By Neil Versel
Electronic health records (EHRs) have been around in one form or another since the 1960s, but the notion of patient records being stored on computers is only beginning to seep into the public’s consciousness. While pretty much every other industry computerized years ago, the vast majority of Americans’ medical records remain on paper.
The goal of electronic health records (and health information technology in general) is to make health care safer and more efficient by providing health professionals and patients alike with information to inform decision-making, promote preventive care and reduce duplication.
It sounds simple enough, but health IT is a complex, frequently misunderstood topic. In this essay, I’ll provide some background on electronic health records and health information technology, a glossary of terms, and some story ideas, with the goal of helping you better cover this important health and business topic.
Ditching paper charts is not easy, nor is writing about the conversion. The central story is not the technology itself, but rather how health information technology will transform care. “It’s really a matter of change management rather than technology,” Dr. David Blumenthal, the Obama administration’s national coordinator for health IT, explained in November 2009.
Online health records for all – “in 10 years”
First, some background: in 2004, President George W. Bush called for “most Americans” to have electronic health records within 10 years and created the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services to help make it happen. One early project of the office was the attempted conversion of VistA, the EHR long in place at the Department of Veterans Affairs, for use in small medical practices. The EHR, which was difficult to install in most doctors’ offices, never made it past a beta version before federal officials dropped the project.
Health IT subsequently drifted in and out of the national spotlight over the next several years, but didn’t garner much coverage in the mainstream press unless there was a local angle, such as a hospital installing a system. As a longtime reporter on this beat, it has been a challenge to “sell” this story outside the trade press. But now that health information technology is a major story, with plenty of interesting national and local angles, I’ve noticed more reporters scrambling to grasp this difficult subject.
So what’s finally turning arcane health information technology into a mainstream news story? Two things: National health reform and the federal stimulus bill.
Health Reform: Can Better Health IT Lower Costs and Improve Care?
Now that health insurance reform legislation[NV1] has passed, I hope mainstream media will turn their attention to a major health information technology story: greater access to health care does not guarantee good care, so it won’t matter much whether government or private companies administer health plans for millions of new enrollees as long as fee-for-service remains the dominant payment model.
The perverse reality is that mistakes can be good for business. Medical errors and other complications lead to more hospitalizations and longer stays. Both the fear of being sued and the inability to access previous results cause doctors to order extra tests, without regard to medical prudence.
Health IT can help prevent errors by offering what’s known as clinical decision support — computerized alerts recommending best practices and warning against harmful actions, such as prescribing a medication to which a patient is allergic. EHRs, if properly connected to laboratory systems, make test results more readily available so there is less need to re-order procedures. A good EHR should keep a record of every instruction a doctor gives to a patient so there is no question what was or was not communicated, in case of a malpractice claim.
From the perspective of a health IT reporter, health reform started not with the bills President Obama signed in March 2010, but more than a year earlier with the passage of the $787 billion stimulus bill, also known as the American Recovery and Reinvestment Act. The 2009 legislation contains an estimated $25.8 billion for health IT, mostly in the form of incentives [NV2] for doctors and hospitals to adopt electronic health records. Those that have not ditched their paper charts by 2015 face lower Medicare and Medicaid reimbursements.
Insurers and employers that provide health benefits tend to reap the greatest financial rewards from EHRs, so there has been little incentive for the actual providers of health care – physicians and hospitals – to invest in technology. The stimulus is supposed to change the paradigm by rewarding providers that demonstrate “meaningful use” of EHRs beginning in October 2010 for hospitals and January 2011 for physician practices.
According to rules proposed at the end of 2009, EHRs should provide clinical decision support, doctors and nurses should enter orders electronically, patients should be able to get a copy of their medical records on demand and users should be able to share data between facilities and organizations. The requirements will get tougher in 2013 and again in 2015; providers eventually will have to prove that they follow nationally recognized standards of practice.
As electronic health records – and subsets of them like personal health records – become more of a hot topic for mainstream media, it’s important to learn the lingo and get your facts straight.
Know your acronyms: a cautionary tale
Here’s what can happen if you don’t: On Dec. 2, 2009, a website called eSecurity Planet published a story about a privacy watchdog organization publishing a pre-emptive strike against personal health records, a subset of EHRs that has virtually zero market traction to date.
The eSecurity Planet story confused consumer-oriented personal health records for “electronic medical records” and wrongly reported that the stimulus is paying for billions in “electronic personal health records (PHRs).” The stimulus is supporting EHRs, a much broader category. Additionally, the story, like far too many others I’ve read, referred to the much-hyped Google Health and Microsoft HealthVault platforms as market leaders. They are nothing more than early-stage products from big names in the consumer arena, not established health IT powerhouses.
Look past the hype, learn the terminology and talk to people on the front lines. Go to the chief information officer and nursing shift managers of a local hospital. Physicians in private practice should have plenty to say as well.
This subject is often tough to grasp, so don’t be afraid to ask seemingly simple questions. I’ve been covering health IT since 2001, and I still frequently need detailed explanations.
