice can qualify with the HITECH Act incentives.

HITECT Act While the HITECH Act may help improve the safety and security of electronic medical records keeping systems, the aspects that clinicians and healthcare providers are excited about is the incentives.

The HITECH Act provides financial encouragement to clinicians, hospitals, and medical practitioners for the “meaningful use” of electronic medical records. A total of $19 billion has been allocated for incentives.

Financial Benefits

There are some great financial benefits to switching to electronic medical records anyway, but the HITECH Act makes things even easier. Physicians could qualify for as much as $44,000 for electronic health record implementation and use over the five years that the Act is funded.

The incentives only apply to the Medicare and Medicaid programs, but they can only get incentives through one program at a time. This means that they can also accrue incentives through one program and then when that runs out, they can accrue the same amount through the other program.

The incentives were also meant to encourage providers to adopt EMR systems for HITECH Act as soon as possible. One deadline was for 2012, and next year the incentives will be lower than they are this year.

And after 2015, medical practices will start to incur penalties if they have not switched to an EMR, starting with a 1% Medicare fee reduction. After 2017, that fee reduction is increased to 3%, an after 2019 the fee reduction will be increased to 5%.

Regional Extension Centers

In addition to financial incentives for adoption of EMR, the HITECH Act also funded 70 regional extension centers that can provide administrative help and guidance for health care providers attempting to make the switch to EMR.

Specifically, these regional extension centers will help “providers select the highest-value option, defined as that which offers the most favorable cost of ownership and operation, including both the initial acquisition of technology, cost and implementation, and ongoing maintenance and predictable needed upgrades over time.”

However, there is no requirement that health care providers use the regional extension centers unless they need help implementing an EMR.

HITECH Act stimulusQualifying for HITECT Act Incentives

The most important requirements for qualifying for HITECH Act incentives for EMR adoption are the proper selection of an EMR system and understanding “meaningful use”.

There are a total of 25 meaningful use criteria, and health care providers must demonstrate 20 out of those 25. Fifteen criteria are pre-determined by the HITECH Act, and out of the final ten, you must choose five. The criteria are measured in three stages over five years.

The first stage of HITECH Act requires that you use a certified EMR system and document set percentages of criteria electronically.

You will also be required to use the reminders and warnings systems that certified EMR systems have, share patient information, and report public health information and quality measures.

The second state of HITECH Act requires that you also send and receive lab results and other information using the EMR.

The third stage of HITECH Act requires that you also enroll patients using public health records, access patient data, improve population health, and report on national high priority conditions. Other criteria may be added in the future.

Medical Management: Defined

Medical Management: Defined

Medical management in today’s world is not as simple as it was decades ago. Many practitioners believe they need to extend their education in order to properly manage their clinic. Nitin Chhoda defines medical management practice in the 21st century.

medical management definitionClinicians and other healthcare practice management professionals spend a lot of time getting a thorough education. Unfortunately, their medical knowledge is not supplemented with quite enough business and medical management study.

Private Practice Trends

Some clinicians opt to get an additional degree in business or medical management so they can comfortably run a private practice. However, that is the exception and not the rule.

There has been a recent trend in private practices where clinicians are finding themselves in financial trouble due to mismanagement of expenses, billing, and health insurance companies refusing to pay for the provided care.

In some ways, the problems of private practice physicians in medical management are not their own fault at all. Insurance companies change their policies frequently, and what was billable one week may not be billable the next.

Additional Education

In response, new degrees and a new career path have been forged so clinicians or their staff can be educated about dealing with the particular challenges of running a medical practice. A medical manager is also often called the healthcare administrator, health services manager, or healthcare executive.

For those interested in medical management careers, you must complete at least a bachelor’s degree in business or a related field, and a master’s degree is highly recommended. The Bureau of Labor Statistics estimates that medical management is growing more rapidly than many other fields due to projections of an increase in demand for medical services over the next decade.

Medical management combines strategy, information management, and leadership for building and managing a successful health care practice.

Components

One of the major components of being able to manage a medical practice is having an understanding of the laws and requirements that health care providers must adhere to, such as HIPAA and the HITECH Act.

medical management definedClinicians are usually concerned with being able to do their job and take care of their patients as best they can.

What a medical management professional can bring to a private practice should include everything else, from understanding how to implement an EMR and EHR system to reporting to government agencies and ensuring that the practice is eligible for tax breaks and HITECH Act incentives.

The health care industry is changing rapidly and clinicians who run a private practice are starting to pay for inattention to administrative and management duties which they do not really have the time to handle.

There are medical management systems that attempt to streamline the way that medical clinics handle administrative tasks, such as billing, scheduling, and health insurance filing.

In fact, most EMR systems are equipped to handle medical management tasks as well as medical records. EMR and EHR systems will include scheduling and billing organization and reminders so that the clinic can be more efficient.

They can also ensure that the proper paperwork is filed for Medicare, Medicaid, and health insurance companies. Claims are often rejected due to illegibility or errors in the paperwork, and EMRs attempt to do away with those kinds of mistakes and rejections.

