How do I Get Paid for EHR Incentive?

How do I get paid for the Electronic Health Record (EHR) Incentive Programs?

Payments for the Medicare and Medicaid EHR Incentive Programs are distributed based on each year of participation, and follow a specific payment schedule. Located below are payment details on the Medicare and Medicaid EHR Incentive Programs. For an overview, see the Medicare Learning Network (MLN) Matters Special Edition article (SE1111) – Medicare Electronic Health Record (EHR) Incentive Payment Process.

Medicare EHR Incentive Program

• Eligible professionals (EPs): EPs can receive up to $44,000 over five years under the Medicare EHR Incentive Program. There's an additional incentive for EPs who provide services in a Health Professional Shortage Area (HPSA).To get the maximum incentive payment, Medicare EPs must begin participation by 2012.


• Eligible hospitals and critical access hospitals (CAHs): Incentive payments to eligible hospitals and CAHs may begin as early as 2011, and are based on a number of factors, beginning with a $2 million base payment.

Medicaid EHR Incentive Program

• EPs: The Medicaid EHR Incentive Program is voluntarily offered by states and territories. EPs can receive up to $63,750 over the six years that they choose to participate in the program. Medicaid EPs must initiate the program by 2016.


• Eligible hospitals: Medicaid hospitals that qualify for incentive payments may begin receiving incentive payments as early as FY 2011. Hospital payments are based on a number of factors, beginning with a $2 million base payment. Medicaid hospitals must initiate the payments by 2016.

IMPORTANT NOTE: Medicare Administration Contractors (MACs), carriers, and Fiscal Intermediaries (FIs) will not be making Medicare EHR incentive payments. CMS has contracted with a Payment File Development Contractor to make these payments.

DON'T: Call your MAC/Carrier/FI with questions about your EHR incentive payment.

INSTEAD: Call the EHR Information Center

• Hours of Operation: 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays.


• 1-888-734-6433 (primary number) or 888-734-6563 (TTY number).

A revised FAQ on payment for the EHR Incentive Programs has been posted to the EHR website
Question: For the 2011 payment year, how and when will incentive payments for the Medicare EHR Incentive Program be made?

Answer: For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. Read the rest of the answer to this FAQ here.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website at http://www.cms.gov/EHRIncentivePrograms for the latest news and updates on the EHR Incentive Programs.

CMS Attestation Calls in May

Sign Up for CMS' National Provider Calls about Attestation
CMS is holding conference calls for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare Electronic Health Record (EHR) Incentive Program to provide information on the attestation process. These calls will take place next week. Mark your calendars for one of the calls below.

• Tuesday, May 3, 2:00 - 3:30 p.m. ET - Register to join this call if you are an eligible hospital or CAH who wants to learn more about the attestation process for the Medicare EHR Incentive Program.


• Thursday, May 5, 1:30 - 3:00 p.m. ET- Register to join this call if you are an EP who wants to learn more about the attestation process for the Medicare EHR Incentive Program.

What the Calls Will Cover

• Path to Payment – Highlighting the steps you need to take to receive your incentive payment


• Walkthrough of the Attestation Process – Guiding you through CMS' web-based attestation system


• Troubleshooting – Helping you successfully attest through CMS' system


• Helpful Resources – Reviewing CMS' resources available on the EHR website


• Q&A – Answering your questions about the attestation process

Instructions on How to Register for a Call
To register for these calls, take the following steps:

1. Visit either:
   
   
   
   • The registration site for the Tuesday, May 3 eligible hospital and CAH call. Registration closes Monday, May 2 , 2:00 p.m. ET.
   
   
   • The registration site for the Thursday, May 5 EP call. Registration closes Wednesday, May 4, 1:30 p.m. ET.
   
   
   
   


2. Fill in all required information and click "Register."


3. You will be taken to the "Thank you for registering" page and will receive a confirmation email shortly thereafter. Please save this page in case your server blocks the confirmation email. (If you do not receive the confirmation email, check your spam/junk mail filter as it may have been directed there.)


4. If assistance for hearing impaired services is needed, please email medicare.ttt@palmettogba.com no later than 3 business days before the call.

Prior to each call, presentation materials will be available in the Upcoming Events section of the Spotlight Page on the CMS EHR website.

Registration closes when all available space has been filled, or 24 hours before each call; no exceptions will be made, so please register early.

Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Workers of Healthcare responsible for Patients’ Health Literacy

April 21, 2011 — Responsibility for recognizing and addressing the problem of limited health literacy lies with all healthcare professionals, according to a Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) published in the May issue of Obstetrics & Gynecology. Two related Committee Opinions in the same issue discuss the impact of communications skills and strategies and cultural sensitivity issues on patient-physician communication.

"The problem of health illiteracy is widespread and goes beyond those who can’t read or those who don't speak English," said Patrice M. Weiss, MD, chair of the ACOG Committee on Patient Safety and Quality Improvement, in a news release. "Physicians, nurses, social workers — everyone in the health care field — must make sure that our patients fully understand their health condition and their treatment, as well as the importance of taking their medications exactly as directed. We simply can't assume that a patient understands because she nods her head or because we think she seems educated."

The Institute of Medicine of the National Academies defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is limited in nearly half of all people in the United States, resulting in a higher risk for hospitalization, more barriers to getting necessary healthcare, and poor comprehension of medical advice causing morbidity and even mortality.

As part of its commitment to promoting health literacy for all patients, ACOG supports the following recommendations, which were adapted from the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion's Quick Guide to Health Literacy:

• Tailor speaking and listening skills to individual patients. Use open-ended questions starting with the words "what" or "how," and use medically trained interpreters when needed. Especially during the informed-consent process, but also in general, check patients' comprehension by having them restate the health information given in their own words. Encourage staff and colleagues to use culturally sensitive plain language to obtain training in improving patient communication.


• Tailor health information to the intended user by ensuring that it reflects the target group's age, social and cultural diversity, language, and literacy skills. Include the target group in the development (pretest) and implementation (posttest) phases of developing information and services to improve effectiveness of the program. Consider cultural factors, including race, ethnicity, language, nationality, religion, age, sex, sexual orientation, income level, and occupation when preparing health information.


• Develop written materials conveying no more than 4 simple messages per handout. These materials should focus on action and give specific recommendations based on behavior rather than on the underlying medical principle. Use the active voice instead of the passive voice, use familiar language, and avoid jargon. Use culturally relevant visual aids such as drawings or models for key points, use 12-point type size or larger, and leave sufficient white space around margins and between sections.

"Many patients are called 'noncompliant' because they haven't followed their doctor's recommendations, but this may be because they don't understand what is expected of them," Dr. Weiss said. "As physicians, we need to use less complex language with our patients when explaining their health conditions, surgeries, and taking medications. Asking our patients to repeat back to us what they understand is enormously helpful in making sure they really do comprehend."

Obstet Gynecol. 2011;117:1250-1253. Extract

Docs, hospitals see Medicare revenue slow

Hospital and physician Medicare revenue grew at the slowest annual rate in six years during the 12 months that ended in February, newly published indexes show.

Standard & Poor's Healthcare Economic Medicare Index increased 3.22% between February and the same month the prior year, the most sluggish growth rate since the ratings agency began to collect data. An index of commercial plan revenue grew more quickly during the year at 7.97%. The composite index for Medicare and private payers increased 6.19% in the same period.

The Standard & Poor's healthcare economic indices track the per capita revenue for hospitals and physicians or other health professionals, from commercial insurers and Medicare, excluding Medicare Advantage.

For hospitals, the annual growth rate for Medicare revenue increased 1.54% during the year that ended in February compared with 8.62% for commercial insurers.

For physicians and other health professionals, Medicare and commercial insurer revenue grew at an annual rate of 5.41% and 7.21%, respectively, during the 12 months.

Medicaid EHR Incentive Program Checklist

Medicaid EHR Incentive Program Checklist 
If you're an eligible professional, in your first year of participation you may adopt, implement or upgrade or become a meaningful user of certified electronic health records to qualify for incentive payments of up to $63,750 from Medicaid. Here's how to qualify:

• Make sure you're eligible for the Medicaid EHR Incentive Program. View eligibility guidelines at our Eligibility page.


• Also eligible for the Medicare EHR Incentive Program? Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program. See the Medicare checklist.


• Get registered. Visit the "Medicaid State Information" page to see if your state is participating in the Medicaid EHR Incentive Program.


• If your state is already participating, register now for the Medicaid EHR Incentive Program.  Visit the Registration and Attestation page for more details


• If your state has not yet begun participating in the Medicaid EHR Incentive Program: you may wish to register now for the Medicare EHR Incentive Program, if you're eligible for both programs. See the Medicare checklist.

