Health information technology (HIT) is a rapidly expanding dimension of health care delivery. Physician practices are subject to government mandates but also are offered opportunities with the technology they use. Here are the active areas and steps that practices should take to succeed.
Meaningful Use of EHRs as Health Care Practices Prepare for Stage 2
Since 2011, the Center for Medicare and Medicaid Services, (CMS) has made incentive payments to hospitals and eligible professionals (EPs), including doctors, for their “meaningful use” of certified EHR technology to improve patient care. More than half of physicians have qualified for payments under Stage 1 and are gearing up for Stage 2.
Thresholds for many of the existing meaningful use requirements have been raised and new requirements have been added. For example, practices must enable at least 50% of their patients to view, transmit and download their health information online and more than 5% must actually do so. Practices also must communicate with more than 5% of their patients through secure electronic messaging.
Practice managers should check with system vendors to ensure that software will be updated in time to accommodate Stage 2 requirements and work with vendors to decide how to re-engineer work processes and patient flows to satisfy the requirements.
HIPAA Security Risk Analyses
Stage 1 and Stage 2 of the EHR incentive program require that practices “conduct or review a security risk analysis.” Plus, under Stage 2, they must examine the security of data they collect and store, implement regular updates and correct identified security deficiencies. A common reason for a breakdown of a CMS meaningful use audit is failing to conduct a proper security risk analysis — a key requirement of the HIPAA Security Rule.
It is possible that the Office for Civil Rights (within the CMS) will be enforcing these requirements more rigorously going forward, so practices should redouble their efforts to monitor and maintain data security protection activities. In March 2014, the Department of Health and Human Services released a new security risk assessment tool designed specifically for small to medium-size practices. You can find it at http://healthit.gov/providers-professionals/security-risk-assessment.
Practice Administrative Simplification
Beginning this year, payers must offer physician practices electronic funds transfer (EFT) and more durable electronic remittance advice (ERA) transactions. These improvements will simplify tasks associated with paper check remittances.
Further simplification in EFT enrollment is possible through a module developed by the Council for Affordable Quality Healthcare (http://www.caqh.org). It allows practices to submit EFT information once and authorize multiple payers to access it. On the patient payments side, procedures for insurance eligibility verification are already in place so practices can check patient service and financial responsibility in less than a minute.
To take advantage of these new measures, review current revenue cycle workflow, determine where further automation would be a benefit, assess the capabilities of the current practice management system and decide whether upgrades in system software or hardware are warranted.
The health care industry was scheduled to transition to a new ICD-10 procedure coding system on Oct. 1, 2014. Although that deadline has been postponed for one year, the consensus is that practices should work aggressively for the changeover from ICD-9. Here are some steps you should address soon:
- Identify processes and systems impacted by ICD-10.
- Negotiate with system vendors for solutions to identified problems.
- Calculate an implementation budget.
- Train administrative and clinical staff on the effects of the transition on their roles in the revenue cycle.
- Educate staff on documentation changes required of them.
- Conduct trial runs of coded claims with payers and clearinghouses.
- Draft a contingency plan that anticipates unprepared vendors and clearinghouses, reduced clinician and coder productivity and increased claims pending or denied.
The plan should contemplate the technology, staffing and financial effects of these issues.
One of our Health Care Group specialists can help you sort through the myriad of regulations as your practice moves on to Stage 2 and its new standards. For questions, contact ORBA Director Bob Rifkin at 312.670.7444. Visit orba.com to learn more about our Health Care Group.