In 1979, Irwin Press, PhD focused his interest on the modern patient experience, the study of which would lead him to become known as a patient satisfaction expert. In 1984, Dr. Press introduced the importance of survey methodology when establishing a patient satisfaction program and by early 1985, he had developed a survey that would measure patient satisfaction as a means to improve performance. To address the need for statistical analysis and survey methodology, he collaborated with Rod Ganey, PhD and together, the two formed Press Ganey Associates in 1985.

According to their website, today Press Ganey “partners with more than 10,000 health care organizations worldwide to create and sustain high performing organizations, and, ultimately, improve the overall health care experience. Press Ganey works with clients from across the continuum of care – hospitals, medical practices, home care agencies and other providers – including 50% of all U.S. hospitals.”

The Press Ganey Pulse Report is an annual report which collates research and analysis of public and proprietary data and the perspectives of patients, employees and physicians to uncover trends in healthcare. The 2011 report reveals:

“The top priority item for medical practices is sensitivity to patient needs, indicating a need for medical practices to personalize their interactions with every patient.”

The remaining top-priority items for medical practices all reference patient satisfaction with the care provider, and include:

• Physicians and medical practices need to serve the “whole” patient.
• Physicians and medical practices need to understand a patient’s culture, the relationship with a patient’s family or caregivers, and the unique communication needs of individual patients.
• Physicians and medical practices need to validate patient concerns and confirm comprehension, which are critical to ensuring compliance with treatment protocols, and also increases the likelihood for better outcomes and greater patient satisfaction.

The report also has some pretty fascinating information on the Overall Satisfaction in Top 25 Medical Practice Specialties (!) and Medical Practice Satisfaction by Waiting Times. Press Ganey outpatient questions are answered by over 3 million people annually over the course of 12 months. You can download the 2011 Press Ganey Pulse Report here.

Press Ganey also has other free resources available on their site:

Improving Health Care Blog

For Medical Practices and Outpatient Facilities – case studies, recorded webinars, ROI resources and White Papers here

For Hospitals – case studies, Pulse Reports, Emergency Department resources, recorded webinars, ROI resources and White Papers here

For Home Care -case studies, recorded webinars, ROI resources and White Papers  here

Government Initiatives for Public Reporting – including the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, and Meaningful Use and Value-based Purchasing here

You thought the individual would be a self-starter, but you found yourself having to give constant direction. Perhaps you needed someone with excellent customer service skills, and received complaints about the individual’s attitude and behavior.

One explanation for this dilemma can be found in the book “Now Discover Your Strengths” by Buckingham and Clifton. The authors differentiate between knowledge, skills, and talents. Talents are innate, whereas skills and knowledge can be acquired through learning and practice. You don’t teach someone to be a self-starter, no more than you teach someone to have a talent for empathy. This is why even after providing training on assertiveness skills, or how to provide excellent customer service, we don’t see much improvement or any at all.

I learned this lesson many years ago from a mentor named Bill.  Bill was Vice President of Distribution and an excellent talent scout.  During an off-site management retreat, Bill introduced his new warehouse supervisor. Bill explained that what he needed for this position was someone who has excellent communication skills, is decisive, and assumes accountability. Bill explained that he found the new warehouse supervisor in his health club. He had observed over several months how this individual communicated with others, the respect he was shown, and how he thought about resolving problems. Some of you might be thinking – “He found a manager while working out?”  The point Bill was making is that he knew that he can provide the knowledge and skills required to be a warehouse supervisor, but he needed the talent to lead. I remember the day Bill asked me to move from the position of Quality Circle Facilitator (a staff position) to Customer Service Manager (with 30 direct reports). I said “Bill, I don’t know this operation, and I have never held a management position – why did you select me?” He looked me in the eye and said “Bob, people believe in you, and will follow you. You will learn the departmental functions, I can’t teach what you have.”

The point in sharing these stories from Bill is this – you must think about your hiring and promotional decisions very carefully. If you focus primarily on knowledge and skills which can be taught, and overlook an individuals talent, you can find yourself regretting the decision.

How do you find talent?

One strategy is to use behavioral-based interviews to assess whether or not this person has the talent you need. For example, if you require someone who is decisive, you might tailor your questions toward asking the candidate to discuss difficult decisions they had to make, and how they went about it. You might need to follow-up by asking for specifics.  If empathy is an important talent, you might ask the individual to describe specific situations where a customer was very upset, and how they handled the situation. Pay close attention to how they describe the situation, and whether you get a sense that they fully connect with the importance of empathy. Although this is not an exact science, it puts the focus of your interview on the most important area – talent. We often make the mistake of looking at a resume and being overly impressed with the individual’s accomplishments. The real question is – how did they go about getting the job done? Are they consensus builders? Do they build strong teams? How did they overcome obstacles? Did they develop a successor? With an internal candidate, don’t make the mistake of promoting someone who has good technical skills and poor interpersonal skills, with the hope that they will learn to deal more effectively with others. Identify the talents needed for the role, and determine if this individual “owns” this or not. Don’t try to train them to be strategic, or nice, or anything else. They are who they are, and that’s OK. Select individuals who demonstrate on an ongoing basis the talents needed for success.

You might not find your next manager in a health club, but leaders should always pay attention to an individual’s talents.

Our role as leaders is to build on people’s strengths, not placing too much attention on improving weaknesses. Place individuals in jobs that allow them to leverage their strengths. If someone loves dealing with customers, and has a natural ability to do so, don’t put them in the back office. If someone doesn’t deal well with others, don’t force them into a position where they need to build consensus, and then be disappointed when it doesn’t happen.

I encourage you to use peer-interviewing as a strategy to find a good fit for a position. The person being hired will need to work well with colleagues, so why not engage the colleagues in the selection process. Teach your staff to also be talent scouts.

An organization is only as good as its people. Being a good talent scout is a competitive advantage. You build customer and staff loyalty, reduce turnover and the associated recruitment expenses, and build a winning team for the future.

Always be on the look out for talent, it’s always around you.

For a complete listing of our services, please visit us at www.rlcooperassoc.com

Bob Cooper
President
RL Cooper Associates
(845) 639-1741
www.rlcooperassoc.com
Innovations in Organizational Management

We hope you enjoy looking ahead with us, and share your ideas, reactions and comments below!

• Natural Language Processing Advances Allow for Improved Insight into Public Health

Writing for KevinMD, Jaan Sidorov, author of the Disease Management Care Blog highlights several examples of how Natural Language Processing- the idea of teaching computer programs to understand the relationship between words in human speech (teaching them to not just hear us, but understand us- like Watson understood the clues on Jeopardy) is being be applied to the Electronic Health Record to predict and prepare for public health trends, as well as to correct mistakes present in the electronic record due to human error. Recent developments like the CDC’s Biosense program allow public health officials at local, state and federal levels to monitor big picture trends in public health by the words and diagnoses reported in medical documentation- keeping an ear on health trends, by “listening” to data about reported health incidents.

• 10 Best Practices for Implementing Telemedicine in Hospitals

Sabrina Rodak at Becker Orthopedic, Spine and Pain Management has put together a fantastic list of the steps and assessments involved in implementing a telemedicine program in a hospital setting. Although written with Orthopods in mind, the questions that need to be answered, and the steps that need to be taken to develop a strong, lasting program are similar across many different programs and specialties. With so much excitement in the field, it is very nice to see someone talk about the process of taking these technologies from drawing board excitement to nuts-and-bolts execution.