Medical Management Streamlined with EMR

Medical Management Streamlined with EMR

Streamlining medical management is now possible with the use of EMR. Nitin Chhoda enumerates the benefits of EMR including the efficiency of billing, scheduling and managing productivity reports.

medical management EMRClinicians, practitioners, and other private practice owners that use medical management are being forced to take certain steps toward efficiency.

The financial pressures of an increasingly hostile and uncooperative health insurance industry, combined with the fact that more and more patients are unable to pay their bills, has put clinicians in an uncomfortable bind.

How can you provide the best medical care possible if you are restricted by financial considerations? The transition may be a bit rough, but it looks as though private practices are going to get some major help by adopting electronic medical records.

Electronic medical records cut down on administrative costs, making it just a bit less expensive to run the clinic. But more importantly, they can streamline medical management and help the practice to run more efficiently.

Billing and Scheduling: Efficiency Traps

It turns out that much of an clinic’s efficiency is decreased because of errors and delays in billing and scheduling. The ways that EMRs can streamline the billing aspects of medical management may be obvious to some.

A billing system that tracks unpaid bills and sets reminders for the medical management personnel responsible for billing will increase the likelihood that bills will not be forgotten.

This is true for patients as well as health insurance companies. Most medical management and health insurance companies have very particular requirements for the filing of claims. These forms can be time intensive and frustrating to complete. EMRs that are designed to streamline medical management will include options for filing the appropriate paperwork and will include reminders so the paperwork is filed in the required timeframe.

Increased efficiency in scheduling is less obvious at first, but the benefits are certainly easy to understand. When a patient cancels an appointment, that time slot is easily lost and left empty. Scheduling components of EMR programs will ensure that all empty slots are filled when possible. They also allow for re-scheduling with a few clicks of the mouse.

medical management streamlineReporting and Medical Management

On the other hand, medical management professionals will tell you that one of the biggest challenges to improving efficiency is the lack of useful data.

On paper, it is overwhelming to attempt to compile reports that detail how many appointments have been missed, how many bills are left unpaid or the collection percentage, and productivity as measured by the number of patients scheduled for each medical professional.

EMRs offer reporting tools and instruments for medical management systems that make evaluation of the practice quick and efficient. Imagine if you could print a referrals report with a few clicks or figure out how many visits each patient typically schedules.

More Productive and Efficient

Medical management can be more productive and more efficient if these kinds of figures can be analyzed. Without EMR and reporting capabilities, this kind of analysis is overwhelmingly challenging and presents time barriers that are insurmountable.

Rather than relying on the business to continue as usual, medical management professionals and EMR systems learn what is working at your practice and what is not working. Once you know how things are actually going, you can take action to change it for the better.

Medical Billing — 5 Mistakes You Must Avoid

Medical Billing — 5 Mistakes You Must Avoid

Nitin Chhoda reveals the 5 mistakes that a practice owner should avoid when it comes to medical billing. In order to have a successful practice, time management and prioritization are crucial to the billing process.

medical billing mistakesMedical billing mistakes are easy enough to make, and unfortunately even the smallest mistake can cost a practice a lot of time and money.

While there are some mistakes that simply cannot be avoided, there are some basic rules for avoiding the major mistakes that most medical billers and medical clinics make.

#5: Understand the Explanation of Benefits

The explanation of benefits, or EOB, is going to sound like the final word from the insurance company every time. But the EOB should be used as a tracking tool and should be carefully read and understood each time your practice receives a payment.

Insurance companies take any opportunity to point out the medical billing mistakes being made, which can make it feel like they are detail oriented to an unimaginable degree. But the truth is that they make mistakes, too. And it will be up to you to catch them.

#4: Follow Up on Every Submitted Claim

In the medical billing world, once a claim is submitted, there is often the sense that it has been dealt with and now it’s time to wait and see what happens. Medical billing is hard enough and takes a lot of time, so once the paperwork is in the hands of the insurance company, billers are unlikely to want to spend any more time thinking about the claim.

But time and again insurance companies let things go or don’t receive claims, and the practice suffers the consequences. Large sums of money are lost every year because nobody has run an aging report and reviewed unpaid claims.

#3: Create a System that Works 

This may seem obvious, but every practice needs system for photocopying IDs and insurance cards, planning time for regular billing, and ensuring that claims are filed and checked on in a reasonable amount of time.

Delays that medical billing claims experience cost the practice money. Set aside time for each task and make sure that a procedure is followed for every patient and ever visit.

#2: Know Medical Coding Practices

medical billing mistakes to avoidA medical biller may or may not the be the same person as the medical coder, but either way the biller should understand the basics of medical coding.

The medical billing mistakes that cause claims to be denied or rejected often have to do with incorrect codes or insufficient medical coding.

#1: Billing is the Biller’s Top Priority

Especially in smaller practices, the staff member who handles medical billing service may have a whole host of jobs to do. They could also be the medical coder, the receptionist, and the scheduler. The problems arise when the medical billing is not given high enough priority in the list of things to do.

