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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.

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 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.

Telehealth Leads to Better Care and Revenue with Chronically Ill Patients

By | Blog, healthcare management consulting, MIPS consulting, Telehealth

Telehealth offers critically ill patients and their healthcare providers opportunities to raise income and improve quality of treatment. Telehealth appointments frequently represent a more convenient approach versus an in-person visit, and the costs are often markedly less than an emergency room visit. Instead of making an unnecessary trip or incurring a hefty emergency room charge, patients using a telehealth platform are able to virtually talk with a physician or a nurse via computer, phone, or tablet.

For healthcare practices, telehealth appointments with chronically ill patients create several revenue opportunities. Regulations have relaxed, and Medicare offers even more leniency when it comes to reimbursing telehealth services. Physicians can now receive the same amount reimbursed for a telehealth appointment as they would for an in-person visit, leading to a more stable revenue stream. Telehealth and remote monitoring for patients with chronic conditions in value-based contracts also enables physicians to reach quality care targets and reduce unneeded readmissions, leading to greater incentive payments.

Regular communication with chronically ill patients solves multiple problems. It’s challenging to keep a consistent chronic care management program going when patients might be afraid to come into the office. Those who need a physical, follow-up visit, or have regularly scheduled appointments, can now keep up with those via virtual visits. As a bonus, providers can also more easily evaluate the home environment with the virtual visit “show and tell” opportunity.

Telehealth has emerged as a good way to provide revenue opportunities, offer more convenience, and avoid interrupting care management programs. Many providers are seeing the benefits.

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.

Things to Consider as Healthcare Facilities Move to Reopen

By | Blog, healthcare management consulting, MIPS consulting

Healthcare providers, using the directions mandated by federal and local governments, locked down their facilities to avoid the spread of COVID-19. This also meant shutting down main clinical service lines and canceling in-person appointments for patients. However, vendors are beginning to open their doors once again with the pandemic subsidizing in some regions.

According to recent data collected by The New York Times, the number of reported COVID-19 cases is dropping in close to half of states around the country, with several other states showing no statistically important change.

Just as healthcare facilities have decided to refrain from in-person appointments to minimize exposure, providers will also need to evaluate safety measures to reduce patient and provider contact with the coronavirus.

According to CMS guidelines, the optimization of telehealth services should be a major priority for healthcare facilities. Providers should remain focused on providing virtual care where appropriate to reduce the risk of spread of the virus, especially if they are dealing with patients that have severe or chronic conditions.

Should a scenario arise where in-person care is required, healthcare facilities should seek tele-triage services prior to resuming in-person care. Boosting remote patient monitoring and other telehealth capabilities may also assist providers with ensuring care access for patients who need medical care but are staying away from healthcare facilities due to understandable concerns.

To read more, please visit https://revcycleintelligence.com/news/key-considerations-for-reopening-healthcare-facilities-amid-covid-19.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, next-generation 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 Push for Extended CMS Telehealth Waivers

By | Blog, healthcare management consulting, MIPS consulting

Many providers and patients have not only become accustomed to the rapidly devised telehealth exemptions, but they also believe it’s an optimum approach to delivering basic healthcare services until the coronavirus is no longer a major threat. This positive attitude about telehealth may also serve as a way to ensure those changes, which some advocates of telehealth were big fans of long before COVID-19 surfaced, become the norm.

Earlier in 2020, CMS took considerable steps to relax regulations relating to the use of telehealth services, stating it was the proper response to make sure patients would still receive services while cities across the country were on lockdown to reduce the spread of COVID-19.

Just over two months later, access to remote care providers has exploded. The powerful American College of Physicists (ACP) lobbying group is one of the groups requesting the changes to remain in place on a long term basis.

In addition to easing regulations and compensation for telehealth services, ACP also wants the newly-granted autonomy to remain in effect in the direct supervision of doctors working at teaching hospitals, along with continuing fee increases for hospital divisions offering these services.

To read more, visit https://www.healthcaredive.com/news/calls-mount-for-cms-to-extend-telehealth-waivers/579264/.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, next-generation 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.

Deriving Value from Your EHR Data

By | Blog, healthcare management consulting, MIPS consulting

An electronic health record (EHR) is perhaps the costliest investment in technology a hospital or healthcare system makes. Most healthcare agencies are hesitant about investing in new technology after the high expense of an EHR. As a result, they use their EHR analytics functionality to attempt to conduct analytics across the organization. How are they doing with such an approach? A Definitive Healthcare survey suggests there may be room for improvement.

The survey reveals healthcare systems using only EHR analytics components are more challenged by technology, whereas consumers who use in-house or analytics-specific systems are less technologically challenged. Organizations that do not use EHR analytics cite similar challenges in technology.

Analytics within an EHR often have limited functionality for results necessary to discover ways to improve outcomes. Because the developers of analytics-specific platforms are well-versed in data analytics and how to create value from results, those products often elicit better, more useful information, especially when combined with the EHR analytics.

Barriers to the use of analytics-specific platforms fall into three categories: cost, interoperability with existing technology, and leadership buy-in. Studies have shown these platforms create significantly more value by reducing cost, improving patient outcomes, and offering a better overall view. The value of results elicited often outweighs the barriers.

The CareOptimize Nextgen EHR page features several products we’ve developed to assist healthcare organizations with easing the process of navigating the rapid changes in healthcare technology.

To read more, please visit https://www.healthitoutcomes.com/doc/how-to-derive-value-from-the-data-in-your-ehr-0001.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, next-generation 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.