(via FierceHealthIT)

• San Diego Health System Seeks to Develop Single App to Access Any EMR

Presenting at a Toronto Mobile Healthcare Summit Last Week, Dr. Benjamin Kanter, CIO of Palomar Pomerado Health presented the two-hospital system’s plans to develop their own native mobile application to view as many different Electronic Medical Records as possible from a single mobile interface. In other words, this fairly small health system, who has only devoted three employees to the project, is taking on one of the biggest, and toughest challenges in HIT by simply saying “We can do it ourselves!”, and from some of the reactions from the conference attendees who saw the presentation, they are off to quite a strong start. The first version of the program should launch for Android in March, and the system already has a deal in place with vendor Cerner to access their systems. Stay tuned!

(via ITWorldCanada)

Be sure to check back soon for another 2.0 Tuesday!

As healthcare embraces technology to improve patient outcomes, streamline operations, and lower costs, the technologies with the most impact are the ones that Make Things Simpler.

One of the most basic ways to simplify a complex process to is remove friction

The electronic medical record removes the friction of paper records – finding, handling, storing, and securing them – all the things that can get between the critical information on the page and the physician who needs it. A smartphone removes the friction of needing to be near a desktop to read and send email, get contact information, and securely access practice and hospital documents and patient data. This technology provides value by simplifying a process to its core so that time, effort and resources are not wasted on mishaps, transportation, and basic human inertia.

Now, think about your practice’s web content: the basic information and elevator pitch about your services that you want to communicate to existing and future patients. Your content is the reason you have a website in the first place and you should always be looking for ways to get eyeballs in front of it. Email lists, Facebook and Twitter, direct mail and practice brochures are all designed to connect people with your content to drive business to your practice. If someone sees a link to your content while they’re at their computer, then the only friction you’ll encounter is getting them to click to go to your page.

But what about all the mobile time your potential customers spend?

If they see an advertisement – TV, billboard, print – that has the URL (web address) you want to send them to, they will have to bypass a lot of potential friction before they see your content. They have to:

• Commit to going to the website later
• Remember the URL, and why they wanted to go to in the first place
• Follow through with this commitment and remember how and why they wanted to go to the page
• Type the URL into a browser

With social media and email campaigns that are usually accessed through internet enabled PCs or mobile devices, a simple link enables you to bypass all of this potential friction because there’s a fairly good chance that your customer will either click the link immediately, or possibly bookmark it to check it out later (enabling a much easier recall). But with print, public, and televised advertising campaigns the odds are the customer doesn’t have either:

1. An internet enabled device on them at the moment, or
2. The time or inclination to check out the website immediately- and if they did, they would encounter more friction typing the address into their mobile.

So how can you overcome this friction, and get the benefits of the simplicity of a link in a “real world” marketing situation? One way is with Quick Response (QR) codes.

A QR code is a two-dimensional barcode that can be quickly and easily read by a fairly simple piece of software to communicate a piece of information: text, or a phone number or other contact information, or a web address to direct a phone’s web browser. Most of the QR Codes themselves are a small jumble of black and white pixelated dots that sort of resemble a “digital bacteria” or some sort of computer life form. But in many ways, Quick Response (or QR) codes are like hyperlinks that exist in our physical lives. By installing a small program on your phone, and then taking a picture of the code with your phone, you can immediately access the information embedded within.

• See a newspaper ad about a sale at one of your favorite stores, and scan the QR code to get a link to a coupon for an additional discount, or to register to be told about other upcoming sales.
• See a TV commercial about a new restaurant, where scanning the code on TV leads your phone to a website to make reservations for dinner, or receive a special two-for-one deal.
• See a poster at a health fair booth and scan the QR code to get an instant calculator app that gives you easy exercise options for someone your age with your level of physical fitness.

By removing the friction of telling someone about web content without giving them the ability to access it automatically, QR Codes lubricate the entire person education process. A QR Code on a brochure can facilitate initial contact with the patient by sending them to a website to get more information, or book an appointment, whereas a phone number to call with more info, or even just the practice’s web address means a patient is left to go the rest of the way on their own. On top of that, a QR code is a simple and effective way to improve your image as an organization on both a technical and user friendly front, and QR codes are flexible enough to handle a lot of different applications in your practice:

• Flyers about annual checkup services: (blood pressure, weight management, mammograms) that your patients see as they leave (often when most motivated to seek additional services) can include links to more information (general info sites, government warnings, approved resource sites, treatment communities) or redirect to content on your site or blog.
• Advertisements for surgical procedures and contain codes to access before and after pictures and patient testimonials, or to a landing page to submit requests for more information.

By streamlining the process of fulfilling a patient’s request to “tell me more”, QR Codes give practices an easy (and did I mention free) way to build relationships, influence patient health choices and outcomes, direct patients to the content you choose for them, and even send the message that your practice is on the leading edge of technology.

Five steps to start using QR codes in your practice right away

1. Decide how QR Codes fit into your overall marketing and education effort. Which real-world situations do you want to link to web content?
2. Setting up a QR plan doesn’t have to involve a big up-front expense. Use free programs like Kaywa (http://qrcode.kaywa.com/) to generate codes for your campaigns, and free readers like i-nigma for iPhone (http://itunes.apple.com/us/app/i-nigma-4-qr-datamatrix-barcode/id388923203?mt=8) and QRDroid for Android (https://market.android.com/details?id=la.droid.qr) to get started right away
3. Think carefully about where you place the codes themselves. You want people to have access to the info, without making the code itself the center of the message. The code is the link to more, not the point of the marketing effort. And make sure people can see and frame the code easily enough that they don’t struggle to scan it. Don’t add friction now!
4. Don’t assume everyone knows what the code is, or what to do with it. Give them a clear call to action, complete with instructions. “Scan this code with a QR reader to receive (learn more, find out, book now…)”
5. Make sure the payoff at the other end of the code is worth the effort. Give them some real value for their scan. It could be a discount, it could be exclusive, valuable, it could be a frictionless way to make an appointment with you (win-win!), but don’t have people scan  if the effort won’t be rewarded with real value.

e-RX: Medicare e-prescribing hardship exemptions under review (jump to story)

EFT: suppliers and providers who are not currently receiving Medicare EFT payments are required to submit the CMS-588 EFT form (jump to story)

SNFs: Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications (jump to story)

ACA: the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception. (jump to story)

EHR Incentive Program: what can still be completed in 2012 in order to receive an incentive payment for CY2011 (jump to story)

5010: National Provider Call:  Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions (jump to story)

Claims Crossovers: Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over(jump to story)

ICD-10: What’s Your Plan, Man?(jump to story)

MLN: Medicare Learning Network Announcements, Updates and Revisions (jump to story)
——————————

Medicare e-prescribing hardship exemptions under review

Last fall, physicians had the opportunity to seek hardship exemptions and avoid penalties for failing to successfully participate in Medicare’s e-prescribing program. The Centers for Medicare & Medicaid Services (CMS) is reviewing each hardship exemption request on an individual basis and has not yet completed its analysis. Therefore, it is possible that some physicians will be subjected to a 1 percent Medicare payment penalty inappropriately until the backlog of exemption requests is reviewed. Ultimately, CMS will reprocess the claims.

Read information regarding remittance advice and information on the impact to physician reimbursement and patient copays. More information on the penalty program can be found here.

Find additional electronic prescribing information and resources on the AMA website.

(Top)

——————————–

The ACA (Affordable Care Act) Mandates Federal Payment to Providers and Suppliers Only by Electronic Means

Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request, or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT).  Section 1104 of the Affordable Care Act further expands Section 1862(a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.  As part of CMS’s revalidation efforts, all suppliers and providers who are not currently receiving EFT payments are required to submit the CMS-588 EFT form with the Provider Enrollment Revalidation application, or at the time any change is being made to the provider enrollment record by the provider or supplier, or delegated official.