Story ideas for your community
As implementation of national health insurance reform begins and EHR money starts flowing from the stimulus bill, I hope you’ll consider these story ideas for your community.
1. Who owns your EHR[NV3] ? Should you be concerned about it being used as a source of information for pharmaceutical researchers or medical marketers?
2. What is your local hospital or large medical group doing to get stimulus money for EHR development? What differences might patients see as a result?
3. How will the physician office visit change as a result of computerization? Will patients be asked to complete medical history forms online rather than filling out the ubiquitous clipboard each time they go to the doctor? Will nurses and physician assistants be able to provide services once the exclusive domain of physicians because if they have access to more complete patient information?
4. How might patients get better preventive care if medical practices are able to generate, with the help of EHRs, automatic reminders for recommended screening based on age, gender and health risk factors?
Above article publish on http://www.ehrexperts.us/covering-electronic-health-records/
Monday, May 10, 2010
EMR Implementation in Small and Large Clinics
I always love to hear clinics talk about the challenges they face in implementing an EMR. For the most part, they are completely predictable. Especially when it comes to the small versus large clinic challenges.
For example, small clinics will complain that they don’t have the resources that large clinics have to implement an EMR. Large clinics will complain that they have too much bureaucracy, red tape and stakeholders that they have to get on board an EMR implementation. They wish they were like smaller clinics who could quickly make decisions and had a much more focused need.
Of course, the reality is that both of these point of views are accurate. It’s not news that small clinics can make decisions easier and that larger clinics have more resources at their disposal. Certainly a generalization, but the reason it’s a generalization is because it’s generally true.
Since both small clinics and large clinics both face major challenges of resources and red tape respectively, then how does any clinic get over them and implement an EMR? Let’s be honest, it’s really more a matter of the priority EMR is given than anything else. So far many doctors offices haven’t decided to make their EMR implementation a priority. Once a clinic makes EMR a priority, it’s really quite amazing to see what happens.
The good news is that for many clinics, the EMR stimulus money has changed this fact and bumped EMR adoption up on their priority list. Plus, in the 4+ years I’ve been writing about EMR software, EMR software has come a really long way. Sure, they still have a ways to go, but the EMR software of today is much improved and can provide some real value to a clinic if implemented correctly.
It’s time to address the excuses for why you can’t do an EMR and start focusing on the benefits you can receive from an EMR. Notice I didn’t say “ignore” or “hide” the excuses. We need to address the excuses people are giving and see what benefits you might be missing because you’re not using an EMR. I know very very few people who use an EMR and would ever want to go back to paper. There’s a reason for this.
Above article publish on http://www.emrspecialists.com/2010/05/emr-implementation-small-large-clinics/
For example, small clinics will complain that they don’t have the resources that large clinics have to implement an EMR. Large clinics will complain that they have too much bureaucracy, red tape and stakeholders that they have to get on board an EMR implementation. They wish they were like smaller clinics who could quickly make decisions and had a much more focused need.
Of course, the reality is that both of these point of views are accurate. It’s not news that small clinics can make decisions easier and that larger clinics have more resources at their disposal. Certainly a generalization, but the reason it’s a generalization is because it’s generally true.
Since both small clinics and large clinics both face major challenges of resources and red tape respectively, then how does any clinic get over them and implement an EMR? Let’s be honest, it’s really more a matter of the priority EMR is given than anything else. So far many doctors offices haven’t decided to make their EMR implementation a priority. Once a clinic makes EMR a priority, it’s really quite amazing to see what happens.
The good news is that for many clinics, the EMR stimulus money has changed this fact and bumped EMR adoption up on their priority list. Plus, in the 4+ years I’ve been writing about EMR software, EMR software has come a really long way. Sure, they still have a ways to go, but the EMR software of today is much improved and can provide some real value to a clinic if implemented correctly.
It’s time to address the excuses for why you can’t do an EMR and start focusing on the benefits you can receive from an EMR. Notice I didn’t say “ignore” or “hide” the excuses. We need to address the excuses people are giving and see what benefits you might be missing because you’re not using an EMR. I know very very few people who use an EMR and would ever want to go back to paper. There’s a reason for this.
Above article publish on http://www.emrspecialists.com/2010/05/emr-implementation-small-large-clinics/
Friday, May 7, 2010
E-prescribing growing, but most practices still don’t use it
By Pamela Lewis Dolan,
A new report finds a significant uptick in the number of physicians who prescribe electronically. But the e-prescribers still only account for about one in four physicians, or 26% of office-based doctors.
The numbers come from Surescripts, which operates the nation’s largest e-prescribing network. It released its annual e-prescribing progress report on March 2. The report found that although there was significant progress in adoption of electronic prescribing, there are still barriers to overcome.
The report found that the percentage of eligible prescriptions sent electronically increased from 6% to 18% from the end of 2008 to the end of 2009, as measured by tracking traffic through the Surescripts network. The 2009 total represented 190 million out of about 1.6 billion eligible prescriptions for an overall annual rate of 12%, according to the report, “Advancing Healthcare in America.”
