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CMS Shares COVID-19 Data Reporting Guidance

By | Blog, healthcare management consulting, MIPS consulting

CMS recently shared guidance on how it aims to enforce a recent temporary final rule mandating condition of participation (CoP) in Medicare for hospitals publishing COVID-19 results.

The guidelines issued earlier this week declared that, during the pandemic, hospitals risk Medicare termination should they fail to report daily on the more than 30 measures required by CMS. The metrics comprise regular COVID-19 admissions, including those affecting ventilated patients, fatalities from COVID-19, and other virus-related hospital utilization data.

Hospitals will now have to submit weekly supply-related metrics and also report new cases of influenza. This is presently voluntary but will become obligatory in November.

Beginning October 7, 2020, hospitals that do not meet the COVID-19 data reporting standards will be given a CMS warning. The hospitals will have three weeks to address any discrepancies in implementation, according to guidelines. Following these warnings, a second advisory alert will be given by CMS to hospitals failing to send out the required daily information.

In general, before being terminated from federal healthcare services, hospitals have a total of 14 weeks to meet Medicare CoP. These terminations would mean hospitals would not obtain payment for the treatment of recipients of Medicare and Medicaid.

To read more, please visit https://revcycleintelligence.com/news/cms-releases-guidance-on-covid-19-data-reporting-as-medicare-cop.

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.

Advance Medicare Payment Relief Is on the Way

By | Blog, healthcare management consulting, MIPS consulting

Near the onset of the pandemic, many clinicians received advanced Medicare payments through CMS’ Medicare Accelerated and Advance Payment Program. The repayment of those funds was recently extended from 210 days to an entire year as part of a resolution recently signed by President Trump, which includes several healthcare-specific provisions.

The Accelerated and Advance Payment Program was instituted when the sharp decline in admissions and visits hospitals and other services were experiencing due to COVID19 became problematic.

Through the program, CMS advances expected Medicare reimbursement and eventually recoups it. Recoupment usually begins 120 days after receipt of the initial payment. That term was extended to 210 days for the pandemic. The recently signed legislation will grant providers a year until CMS will begin reclaiming the disbursements.

For the first eleven months of recovery, CMS is only allowed to offset a provider’s cost by 25 percent. That rises to 50 percent for the following six months. CMS will postpone Medicare reimbursement for 29 months from the date of the first payment under the initiative.

The bill is a victory for caregivers who, given the current public health emergency, have been pressing on lawmakers to grant them more attractive reimbursement terms.

To read more, please visit https://revcycleintelligence.com/news/lawmakers-provide-accelerated-advance-medicare-payment-relief.

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.

EHR Plays a Role in Value-Based Hospice Care

By | Blog, healthcare management consulting, MIPS consulting

As healthcare transitions towards value-based care, electronic health record (EHR) systems are gradually adding functionality to specifically target providers of end of life and acutely ill care. In order to remain competitive in a packed marketplace and provide data-powered reporting for regulatory obligations, numerous hospice and palliative care providers have stepped up efforts to incorporate electronic systems.

With capabilities to handle treatment plans, prescriptions, and workflows off-site, EHR systems can supply scheduling capabilities for patient intake and continuing visits and evaluations amid hospice clinical and operational teams. To minimize industry-wide worker mental collapse and employee shortfalls, workflow enhancement has been crucial. Electronic analysis of the hospice-specific billing code is an extra function of certain electronic health record-keeping systems to improve productivity and decrease time used on long documentation procedures.

Taking advantage of EHR capabilities may also allow proactive detection of patients who might benefit from severe illness and end of life treatment, facilitating standardized usage of evidence-based screening and evaluation methods. Care coordinators can make use of clinical data to better the quality of reporting, determine the effectiveness of treatment, and enable process and outcome measures to easily extract data.

For more information on our Nextgen EHR products, please visit https://careoptimize.com/products/. 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.

Optimize Your Clinic With a Patient Tracking System

By | Blog, healthcare management consulting, MIPS consulting, Patient Tracking System

Ambulatory care surgical centers and urgent care clinics often grapple with numerous patients and clinical activity that need consistent tracking. Failure to streamline the process may affect the efficiency of the clinic or healthcare practice which, in turn, can lead to serious consequences. Greater wait times mean more disgruntled patients and stressed staff and providers. Increased wait times may also endanger a patient’s condition, requiring emergent care.

CareOptimize has developed a solution. Our Patient Tracking System helps clinics and surgical centers keep track of all clinical activity in real-time, boosting operational efficiency and ensuring better patient and provider satisfaction.

The Patient Tracking display is designed to be user-friendly and can be displayed on screens of various sizes. With this tool, the clinical staff is always aware of the location of each patient and provider on your floor plan and the degree of acuity and clinical actions for each case. Furthermore, the tool shows the average and longest wait time, plus the number of patients waiting to be seen, providing the right data to allow concentration of efforts to reduce wait times while, at the same time, offering optimal care.

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.

EHR Target Goals

By | Blog, healthcare management consulting, MIPS consulting

Electronic health records (EHR) assist in the process of collecting patient data and record keeping. However, an EHR has broader implications. Based on what the objectives are, an EHR has the power to alter your entire practice’s workflow, structure, and cultural process. That’s why choosing an EHR that complements and enhances your office operations is so vital.

