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healthcare management consulting

Appropriate Use Criteria Guidelines In Effect January 1, 2021

By | Blog, healthcare management consulting, MIPS consulting
As of January 1, 2021, providers who serve Medicare patients will be required to consult a Clinical Decision Support Mechanism (CDSM) and obtain a determination as to whether the test conforms to the Appropriate Use Criteria (AUC) before the test can be administered.

Advanced diagnostic imaging services are crucial tools for ensuring accurate diagnoses and planning suitable treatment. Examples of CDSM imaging services are CT (Computed Tomography), PET (Positron Emission Tomography), Nuclear Medicine, and MRI (Magnetic Resonance Imaging). Any time any of these services are ordered, providers are required to consult the CDSM and receive a determination whether or not the order follows AUC guidelines.
All physicians and other providers who treat Medicare patients and any facility that furnishes those services in a physician’s office, hospital outpatient department, ambulatory services department, or independent diagnostic testing facility will be required to adhere to the regulation. The program is now in the educational and operational testing phase, so no payment consequences will result from not following the recommended workflow. Providers should take this time to familiarize themselves with the process, however, as any practitioner who treats Medicare Part B beneficiaries will be required to abide by this rule from January 1, 2021 on.
The CDSM is a tool within your certified EHR. (All CEHRT systems should be on the 2015 certified version.) This tool must be enabled to be incorporated into the workflow. Ideally, this consult should be done at time of ordering, so the test will not be denied later. Embedding the AUC requirement into your workflow will ensure you are following prescribed guidelines and avoiding any payment penalties.
CareOptimize is ready to help any practitioner with any questions about this new rule. Our value-based experts can assist with:
• Ensuring your workflow is adjusted to accommodate the AUC requirement

• Enabling the tool within your EHR

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

CMS Will Examine Telehealth Reimbursement Rates Following the Pandemic

By | Blog, healthcare management consulting, Nextgen EHR
Telehealth reimbursement is being evaluated by CMS to render Medicare telehealth extensions permanent after the COVID-19 pandemic. CMS administrator Seema Verma recently suggested reforms initiated during the pandemic could become permanent, including payment for telehealth services provided to non-rural patients and the provision of telehealth treatment in patients’ homes.
To settle telehealth reimbursement rates, CMS would need to assess the costs for telehealth vs. in-person services. Medicare payment rates for in-person treatment take supply costs such as hospital gowns, washing, disinfectants, and other service costs into account. Telehealth services do not require these supplies. The costs associated with generating new systems and workflows to enable telehealth visits also need to be considered. For CMS to properly reimburse providers for permanent Medicare telehealth extensions, all such expenses will need to be reviewed.
Short-term payment changes allowed practices to implement telehealth services rapidly. Telehealth has proved essential to COVID-19 approaches for the response. Providers have been able to continue treating patients via telehealth, preventing unnecessary staff or employee exposure to the extremely infectious virus.
Virtual treatment has also proved invaluable in ensuring the health of patients and staff within the hospital setting. Hospitals have been able to reduce interaction with infected patients by using smartphones, laptops, and other mobile devices, while still placing caregivers and family near the patient.
This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting , and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475

Integrating Telehealth and EHR

By | Blog, healthcare management consulting, Nextgen EHR

The telehealth boom as a result of the COVID-19 pandemic has sparked discussions on how to reach the smooth integration of telehealth into electronic health records. Some telehealth platforms provide agnostic integration with a number of EHR systems, whereas some EHRs have their own telehealth solution in-house.

What works for a certain system may not necessarily be the best solution for another. There are many considerations to take into account. when choosing an EHR provider or considering a move to another.

You may wish to begin by understanding whether the vendor for whom you are operating currently provides a unified solution, or have other solutions been developed along the way. Where do you begin, and is it a fully integrated platform versus one vendor with several platforms to offer? A trade-off study should also be considered: What do you lose in feature functions with a single vendor versus integration gain? The third consideration is the case of intended use: More specialized treatment may mean having to find a more specialized solution.

At CareOptimize, we offer a rich array of EHR utilities designed to assist clients and staff in increasing their productivity, including free utilities such as our Document Auto-Completion templates and the Coronavirus Crystal Report.