“For e-prescription use to jump from 6% to 18% in one year indicates several things,” said Harry Totonis, president and CEO of Surescripts, in a prepared statement. “First, that the federal government’s leadership and incentive structures are working. Second, that the benefits of e-prescribing — including increased safety, lower costs and increased efficiency — are widely understood. And last, that the nation’s experience with e-prescribing — in building the network and the ecosystem to support it — provides a definitive road map for how to drive adoption of a broader electronic health record for all Americans.”
The Surescripts report found that about 70% of physicians who do e-prescribe use an application on their EMRs. Company spokesman Rob Cronin said many EMRs might not have been certified in 2009 for e-prescribing under the rules that qualify physicians for incentives. Many of those systems are now becoming certified, and that accounted for a large chunk of the e-prescribing growth.
On the subject of electronic prescribing’s safety benefits, in February Weill Cornell Medical College in New York released the results of its study comparing the safety of e-prescribing with paper-based prescribing.
The authors found that nearly two of every five paper prescriptions contained an error. The authors reviewed 3,684 paper-based prescriptions at the start of the study, and 3,848 paper-based and electronic prescriptions written one year later. It found that after a year, the percentage of errors dropped from 43% to 7% for physicians and other prescribers using the electronic system.
The Centers for Medicare & Medicaid Services e-prescribing incentives, which started in January 2009, also were a motivator for adoption of electronic prescribing, according to Surescripts. And the incentives that will be made available through the American Recovery and Reinvestment Act to stimulate EMR growth are expected to motivate even more to adopt e-prescribing, experts said. E-prescribing is one criteria that must be met to qualify for EMR incentive money.
Also cited as drivers of e-prescribing adoption were numerous public and private efforts, including the American Medical Association’s June 2009 introduction of its Zero-In Rx e-prescribing learning center.
But some experts wonder if e-prescribing adoption rates would be higher if it weren’t for a Drug Enforcement Administration rule that requires all controlled substance prescriptions be written on paper.
David Hunt, MD, officer of provider adoption support for the Office of the National Coordinator for Health Information Technology, told a crowd of physicians and others gathered in March for the annual meeting of the Healthcare Information and Management Systems Society that he himself doesn’t e-prescribe because of the DEA issue. Dr. Hunt, a surgeon, said a large percentage of his prescriptions are not eligible for electronic submission. Instead of running his practice with two workflows, to incorporate e-prescribing, he said he has stuck with his paper pad.
Other experts say physician resistance to e-prescribing is not as clear-cut.
In New Hampshire, for example, there was an aggressive campaign launched in 2007 aimed at getting 100% of physicians e-prescribing within one year. New Hampshire State Rep. Cindy Rosenwald, whose husband is a cardiologist, said that three years later, 50% of doctors in New Hampshire use some form of an EMR, but only 20% have e-prescribing capabilities.
“That’s going to be a huge challenge for us,” Rosenwald said at a public policy forum held during HIMSS, which met in early March in Atlanta.
Rosenwald said another contributing factor in New Hampshire could have been a state law that was passed, after the e-prescribing initiative was announced, giving patients the right to a paper prescription for the purpose of shopping around.
Other barriers mentioned by Surescripts in the report were the limited number of state Medicaid programs that can provide formulary and eligibility information to prescribers.
It also says prescriber and pharmacy directories need to be maintained actively to ensure that prescriptions that can be sent electronically are transmitted electronically as often as possible. Generally, a prescription that is sent electronically but comes to the pharmacy as a fax — because the pharmacy doesn’t have the technology to accept the transmission — is not considered e-prescribing.
ADDITIONAL INFORMATION:
2007 2008 2009
Electronic prescriptions 29 million 68 million 190 million
New prescriptions 24 million 55 million 156 million
Renewal requests 5 million 13 million 35 million
Overall growth 131% 180%
Active e-prescribers 36,000 74,000 156,000
Connected pharmacies 41,000 46,000 53,000
Source by Surescripts
Above article publish on http://www.eprescriptionservices.com/eprescribing-growing-practices/
A new report finds a significant uptick in the number of physicians who prescribe electronically. But the e-prescribers still only account for about one in four physicians, or 26% of office-based doctors.
The numbers come from Surescripts, which operates the nation’s largest e-prescribing network. It released its annual e-prescribing progress report on March 2. The report found that although there was significant progress in adoption of electronic prescribing, there are still barriers to overcome.
The report found that the percentage of eligible prescriptions sent electronically increased from 6% to 18% from the end of 2008 to the end of 2009, as measured by tracking traffic through the Surescripts network. The 2009 total represented 190 million out of about 1.6 billion eligible prescriptions for an overall annual rate of 12%, according to the report, “Advancing Healthcare in America.”