For more information about provider enrollment revalidation, review the Medicare Learning Network’s Special Edition Article #SE1126, titled “Further Details on the Revalidation of Provider Enrollment Information.”

(Top)

——————————–

Allowing Physician Assistants to Perform Skilled Nursing Facility (SNF) Level of Care Certifications and Recertifications

http://www.cms.gov/MLNMattersArticles/Downloads/MM7701.pdf

(Top)

——————————–

A Statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius

In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible.  The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicine’s recommended preventive services, including all FDA -approved forms of contraception.  Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesn’t include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.

After evaluating comments, we have decided to add an additional element to the final rule. Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law. Employers wishing to take advantage of the additional year must certify that they qualify for the delayed implementation. This additional year will allow these organizations more time and flexibility to adapt to this new rule.  We intend to require employers that do not offer coverage of contraceptive services to provide notice to employees, which will also state that contraceptive services are available at sites such as community health centers, public clinics, and hospitals with income-based support.  We will continue to work closely with religious groups during this transitional period to discuss their concerns.

Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women. This rule will provide women with greater access to contraception by requiring coverage and by prohibiting cost sharing.

This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services. The administration remains fully committed to its partnerships with faith-based organizations, which promote healthy communities and serve the common good.  And this final rule will have no impact on the protections that existing conscience laws and regulations give to health care providers.

(Top)

———————————

Receiving an EHR Incentive Program Payment for CY2011

As 2012 begins, CMS wants to remind eligible professionals (EPs) participating in the Medicare Electronic Health Record (EHR) Incentive Program of important deadlines approaching and what can still be completed in 2012 in order to receive an incentive payment for CY2011.

Important Medicare EHR Incentive Program Dates

On Saturday, December 31, 2011, the reporting year ended for EPs who participated in the Medicare EHR Incentive Program in 2011.  What does this mean?  For participating EPs, they must have completed their 90-day reporting period by the end of 2011.

However, EPs have until Wednesday, February 29, 2012 to actually register and attest to meeting meaningful use to receive an incentive payment for CY2011 through the Medicare & Medicaid EHR Incentive Program Registration and Attestation System.

Payment Threshold Information
Wednesday, February 29, 2012 is also the deadline for EPs to submit any pending Medicare Part B claims from CY2011, as CMS allows 60 days after Saturday, December 31, 2011 for all pending claims to be processed.  This means that EPs have 60 days in 2012 to submit claims for allowed charges incurred in 2011.

Medicare EHR incentive payments to EPs are based on 75% of the Part B allowed charges for covered professional services furnished by the EP during the entire payment year.  If the EP did not meet the $24,000 threshold in Part B allowed charges by the end of CY2011, CMS expects to issue an incentive payment for the EP in April 2012 for 75% of the EP’s Part B charges from 2011.

Note for Medicaid Participants:  Medicaid incentives will be paid by the states, but the timing will vary according to state.  Please contact your State Medicaid Agency for more details about payment.

Want more information about the EHR Incentive Programs?  Visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

(Top)

——————————–

National Provider Call:  Medicare FFS Implementation of HIPAA Version 5010 and D.0 Transactions – Register Now

Wednesday, January 25, 2012, 2-3:30pm ET

CMS will host a special National Provider Call regarding the Medicare FFS implementation of HIPAA Version 5010 and D.0 transaction standards.

Target Audience:  Vendors, clearinghouses, and providers who need to make Medicare FFS-specific changes in compliance with HIPAA Version 5010 requirements.

Agenda (there will be no slide presentation for this call):

• HIPAA Version 5010 implementation update

• Question & answer session

If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to the 5010 FFS Information resource mailbox at 5010FFSinfo@CMS.hhs.gov.  Note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.

Registration Information:  In order to receive the call-in information, you must register for the call.  Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.  For more details, including instructions on registering for the call, please visit http://www.eventsvc.com/blhtechnologies.

(Top)

———————————

Greater instances of Medicare correspondence letters that make reference to error N22226 as the basis for patient claims not crossing over

On Monday, December 5, 2011, CMS issued a Special Edition MLN Matters Article (SE1137) entitled “Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process.”  CMS issued this guidance for the benefit of physicians/practitioners, providers, and suppliers to help them understand why they were seeing greater instances of Medicare correspondence letters that made reference to error N22226 as the basis for why their patients’ claims could not be crossed over.

CMS has since learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 or National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats or NCPDP D.0 batch claim formats.  This is not true.

During the 90-day Version 5010 non-enforcement period (Sunday, January 1, 2012 through Saturday, March 31, 2012), Medicare will have the systematic capability to perform up- or down-version conversion of incoming claim formats (ie. convert incoming hardcopy formats to HIPAA equivalent claim formats and convert incoming version 4010A1 claim formats to 5010 formats and vice-a-versa), in accordance with external supplemental payer specifications concerning production claims format.  This practice will discontinue, however, at the conclusion of the 90-day non-enforcement period, with the exception below.  (This action is controlled by information that the Common Working File receives concerning individual supplemental payers’ ability to accept HIPAA 5010 or NCPDP D.0 claim formats in “production” mode.)

Note that physicians/practitioners, providers, and suppliers that have authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes.  This is true at all times, not just during the 90-day non-enforcement period.

(Top)

———————————-

What’s Your Plan, Man?

Is your organization preparing for a smooth transition to ICD-10 on Tuesday, October 1, 2013?  ICD-10 National Provider Calls, hosted by the CMS Provider Communications Group, can help you prepare for the US healthcare industry’s change from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding.

Video slideshow presentations from the following National Provider Calls are available on the CMS YouTube Channel.  These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session.

• ICD-10 Implementation Strategies and Planning – Thursday, November 17, 2011

The ICD-9-CM and ICD-10 Cooperating Parties – CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) – discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011.

• ICD-10 Implementation Strategies for Physicians – Wednesday, August 3, 2011

CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers.

• CMS ICD-10 Conversion Activities – Wednesday, May 18, 2011

CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs).

Podcasts, complete audio files, and complete written transcripts for these ICD-10 National Provider Calls are also available on the CMS ICD-10 webpage at http://www.CMS.gov/ICD10/Tel10/list.asp.

Available 24/7, YouTube video presentations and podcasts make learning about the ICD-10 transition easy and convenient. Check them out today.

(Top)

——————————–

Medicare Learning Network Announcements, Updates and Revisions

From the MLN:  “Health Professional Shortage Area Bonus Payment Policy Reminders” MLN Matters Article Released – A new MLN Matters® Special Edition Article #SE1202, “Health Professional Shortage Area (HPSA) Bonus Payment Policy Reminders,” has been released in downloadable format.  This article is designed to provide education on the HPSA Bonus Payment Program, and provides information about the program and resources that providers can use to determine whether they are eligible to receive the bonus payment.

From the MLN:  New “Medicare Coverage of Radiology and Other Diagnostic Services” Fact Sheet Released - A new “Medicare Coverage of Radiology and Other Diagnostic Services” fact sheet (ICN 907164) has been released in downloadable format.  This fact sheet is designed to provide education on Medicare coverage and billing information for radiology and other diagnostic services, and includes specific information concerning billing and coding requirements and an overview of coverage guidelines.

From the MLN:  New Fast Fact on MLN Provider Compliance Webpage – A new fast fact is now available on the MLN Provider Compliance webpage.  This page provides the latest educational products designed to help Medicare Fee-For-Service providers understand – and avoid – common billing errors and other improper activities.  Please bookmark this page and check back often as a new fast fact is added each month!