Note: Register as soon as possible. You can register before having a system installed.

• Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.
  
  


• Get qualified. To receive EHR incentive payments in the first year under the Medicaid EHR Incentive Program, you must do at least one of the following:
  
  
  
  • Adopt certified EHR technology; or
  
  
  • Implement certified EHR technology you have already purchased; or
  
  
  • Upgrade your current EHR technology to the newly certified version; or
  
  
  • Demonstrate "meaningful use" of certified EHR technology for a 90-day period.Visit your state's Medicaid agency Web site or our Meaningful Use page to learn about meaningful use objectives and measures.
  
  
  
  


• Attest for incentive payments. To get your EHR incentive payment, you must attest (legally state) through your state's Medicaid agency Web site that you've met all of the eligibility criteria, including having adopted, implemented, upgraded or meaningfully used certified EHR technology. Visit your state's Medicaid agency Web site for more information.

Medicare EHR Incentive Program Checklist

Medicare EHR Incentive Program Checklist 
If you're an eligible professional, become a meaningful user of certified electronic health records to qualify for incentive payments of up to $44,000 from Medicare.

Here's how to qualify:

• Make sure you're eligible for the Medicare EHR Incentive Program. View eligibility guidelines at our Eligibility page.


• Also eligible for the Medicaid EHR Incentive Program? You can receive higher incentive payments, up to $63,750, through the Medicaid EHR Incentive Program. See the Medicaid checklist.


• Get registered. Registration is now open to eligible professionals. Visit the Registration and Attestation page for more details.

Note: Register as soon as possible. You can register before having a system installed.

• Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.


• Be a Meaningful User. You have to successfully demonstrate "meaningful use" for a consecutive 90-day period in your first year of participation (and for a full year in each subsequent years) to receive EHR incentive payments. Visit our Meaningful Use page to learn about meaningful use objectives and measures.


• Attest for incentive payments. To get your EHR incentive payment, you must attest (legally state) through Medicare's secure Web site that you've demonstrated "meaningful use" with certified EHR technology. Starting in April 2011, you can get to our secure attestation Web site through a link at our Registration and Attestation page.

Top Surgeon Resigns Over Controversial Editorial

April 18, 2011 — Lazar Greenfield, MD, is a textbook author, prolific researcher, educator, inventor of the Greenfield vena cava filter for the prevention of pulmonary embolism, and, until yesterday, the president-elect of the American College of Surgeons (ACS).

On Sunday, the 76-year-old Dr. Greenfield resigned from his post as president-elect amid a furor over a Valentine's Day editorial in an ACS newsletter in which he wrote that semen brightens a woman's mood.

"So there's a deeper bond between men and women than St. Valentine would have suspected, and now we know there's a better gift for that day than chocolates," he wrote in the February issue of Surgery News. At the time, Dr. Greenfield was the publication's editor-in-chief. He announced his resignation from the post in the April issue.

Many physicians took offense at the editorial, which they considered indicative of a male chauvinism that is perceived as prevalent in the specialty of surgery.

In an interview with Medscape Medical News, Dr. Greenfield said he considered the piece "a light-hearted attempt to highlight some of the new findings that nature provides to promote stronger bonding between men and women."

"It's unfortunate," Dr. Greenfield said about the controversy. "I think it's an overreaction, but of course, I'm biased."

'Deep Regret'

In a press release issued today, the ACS stated that its Board of Regents met Sunday to discuss Dr. Greenfield's status as an officer of the group in response to "numerous communications" from surgeons about the editorial.

Dr. Greenfield addressed the board, expressed his "deep regret that individuals had been offended," reaffirmed his long-standing support for women in surgery, and tendered his resignation.

The ACS said it wished to honor Dr. Greenfield for "his inestimable contributions to the College and the surgical community" but that it could not be "distracted by any issues that would diminish its focus on improving care of the surgical patient."

Patricia Numann, MD, the current first vice-president-elect of the ACS, was named the society's new president-elect.

Dr. Greenfield said that the Board of Regents had asked him to resign.

"I initially refused and then changed my mind," he said. "I decided that it [the editorial] should no longer be a divisive issue in the College."

Mood Enhancer?

When Dr. Greenfield was editor-in-chief of Surgery News, he wrote a monthly editorial titled The Cutting Edge. In February, he turned his attention to the role that physiology plays in sexual attraction.