“For e-prescription use to jump from 6% to 18% in one year indicates several things,” said Harry Totonis, president and CEO of Surescripts, in a prepared statement. “First, that the federal government’s leadership and incentive structures are working. Second, that the benefits of e-prescribing — including increased safety, lower costs and increased efficiency — are widely understood. And last, that the nation’s experience with e-prescribing — in building the network and the ecosystem to support it — provides a definitive road map for how to drive adoption of a broader electronic health record for all Americans.”
The Surescripts report found that about 70% of physicians who do e-prescribe use an application on their EMRs. Company spokesman Rob Cronin said many EMRs might not have been certified in 2009 for e-prescribing under the rules that qualify physicians for incentives. Many of those systems are now becoming certified, and that accounted for a large chunk of the e-prescribing growth.
On the subject of electronic prescribing’s safety benefits, in February Weill Cornell Medical College in New York released the results of its study comparing the safety of e-prescribing with paper-based prescribing.
The authors found that nearly two of every five paper prescriptions contained an error. The authors reviewed 3,684 paper-based prescriptions at the start of the study, and 3,848 paper-based and electronic prescriptions written one year later. It found that after a year, the percentage of errors dropped from 43% to 7% for physicians and other prescribers using the electronic system.
The Centers for Medicare & Medicaid Services e-prescribing incentives, which started in January 2009, also were a motivator for adoption of electronic prescribing, according to Surescripts. And the incentives that will be made available through the American Recovery and Reinvestment Act to stimulate EMR growth are expected to motivate even more to adopt e-prescribing, experts said. E-prescribing is one criteria that must be met to qualify for EMR incentive money.
Also cited as drivers of e-prescribing adoption were numerous public and private efforts, including the American Medical Association’s June 2009 introduction of its Zero-In Rx e-prescribing learning center.
But some experts wonder if e-prescribing adoption rates would be higher if it weren’t for a Drug Enforcement Administration rule that requires all controlled substance prescriptions be written on paper.
David Hunt, MD, officer of provider adoption support for the Office of the National Coordinator for Health Information Technology, told a crowd of physicians and others gathered in March for the annual meeting of the Healthcare Information and Management Systems Society that he himself doesn’t e-prescribe because of the DEA issue. Dr. Hunt, a surgeon, said a large percentage of his prescriptions are not eligible for electronic submission. Instead of running his practice with two workflows, to incorporate e-prescribing, he said he has stuck with his paper pad.
Other experts say physician resistance to e-prescribing is not as clear-cut.
In New Hampshire, for example, there was an aggressive campaign launched in 2007 aimed at getting 100% of physicians e-prescribing within one year. New Hampshire State Rep. Cindy Rosenwald, whose husband is a cardiologist, said that three years later, 50% of doctors in New Hampshire use some form of an EMR, but only 20% have e-prescribing capabilities.
“That’s going to be a huge challenge for us,” Rosenwald said at a public policy forum held during HIMSS, which met in early March in Atlanta.
Rosenwald said another contributing factor in New Hampshire could have been a state law that was passed, after the e-prescribing initiative was announced, giving patients the right to a paper prescription for the purpose of shopping around.
Other barriers mentioned by Surescripts in the report were the limited number of state Medicaid programs that can provide formulary and eligibility information to prescribers.
It also says prescriber and pharmacy directories need to be maintained actively to ensure that prescriptions that can be sent electronically are transmitted electronically as often as possible. Generally, a prescription that is sent electronically but comes to the pharmacy as a fax — because the pharmacy doesn’t have the technology to accept the transmission — is not considered e-prescribing.
ADDITIONAL INFORMATION:
2007 2008 2009
Electronic prescriptions 29 million 68 million 190 million
New prescriptions 24 million 55 million 156 million
Renewal requests 5 million 13 million 35 million
Overall growth 131% 180%
Active e-prescribers 36,000 74,000 156,000
Connected pharmacies 41,000 46,000 53,000
Source by Surescripts
Above article publish on http://www.eprescriptionservices.com/eprescribing-growing-practices/
How To Evaluate Medical Billing Services
By, Chris Thorman
We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.
How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:
* Level of service;
* Industry experience;
* Use of technology;
* Pricing model; and,
* Capacity to take on new clients.
What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.
To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:
1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.
These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.
Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.
Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.
Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:
Function
Possible Issues
Pursuing denied claims Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.
Billing follow up If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.
Complying with regulations By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.
Reporting and analysis One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?
It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.
Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.
Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.
Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.
The certification implies that the recipient is knowledgeable in the areas of:
* ICD9, CPT4 and HCPCS Coding;
* Medical Terminology;
* Insurance claims and billing, appeals and denials, fraud and abuse;
* HIPAA and Office of Inspector General (OIG) Compliance;
* Information and web technology; and,
* Reimbursement.
Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.
Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.
Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.
Here are some potential technology issues in those realms that will need to be addressed:
* How will superbills and claims be shared?
* How does billing service fit with the provider’s electronic health record (EHR) strategy?
* Does the service have an integrated EHR?
* How does the service ensure data security?
* What are the disaster recovery procedures?