From the MLN:  “Acute Care Hospital Inpatient Prospective Payment System” Fact Sheet Revised – The “Acute Care Hospital Inpatient Prospective Payment System” fact sheet (ICN 006815) has been revised and is available in downloadable format.  This fact sheet includes information on payment background, the basis for the Acute Care Hospital Inpatient Prospective Payment System payment, payment rates, and how payment rates are set.

From the MLN:  “Items and Services That Are Not Covered Under the Medicare Program” Booklet and “Medicare Claim Submission Guidelines” Fact Sheet Now Available in Hardcopy – The “Items and Services That Are Not Covered Under the Medicare Program” booklet (ICN 906765), available now in hardcopy, includes information about the four categories of items and services that are not covered under the Medicare program and applicable exceptions to exclusions and the Advance Beneficiary Notice of Noncoverage.

The “Medicare Claim Submission Guidelines” fact sheet (ICN 906764), available now in hardcopy as well, includes information about applying for a National Provider Identifier and enrolling in the Medicare program, filing Medicare claims, and private contracts with Medicare beneficiaries.

From the MLN:  “Medicare Claim Review Programs” Booklet Revised – The revised “Medicare Claim Review Programs: MR, NCCI Edits, MUEs, CERT, and RAC” booklet (ICN 006973) is designed to provide education on the different CMS claim review programs and assist providers in reducing payment errors, including, in particular, coverage and coding errors.  It includes frequently asked questions, resources, and an overview of the various programs, including Medical Review, Recovery Audit Contractor, and the Comprehensive Error Rate Testing Program.

From the MLN:  “Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT)” Fact Sheet Revised – This revised “Substance (Other Than Tobacco) Abuse Structured Assessment and Brief Intervention (SBIRT)” fact sheet (ICN 904084) is designed to provide education on SBIRT, an early intervention approach that targets those with nondependent substance use to provide effective strategies for intervention prior to the need for more extensive or specialized treatment.

From the MLN:  “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Article Released – The new “Non-Specific Procedure Code Description Requirement for HIPAA Version 5010 Claims” MLN Matters Special Edition Article (#SE1138) is designed to provide education on the requirements for non-specific procedure codes for HIPAA 5010 claims, as established in Change Request 7392.  It includes guidance to help providers comply with the requirements and submit HIPPA-compliant claims for all non-specific procedure codes.

From the MLN:  “Federally Qualified Health Center” Fact Sheet Revised – The revised “Federally Qualified Health Center” fact sheet (ICN 006397) includes the following information: background; FQHC designation; covered FQHC services; FQHC preventive primary services that are not covered; FQHC Prospective Payment System; FQHC payments; and Medicare Prescription Drug, Improvement, and Modernization Act of 2003 provisions that impact FQHCs.

From the MLN:  Medicare Preventive Services Series: Part 2, Web-Based-Training Course (WBT) Revised – This WBT is designed to provide education on Medicare Preventive Services.  It includes information on Medicare’s coverage for the initial preventive physical exam (IPPE), ultrasound screening for abdominal aortic aneurysm (AAA), screening electrocardiogram (EKG), Annual Wellness Visit (AWV), cardiovascular screening blood tests, diabetes-related services, human immunodeficiency virus (HIV) screening and smoking and tobacco-use cessation counseling services. To access the WBT, visit the MLN Products page, scroll to the “Related Links Inside CMS,” and select the “Web-Based Training (WBT) Courses.”

From the MLN:  MLN Guided Pathways (Basic, A, and B) Provider-specific Resource Booklets Revised – The revised MLN Guided Pathways curriculum is designed to allow learners to easily identify and select resources by clicking on topics of interest.  The curriculum begins with basic knowledge for all providers and then branches to information for either those enrolling on the 855B, I, and S forms or on the 855A form (or Internet-based PECOS equivalents).  The resource booklets are:

• MLN Guided Pathways to Medicare Resources – Basic Curriculum for Health Care Professionals, Suppliers, and Providers
• MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Providers (Part A)
• MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Professionals and Suppliers (Part B)

From the MLN:  “MLN Guided Pathways Provider-specific” Resource Booklet Revised – The Revised MLN Guided Pathways to Medicare Resources provider-specific resource booklet provides various specialties of healthcare professionals, (physicians, chiropractors, optometrists, podiatrists), nurses (APN, RNCNS, NP, Midwife) PAs, social workers, psychologists, therapists (OT, PT, SLP), dietitians, nutritionists, suppliers (ambulance, ASC, DMEPOS, FQHC, RHC, Labs, mammography, radiation therapy, portable x-ray), and providers (CMHC, CORF, ESRD, HHA, hospice, OPT, pathology and SNF) with resources specific to their specialty including Internet-Only Manuals (IOMs), Medicare Learning Network^® publications, CMS webpages, and more.  This version includes the addition of pathways for Anesthesiology Assistant/Certified Registered Nurse Anesthetist, Anesthesiologist, Ophthalmologist, and Optometrist, along with a fully developed pathway for Mass Immunization Roster Biller.

All of the MLN Guided Pathways booklets above are available at http://www.CMS.gov/MLNEdWebGuide/30_Guided_Pathways.asp.

From the MLN: “Preventive Services Educational Resources for Health Care Professionals” MLN Matters® Article Released – The new “Preventive Services Educational Resources for Health Care Professionals” MLN Matters® Special Edition Article (#SE1142) is designed to provide education on available educational resources related to Medicare-covered preventive services.  It includes a list of MLN products that can help Medicare FFS providers understand coverage, coding, reimbursement, and billing requirements related to these services.

From the MLN:  “Advanced Payment Accountable Care Organization Model” Fact Sheet Available - The new “Advanced Payment Accountable Care Organization Model” fact sheet (ICN 907403) is designed to provide education on the advance payment model for Accountable Care Organizations (ACOs).  It includes a summary of the Advance Payment ACO Model, background, and information on the structure of payments, recoupment of advance payments, eligibility, and the application process.

From the MLN:  “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” Fact Sheet Available – The new “Summary of Final Rule Provisions for Accountable Care Organizations Under the Medicare Shared Savings Program” fact sheet (ICN 907404) is designed to provide education on the provisions of the final rule that implements the Medicare Shared Savings Program with ACOs.  It includes background, information on how ACOs impact beneficiaries, eligibility requirements to form an ACO, and information on monitoring and tying payment to improved care at lower costs.

From the MLN:  “Improving Quality of Care for Medicare Patients: Accountable Care Organizations” Fact Sheet Available - The new “Improving Quality of Care for Medicare Patients: Accountable Care Organizations” fact sheet (ICN 907407) is designed to provide education on improving quality of care under ACOs. It includes a table of quality measures under the program.

From the MLN:  “Medicare Shared Savings Program and Rural Providers” Fact Sheet Available – The new “Medicare Shared Savings Program and Rural Providers” fact sheet (ICN 907408) is designed to provide education on how the Medicare Shared Savings Program impacts rural providers.  It includes information on federally qualified health centers, rural health clinics, critical access hospitals, and how this program impacts them.

(Top)

HIMMS fellow Michael Paquin advises how to set up an appropriate EMR selection meeting in this short video.

Michael Paquin: Okay, so one of the things as physicians decide to select a vendor for Electronic Medical Records that I always suggest to my clients is to select four to five EMR vendors and have them set up with what you would like to see during demonstration.

So let’s look at how this might affect your practice. If I were to call Vendor A, I would probably send two or three pieces of the papers you use mostly in your office. That could be an insurance form, that could be a doctor’s note, that could be something that you’re very familiar with maybe the top two pieces of paper in your office. I would send that to the vendor and I would say, “I’d like to see you for an appointment for a demonstration at my office and when you come I would like you to be able to show me how that paper becomes real in your Electronic Medical Record.”