If you feel your existing EHR isn’t adding value, it may be time to opt for another solution. Moving over to a new EHR is often an extended process. Once all the data has been entered into the new system, your staff must be trained on how to use the different functions and features. This training can take several weeks. Long term needs and goals should drive the process of switching to a new EHR. This lessens the odds of spending the time to transition to a new EHR only to realize that the new solution is ultimately not one that is adapting to the distinct needs of your practice.

Make sure to remain connected with your patients throughout the process as they become familiar with the new EHR, and provide feedback. Identify any problem areas quickly, and take the steps to rectify them, when possible. Patient feedback also shows while you are focused on creating an efficient and effective office, your system also has your patients in mind. You want an EHR solution that follows your new EHR targets for better productivity and delivers as much value to patients as it does to you.

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.

EHR Optimization Among Seniors May Need Improvement

By | Blog, healthcare management consulting, MIPS consulting

A Journal of the American Medical Informatics Association (JAMIA) study reveals acute care hospital EHR optimization may not be meeting rigid healthcare standards when it comes to older patients. Current optimization for this demographic is not reaching the standards of the “4Ms” Framework, implemented back in 2017 as a way to boost healthcare for seniors. The 4Ms are a series of healthcare preferences and goals: What Matters, Medication, Mentation, and Mobility. 

EHRs could be modified, for instance, to integrate features that tackle the 4Ms by incorporating reminders and fields in the EHR for clinicians to implement standardized treatment, target documentation, or revisit medicines known to affect mobility and mentation (the prevention, identification, and management of mental illnesses like delirium and depression). According to the JAMIA study, however, there may be a lack of awareness among clinicians on ways to integrate certain needs for older adults.

 

The JAMIA findings may suggest that hospitals do not rely on EHR optimization to improve older adult care, while the bulk of the inpatient population is actually older adults. Applying policy and realistic initiatives that concentrate on improving care for this age group may help tackle this problem.

To read more, please visit https://ehrintelligence.com/news/older-population-often-overlooked-during-ehr-optimization.

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.

Transitioning to Full-Risk Capitation

By | Blog, healthcare management consulting, MIPS consulting

Healthcare’s “value movement” is a concept just about everyone comprehends. It’s easier to compensate someone for the value they’re making versus simply doing the job. A situation of affordability sparked value-based care, with the Affordable Care Act contributing heavily. Today, among the few programs that have near-universal political support, value-based care is one. When efficaciously enforced, clinicians are spurred to care for the entire person and tackle the risk factors so essential to the quality of life of patients.

Many value systems are still developed on a fee-for-service basis, where doctors are constrained in what they can do with the conventional method of billing and coding. What’s more, these programs too often measure processes rather than results (for example, checking blood pressure versus improving it and cutting down on hospitalizations). It’s not clear whether calculated actions would result in the true desired outcome of less expensive, more sustainable healthcare, and those acts say little about the experiences of actual patients.

A typical primary care doctor sees about thirty patients daily, generating around $600,000 in a year at $80 a visit. This individual is trying to keep patient visits short, there is a ton of paperwork they need to take care of, and, after covering the costs of running the practice, they are hoping to take home a portion of what specialists earn. There is minimal benefit resulting from value-based care payouts, regardless of their PCP skills.

What if the individual assumed “full” risk for these patients? If the doctor took the reins and was responsible for everything about their patients? Things shift radically. Presuming the payor negotiations have been taken care of, this same doctor may have somewhere around $12 million (average $500 per patient per month), about twenty times the money. There is the danger the $12 million is expended, and the doctor incurs a loss. But primary care is worth more than five percent ($600,000 of the $12 million) of overall costs collected by the doctor in the fee-for-service environment because PCPs will redefine the “downstream” treatment use. To stop wasting the other 95 percent of preventable, avoidable, and wasteful treatment, everything now becomes how to maximize patient health. It’s about working with patients, encouraging them to do what’s needed to have a positive effect.

To read more, visit https://www.linkedin.com/pulse/full-risk-capitation-model-why-make-change-christopher-chen/.

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.

COVID-19 Waivers Boost Medicare Telehealth Access

By | Blog, healthcare management consulting, MIPS consulting

Per a recent study, Medicare Advantage Plans and other stakeholders indicated that during the coronavirus pandemic, CMS exemptions proved successful in allowing access to Medicare and Medicare Advantage telehealth. However, there are still hurdles to overcome.

After reviewing the data from 2017, the researchers discovered that, particularly in metropolitan areas, internet coverage was primarily targeted towards younger Medicare beneficiaries with income deemed medium to high. Standard Medicare beneficiaries were more likely to use the internet than beneficiaries of Medicare Advantage, in all the groups analyzed.

CMS provided several telehealth flexibility plans for Medicare and Medicare Advantage, including broadening coverage to Medicare telehealth visits, virtual check-ins, and e-visits, and finally, audio-only services.

Policies that shared risk-bearing payment structures assisted with the rapid adjustments of plans and providers to the pandemic. These models let Medicare Advantage plans employ telehealth services and grow in a brief time to current platforms.

Fee-for-service payment programs proved trickier for both traditional Medicare and Medicare Advantage patients as they navigated the adoption and expansion of telehealth.

Certain factors that increased the adoption and growth of virtual care included promoting home-based telehealth, removing the requirement for providers to have a previous relationship, and increasing the eligibility requirements for provider and service reimbursement.

To read more, visit https://healthpayerintelligence.com/news/covid-19-waivers-improved-medicare-advantage-telehealth-access.

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.

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.