* Where and how is backup data stored?
* Will a provider need to install and maintain software or access the system online?
* Is the technology HIPAA compliant?
Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.
Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.
There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:
Description
Pros
Cons
Percentage-based The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections. The success of the billing company is tied to the success of the practice. Small claims may not be pursued as aggressively due to lower payoff.
Fee-based With this model, the billing services charges a fixed dollar rate per claim submitted. This model is potentially more cost effective. Less incentive for the billing service to follow-up on denied claims.
Hybrid With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others. This model is potentially more cost effective. Less incentive for the service to follow-up on certain claims.
Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.
Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.
Determining capacity involves collecting a number of metrics about the company’s performance, including:
* Years in the business;
* Number of employees and reporting structure;
* Number of clients by specialty;
* Gross number of billings; and,
* Number of claims processed annually.
Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:
* Average number of days in A/R by specialty;
* Coding, submission and follow-up delay metrics;
* By what percentage they’ve been able to increase revenues for existing clients; and,
* By what percentage they’ve been able to reduce payment delays.
How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.
Above article publish on http://www.mymedicalbillingoutsourcing.com/evaluate-medical-billing-services/
We recently penned a post, “Should You Outsource Your Medical Billing,” which compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.
How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand overtheir patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:
* Level of service;
* Industry experience;
* Use of technology;
* Pricing model; and,
* Capacity to take on new clients.
What Functions Will a Billing Service Perform?
Before getting into the selection details, let’s quickly review how a billing service fits into the medical billing process. A medical billing company will be able to take over most billing functions in a provider’s office.
To see a substantial benefit, a provider needs to select a medical billing service that performs at least these functions:
1. Claim generation and submission;
2. Carrier follow-up;
3. Payment posting and processing;
4. Patient invoicing and support; and,
5. Collection agency transfer services.
These functions are the “guts” of medical billing. Following up with insurance carriers and pursuing denied claims are two areas where medical billing services typically excel versus a provider’s in-house staff.
Other services that may be offered include credentialing, medical coding, transcription, insurance eligibility verification and appointment scheduling.
Naturally, as the number of services increases, fees will increase. A provider will want to strike the proper balance between cost and service by honestly evaluating their own capacity to perform these functions.
Criteria #1: Level of Service
In addition to the basics of medical billing mentioned above, there are more details a provider will want to be clear on before choosing a medical billing service. Here are some important functions that a provider and billing service should delineate before they enter into a partnership:
Function
Possible Issues
Pursuing denied claims Will the service pursue denied claims or will the provider have to? If they do pursue denied claims, a provider will want to know what procedures the company has in place to do so to ensure they aren’t being paid lip-service.
Billing follow up If a patient doesn’t pay their bill, who follows up? Many medical billing services will correspond with patients regarding billing issues, which for many providers is a necessary function to outsource.
Complying with regulations By handing over a patient’s medical information to a third-party, a provider becomes responsible for the third-party’s compliance with the Health Insurance Accountability and Portability Act (HIPAA). The billing service must protect patient privacy to the same degree that the provider does.
Reporting and analysis One of the other benefits of a medical billing service is that they’re going to have business insight that a provider doesn’t. Will the service provide feedback about how to improve the practice? Or just send a one-page financial statement each month?
It’s important that a provider and a billing service agree on the level of service before they get started. If the right level of service isn’t chosen, a provider won’t reap the full benefits of outsourcing their medical billing.
Criteria #2: Industry Experience
When a provider evaluates a medical billing service’s experience, they need to look beyond the number of years the company has been in business. Experience includes not only time but also familiarity with certain specialities. Billing certification plays a key role here as well.
Billing procedures will vary by medical speciality, so a provider will want to choose a billing service that is familiar with their specialty. Experience with billing to Medicare and Medicaid will be a huge plus, in any speciality.
Choosing a service with staff members that are certified by the American Medical Billing Association (AMBA) is important as well. The AMBA offers a Medical Reimbursement Specialist certification designed to promote professional medical billing.
The certification implies that the recipient is knowledgeable in the areas of:
* ICD9, CPT4 and HCPCS Coding;
* Medical Terminology;
* Insurance claims and billing, appeals and denials, fraud and abuse;
* HIPAA and Office of Inspector General (OIG) Compliance;
* Information and web technology; and,
* Reimbursement.
Even with a certified staff, the proper procedures and technology will need to be employed to maximize benefits of the provider/billing service relationship.
Criteria #3: Use of Technology
Software for medical billing is allowing billing services to accomplish more with less. However, just because a company is using sophisticated billing software doesn’t necessarily mean they’re going to do an efficient job. They need to have the proper procedures in place to take advantage of everything the billing company software offers.
Most importantly when it comes to technology, a provider will want to know about a company’s information sharing, data security, recovery procedures, data backup procedures.
Here are some potential technology issues in those realms that will need to be addressed:
* How will superbills and claims be shared?
* How does billing service fit with the provider’s electronic health record (EHR) strategy?