All medical record companies say they can make a document electronically so I want to select a vendor that’s going to show the time and effort to show how something that is important in my practice is actually working in their Electronic Medical Record.

They all can do this for you. I’d give [the papers] to all five vendors and ask them to come and set up for their appointment.

Next, I set the location and the place for the presentation. It needs to be something such as an exam room where everybody can clearly see a monitor or a video screen and actually look at the product.

The next thing that we want to do is really set up the audience and by setting up the audience I think it’s highly important that you first look at the EMR the way the vendor would like to show it to you. Let me explain that.

What will happen quite often is you’ll get 4-5 doctors in the room or a doctor and 2-3 nurses and the vendor will start to show you the product and all of a sudden it will be, “Can you show me how it does this?” or, “Can you show me how it does that?”

What happens is the mind doesn’t see the workflow the way it would actually happen in office. You start to get confused because you have a vendor go quickly to this screen or quickly to this screen, I call it the “Puppy Dog Syndrome” and that’s where the vendor becomes the Puppy Dog and wags the tail trying to answer your question.

Save or write down all of your questions, let the vendor demo his product so you can see what the actual workflow is going to be in your practice. Take a look at that workflow and then take a small break and come back and ask the questions and then you’ll see how the vendor goes between the different templates, the different documents, the different things that they need to go through.

At that time also I would imagine you have half the questions taken off of your list and be able to see them in his first demonstration where he actually shows you the product. You’ll get a much nicer complete feeling of the product.

That’s all the tips for today and we thank you for your time.

Joe Hage: Thank you Michael.

See the first video interview with Michael Pacquin here.

Also from Medical Marcom: US Doctors on Twitter, a sortable and downloadable list.

When do you think about customer service in your practice?

When things start heading downhill? You overhear something that surprises you, complaints seem to be on the rise and you think, “time for another customer service seminar.”

The problem with this, of course, is that customer service is a day-to-day relationship. If you wait until you recognize the signs of things heading in the wrong direction, it could be too late. Just like other relationships, customer service in your practice needs consistent attention and creativity to keep things fresh and in the forefront of everyone’s mind. Just like other relationships, customer service is a living thing that needs care and feeding.

Here is what Customer Service isn’t:

• A script.
• Regional casual endearments like honey, darlin’ or sugar.
• Talking to another employee about something unrelated to the patient in front of the patient.
• Telling the patient the physician is delayed due to an emergency when he’s late because_____________. (fill in your own answer)
• Having patients sign in, then shouting out to the waiting area for the patient to come back up to check in.
• Leaving patients in the examining room for longer than 15 minutes without checking in on them and giving them an update.
• Bad customer service means patients may not come back, they may tell 10 or more people about their experience and they’ll probably give your practice a very bad review on Twitter, Facebook, Yelp, Angie’s List, HealthGrades and 10 other rating sites.

Here is what Customer Service is:

• Seeing people as individuals and remembering something about each one of them (yes, you probably will have to write it down to remember it, but I’m sure your computer system has some place to write a note.)
• Setting the practice thermostats to a comfortable level for the patients, not the staff. If you can’t get the thermostat to behave, tell every patient that the office is chilly and to bring a sweater or jacket. Buy a refurbished blanket warmer. Everyone loves a warm blanket!
• Inviting patients to roundtables to tell you what they like and don’t like about a practice. Don’t forget to invite the patients who are really, really mad at the practice – they give you the best information and can become your greatest advocates.
• Telling patients when they call for their first appointment that the doctor always runs late and that no matter what appointment time they get, they should always come 30 minutes later. (Yes, you could try to retrain the physician, but I’ve never been able to, have you?)
• Excellent customer service means patients will feel good about coming back, they may tell 3 or more people about their experience and they might even give your practice a very good review on Twitter, Facebook, Yelp, Angie’s List, HealthGrades and 10 other rating sites.

Customer Service is WHATEVER MAKES PEOPLE FEEL BETTER.

It is anything from saying “I’m sorry we didn’t do the best that we could have for you,” to providing a drink or a place to have a private conversation.  We don’t have to be perfect, we just have to have the desire to provide the perfect experience for each patient. Compassion is having no preconceptions about the other person and being willing to serve the other person’s needs regardless of your own feelings about the person.  It is taking “you” out of the equation.

Try this exercise with your staff. Tell them that none of the patients coming through the door today will be paying, except for one person. That one person will be paying for all the patients in your practice today, and that one person will make it possible for the practice to stay open and for the staff to receive their paychecks. However, no one will know which person is the one that is paying for everyone. How will the staff treat the patients today?

How do you create a culture of service in your practice?

1. Your physicians model it. The manager can be the most service-oriented person in the universe, but if the physicians don’t model it, it’s all over. The physicians must be respectful. (Dear physicians, please don’t stand outside exam rooms and tell jokes, or talk to drug reps or talk about other patients because I have never met the exam room wall that you can’t hear right through. You upset the patients and make the staff uncomfortable.)
2. You model it. You prioritize patient complaints by meeting with patients and speaking with patients when they call. You apologize. You investigate their concerns.
3. You recruit for it. You tell applicants that this practice exists to be of service to others, and if that is not a concept they are comfortable with, this is not the job for them. If they want to be of service to others, ask them for some examples of how they have been of service in previous jobs and what they would intend to do here.
4. You acknowledge good customer service when you see it or hear about it from others. You may have a reward program in your practice for excellent customer service. You publish compliments about customer service in your newsletter or on a staff bulletin board.
5. You establish clear expectations. Speak respectfully to all people in the practice. Keep voices down. Smile. Patients often remember the “hello” and the “good-bye” the most – make them count. Be confidential. LISTEN and do not think you already know what every patient is going to say. Read this.
6. You talk about it in staff meetings. Someone told me once that there are only two reasons why people get angry – they’re either hurt or they’re scared. That has stayed with me for a long time. Teach employees to diffuse situations, to apologize sincerely, and help them by role playing the right answers to patients who are angry or disappointed or sick. Make sure everyone knows that patients have lots of choices for healthcare.
7. You measure patient satisfaction. You can measure it in a BIG WAY or in a small way, but start to measure it. There are a number of very fine organizations who will develop custom patient satisfaction forms for you, distribute them, collate them and interpret them for you and get you started on the road to improvement. You can also brainstorm with your team about a customer service focus each month of the year, and see what improvement gets the most comments from patients. Try a greeter in the reception area, calling every patient who had a sick visit the previous day to check on their progress, a nurse visiting your patients in the hospital (not cared for by you), a limited house call schedule – they can be little things or big things – recipes for patients to take home, patient voting on a big ballot for the magazines they’d like to see in your waiting area and exam rooms…the ideas are endless.

What will you do this year to change customer service at your practice?

Grand Rounds is a weekly summary of the best healthcare writing online, featuring stories, opinion and analysis from doctors, nurses, patients, researchers and administrators, as well as journalists. Each Tuesday, a different blogger takes the helm, publishing a new edition of Grand Rounds on their site. Each edition features the host’s picks for the ten best healthcare links of the week.

This week, one of my very favorite bloggers hosts Grand Rounds, Dr. Bryan Vartabedian of the famed blog 33charts.com. Dr. V. is a pediatric gastroenterologist at Texas Children’s Hospital/Baylor College of Medicine. If you’ve never read Dr. V’s blog, try it – his writing is excellent.

