Electronic Medical Records Blog by Sunrise Services.

Tuesday, June 16, 2015

Groups Praise, Urge Caution for Meaningful Use Modifications

Several groups have submitted comments on CMS' proposed meaningful use modifications for 2015 through 2017, Clinical Innovation & Technology reports (Walsh, Clinical Innovation & Technology, 6/15).
Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Details of Proposal

In April, CMS released a proposed rule that would shorten Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015.
Overall, the proposed rule would:
  • Realign the reporting period starting in 2015 to allow hospitals to participate on the calendar year instead of the current fiscal year period;
  • Reduce the number of meaningful use objectives to improve advanced use of EHRs; and
  • Remove redundant measures and those that have become widely adopted.
In addition, the proposed rule would change Stage 2 meaningful use requirements related to patient engagement. Specifically, CMS proposed reducing the requirement for patients to use technology to electronically download, view and transmit their medical records from 5% of eligible providers' patients to just one patient (iHealthBeat, 4/13).
Comments on the proposed modifications were due June 15 (iHealthBeat, 5/28).

American Medical Group Association Comments

The American Medical Group Association in its comments praised CMS for easing the program's reporting requirements, as well as for proposing a shorter 90-day reporting period.
AMGA CEO Donald Fisher said, "This proposed rule reflects that CMS has been sensitive to the struggles that the health care industry has had with meaningful use by simplifying some of the reporting requirements through 2017."
The group also urged CMS to help strengthen the health IT infrastructure to support future data sharing requirements (AMGA release, 6/15).

College of Healthcare Information Management Executives Comments

Russell Branzell, president of the College of Healthcare Information Management Executives, in his comments called for a middle ground on patient engagement. He wrote that rather than requiring every specialist to demonstrate that patients can "view, download and transmit" their health information, those data should be aggregated into a single location for patients.
He added, "I definitely want patient data made accessible to patients or those taking care of them. But I don't want to get every note out of some subspecialty office" (Pittman et al., "Morning eHealth," Politico, 6/16).

Consumer Partnership for eHealth Comments

Meanwhile, a group of 50 advocacy groups organized by the Consumer Partnership for eHealth and the Consumer-Purchase Alliance in its comments expressed disappointment, saying CMS' proposal to reduce patient engagement requirements would undermine patient engagement efforts (Clinical Innovation & Technology, 6/15). Specifically, CPeH said, "CMS' proposed amendments constitute a dramatic retreat from essential efforts to make patients and family caregivers true and equal partners in improving health through shared information, understanding and decision making" ("Morning eHealth," Politico, 6/16).
Debra Ness -- president of the National Partnership for Women & Families, which was part of the coalition -- said the groups "urge CMS to keep the existing patient engagement thresholds."
Meanwhile, Bill Kramer, co-chair of the Consumer-Purchase Alliance, noted that maintaining efforts to give patients and caregivers "electronic access to and use of their health information" is key to achieving interoperability in the U.S. health care system (Clinical Innovation & Technology, 6/15).

Healthcare Information and Management Systems Society Comments

The Healthcare Information and Management Systems Society in a letter to CMS supported the agency's proposal to ease reporting requirements but urged CMS to be cautious moving forward with other proposals, Health Data Management reports.
Among other things, HIMSS recommended that CMS:
  • Phase-in the new thresholds for the Patient Electronic Access Objective;
  • Reconsider the "unrealistic goal" of the 2016 hospital electronic prescribing requirement; and
  • Take into account the timing of the release of the final rule in terms of the "short turnaround in meeting" its requirements (Slabodkin, Health Data Management, 6/16).

Friday, May 15, 2015

CMS Announces July 2015 Transition from IACS to EIDM

CMS Announces July 2015 Transition from IACS to EIDM

The Centers for Medicare & Medicaid Services (CMS) would like to inform Physician Quality Reporting System (PQRS) participants and their staff to an important system update scheduled to be in place on July 13, 2015.

The Individuals Authorized Access to CMS Computer Services (IACS) system will be retired, but current IACS user accounts will transition to an existing CMS system called Enterprise Identity Management (EIDM). The EIDM system provides a way for business partners to apply for, obtain approval, and receive a single user ID for accessing multiple CMS applications.

Existing PQRS IACS users, their data, and roles will be moved to EIDM and will be accessible from the ‘PQRS Portal’ portion of the CMS Enterprise Portal at  http://portal.cms.gov. Users will then access the PQRS Portal to submit data, retrieve submission reports, view feedback reports, or conduct various administrative and maintenance activities. New PQRS users will need to register for an EIDM account.

Stay tuned for more information and resources in the coming weeks and months! In the meantime, please ensure that your IACS account is active, current, and you’re able to log in. This will help ensure a smoother transition to EIDM.

For additional assistance regarding IACS or EIDM, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via email at qnetsupport@hcqis.org. To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.