* Does the service have an integrated EHR?
* How does the service ensure data security?
* What are the disaster recovery procedures?
* Where and how is backup data stored?
* Will a provider need to install and maintain software or access the system online?
* Is the technology HIPAA compliant?
Choosing a medical billing service company that employs technology in a way that effortlessly bridges the gap between provider and biller can mean the difference between profit and loss. By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR), that gap can be closed even more.
Criteria #4: Pricing Options
When dealing with practices whose revenue is in the millions of dollars, the cost savings between pricing models can be in the hundreds of thousands of dollars.
There are three pricing options offered by medical billing companies and we’ve broken them down in the table below:
Description
Pros
Cons
Percentage-based The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections. The success of the billing company is tied to the success of the practice. Small claims may not be pursued as aggressively due to lower payoff.
Fee-based With this model, the billing services charges a fixed dollar rate per claim submitted. This model is potentially more cost effective. Less incentive for the billing service to follow-up on denied claims.
Hybrid With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others. This model is potentially more cost effective. Less incentive for the service to follow-up on certain claims.
Percentage-based models are most common on the market today. Fee-based models are the next most common option with the hybrid option appearing with less frequency. Many billing companies offer two or three of these options.
Criteria #5: Capacity to Take on New Clients
Finally, a provider will want to get into the nitty gritty of a medical billing company’s performance to evaluate whether the company has the capacity to take them on as a client. Remember, much of the payoff in hiring a billing service comes from the pursuit of denied claims and fee collection. A billing service that doesn’t have the capacity to effectively follow up with outstanding bills will provide minimal benefit.
Determining capacity involves collecting a number of metrics about the company’s performance, including:
* Years in the business;
* Number of employees and reporting structure;
* Number of clients by specialty;
* Gross number of billings; and,
* Number of claims processed annually.
Knowing this information will help a provider determine the level of service a billing company will be able to provide to their practice. Getting even more detailed, a provider will also want to delve into a number of “quality” metrics about billing companies. These include:
* Average number of days in A/R by specialty;
* Coding, submission and follow-up delay metrics;
* By what percentage they’ve been able to increase revenues for existing clients; and,
* By what percentage they’ve been able to reduce payment delays.
How a medical billing service performs on each of these metrics will significantly affect a provider’s bottom line.
Above article publish on http://www.mymedicalbillingoutsourcing.com/evaluate-medical-billing-services/
Thursday, May 6, 2010
Speakers at Boston Conference Highlight Health IT Opportunities
On Thursday, National Coordinator for Health IT David Blumenthal discussed national progress on health IT adoption during a speech at a conference hosted by the Massachusetts Health Data Consortium, Computerworld reports.
Blumenthal highlighted the grants his office is distributing for health IT education and training at regional extension centers. He said federal investment in health IT training could help create between 45,000 and 50,000 jobs over the next five years.
Blumenthal also discussed how federal officials plan to investigate safety issues associated with electronic health records. He said the Office of the National Coordinator for Health IT will prioritize patient safety goals as it works to promote EHR adoption nationwide.
According to Blumenthal, over the next year ONC will focus on:
* Finalizing “meaningful use” regulations for EHRs;
* Helping hospitals and health care providers adopt standards that align with the National Health Information Network; and
* Implementing the “beacon community” grant program to support regional health IT infrastructure and data exchanges (Mearian, Computerworld, 4/30).
Blumenthal said ONC will announce the awards for the beacon community program “very, very soon” (Monegain, Healthcare IT News, 4/30).
Governor Discusses Massachusetts’ Experience
Also during the conference, Massachusetts Gov. Deval Patrick (D) discussed how health IT initiatives have played out in his state, which requires most residents to obtain a minimum level of health coverage (Computerworld, 4/30).
Patrick said that:
* 45% of Massachusetts physicians have adopted EHRs;
* 50% of state physicians use computerized physician order entry systems; and
* Massachusetts leads the country in electronic prescribing (Healthcare IT News, 4/30).
The governor also said that his state could face challenges in connecting health care providers through health information exchange networks (Computerworld, 4/30).
Above article publish on http://www.ehrexperts.us/speakers-at-boston-conference-highlight-health-it-opportunities/
Blumenthal highlighted the grants his office is distributing for health IT education and training at regional extension centers. He said federal investment in health IT training could help create between 45,000 and 50,000 jobs over the next five years.
Blumenthal also discussed how federal officials plan to investigate safety issues associated with electronic health records. He said the Office of the National Coordinator for Health IT will prioritize patient safety goals as it works to promote EHR adoption nationwide.
According to Blumenthal, over the next year ONC will focus on:
* Finalizing “meaningful use” regulations for EHRs;
* Helping hospitals and health care providers adopt standards that align with the National Health Information Network; and
* Implementing the “beacon community” grant program to support regional health IT infrastructure and data exchanges (Mearian, Computerworld, 4/30).
Blumenthal said ONC will announce the awards for the beacon community program “very, very soon” (Monegain, Healthcare IT News, 4/30).