Here’s his intro:

Welcome to this edition of Medical Grand Rounds.  I scoured the web and pulled together what I think are some of the more interesting posts and news items of the past couple of weeks.  I’ve tried to explore some voices that perhaps haven’t crossed your radar.  We’ve got sociologists, medical students, IT gurus, medical futurists and even a couple of doctors.  Some of the discussions have related posts that you might find interesting.  Posts are not listed in any particular order.

Give yourself a little gift and click here to read Grand Rounds.

Here is a collection of  the latest Medicare updates to get your New Year off to a good  informed start:

Pay Cut:  Physicians continue to receive 2011 pay rates for an additional two months while lawmakers seek a compromise on a package that could last through the remainder of 2012 (jump to story)

PQRS -  National Provider Call on Physician Quality Reporting System & Electronic Prescribing Incentive Program (jump to story)

ICD-10:  Did you miss the November 17th National Provider Call on ICD-10?  YouTube Slideshow, Podcasts here (jump to story)

5010:  New FAQs for 90 Day Discretionary Enforcement Period of ASC X12 Version 5010 (jump to story

Medicare Enrollment:  Having trouble committing to Medicare this year? You have five more weeks to think about it. (jump to story)

eRx:  The 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report ain’t gonna happen due to the huge volume of exemptions filed.(jump to story)

IDTF:  Did you get your accreditation to be able to perform the technical component of MRIs, CTs and Nuclear Medicine tests for Medicare patients? (jump to story)

PQRS:  CMS announces the posting of 2012 Physician Quality Reporting System educational products (jump to story)

EFT & RA:  Interim Final Rule Standards for the Health Care Electronic Funds Transfers (EFT) and Remittance Advice transaction (RA) (jump to story)

—————————–

Physician Pay Cut Delayed Until March 1, 2012

Medicare pay cut averted After a nearly weeklong standoff over a payroll tax cut package containing a temporary Medicare physician payment patch, Congress on Friday approved a bill that delays the scheduled pay cut from Jan. 1 to March 1. The pay patch means physicians will continue to receive 2011 pay rates for an additional two months while lawmakers seek a compromise on a package that could last through the remainder of 2012. Click here for the rest of the story that led up to the delay – from amednew.com.

———————–

National Provider Call on Physician Quality Reporting System & Electronic Prescribing Incentive Program

Tuesday, January 17, 1:30-3pm ET

The Centers for Medicare & Medicaid Services (CMS) will host a national provider call on the Physician Quality Reporting System & Electronic Prescribing Incentive Program. Subject matter experts will provide an overview on how the 2012 electronic prescribing (eRx) payment adjustment will appear on your remittance advice, as well as, an overview of the self nomination process.. A question and answer session will follow the presentation.

Target Audience: Medicare fee-for-service (FFS) providers, Medical coders, Physician office staff, Provider billing staff and Vendors

Agenda:

• Opening Remarks
• Program Announcements
• Overview on how the 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment will appear on your remittance advice
• Overview of the self nomination process
•  Question & Answer Session

Registration Information – Please visit http://www.eventsvc.com/blhtechnologies/ to register for this informative session. Registration will close at 12:00 p.m. ET on January 17, 2012, or when available space has been filled. No exceptions will be made. Please register early.

Presentation:  The presentation will be posted at least one day before the call at:  http://www.cms.gov/PQRS/04_CMSSponsoredCalls.asp in the “Downloads” section on the CMS website.

————————-

Miss the November 17th National Provider Call on ICD-10?  YouTube Slideshow and Podcasts are available.

The Centers for Medicare & Medicaid Services (CMS) has released a YouTube video slideshow presentation and podcasts from the November 17, 2011 National Provider Call on “ICD-10 Implementation Strategies and Planning.”

Did you miss the November 17^th ICD-10 National Provider Call? The call presentation is now available on the CMS YouTube Channel as a video slideshow that includes the call audio with captions. 

Limited on time? Podcasts are perfect for the office, in the car, or anywhere you carry a portable media player or smartphone. The following podcasts are now available from the November 17^th  ICD-10 call:

• Podcast 1 of 4: Introduction, General ICD-10 Requirements, and CMS Implementation Planning
• Podcast 2 of 4: General Implementation Planning and Strategies
• Podcast 3 of 4: NCVHS Meeting Update and Medicare FFS Claims Processing, Billing, and Reporting Guidelines
• Podcast 4 of 4: Question and Answer Session

The podcasts are now available on the CMS website at http://www.cms.gov/ICD10/Tel10/itemdetail.asp?itemID=CMS1253081.

———————-

New FAQs for 90 Day Discretionary Enforcement Period of ASC X12 Version 5010

Medicare Fee-For-Service (FFS) issued an announcement Wednesday, December 14, 2011 regarding its plan for the 90 Day Discretionary Enforcement Period for non-compliant HIPAA covered entities.  CMS has published six FAQ items related to this plan.  These new FAQs can be found at: http://www.cms.gov/Versions5010andD0/Downloads/QandA_for_90_day_announcement.pdf.

­­­­­­­­­­

For more information on ASC X12 Version 5010, NCPDP D.0, and NCPDP 3.0; please visit www.CMS.gov/Versions5010andD0.

——————–

Attention Health Professionals:  2012 Annual Participation Enrollment Program Extension

CMS is anticipating Congressional action to avert the negative update for the 2012 Medicare Physician Fee Schedule.  Therefore, CMS is extending the 2012 Annual Participation Enrollment Period through Tuesday,  February 14, 2012.  The enrollment period now runs Monday, November 14, 2011 through Tuesday, February 14, 2012.

The effective date for any participation status change during the extension, however, remains Sunday, January 1, 2012, and will be in force for the entire year.

Contractors will accept and process any participation elections or withdrawals made during the extended enrollment period that are post-marked on or before Tuesday, February 14, 2012.

———————

The 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report ain’t gonna happen due to the huge volume of exemptions filed.

CMS would like to advise providers, due to the high volume of significant hardship exemption requests received it is no longer technically feasible for CMS to provide a 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report as originally intended.

As CMS continues to explore alternative means to notify eligible professionals that they are subject to the 2012 eRx payment adjustment, we urge you to review your remittance advices for claims submitted for dates of services on or after Sunday, January 1, 2012.

Eligible professionals and group practices (GPRO) participating in the eRx GPRO that receive the 2012 eRx payment adjustment will see the term “LE” on their remittance advice for all Medicare Part B services rendered Sunday, January 1, 2012 through Monday, December 31, 2012.

The remittance advice will also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC):

§  CARC 237 – Legislated/Regulatory Penalty.  At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

§  RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing (eRx) Incentive Program.

If an eligible professional or group practice that participated in the eRx GPRO receives the payment adjustment in error (e.g., the eligible professional or group practice submitted a hardship exemption request that is ultimately approved by CMS), the claim will be reprocessed to return the 1.0% and the remittance advice for the reprocessed claim will include the following codes and messages:

§  CARC 237 – Legislated/Regulatory Penalty.  At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

§  RARC N546 – Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.

For more information on how the 2012 eRx payment adjustment will be assessed and applied, please refer to MLN Matters Article SE1141 for additional information, or visit the eRx Incentive Program webpage at http://www.cms.gov/erxincentive.

——————-

Did you get your accreditation to be able to perform the technical component of MRIs, CTs and Nuclear Medicine tests for Medicare patients?

Suppliers of the technical component  of Advanced Diagnostic Imaging that are billing with a service date on or after Sunday, January 1, 2012 must evidence an active accreditation date for diagnostic imaging of CPT codes attached to an MRI, CT, and Nuclear Medicine claim.  The professional component claims are not affected by the accreditation requirements and must be processed as usual.  Refer to Transmittal #380, http://www.cms.gov/transmittals/downloads/R380PI.pdf or MLN Matters 7177, http://www.cms.gov/MLNMattersArticles/downloads/MM7177.pdf  for further information on claims processing.

