On December 31st, 2009, DHHS (the Department of Health & Human Services) finally released a 556 page document describing a proposed rule for the EHR incentive program that’s part of the recent HITECH (Health Information Technology for Economic and Clinical Health Act) legislation.
In the event you’ve been living on Mars, HITECH, among other things, provides for several years of potential incentive payments to EP’s (that’s Eligible Professionals) in an effort to make the entire healthcare system more efficient.
Problem #1
In 2009, many chiropractors were told to purchase “CCHIT certified” software at seminars, by management consultants, etc. As I explained to any of you who were listening in 2009, it’s not that simple. Much of the information you were provided was at best… misinformed.
- You’re a chiropractor. Though CCHIT has been around for years, as of January 2010, CCHIT has yet to define standards specific to you. If you review their website, you’ll note that they have standards for some – not all – medical specialties.
- CCHIT is all about medical records… as in height, weight, and blood pressure. Yet, one of the most important aspects of Stage I of the above referenced proposal is HIPAA mandated ANSI 837 electronic claims submission. To the best of my knowledge, CCHIT has absolutely no prior experience with this as of the end of 2009.
- CCHIT is a private, nonprofit company. Though I have no doubt that they will become a certifying body and receive accreditation from the federal government, they don’t have any such accreditation now (no company does)… and they can’t apply for it yet because the standards for accreditation agencies have yet to be finalized. (Specific to Electronic Health Records, CCHIT has played a major role in standards development in conjunction with the Office of the National Coordinator for Health Information Technology.)
Hopefully you are beginning to realize that a great deal of the information you’ve been told or think you know… is simply not true.
So, which EMR/Notes program should you buy? Oh. Sorry. That’s a trick question. I wanted to see if you were paying attention. And by the way, progress notes (see page 53 of the proposal) have little to do with that $44,000 incentive you were promised by software vendors looking to sell their wares.
Which brings us to…
Problem #2
A variety of sources have repeatedly focused you on your electronic notes as the ultimate arbiter of whether you’ll be “prepared” for upcoming HITECH legislative changes. The proposal referenced above has been broken into three stages.
So what’s the deal with Stage I?
For starters, you will need to demonstrate that you can submit HIPAA compliant ANSI 837 claims to public & private payers.
So here’s my first question to you… Can your practice management system send ANSI 837 claims directly to Medicare right now? If this isn’t a builtin feature (after all, it’s a mandatory part of HIPAA with far reaching implications*) perhaps you’re relying on the wrong vendor. Why? Well, if your vendor handles “print capture” of the CMS 1500 form through a third party clearinghouse, you’re okay for the moment. BUT, think about how that’s going to affect you as the rest of HITECH comes down the pike over the next year or two. A vendor who can’t directly handle government mandated electronic formats may be ill equipped to handle the various types of clinical data required in later stages of the HITECH proposal.
Oh, one last thing here, it’s not enough to send claims electronically, you’ll be expected to send a certain percentage (yet to be determined) electronically vs. on paper.
Does your present system allow you to (page 88) “provide patients with a copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request?” Again, this has little to do with your progress notes. Your present system needs to have places to store this information as “structured data” – which means that blood pressure (for example) can’t be part of a note. It needs to be a separate, accessible field that unequivocally relates to a specific data item – like a patient’s last name.
Problem #3
“When will I get my $44,000” has become a common refrain. Anyone who has an interest in selling you something has led you there. Of course, it’s never been that simple.
For starters, look at example 1 on page 194 of the proposal. In 2011 (the first year of the program), if you bill Medicare (not private insurance) at least $24,000 (that’s Medicare’s allowed charges not your fees), you’ll be eligible to receive as much as $18,000 (75%) in incentive payments on or before February 29, 2012.
Of course, that’s a simple example.Geographic hardship areas and other factors may affect the amount.
Problem #4
Eventually, your clinical data may need to accompany your billed services. Ask every vendor you look at for current examples where they’re actually sending your clinical notes electronically as attachments to bills. And find out what format (e.g. PDF) those attachments take. Why? Companies that are handling this now should certainly possess the capability to handle any changes.
For example, in the 1990’s, electronic submission was typically handled via the National Standard Format. The 1996 HIPAA legislation mandated new formats. Everyone rewrote their software.
Finally please beware of self-proclaimed experts. Perhaps they’re experts in other things… so you take them at their word. In the end, you’re more confused.
HITECH is mostly about sending electronic data back and forth over computer connections. Think about what kind of experts you should be speaking to about that. Anyway, I’ll discuss more of this in an upcoming article.
Among other things, electronic submission of secondary claims requires information returned in 835 remittance files after submission of primary claims. If you don’t have an 835 file that can be imported automatically, entering the data by hand can be a time intensive process.
© 2010 Mike Norworth
About the Author
With degrees in Biology & Chemistry, graduate degrees in Computer Science and over 25 years of experience in health care, Mike is the chief architect of ECLIPSE® Practice Management Software. He also has extensive experience with audits & computer forensics investigations at the local, state, and federal level. Finally, he has advised health care providers, equipment manufacturers, corporations and management consultants for over two decades with regard to business practices, operations and technical issues.