Governor Discusses Massachusetts’ Experience
Also during the conference, Massachusetts Gov. Deval Patrick (D) discussed how health IT initiatives have played out in his state, which requires most residents to obtain a minimum level of health coverage (Computerworld, 4/30).
Patrick said that:
* 45% of Massachusetts physicians have adopted EHRs;
* 50% of state physicians use computerized physician order entry systems; and
* Massachusetts leads the country in electronic prescribing (Healthcare IT News, 4/30).
The governor also said that his state could face challenges in connecting health care providers through health information exchange networks (Computerworld, 4/30).
Above article publish on http://www.ehrexperts.us/speakers-at-boston-conference-highlight-health-it-opportunities/
Online Patient Portal – Another Innovation of Medical Technology
By Jonathan G Ponting
Latest technology has simplified our lives to a great extent. Internet is helping to simplify many complicated procedures and few examples of the same are exchanging messages, contacting people in distant places using chat and emails, online shopping, reading information of latest events and happenings across the world and collecting information required related to any topic.
One of the most benefited industries from internet is the field of medicine. The latest innovation of medical technology is online patient portals. It is designed to increase communication and relation between patient and health care providers.
Online patient portal helps in efficiently managing the available resources with the local physician or provider to reduce the cost of treatment for both patient and the provider that uses advanced technology. It also enables doctors and providers in transmission of everything that is related to treatment of the patients like medical images for diagnosis, reports, medical date related to patient etc. It is also helpful in educating local physicians online on preventing development of chronic diseases via video conferences.
Online portals are also helping physicians to easily schedule appointment with patients as there is increase in demand for health care services which helps patients in avoiding to stand in lengthy lines. Patient portal helps patients to have better understanding of the disease they are suffering from, with the help of information provided and can also request for renewal of prescriptions at these portals. Patients are also offered to join various groups where other members also suffer from similar chronic diseases which help in lifting of spirits.
Patient portals not only help patients to directly contact with physicians but also to have remote access to mobile tools. Online patient portals are helping to improve quality of health care in remote and rural areas.
Patient portals are best and easy way of contacting doctors for various ailments and getting them treated without waiting for long time. They are best sources of getting advanced treatment for patients’ condition at affordable prices. They are highly beneficial for both patient and the health care provider in offering and availing best of treatments irrespective of geographic location.
Above article publish on http://www.emrspecialists.com/2010/05/online-patient-portal-innovation-medical-technology/
Latest technology has simplified our lives to a great extent. Internet is helping to simplify many complicated procedures and few examples of the same are exchanging messages, contacting people in distant places using chat and emails, online shopping, reading information of latest events and happenings across the world and collecting information required related to any topic.
One of the most benefited industries from internet is the field of medicine. The latest innovation of medical technology is online patient portals. It is designed to increase communication and relation between patient and health care providers.
Online patient portal helps in efficiently managing the available resources with the local physician or provider to reduce the cost of treatment for both patient and the provider that uses advanced technology. It also enables doctors and providers in transmission of everything that is related to treatment of the patients like medical images for diagnosis, reports, medical date related to patient etc. It is also helpful in educating local physicians online on preventing development of chronic diseases via video conferences.
Online portals are also helping physicians to easily schedule appointment with patients as there is increase in demand for health care services which helps patients in avoiding to stand in lengthy lines. Patient portal helps patients to have better understanding of the disease they are suffering from, with the help of information provided and can also request for renewal of prescriptions at these portals. Patients are also offered to join various groups where other members also suffer from similar chronic diseases which help in lifting of spirits.
Patient portals not only help patients to directly contact with physicians but also to have remote access to mobile tools. Online patient portals are helping to improve quality of health care in remote and rural areas.
Patient portals are best and easy way of contacting doctors for various ailments and getting them treated without waiting for long time. They are best sources of getting advanced treatment for patients’ condition at affordable prices. They are highly beneficial for both patient and the health care provider in offering and availing best of treatments irrespective of geographic location.
Above article publish on http://www.emrspecialists.com/2010/05/online-patient-portal-innovation-medical-technology/
Wednesday, May 5, 2010
Transcription trade groups offer ethics guide
By Joseph Conn
The medical transcription industry, represented by its two trade groups, is preparing for what it sees as the possibility of heightened privacy, security and fraud enforcement by coming up with its own guidebook of ethics and best practices.
The Association for Healthcare Documentation Integrity, an association of medical transcription practitioners, formerly known as the American Association for Medical Transcription, and the Medical Transcription Industry Association, the trade group for transcription service providers, have released their “Manual of Ethical Best Practices for the Healthcare Documentation Sector.”
The release of the full guideline is timed to coincide with the MTIA’s annual conference April 28th-May 1st in Daytona Beach, Fla., according to Peter Preziosi, CEO of the two organizations, which formed what they describe as “a strategic legal partnership” in 2007.