——————

CMS announces the posting of 2012 Physician Quality Reporting System educational products

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the posting of 2012 Physician Quality Reporting System educational products at http://www.cms.gov/PQRS on the CMS website.

·         2012 Physician Quality Reporting System Measures List – this document identifies and explains the measures used in Physician Quality Reporting, including information on the reporting options/methods, measure developers and their contact.   **Please note that this document was updated and re-posted on 1/05/2012.

·         2012 Physician Quality Reporting System Quality-Data Code (QDC) Categories – a table that outlines, for each measure, each QDC that should be reported for a corresponding quality action performed by the individual eligible professional as noted in the measures specification. This determines how each code will be used when calculating performance rates. This also clarifies those measures that require two or more QDCs to report satisfactorily. Insufficiently reporting the QDCs (as specified in the 2012 Physician Quality Reporting System Measure Specifications Manual) will result in invalid reporting.

·         2012 Physician Quality Reporting System Single Source Code Master – this file includes a numerical listing of all codes included in 2012 Physician Quality Reporting for incorporation into billing software.

·         2012 Physician Quality Reporting System Measure Specifications Manual for Claims and Registry Reporting of Individual Measures – the 2012 measure specifications include codes and reporting instructions for the 210 Physician Quality Reporting System measures for claims and/or registry-based reporting.  **Please note that this document was revised and re-posted on 1/05/2012.

·         2012 Physician Quality Reporting System Measure Specification Release Notes – outlines changes from the 2011 Physician Quality Reporting System Measure Specifications Manual in the form of Release Notes.  **Please note that this document was revised and re-posted on 1/05/2012.

·         2012 Physician Quality Reporting System Implementation Guide – provides guidance about how to select measures for reporting, how to read and understand a measure, and outlines the reporting options available for 2012 Physician Quality Reporting System. The Implementation Guide also details how to implement claims-based reporting of measures to facilitate satisfactory reporting of quality-data codes by eligible professionals.

·         2012 Physician Quality Reporting System Measures Groups Specifications Manual – measures group specifications are different from those of the individual measures that form the group. Therefore, the specifications and instructions for measures group reporting are provided in a separate manual. The 2012 measures groups specifications include codes and reporting instructions for the 22 Physician quality Reporting System measures groups for claims or registry-based reporting.

·         2012 Physician Quality Reporting Measures Groups Release Notes – this document outlines changes from the 2011 Physician Quality Reporting System Measures Groups Specifications Manual in the form of release notes.

·         Getting Started with 2012 Physician Quality Reporting System of Measures Groups – provides guidance on implementing the 2012 Physician Quality Reporting System measures groups.

·         2012 Physician Quality Reporting Measures Groups Single Source Code Master – this file includes a numerical listing of all codes included in 2012 Physician Quality Reporting System Measures Groups for incorporation into billing software.

·         2012 Physician Quality Reporting System Measure-Applicability Validation Process for Claims-Based Reporting of Individual Measures – provides guidance for those eligible professionals who satisfactorily submit quality-data codes for fewer than three Physician Quality Reporting measures, and how the measure-applicability validation process will determine whether they should have submitted QDCs for additional measures.

·         2012 Physician Quality Reporting Measure-Applicability Validation Process Release Notes – the release notes for the changes occurring for the 2015 Physician Quality Reporting Measure-Applicability Validation Process (MAV).

·         2012 Physician Quality Reporting System Measure-Applicability Validation Process Flow – a chart that depicts the Measure-Applicability Validation Process (MAV).

·         Group Practice Reporting Option (GPRO) Requirements for Submission of 2012 Physician Quality Reporting System Data – provides guidance on how a group practice of over 25 eligible professionals can self-nominate to participate in GPRO for 2012 data submission.

·         2012 Physician Quality Reporting System Group Practice Reporting Option (GPRO) Measures List – a document containing a list of the 2012 Physician Quality Reporting GPRO Measures.

·         2012 Physician Quality Reporting GPRO Narrative Measure Specifications and Release Notes – this document contains descriptions of the 2012 Physician Quality Reporting GPRO measures and changes in the program since the 2011 reporting year.

·         2012 EHR Direct Vendor Qualification Requirements – provides guidance on how EHR Direct Vendors can self-nominate and qualify to submit Physician Quality Reporting System measures data for 2012.

·         2012 EHR Data Submission Vendor Qualification Requirements – provides guidance on how EHR Data Submission Vendors can self-nominate and qualify to submit Physician Quality Reporting System measures data for 2012.

·         2012 EHR Documents for Eligible Professionals – this zipped file contains the following:

−     2012 Physician Quality Reporting System EHR Measure Specifications – the detailed description of data element names and codes related to each of 51 2012 Physician Quality Reporting System quality measures available for electronic submission.

−     2012 Physician Quality Reporting System Physician Quality Reporting System EHR Measure Specifications – Release Notes – the corresponding release notes for the 2012 EHR Measure Specifications.

−     2012 EHR Downloadable Resource Table

−     2012 EHR Downloadable Resource Table – Release Notes

·         2012 EHR Documents for Vendors – this zipped file contains the following:

−     Data Submission Specifications Utilizing HL7 QRDA Implementation Guide Based on HL7 CDA Release 2.0

−     Updated EHR Data Submission Specifications Utilizing QRDA – Release Notes – release notes for Data Submission Specifications Utilizing HL7 Quality Reporting Document Architecture Based on HL7 CDA Release 2.0

−     2012 EHR Downloadable Resource Table

−     2012 EHR Downloadable Resource Table – Release Notes

−     Updated EHR Data Submission Specifications Utilizing QRDA Header Errors and Edits

−     Updated EHR Data Submission Specifications Utilizing QRDA Body Errors and Edits

−     2012 CMS EHR QRDA Data Submission Specifications and Errors Edits Release Notes

To access the 2012 Physician Quality Reporting System educational products, visit the Spotlight page at http://www.cms.gov/PQRI/02_Spotlight.asp on the CMS website for the listing of educational products and the corresponding section page where they can be found.

—————————

Interim Final Rule Announced for the Health Care Electronic Funds Transfers (EFT) and Remittance Advice transaction (RA) Standards

The Centers for Medicare & Medicaid Services (CMS) today announced an interim final rule with comment period (IFC) (CMS-0024-IFC) under which the Department of Health and Human Services (HHS) adopts standards for the Health Care Electronic Funds Transfers (EFT) and Remittance Advice transaction (RA) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Section 1104 of the Patient Protection and Affordable Care Act of 2010 requires CMS to issue a series of regulations over the next five years that are designed to streamline health care administrative transactions, encourage greater use of standards by providers, and make existing standards work more efficiently.  On July 8, 2011, CMS published the first regulation, an IFC that puts in place operating rules for two electronic health care transactions that make it easier for providers to determine whether a patient is eligible for coverage and the status of a health care claim submitted to a health insurer.

The regulation announced today is the second in the series and establishes EFT standards that, when implemented by health plans, will save physician practices and hospitals between of $3 billion to $4.5 billion over the next ten years.  Further environmental benefits from the use of an electronic payment in contrast to payments made by paper checks will result in an estimated 800,000 pounds of paper saved and 2.2 million pounds of greenhouse gases avoided over ten years.

Future administrative simplification rules will address adoption of:

•          A standard unique identifier for health plans;

•         A standard for claims attachments; and

•         Requirements that health plans certify compliance with all HIPAA standards and operating rules.