Tuesday, February 24, 2015

Ensure ICD-10 Updates for Important EHR Templates

The follow article, written by Cathie Wilde pertains to any EHR that is "template driven".  As we approach (hopefully) adoption of ICD-10 codes, looking at how your templates are coded is one of those great first steps a practice can take to begin it's transition to ICD-10.

Published from ICD-10 monitor:

"Templates can either enhance documentation necessary for coding and data quality, or they can hinder things by restricting options and failing to prompt physicians to document specific information. However, templates cannot be overlooked when it comes to ICD-10. This is particularly true if a hospital relies more heavily on templates to capture structured data. Many hospitals may use templates for certain diagnoses, orders, or visit types and allow physicians to dictate information for everything else.
Regardless of a hospital’s specific use of templates, one point remains clear: the templates must be updated to accommodate the details necessary for ICD-10. At a minimum, these details include laterality, specificity, and etiology. The number of physicians who could be using a specific template at any given time — or even over a short period of time — could be significant. If one template is not updated correctly to accommodate ICD-10, data quality and reimbursement could be compromised.
Health information management (HIM) directors cannot assume that electronic health record (EHR) vendors will handle this effectively and in a timely manner. Instead, take the following steps to ensure that all updates will be made:

1. Take an inventory of all current templates in use. Are some of these templates used more frequently than others? Can any of them be retired if not in use? Ask for input from coders — what information is typically missing from the templates? Can you add or revise this information during the ICD-10 update? Work with your EHR vendor to make these changes before tackling ICD-10 updates.
2. Form a committee to address ICD-10 template updates. This committee, which can be a subcommittee of the ICD-10 implementation committee, should include coders, clinical documentation improvement (CDI) specialists, a physician champion, and an EHR representative. Compile a list of all diagnoses and procedures that require greater specificity in ICD-10 and cross-check this list with any templates that are in use. Ensure that each and every reference to these diagnoses and procedures is updated to accommodate ICD-10 specificity and other requirements.
3. Tie your template update efforts to your query update efforts. As CDI specialists review queries to ensure the implementation of updates for ICD-10, they can easily use this information to review templates in light of ICD-10 changes. If templates ultimately capture all of the relevant information that coders need, a query may not even be necessary.
4. Review templates after updates have been made. Set a deadline for all template updates to be completed. Then manually review each template to ensure that updates have been entered correctly.
5. Educate physicians. Physicians don’t need template-specific training; however, let physicians know that the updated templates exist when performing specialty-specific ICD-10 training. Reiterate that the templates exist to make physicians’ jobs easier by prompting them to document what’s necessary and pertinent to ICD-10 in the most concise way.

Clinical areas for review 
Consider focusing on the following templates that require new and more specific documentation in ICD-10:
Obstetrics-related templates
  • Specific trimester: The majority of codes in Chapter 15 (Pregnancy, Childbirth, and the Puerperium) feature a final character that indicates the trimester of the pregnancy. Assignment of this character is based on the provider’s documentation of the patient’s trimester during the admission/encounter. Templates should include the weeks of gestation at the time of admission and/or delivery.
  • Fetus identification: ICD-10 requires a seventh character to denote multiple gestations, when applicable. This character identifies the fetus for which the complication code applies. Templates should provide an option for this character.
  • Multiple gestation placenta status: ICD-10 features a combination code for multiple gestation and identification of the number of placentas and amniotic sacs. Templates should capture this information as well.
Trauma-related templates
  • Glascow coma scale: This scale denotes the degree of consciousness and is used commonly with head trauma cases. The score can function as an indicator for testing or treatment as well as predict the duration and outcome of the coma. Templates for head injuries should specifically include this information.
  • Gustilo classification: This classification applies to open fractures of the long bones, including the humerus, radius, ulna, femur, tibia, and fibula. The classification system groups open fractures into three main categories and three subcategories defined by these characteristics: mechanism of injury, extent of soft tissue damage, and degree of bone injury or involvement. Templates for open fractures should include this information.
  • Salter-Harris classification: This classification includes nine types of fractures that occur along the epiphyseal (growth) plates in bones that have not reached full maturity. With these types of fractures, plates are still open and filled with cartilaginous tissue. These fractures are common among children. Templates for these fractures should include information related to the Salter-Harris classification system. 
Wound-related templates
  • Severity: In addition to specific location and etiology of non-pressure skin ulcers, ICD-10 also requires physicians to document the severity of the ulcer as follows:
    • Limited to breakdown of skin
    • With fat layer exposed
    • With necrosis of muscle
    • With necrosis of bone
Any and all wound templates should include these designations. Pressure ulcer templates should continue to include the stage of the ulcer.
Nutrition templates
  • Obesity: In addition to the current body mass index documentation on nutrition orders/templates for obesity, ICD-10 includes additional codes for obesity due to excess calories, drug-induced obesity, and morbid obesity with alveolar hypoventilation. Templates should be updated to include these designations. "
About the Author
Cathie Wilde, RHIA, CCS, is the director of coding services for MRA. Ms. Wilde has been active in the healthcare industry for more than 30 years. Her previous positions have included assistant director of HIM, DRG coordinator at the Massachusetts Hospital Association, and DRG validator at Blue Cross Blue Shield. She has extensive experience in ICD-9-CM and CPT coding, auditing, data analysis, development and testing of coding products, specialized reporting, and in-service training. As director she is responsible for overseeing the coding division, providing the strategic direction of MRA as a local industry leader of quality coding, auditing, and denial management services. Ms. Wilde is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS trainer.