Scott Edelstein, a Washington, D.C., lawyer in the healthcare law practice at Squire, Sanders & Dempsey, was the lead author of the manual for the MTIA and AHDI. Edelstein said that more stringent privacy and security protections in the American Recovery and Reinvestment Act of 2009—which include new breach notification provisions and empower state attorneys general to enforce HIPAA privacy laws—as well as the increased fraud-fighting sections of the recently enacted Patient Protection and Affordable Care Act, will likely yield more government enforcement activities going forward, Edelstein said.
And that prompted the two trade groups to take a pro-active approach in producing the manual. “I think just generally, the tone for this administration is going to be increased in enforcement, because there is increased sensitivity for privacy of information,” Edelstein said.
“Most of the companies in the medical transcription industry tend to be small mom-and-pop operations, but they’re handling such sensitive information,” he said. “The concern is that some of these companies may not have taken all the measures needed under HIPAA and fraud and compliance laws, and this manual was to provide guidance for them.”
Data on the medical transcription industry is somewhat sketchy. The federal Bureau of Labor Statistics places the number of medical transcriptionists in the U.S. workforce at around 100,000, but the BLS figures don’t capture independent contractors, according to Preziosi, “and I’d say a good 50% are independent contractors.”
Add in small physician offices where the office manager might double for an MT and, all told, there may be as many as 250,000 to 300,000 medical transcriptions working full or part-time for 1,500 to 1,700 companies, mostly sole proprietorships, though there also are a handful of “giants,” he said.
The manual offers a best practices check list, copies of the codes of ethics of both organizations, guides on billing practices and the rules on hiring employees vs. independent contractors, roughly 170 pages devoted to compliance with Health Insurance Portability and Accountability Act privacy and security rules, a how-to section on establishing a HIPAA-compliant home-based office, and a “50-state data privacy survey,” according to a listing of the manual’s contents on the AHDI website.
Such guidance doesn’t come cheap. Copies of the manual cost $4,000 for non members of the two associations, with prices ranging between free to $750 for MTIA members and $750 or $950 for AHDI members.
Above article publish on http://www.medicaltranscriptionoutsource.com/transcription-trade-groups-offer-ethics-guide/
The medical transcription industry, represented by its two trade groups, is preparing for what it sees as the possibility of heightened privacy, security and fraud enforcement by coming up with its own guidebook of ethics and best practices.
The Association for Healthcare Documentation Integrity, an association of medical transcription practitioners, formerly known as the American Association for Medical Transcription, and the Medical Transcription Industry Association, the trade group for transcription service providers, have released their “Manual of Ethical Best Practices for the Healthcare Documentation Sector.”
The release of the full guideline is timed to coincide with the MTIA’s annual conference April 28th-May 1st in Daytona Beach, Fla., according to Peter Preziosi, CEO of the two organizations, which formed what they describe as “a strategic legal partnership” in 2007.
Scott Edelstein, a Washington, D.C., lawyer in the healthcare law practice at Squire, Sanders & Dempsey, was the lead author of the manual for the MTIA and AHDI. Edelstein said that more stringent privacy and security protections in the American Recovery and Reinvestment Act of 2009—which include new breach notification provisions and empower state attorneys general to enforce HIPAA privacy laws—as well as the increased fraud-fighting sections of the recently enacted Patient Protection and Affordable Care Act, will likely yield more government enforcement activities going forward, Edelstein said.
And that prompted the two trade groups to take a pro-active approach in producing the manual. “I think just generally, the tone for this administration is going to be increased in enforcement, because there is increased sensitivity for privacy of information,” Edelstein said.
“Most of the companies in the medical transcription industry tend to be small mom-and-pop operations, but they’re handling such sensitive information,” he said. “The concern is that some of these companies may not have taken all the measures needed under HIPAA and fraud and compliance laws, and this manual was to provide guidance for them.”
Data on the medical transcription industry is somewhat sketchy. The federal Bureau of Labor Statistics places the number of medical transcriptionists in the U.S. workforce at around 100,000, but the BLS figures don’t capture independent contractors, according to Preziosi, “and I’d say a good 50% are independent contractors.”
Add in small physician offices where the office manager might double for an MT and, all told, there may be as many as 250,000 to 300,000 medical transcriptions working full or part-time for 1,500 to 1,700 companies, mostly sole proprietorships, though there also are a handful of “giants,” he said.
The manual offers a best practices check list, copies of the codes of ethics of both organizations, guides on billing practices and the rules on hiring employees vs. independent contractors, roughly 170 pages devoted to compliance with Health Insurance Portability and Accountability Act privacy and security rules, a how-to section on establishing a HIPAA-compliant home-based office, and a “50-state data privacy survey,” according to a listing of the manual’s contents on the AHDI website.
Such guidance doesn’t come cheap. Copies of the manual cost $4,000 for non members of the two associations, with prices ranging between free to $750 for MTIA members and $750 or $950 for AHDI members.
Above article publish on http://www.medicaltranscriptionoutsource.com/transcription-trade-groups-offer-ethics-guide/
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