The piece touched briefly on reproduction in a variety of life forms, including fruit flies, the bacterium Lactobacillus plantarum, rotifers, and finally Homo sapiens. Dr. Greenfield cited research purporting to show that human semen contained mood enhancers, such as estrone and serotonin, with "major salutary effects for the recipient."

The editorial also suggested that semen may be one reason why lesbians who live together do not have synchronized menstrual cycles, a phenomenon common among heterosexual women.

After some ACS members complained, the editorial was pulled from the online edition of Surgery News posted on the ACS Web site.

Dr. Greenfield said that the majority of the feedback he received from fellow surgeons to the editorial was supportive. "They didn't find it offensive," said Dr. Greenfield, who holds the rank of professor emeritus in surgery at the University of Michigan in Ann Arbor.

However, Dr. Greenfield acknowledged there were also physicians who considered the editorial sexist. He told Medscape Medical News that he apologized to these doctors — over the phone and in writing.

"I apologized for the way they had been hurt, and had interpreted [the editorial]," he said. "I expressed...that I wanted to make amends and work with them. If they wanted to make this a learning experience for others, if [the editorial] had been some form of unconscious bias, I thought it would be a valuable teaching experience."

No 'Old Boy's Network'

Dr. Greenfield said his editorial is not an indication that the ACS is dominated by an old-boy's network.

"I've always been a strong advocate for women in surgery," he said. "That's why half the people in the Department of Surgery at the University of Michigan are women."

Several female surgeons interviewed by the New York Times for a story about Dr. Greenfield's editorial described him as a role model for promoting gender equality.

In 2004, as a member of a blue-ribbon committee formed by several medical societies, he coauthored a position paper on surgical education that called for making the field — in residency training and beyond — more attractive to women.

Before he wrote the Valentine's Day editorial, Dr. Greenfield was perhaps best known for inventing the Greenfield vena cava filter in 1973 for patients at risk for pulmonary embolism. The device is still in use.

He also has left his mark on the surgical field as the editor of 2 major textbooks and several hundred peer-reviewed articles. From 1987 to 2002, he chaired the surgery department at the University of Michigan in Ann Arbor. He is now retired from active teaching and research.

Alert: Medicare EHR Incentive Program Attestation Begins Today!

Attestation for the Medicare EHR Incentive Program Begins Today!
Today, attestation for the Medicare EHR Incentive Program begins. This means that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) can attest through the CMS web-based attestation system and be on their way to receiving Medicare EHR incentive payments.

We can help you successfully attest
Several new CMS resources can help you successfully navigate the Medicare EHR Incentive Program:

• A new attestation page on the CMS EHR website, where participants in the Medicare EHR Incentive Program can find important information on attestation.


• The Meaningful Use Attestation Calculator allows EPs and eligible hospitals to check whether they have met meaningful use guidelines before they attest in the system. The calculator prints a copy of each EP's or eligible hospital's specific measure summary.


• The Eligible Professional User Guide and the Eligible Hospital and Critical Access Hospital User Guide provide step-by-step guidance for EPs and eligible hospitals on navigating the attestation system.

Coming soon

• Attestation Worksheets for EPs and eligible hospitals allow users to fill out their meaningful use measure values, so they have a quick reference tool to use while attesting.


• Attestation Video Webinars will provide a video version of the user guides for EPs, eligible hospitals and CAHs. The videos show EP and eligible hospital representatives completing the attestation process.

If you are not ready to attest, follow these steps to participate in the programs:

• Make sure you're eligible for the EHR Incentive Programs. View eligibility guidelines at our Eligibility page and select the program in which you want to participate.


• Get registered. Registration is open for EPs, eligible hospitals, and CAHs. Visit the Registration page for more details.


• Use certified EHR technology. To receive incentive payments, make sure the EHR technology you're using or are considering buying has been certified by the Office of the National Coordinator for Health Information Technology. Visit our Certified EHR Technology page for details.


• Be a Meaningful User. You have to successfully demonstrate "meaningful use" for a consecutive 90-day period in your first year of participation (and for a full year in each subsequent years) to receive EHR incentive payments. Visit our Meaningful Use page to learn about meaningful use objectives and measures.


• Attest for incentive payments. To get your EHR incentive payment, you must attest through Medicare's secure website that you've demonstrated meaningful use with certified EHR technology.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Source: Centers of Medicare & Medicaid Services

Deficit Reduction Plan to Implement Feared Cost-Control Tool

April 13, 2011 — The deficit-reduction plan unveiled by President Barack Obama today strengthens a cost-control tool in healthcare reform that organized medicine fears.