Friday, July 12, 2013

Four Steps to Successful Medisoft EMR Implementation

Four Steps to Successful Medisoft EMR Implementation

So you finally have decided that your practice needs Medisoft, the award winning EMR and medical billing solution. The only thing that remains is actually implementing the new electronic patient records into your practice workflow. If you search online, you’ll find dozens of articles giving you helpful tips in bite-size pieces on how to use your new Medisoft software, which would be handy if you wanted to implement your EMR in bite-size pieces. If you want to do things the right way, though, these four steps will help you implement Medisoft Clinical in a practical, meaningful way that interrupts your practice as little as possible.
In a nutshell:
-          Document Your Current Workflow
-          Communicate with your Staff and Patients
-          Watch Your Meaningful Use
-          Train Staff Continually
Workflow Documentation
The better you understand how your current workflow operates, the easier it will be to adapt to the new – and more efficient – workflow with Medisoft. Before you start implementation, take time to sketch out exactly how things work in your office. Where and how do patients check in? How do you record data? How does the data get to your admin staff and your billing provider? How are patients reminded of upcoming appointments? Once you have the workflow documented, you’ll understand what you’ll need to change and how the new workflow will affect your current practices.
Be an Information Leader
The most effective, most painless Medisoft implementations are the ones where the practitioners are information leaders. Communicate clearly to your staff about the migration, explaining how it will benefit each of them. Communicate your enthusiasm for the project. Keep your eyes on your staff to see who needs additional training and who grasps the basic concepts quickly. In addition, help your patients understand how your new electronic patient records will ensure better care for them and a better doctor-patient relationship for you both. If you choose to implement the Patient Portal, schedule some time during initial appointments after implementation to make sure they know how to access their information conveniently.
Keep on Top of Meaningful Use
Medisoft Clinical meets all the requirements and is certified for Meaningful Use incentives. If you’re participating in the initiative, stay on top of the record keeping and reporting. It’s important to follow the reporting in order to qualify for your payments, and, just as importantly, your reporting and data will help guide new policies in the use of electronic patient records.
Keep Learning
McKesson Medisoft has tons of features you probably won’t use immediately – but don’t relegate them to the trash heap. Keep learning the capabilities of the software and adopt the features that make the most sense for your practice.
Medisoft is the most affordable full-featured EMR for small and medium practices. Understanding how to implement it effectively can help you get a great start on using and benefiting from electronic patient records.

Tuesday, December 6, 2011

Must Knows about ANSI 5010

The Centers for Medicaid and Medicare Services (CMS) announced a 90-day extension for enforcing penalties on those physicians whom have not yet converted to ANSI 5010. This opportunity will serve for physicians to familiarize themselves with the conversion to ANSI 5010 until March 31st, 2012, before acquiring penalties. However, the sooner the conversion process begins, the fewer the incurred delays in receiving reimbursements and additional paperwork for the physician and practice to be impacted with

Minimize Cash Flow Interruptions

Converting to Version 5010 before December 31st, 2011, will save practices time and money.

"I'm betting that some organizations will think this means they don't have to implement HIPAA 5010 for another 90 days, but that would be wrong. Any claims or bills they submit after Jan 1, 2012, that are not in HIPAA 5010 will still get rejected, but this delay in enforcement will also allow them to resubmit in the appropriate HIPAA 5010 format without penalty," said AHIMA-certified coding trainer Pati Hildebrand. Practice.

The sooner the practice starts transitioning, the more time billing staff will have to work through the kinks and reduce claim rejection risks.

Transitioning to ANSI 5010 is Easy with Medisoft V17 sp2 Revenue Management

All of Medisoft V17 sp2 users will completely avoid any complications since Medisoft V17 revenue management has long been ANSI 5010 ready.

Physicians can prepare themselves for this change with Medisoft V17 sp2 highly rated customer support. Aside from hosting webinars in efforts to train physicians and staff on how to comply with Version 5010, Sunrise Services is offering services to set up physicians' 5010 EDI for their clearinghouses, a required part of Version 5010 compliance.

For more information on Revenue Management and the specialty-specific tailor made solutions, visit http://www.sunrize.com/ or give one of our sales specialist a call on our toll free number 888-880-0384.

Sunrise Services LLC

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Fax: 502-538-6853

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