2015 Provider Enrollment Application Fee Effective 1/1/2015 Through 12/31/2015

Institutional providers (i.e., all providers except physicians, nonphysician practitioners, physician group practices, and nonphysician practitioner group practices) must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment; or adding a new Medicare practice location.

  • CY 2015 fee of $553 is required with any Medicare enrollment application submitted 1/1/2015 through 12/31/2015

For background information, click here.

Tiptastic Tuesday: 5 Ways To Improve The Patient Experience

Healthcare organizations are constantly seeking new ways to improve the patient experience. To help providers achieve this goal, here are few strategies you and your staff can implement:

  1. Ensure the patient feels respected during their visit. Let them know their views and opinions are valued.
  2. Become an active listener and elicit patient concerns. Patients and doctors often do not understand/agree on the main problem. Take the time and learn to listen to your patients.
  3. Communicate clearly and in a way the patient understands. Patient healthcare literacy averages at the 8th grade level, according to experts. Physicians must communicate in a manner that the patient will understand.
  4. Work with the patient to identify needs and then set up mutually agreed upon goals. Help your patients see the benefits of behavior changes and make sure to set small, attainable goals.
  5. Take the time to learn new approaches on how to engage patients. Often times, physicians have very little communication training. Find educational programs to help teach you and your staff on how to better communicate.

Click here to read more.

Doctors Will Face Medicaid Cuts As Fee Boost Ends

Primary care doctors caring for Medicaid patients may see steep fee cuts next year as a temporary program in the health law expires, reducing access for millions of new patients. A new study from the Urban Institute estimates fee reductions will average about 40 percent nationwide, but could reach 50 percent or more for primary care doctors in certain states. These states include California, New York, New Jersey, and Illinois-all states that have expanded Medicaid under the ACA. Low pay for doctors is an issue for Medicaid because it reduces access to primary care for low-income patients.  In 2013 and 2014, the ACA increased Medicaid fees for primary care doctors in order to increase access. However, the boost is set to expire on January 1, and any efforts to extend it do not look promising. Experts say most doctors will not have to stop seeing their current Medicaid patients, but it may affect them accepting new ones. Despite the uncertain future of fee increases, fifteen states are planning to use their own money to continue to pay higher Medicaid feeds through 2015.

Click here to read more.

EHR Incentive Program Blog Series Part I: Meaningful Use

The CMS EHR Incentive Program requires that the EHR you use and the information you submit meet the requirements of the EHR Incentive Program. So, what are these requirements? To receive an EHR incentive payment, providers must show they are “meaningfully using” their EHRs by meeting thresholds for a number of objectives. CMS has established the objectives for “meaningful use” that everyone must meet to receive an incentive payment. In other words, it’s not enough just to own a certified EHR. Providers must show CMS that they are using their EHRs in ways that positively affect the care of their patients.

In order to demonstrate “meaningful use,” providers need an EHR that stores data in a structured format. Structured data allows data to be easily retrieved and transferred, and it also allows the provider to use the EHR in ways that can aid patient care. For more information about certified EHR technology, click here. You can also find a complete list of certified EHR technology at the Certfied Health IT Product List (CHPL) website. Click here to see it.

CMS released a final rule in August 2014 that grants flexibility to providers who are unable to fully implement 2014 Edition Certified EHR Technology (CEHRT) for an EHR reporting period in 2014 due to delays in 2014 CEHRT availability. Click here to see more detailed information about the requirements for Stage 1 and Stage 2 from CMS.



CMS Releases New Proposal To Improve ACOs

CMS recently released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) by placing greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. CMS is seeking to continue this dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs. The proposed rule is part of CMS’ continued commitment to reward value and care coordination, rather than volume and care duplication. CMS encourages doctors, hospitals and other healthcare providers to work together to better coordinate care, which can ultimately reduce healthcare costs and improve outcomes.

Click here to read more from CMS.

EHR Incentive Program Blog Series: An Introduction

During the month of December, HMS Healthcare Management Solutions, Inc. will kick off our latest blog series on the EHR Incentive Program for certain healthcare providers. In this introduction, we’ll provide background information on the CMS program.

The EHR Incentive Program provides incentive payments for certain healthcare providers that use EHR technology in ways that positively affect patient care. An electronic health record (EHR), sometimes called an electronic medical record (EMR), allows providers to record patient information electronically instead of relying on paper records. It’s important to note that EHRs are capable of doing more than recording information. The EHR Incentive Program asks providers to use the capabilities to achieve benchmarks that can lead to improved patient care. However, it is not an reimbursement program for purchasing or replacing an EHR and providers must meet specific requirements in order to receive incentive payments.

Stay tuned to the HMS blog as we delve deeper into the EHR Incentive Program, its requirements and its impact on providers.

ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready Part I

This installment of the ICD-10 implementation blog series will take a look how providers can start preparing to ensure they’re ready for the switch on October 1, 2015.

Most providers around the country do not have a formal plan for transition and instead rely entirely on their staff or their EHRs to handle the transition to ICD-10. Neither of these are good ideas. Because the ICD-10 code set is much larger and more complex than the ICD-9 coding set, it will introduce thousands of new codes. These codes will often times be longer because ICD-10 uses combination codes to classify such things as multiple diagnoses or a diagnosis with a complication. In order to understand the additional specificity of the ICD-10 codes, providers and their coders will need to understand how to effectively search for and select the proper code.

How can you do this? We advise providers to develop an implementation strategy that includes an assessment of the impact on your organization. Start by determining timelines and budget. Try to schedule time every month to work on it with your staff. Staff includes anyone in your organization who collects, produces, uses, or reports diagnosis codes.

Next, identify the systems and applications in your organization that will be affected. This will be any piece of software that uses ICD-9 codes. Start by tracking a patient’s encounter with the staff and examine every step from the scheduling to examination to billing. Find out what ICD-10 codes will be needed. This way, you’ll become familiar with the new codes when they’ll be used. Also, begin learning the codes relevant to your specialty and make a list of other codes you regularly use.

In addition to preparing internally, ask your payers and vendors about their ICD-10 readiness timelines. This will help you set up a thorough ICD-10 assessment you can build on in the months leading up to implementation.

Stay tuned to the ICD-10 Implementation Is Less Than A Year Away: What You Need To Be Ready series as we look at other components of ICD-10 preparation.