To read more, please visit https://www.healthcareitnews.com/news/when-integrating-ehr-and-telehealth-one-size-doesnt-fit-all.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

What to Consider as Telehealth Legislation Moves Forward

By | Blog, healthcare management consulting, MIPS consulting

The Protecting Access to Post-COVID-19 Telehealth Act introduced last week is aimed at broadening the use of telehealth beyond the current health situation. One of the many things it will address is the removal of geographic restrictions permitting a patient’s home to be used as an originating site. It will also make permanent the Department of Health and Human Services waiver authority for emergencies. As the legislation proceeds, what do healthcare organizations, hospitals, and providers need to keep in mind?

Organizations and providers must assess whether the method of delivery of telehealth services for patients is clinically appropriate and safe versus a visit in person. Providers and organizations should also ensure Medicare has reimbursed providers the same amount for telehealth services throughout the public health crisis as it would pay for a visit done in person. An important question is whether this trend will continue.

Temporary exemptions allow Medicare providers to operate across state lines during the emergency, while each state is required to apply for specific Medicaid exceptions. Although there is a movement toward proceeding with such efforts supported by organizations like the American Nursing Association and the American Medical Association, the process remains complex.

Since telehealth needs an investment in technology, incentives may need to be provided to promote spending on technology.

To read more, please visit https://www.healthleadersmedia.com/innovation/7-things-consider-new-telehealth-legislation-proposed.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Telehealth Compliance Programs Are Imperative

By | Blog, healthcare management consulting, Nextgen EHR

The rapid expansion of telehealth throughout the United States as a result of the COVID-19 pandemic has allowed providers to continue to support their patients while reducing business disruption. The growth of telehealth has also encouraged businesses to leverage technology, find new ways to provide medical care, and lower costs.

Although telehealth offers tremendous provider opportunities, there are also considerable risks. The recent surge of telehealth services has significantly prompted changes to federal and state regulations and requirements. The tangled network of federal and state regulations make legal compliance for telehealth providers exceptionally challenging, reinforcing the need to have robust compliance programs and measures in place.

Providers should make sure written policies that specifically require compliance with relevant federal and state laws, regulations, and requirements have been implemented. Policies enacted prior to the outbreak of COVID-19 should be evaluated and tweaked as needed. To oversee these changes, practices should name a compliance officer, who can also take care of allocating resources to carry out compliance program integration. Along with training all staff, annual compliance program audits should be undertaken to measure compliance activity and its effectiveness. Furthermore, staying on top of evolving laws and regulations is key in maintaining successful and current enforcement policies in place.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Telehealth Still Has Room for Improvement

By | Blog, healthcare management consulting, MIPS consulting
Three-quarters of patients that received telehealth have stated they would like to see it incorporated as a standard care component in the future. However, a significant portion of patients also said that they did not know how to proceed following the telehealth visit, suggesting healthcare providers may need to implement standard follow-up care measures.
It may not be surprising to learn that, given the surge in telehealth visits, the majority of patients had not taken advantage of virtual care prior to 2020. Close to three-quarters made use of telehealth because they’d had an original appointment delayed or canceled, and more than 70 percent of respondents also had a previous appointment canceled or postponed, either voluntarily or due to the actions of the healthcare provider.
Statistics prove the interest in continuing healthcare with a telehealth option is attractive to patients, yet only 35 percent of patients stated their healthcare provider contacted them for a follow-up, and a little over 40 percent said they were aware of how they could receive future telehealth access.
The opportunities to attract even more patients to telehealth have definitely been brought to the forefront with the pandemic. Beyond canceled in-person appointments being rescheduled as virtual, there are many other chances for practices not only to retain patients but also to attract new business with a telehealth option. Comprehensive retention procedures need to be in place to keep those patients interested in telehealth from falling through the cracks.
This update is provided by CareOptimize. We provide healthcare management consultingservices and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

States Move Toward Permanent Telehealth Expansion

By | Blog, healthcare management consulting, MIPS consulting

With healthcare practices increasingly adopting telehealth access and coverage due to the COVID-19 pandemic, some states are making moves to permanently embrace the technology.

he governor of Colorado, for example, recently signed a bill expanding access to telehealth by preventing insurance providers from mandating patients have an established provider relationship for telehealth services. Remote monitoring services are now covered under the new law, and restrictions on technology, as long as the technology is HIPAA-compliant, were also removed.

In Idaho, the governor signed an executive order urging agencies throughout the state to take action to immediately solidify the telehealth rule waivers and other regulations imposed during the COVID crisis. The exemptions also extend the technologies that could be used for telehealth, permitting telehealth providers to prescribe more drugs, including drug-assisted therapy for opioid use disorder.