The savings mechanism is the Independent Payment Advisory Board (IPAB). Under the Affordable Care Act (ACA), the IPAB will advise Congress on ways to curb the per capita growth of Medicare spending if it exceeds growth-rate targets set by the law.

If it does not implement IPAB recommendations, Congress must enact policies that save just as much, or else let the Department of Health and Human Services make the cuts.

The Medicare growth-rate target initially will be the average of the consumer price index (CPI) for urban residents and the CPI for medical costs. In 2018, the target changes to growth in the gross domestic product (GDP) plus 1%.

To wring more savings from Medicare, Obama proposes to lower the second spending target, triggering IPAB action to GDP growth plus 0.5% beginning in 2018. In addition, the IPAB would gain additional tools and enforcement mechanisms to control Medicare spending.

The greater role of the IPAB is part of a plan to reduce the federal deficit by $4 trillion over 13 years or less that Obama outlined in a speech at George Washington University.

End of Medicare "As We Know It"

Obama would hit those numbers with $3 in spending cuts and interest savings for every $1 in higher tax revenue, partly derived from ending Bush tax cuts for the wealthiest Americans. Obama said his prescription borrows from the recommendations of a bipartisan fiscal commission that he appointed last year, and incorporates $1 trillion already contained in his budget proposal for fiscal 2012, which begins October 1.

Obama laid out a different path toward a balanced budget than Rep. Paul Ryan (R-WI), the chair of the House Budget Committee, did last week. Under the Ryan proposal, federal outlays would decrease by $5.8 trillion over 10 years based on current spending policies.

The GOP plan achieves these savings partly by giving seniors who turn age 65 in 2022 and beyond a subsidy for buying healthcare coverage from private insurers, and turning federal contributions to state Medicaid programs into block grants.

Obama opposes the GOP "voucher" system, saying it would "end Medicare as we know it" and shift more costs from the federal government to seniors. He also argues that converting Medicaid into a block-grant program would leave it underfunded.

Hitting a Raw Nerve

Although Obama intends to preserve Medicare as an entitlement as opposed to a subsidy program, he nevertheless seeks to trim $340 billion from it over 10 years, which is on top of more than $400 billion in savings through 2019 that the ACA calls for. Some of the extra economizing involves improving patient safety, cutting unnecessary prescription drug outlays, and reducing waste and abuse that drives up costs.

None of those measures, however, is likely to hit a raw nerve in medical circles like the increased reliance on the 15-member IPAB to control Medicare spending.

Ever since the ACA was passed in 2009, organized medicine has sought to eliminate or drastically reshape this new entity, designed to function in a framework resembling the sustainable growth rate (SGR) formula for determining physician reimbursement in Medicare.

That formula sets an annual target for Medicare spending on physician services based on GDP growth, which also forms the basis for IPAB targets starting in 2018. If actual spending on physician services exceeds the target in a given year, reimbursement rates under the SGR formula must decrease the following year to make up the difference.

Organized medicine argues that the SGR formula is flawed because physician practice costs typically rise faster than the GDP. Every year since 2003, the SGR formula has triggered cuts to Medicare rates that Congress has subsequently postponed, causing them to pile up. As a result, physicians face a 29.5% reduction in 2012.

Obama's deficit-reduction plan allocates a "sufficient" amount of money to reform the SGR formula and avert this catastrophe but does not provide details on what this reform looks like.

In the meantime, the IPAB looms as a similar threat to physician compensation. Leaders of the American Medical Association and other medical societies contend that the IPAB could expose physicians to a double whammy by requiring pay cuts in addition to those mandated by the SGR formula.

"Strong Concerns"

In a written statement issued after Obama's speech today, American Medical Association Chairwoman Ardis Hoven, MD, said that her group has "strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus."

Medical societies also object to a group of unelected officials having so much power over physician reimbursement. And they consider it unfair that hospitals are spared IPAB cuts until 2019.

There are other restrictions that cause physicians to feel the brunt of IPAB spending decisions. The ACA prohibits the board from recommending any solutions that would reduce Medicare eligibility and benefits or increase costs borne by beneficiaries, including Part A and Part B premiums. In short, seniors avoid the IPAB axe just as hospitals do.

However, a senior White House official hinted during a not-for-attribution press briefing today that the IPAB might spread out the pain. When asked whether the various restrictions on IPAB cuts might disappear under the president's deficit-reduction plan, the official replied, "No, not all of them. I think the idea is there would be some expansion."