BACKGROUND

Congress addressed the need for a consistent framework for electronic health care transactions and other administrative simplification issues through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), enacted on August 21, 1996.  HIPAA amended the Social Security Act (the Act) by adding Part C—Administrative Simplification—to Title XI of the Act, requiring the Secretary of the Department of Health and Human Services (DHHS) to adopt standards for certain transactions to enable health information to be exchanged more efficiently and to achieve greater uniformity in the transmission of health information.

Section 1104(b)(2)(A) of the Patient Protection and Affordable Care Act (Pub. L. 111‑148) amended section 1173(a)(2) of the Act by adding the electronic funds transfers (EFT) transaction to the list of electronic health care transactions for which the Secretary must adopt a standard under HIPAA.

In general, the savings and benefits related to use of EFT for business and consumer payments are well established.  The most common savings are in paper, printing, and postage costs, as well as savings in staff time to manually process and deposit paper checks.  Yet adoption and use of EFT by the health care industry has been low, resulting in administrative savings that go unrealized.  The obstacles to greater use of EFT by the health care industry can be lessened by standardization of the EFT transaction.  Beyond the material and administrative time savings for health care providers and health plans, the time and resources that physician practices and hospitals spend on billing and related tasks will be better spent on delivering health care to patients.

On December 3, 2010, the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards held a hearing and from it gathered a comprehensive review of the health care payment and remittance advice transaction for purposes of making a recommendation to the Secretary.  Participants represented a cross section of the health care industry.  On February 17, 2011, the NCVHS sent a letter to the Secretary that contained recommendations for adoption of a “health care EFT” standard.

Based on that recommendation, HHS is adopting two standards for the health care EFT that a health plan must comply with in order to transmit health care claim payments to providers via EFT.  The first is a standard format for when a health plan orders, authorizes, or initiates an EFT with its financial institution.  The second standard specifies the data content to be contained within the EFT.

The goal for adopting these standards is to ensure that a trace number that connects the payment to the electronic remittance advice is inputted into a standard EFT format and that is received without error by the health care provider.  This can be best achieved by requiring that a single electronic file format (CCD+Addenda) be used by all health plans that transmit health care EFT to their financial institutions and by requiring that data elements are consistent and ordered according to clear implementation specifications.

PROVISIONS OF THE IFC ANNOUNCED TODAY

HHS is adopting two standards for the health care EFT:  the CCD+Addenda implementation specifications in the 2011 National Automated Clearing House Association (NACHA) Operating Rules & Guidelines, and the TRN Segment implementation specifications in the X12 835 TR3 for the data content of the Addenda Record of the CCD+Addenda.

COSTS/BENEFITS

Although all covered entities are required to comply with the adopted standards of HIPAA transactions, the health care EFT standards are expected to have the most substantial cost and benefit impacts on physician practices, hospitals, and commercial and government health plans.

We estimate that many health plans will have direct costs associated with implementing and using the health care EFT standards.  However, those costs are expected to be comparably small software investments, approximately $18 million to $28 million overall for all commercial health plans, and $400,000 to $600,000 for Medicaid, the Children’s’ Health Insurance Program (CHIP), and the Indian Health Service (IHS).  The savings for commercial health plans could be as much as $40 million over ten years, $31 million for Medicaid, CHIP, and IHS.

For physician practices and hospitals, there is little to no cost to implement the health care EFT standards, as providers are the receivers of the standardized transaction and not the senders.  Overall, physician practices and hospitals should see savings of $3 billion to $4.5 billion over the next ten years as health plans implement the health care EFT standards.

We can also expect a modest environmental benefit from the use of an electronic payment in contrast to payments made by paper checks, including an estimated 800,000 pounds of paper saved and 2.2 million pounds of greenhouse gases avoided over ten years.

REGULATION EFFECTIVE DATE/ STANDARDS COMPLIANCE DATE

The effective date of this regulation is January 1, 2012.  Under the Affordable Care Act, HIPAA-covered entities must be in compliance with the standards (in other words, use the health care EFT standards ) on January 1, 2014.

The rule (CMS-0024-IFC) is on display today and may be viewed at www.ofr.gov/inspection.aspx.  A news release on the rule may be viewed at http://www.hhs.gov/news.

One is the appointment book.

The other is patient statements.

My first experience with creating patient statements was placing patient ledger cards on the copier. The copies were folded and slid into envelopes and mailed to patients. Despite a bad photocopy of handwriting of several different people squashed onto skinny lines, patients routinely understood what the bill said and paid the total. That was 25 years ago.

Today the process of sending statements to patients is largely outsourced along with electronic claims, but it’s not very electronic. If we can get paid by insurance companies electronically, why not get paid by patients electronically?

I suggest that the practice of sending patient statements is not only resource-intensive, but it is also a 20th century business practice unsuited for a 21st century business. Why do practices insist on clinging to an outdated method of billing?

Here are the excuses I routinely hear for not eliminating statements:

• “Patients must get statements, or they won’t know to pay us.”
• “Healthcare payments are so complicated that patients need a statement to understand them.”
• “It’s not legal not to send a statement.”
• “We don’t know how much the patient owes us until the insurance company pays.”
• “We don’t get to see our patients face-to-face, so we have to send a statement.”

Let’s address these objections one at a time.

• “Patients must get statements, or they won’t know to pay us.” I disagree. Patients do not need statements to know to pay us. If they did, then we’d only have to send one statement and everyone would pay! We know that’s not true.
• “It’s illegal not to send a statement.” Nope.
• “Healthcare payments are so complicated that patients need a statement to understand them.” It is our job to educate patients about their financial responsibility. We understand that insurance coverage is complex, but it’s not so complex that we can’t explain it to them. Our businesses, our very jobs, rely on our ability to explain to patients what they owe. It’s just that simple.
• “We don’t know how much the patient owes us until the insurance company pays.” That may be true, but we have all the tools we need to make a very educated estimate. There is no reason why we cannot estimate the patient’s portion and make a small adjustment (refund or additional charge) on the patient’s credit or debit card once the insurance company pays.
• “We don’t get to see our patients face-to-face, so we have to send a statement.” Most practices are dealing with this head-on by placing staff in areas, mostly hospitals, where staff can meet with patients and discuss financial responsibility.

Setting up a statement-free practice is relatively easy. Here are some tips.

1. Use an online payment system that allows electronic payment plans. An electronic payment plan enables a practice to enter a payment plan once, and have the system draft the credit/debit card appropriately without staff management. It should also be able to send a receipt to the patient’s email, or to send a message to the patient to pick up the receipt through a secure portal.
2. Load your contract allowables into your practice management system. If your system doesn’t have that capability, create a cheat sheet of your top codes for each contracted payer, so your check-out staff can calculate what the patient owes. There are also systems that can put together your contract information and the patient information into an estimate of what the patient owes for you.
3. Get online eligibility access that includes information about the patients’ benefits, deductibles, co-pays and co-insurance. This is available through your practice management system, your clearinghouse, or from a separate system that reads from your appointment schedule,
4. Practices that offer procedures or surgery should employ a financial counselor to sit down with patients and talk through financial responsibility and set up payment plans.
5. Coach staff on talking to patients about money. Teach them to become comfortable with collections.

What’s the bottom line?

People pay their bills via their credit/debit card routinely – this is not new or unusual for the majority of people.

The ability to “set it and forget it” via electronic payment plans simplifies the payment system and speeds up cash flow.

The ability to adjust a patient plan once insurance pays means no waiting to refund the patient or collect the remaining dollars.

Your staff will still have to post the payments into the practice management system (although a few have integrated posting), but eliminating statements will save your practice money and time.