As the pandemic started to affect patient numbers in March, health systems and physician offices turned rapidly to telehealth as a way to preserve revenue and keep track of patients who were chronically ill. Payers made it simpler for them by covering telehealth services, and the use of telemedicine rose rapidly.

CMS relaxed many of the regulations previously preventing telehealth expansion. They extended telehealth coverage for Medicare beneficiaries and reduced the requirements that previously forced patients to be housed at certain rural locations. The agency also expanded the number of telehealth services it would pay for and permitted telehealth providers to conduct telehealth via phone.

Many of the flexibilities put into place to allow easier access to telehealth are set to expire when the health emergency ends. Confusion about continued flexibility and what will be covered at that time has led many to speculate whether or not telehealth will remain a popular choice for providers. The laws enacted by the governors of Colorado and Idaho are aimed at solidifying some of those temporary fixes to help keep telehealth a viable option.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Telehealth Results in a Safer Future for Healthcare

By | Blog, healthcare management consulting, MIPS consulting

Until recently, the main obstacles facing the general implementation of telehealth were geographical limitations and the originating point of treatment. CMS had narrowed Medicare’s payment to telehealth services that met certain criteria including using a location within a specified area of skilled rural health care shortage or that the patient received treatment at an approved facility such as a provider’s office or hospital.

COVID-19 ‘s declaration has led CMS, at least for now, to use waivers to remove those obstacles. Telehealth, though, has other challenges ahead of it.

Many people still lack access to the fundamental infrastructure that makes a virtual doctor visit feasible. Technical issues could also be problematic for those providers who likewise lack infrastructure enabling such visits. Additionally, a major challenge has been widespread reimbursement of these programs.

Hospitals and healthcare facilities with a patient-centered approach to treatment require an effective communication plan for their patients conducive to a successful telehealth program. There have also been initiatives to utilize technology networks for the healthcare sector capable of secure, real-time virtual visits to meet more patients, easily trial them, and enhance the quality of treatment. In addition, during the pandemic, virtual visits have the ability to save resources. Increasing the adoption of telehealth in a prearranged manner can make an important contribution to the efforts to screen, test, and treat coronavirus.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Embracing Telehealth Demands as a Small Practice

By | Blog, healthcare management consulting, MIPS consulting

The COVID-19 pandemic resulted in many healthcare providers unexpectedly needing to turn to virtual treatment solutions. The transition may have been relatively smooth for larger healthcare providers with greater resources, but smaller practices had to deal with even more challenges. It wasn’t until the government instituted regulatory changes to broaden reimbursement for virtual visits that the smaller practices began to believe they, too, could move in that direction. As patients began seeing their local practices offer telehealth, their interest also increased.

The very makeup of a smaller practice forces it to think more creatively in planning and adopting emerging telemedicine needs. Some items to keep in mind include patient needs, where they come from, and what technologies they and the medical staff might use to reap the most benefits. Telehealth does not necessarily have to completely replace in-person visits, but practices could offer after-hours consultations to patients or asynchronous services for patients that require ongoing care.

Smaller practices may also wish to seek out telehealth resource centers. In addition to federally funded programs, private companies such as CareOptimize offer comprehensive telehealth services. Providers should also ensure that whatever telehealth solutions they use are compliant with HIPAA regulations, even if those regulations are being temporarily relaxed.

The future of telehealth post-pandemic remains to be seen, but many of the pieces are now in place to give all size practices the ability to institute and maintain successful telehealth programs.

To read more, please visit https://www.healthcareitnews.com/news/heres-how-smaller-practices-can-prepare-continuing-telehealth-demands.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

The Latest Insights Webinar Delves Deep into CPT E/M Changes

By | Blog, healthcare management consulting, Nextgen EHR

This week, we’re back with an all-new CareOptimize Insights Webinar highlighting changes coming with CPT E/M codes.

The code changes will go into effect on January 1, 2021, so it’s time to get your providers and coders ready. This comprehensive webinar explains how to navigate all of the Evaluation and Management changes and what they mean for reimbursement, including which codes to use when, which codes belong in conjunction, and what can be reported. There’s also a 10-step guide from acdis.org on how to successfully transition to the 2021 guidelines.

The Insights2020 CPT EM Code Changes for 2021 is up for viewing on the CareOptimize YouTube channel as well as on our Insights page. Remember you can watch all of our webinars by visiting https://www.youtube.com/careoptimize.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.