Without efficient and timely medical billing, the practice will suffer. Unfortunately we cannot rely on goodwill and good medicine to ensure that patients and clinicians experience a mutually beneficial outcome. Medical billing has to be a high priority, including the previous four ways to avoid mistakes.

Medical Billing And Coding In-House

Medical Billing And Coding In-House

Whether your medical billing and coding should be in-housed or outsourced, there are certain things that are worth considering.  Nitin Chhoda shares the advantages of an in-house medical billing and coding for a small or new private practice.

medical billing and coding in-houseOne of the biggest considerations for many practices is whether or not to conduct the medical billing and coding in-house or to outsource the work.

The question tends to focus on costs, which makes sense.

If your practice can save money by hiring a company to handle the medical billing and coding for you, why hire someone in-house?

But of course, calculating how you are best served is not all that simple. The determination often depends on the size of the office, how many claims need to be filed per day, how many clinicians work at the practice, and the costs of related hardware and software.

And of course, does in-house medical billing and coding improve the rate at which your claims are accepted and paid, or will outsourcing improve collection rates?

Benefits of In-House Billers

The most obvious decision will have to do with the amount of billing that your in-house billers and coders can handle.

In a very small practice, where the receptionist can handle scheduling, medical coding, and medical billing without being overwhelmed, hiring out medical billing and coding is probably unnecessary. And there are a few benefits to having the medical billing and coding professional right there in the office with clinicians.

When you can talk to your medical billing and coding staff member directly, all the details can be accessed at any time about any claim. One downside of an off-site service is that you have less control over and less access to your billing history.

Some services will provide reporting as a scheduled service or on demand. But timing will still be hampered by the fact that the medical billing and coding staff handling your practice probably has a number of practices to worry about. The process becomes less personal.

medical billing and coding needsAnother benefit of in-house medical billing and coding is that the information only has to be communicated once.

In other words, in many ways an outsourced system will require that someone put in a decent amount of work to get the billing accomplished.

In the most efficient scenario, you could simply scan relevant documents and hope they understand what is written.

But outsourcing will not mean that all aspect of medical billing and coding will be handled elsewhere. Someone still needs to be available for communication and transfer of information.

Size Matters When it Comes to Price

As you can imagine, the larger a practice gets, the more efficient an in-house biller can be. If you have a very small office, hiring one or two staff members just to handle medical billing and coding careers will be very expensive. In a private practice, there is a fine line to be drawn between having one staff member to handle everything administrative, and having too much work for a single staff member to handle.

When staff members with lots of responsibilities get overwhelmed, all tasks begin to suffer. And when medical billing and coding suffers, the entire practice is put in jeopardy.

Insurance Eligibility Determination

Insurance Eligibility Determination

Nitin Chhoda shares why verifying insurance eligibility should happen before and not after treating patients.

insurance eligibility determinationThe biggest challenges for medical coders and billers come from health insurance companies and its insurance eligibility.

With such high rates of rejection and denial of claims, the medical biller or coder, or physical therapy billing staff can be responsible for significant losses and a reduction in efficiency that can be damaging to the practice.

Claims submission rules change from company to company, not to mention for federal, state, and local programs. To reduce rejections and denials, take these steps to make sure you determine insurance eligibility.

Determining insurance eligibility should be done at the very beginning of any patient induction process. Ideally, before the patient even shows up for their appointment, so that you and the patient will already know what is covered and what is not.

Goals to Focus On

Remember that the purpose of checking for insurance eligibility will help you stay focused. Your goals should be to minimize claim denials and re-submittals, as well as eliminate any unpaid balances that patients owe. If you can keep those goals in mind, you will have an easier time controlling the aspects of the process that you can control.

Change Workflows

Another key thing to remember when it comes to insurance eligibility verification is that your patients likely have no idea what their insurance plan covers and does not cover. Many practices institute a pre-screening process to get some basic information from the client and learn what their expectations are before they have any bills to pay.

Pre-screening for insurance eligibility may be hard to get used to at first, because it will require that the medical biller actively spends time finding out information. That time will be hard to find for most medical billers.

On the other hand, consider the amount of time that you spend dealing with rejections, denials, and re-submittals of forms. How much is it hurting the practice to carry a large balance in accounts receivable?

And wouldn’t it be more time and cost effective if you got that part of determining insurance eligibility out of the way from the beginning? The answer to that last question is a definite yes! So consider starting with a workflow that adds a bit of time at the beginning but cuts a lot of time on the other end of the billing and insurance eligibility process.

Communication is Keyinsurance eligibility requirements

It may be difficult at first, but you will get used to talking to clients regularly about their insurance status. New patients will be easy.

If you use the approach that you are trying to help them, they should be amenable to giving you answers where they can.

Let them know that you understand how complicated it is, but that it will be easier for them and for you if you both figure it out now.

But it’s not only new patients you need to worry about. Patients whose coverage changes or who you haven’t seen in a while will also need verification of insurance eligibility.

If you can make some small changes, you can figure out just how much a patient will owe even before you file any claims. Ideally, you can even ask patients about their insurance eligibility and have them pay their portion up-front, entirely eliminating unpaid balances from accounts receivable.

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