CIODITY Home Remedies

Heartburn. You are trying to quickly eat a sandwich before rushing back to work and suddenly your chest begins to burn. The problem is usually caused from eating too fast, causing acid from your stomach to go upwards in your esophagus. An estimated 40% of people experience heartburn at least once a month. Many times the burn will quickly fade. However, if your heartburn seems to linger, try one of these acidity home remedies.

1. Ginger root

Put a teaspoon of freshly grated ginger root in a cup of hot water and drink (or swallow 1,000 mg. of ginger root powder). Ginger helps the body to digest food better, especially when eating spicy foods. If you get heartburn a lot, consume ginger every day.

2. Mustard

One of the most effective acidity home remedies is mustard. As soon as heartburn occurs, eat a spoonful or two of mustard. In a few minutes you should feel relief.

3. Hot water bottle

If you're experiencing a lot of discomfort, place a hot water bottle over your liver (upper right abdomen). The heat will help your liver break down food better. Sit in a relaxed position with the hot water bottle, but don't lay down. Laying down could force acid upward.

4. Licorice

Break open a 250 mg. licorice capsule and dissolve it in two ounces of water. Drink it right away. You can also try two 250 mg. chewable tablets instead. If you have hypertension, you shouldn't use this remedy.

5. Pineapple

If you have frequent heartburn, end your meals with a couple of slices of fresh pineapple. Canned pineapple will not have the same effect.

6. Celery

Eat a stalk of fresh raw celery to reduce heartburn. Heartburn is a common pregnancy discomfort so this is an excellent choice for moms-to-be.

7. Pickle juice

Ever wonder what to do with all that leftover pickle juice? Use it to settle your stomach! Drink 1/4 cup next time you experience heartburn.

8. Tea

Sipping on chamomile or peppermint tea will help soothe heartburn. To prevent heartburn from happening again, sip on one of these teas after each meal.

9. Apple cider vinegar

Some acidity home remedies have been used for ages and vinegar is one of them. Mix 1/4 cup vinegar with a tablespoon of honey. This concoction should stop heartburn immediately.

10. Yogurt

As soon as you feel heartburn coming on, eat two spoonfuls of plain yogurt. Eating half a cup of yogurt daily will greatly reduce your chance of experiencing heartburn.

11. Gum

Try chewing a stick of gum when heartburn hits. The production of saliva will neutralize the acid and will help push the digestive juices downward.

12. Banana

Eat half of a fresh banana or a few dried banana pieces. Bananas have a natural antacid effect and will quickly fight off heartburn.

Senate Bill to Put Physicians & Medicare Billing Data Online

April 9, 2011 — How much individual physicians receive from Medicare for treating seniors on a service-by-service basis — level-4 office visits, vaccinations, chest x-rays — would be posted online for all to see under a bill introduced April 7 by Sen. Charles Grassley (R-IA) and Sen. Ron Wyden (D-OR).

The 2 senators contend that public disclosure of billing information would help citizens and consumer watchdog groups spot Medicare fraud, waste, and abuse — and also deter clinicians from engaging in it.

"I believe transparency in the healthcare system leads to greater accountability," Sen. Grassley said on the Senate floor. "I’ve often quoted Justice Brandeis, who said, 'Sunlight is the best disinfectant.'" Accordingly, he and Wyden titled their legislation the Medicare Data Access for Transparency and Accountability Act.

The American Medical Association (AMA) counters that physicians deserve privacy when it comes to Medicare billing. Furthermore, it argues, government entities charged with combating Medicare fraud, such as the Department of Justice and the Office of Inspector General of the Department of Health and Human Services, already have access to the data. The plan to post a physician’s National Provider Identifier number along with the billing information could "put physicians at significant risk of identity theft," said J. James Rohack, MD, the AMA's immediate past president.

The proposed government Web site would contain Medicare billing data for all providers and suppliers, not just physicians. The Senate legislation requires it to be searchable, including on the basis of individual items and services. The public could access the site free of charge.

The legislation comes in the wake of a series of stories published last year by the Wall Street Journal based on an analysis of a limited amount of Medicare billing data. The stories spotlighted a number of physicians who received more than a $1 million a year from Medicare by performing an unusually high number of diagnostic tests and surgeries for seniors.

Sen. Grassley acknowledges that sheer volume for a particular service does not necessarily mean a physician is engaged in shady business. Rather, he or she may be a leader in that field, attracting more patients as a result. His legislation requires the billing-data Web site to state upfront that the information does not reflect on the quality of the service or the clinician who provides it.

The controversy over public disclosure of Medicare billing information goes back to the late 1970s, when the old Department of Health, Education, and Welfare sought to publish a list of all clinicians who treated Medicare patients and what they earned from it. The Florida Medical Association and the AMA asked a federal district court in Florida to issue an injunction blocking publication of the list, and the court obliged in 1979.

Dow Jones, the publisher of the Wall Street Journal, filed suit in that same federal court in January and asked it to lift the injunction. The case is pending.

Impact of EHR on Revenue Cycle Management

The innovation of electronic claims processing has raised the benchmark on what can be done to improve patient care, reduce costs, increase productivity, and reduce the time between reimbursements. Revenue cycle management has evolved to bridge the gap between the clinical side of electronic medical records and the billing side. Some electronic medical record software has integrated this process for a seamless patient flow - making the revenue cycle management process start as soon as a patient is registered. For physician services, revenue cycle management is one of the biggest parts of how a practice is paid. The revenue cycle begins when the patient is scheduled for an encounter and ends when payment for all services and procedures provided during the encounter is received.

Most practices understand the importance of ensuring third party payment is appropriate and that the full amount due is received in a timely fashion. Practices understand that failure to ensure that insurance payments are appropriate and accurate can negatively impact the total payment received as well as the amount the patient will ultimately pay. With revenue cycle management designed to work with the EMR seamlessly, practices are able to streamline and automate many of the processes that occur. Additionally, revenue cycle management integrated with an EMR eliminates many of the common issues which affects physician offices on a daily basis.

Daily reconciliation is handled with a click of a button for office staff to monitor the flow of patients to payouts. Physician offices which outsource their billing also have the option to allow their billing company to utilize their software - maintaining a transparent view of the work performed by the billing vendor. As the delivery of patient care changes, so will the technology that enhances it.

Practices which use an electronic medical record understand that revenue cycle management and clinical information need to work smoothly in order for a practice to run efficiently. Physicians shouldn't have to worry about the business side of practicing medicine so they can have more time to spend delivering the best care to their patients.

Are you Still Confused to Choose a right EHR for you?

Introduction

If you're still weighing the pros and cons of an electronic health record (EHR) purchase, consider this: Forget about going to an EHR because the government may or may not force you to comply. Think of improving your practice and perhaps your quality of life with the benefits of an EHR. Your coding compliance will increase. You'll have access to data about your practice and patients that would be impossible with a paper chart. An EHR will have a major impact on your practice and the way that you currently triage patients in the office. Here are common scenarios in offices without an EHR: A paper chart is expensive to produce and you can never seem to find it when you need it most. A chart audit will most likely confirm that your documentation does not add up to the code reported. In my chart reviews I find that physicians are either under coding or under documenting services performed and that approximately 30% of handwritten charts are not compliant. Although choosing the right EHR can be confusing, these 10 steps can help ensure that you'll be happy with your selection.

1. Take a closer look at ASP technology.

Application service provider (ASP) technology means that the EHR program and data are housed securely at a vendor's or institution's location; you don't need to have expensive servers and tech support in your office if you have high-speed Internet access. The ASP EHR model will range from about $350 to $650 per month, plus training. Billing software will be an additional cost. The other option is buying an EHR that requires an in-house server and software. Systems like this that I reviewed averaged between $40,000 and $60,000 depending on the amount of bells and whistles added. With ASP models, benefit changes and software improvements are continually updated on your site so that your practice is always using the most recent data and advanced software. You don't need proprietary hardware or additional servers. You do not need to house your own server, and many systems have a minimal cost up front. You also will be able to log in from home to view patient data and reports. The downside to ASP technology is that when the Internet is down, so are you. Make sure you have good, stable Internet service before considering this option.

2. Take your time and evaluate companies thoroughly.

Two good resources for starting your search are the KLAS reports and CCHIT- certified companies. The KLAS rating will show you detailed information from physicians about software performance and cost. CCHIT (Certification Commission for Health Information Technology) is an independent organization that performs certification criteria and inspections for EHRs. Products must significantly exceed minimum federal-standards requirements, are rated for usability, and are verified to be in use successfully at multiple sites, according to the CCHIT Website. You may consider hiring a consultant to help you review your practice's EHR needs. There are several places to locate a consultant with experience. Try your local chapter of the American Medical Association or the National Society of Certified Healthcare Business Consultants. The NSCHBC's Website (www.nschbc.org) lists consultants by state.

3. Check out your software vendor.

Ask for references in your specialty. Call practices that have worked with the vendor and ask about downtime, software support, and overall satisfaction with the software. Choosing a company is half the battle. What will you be married to after the salespeople leave? Once you have done your research, choose 2 or 3 top contenders and then compare what I call the "nuts and bolts," which is the daily interaction with the EHR company.

4. Evaluate the EHR company's daily support structure.

How does the company handle support calls? Some companies require you to send an email with the problem described. These emails may be handled outside of the United States and may be processed by a computer rather than a human being. You will get to speak to a real person only when the email consultation fails. Email is a frustrating medium when your software won't work. Make sure that you are comfortable with your vendor's support system.

5. Make sure the company interfaces with your laboratory.

Most companies can build an interface for lab data. Make sure you ask about the cost of the interface. Some companies will charge as much as $5,000 plus a monthly fee for an interface.

6. Scrutinize the medical notes preloaded in the EHR.

If you find that most of the data preloaded in the system will not fit within your scope of practice, pass up using that EHR. It has been my experience that it is too overwhelming to learn a new EHR and build templates at the same time. If you have to build it yourself, take a pass and find a company that suits your needs.

7. Research the billing package.

The EHR is only part of the purchase. Discuss the billing package of your new system in detail. Must-haves in billing software: CPT and ICD-9 codes updated yearly. You want a system that automates this process. Most cutting-edge billing software will automatically update codes every year with a download. Automated statements will save you time and money. Most vendors offer this service at a discounted rate compared with postage. You will get to take advantage of the bulk discount rate. Automated verification of benefits is a big plus for family practice or internal medicine groups. The patient benefits are downloaded into the system. Copays and deductibles are easily identified and save staff hours of time. Your copay can be as much as 30%-40% of your income on an exam, so this is a significant benefit to your practice. Rejected claim reports. Most vendors will tell you that they have a "claim-scrubbing process." The software scrubs the claims for several different factors, and therefore reduces error. This is true to some extent. Invalid CPT codes and ICD-9 codes without the fifth digit are screened by this process as are claims with other basic coding errors. The most important factor in billing software is the ability to load LCD or CCI edits and specific carrier-required modifiers. An example of this is screening colonoscopy or well exams. Most carriers only cover a specific diagnosis for these procedures. Good billing software will warn you if you are not billing the service with a covered diagnosis. This tool is a major benefit for billing staff. Electronic posting of payments. This service is a real time-saver. A 20-page EOB from Medicare can be downloaded in seconds. The software posts all payments, adjustments, and rejections. You receive a report of all postings for review. EDI transmission reports are extremely important to your billing success. Investigate how the company reports provide you with a list of claims transmitted. Carrier errors and rejections should be easy to access. You will also want proof of timely filing to be at your fingertips.

Hints for Introducing an EHR to Your Practice

8. Add the scheduling and billing module first before bringing on the EHR.

If you are adding a new billing system and EHR at the same time, I highly recommend that you add the scheduling and billing system first. This will give you time to populate that patient demographics and allow staff the time to train and become efficient with the scheduling software.

9. Set aside enough time to train.

Regardless of how great the EHR performs, you will not be able to enjoy its full benefits if your staff is not fully trained. Lighten your workload on the first few days of training. Don't schedule meetings or take outside calls if they are not completely necessary. Devote your time allowed for training to the trainer. I have seen an office spend several thousand dollars for training and not get the full benefit because the patient load was too heavy or other activities were planned at the same time. When the trainer leaves, you will be lost if your staff aren't fully trained. I recommend that you schedule 3-5 full training days with a follow-up of 2 more days in a couple of weeks. You can absorb only so much information in a single session. I also advise clients to request a seasoned trainer. EHR sales have sparked in the last 2 years and companies are hiring new trainers. Make sure that if you have a new trainer, the company will send an experienced representative to assist.

10. Prepare yourself and your staff for change.

Even with the best EHR system, you will experience confusion, frustration, and tears. Why? Because everything changes and the prized paper chart is gone. You will forget about your beloved paper after a few weeks of using the EHR, however. Educate your staff about the transition. Prepare them for confusion in the first couple of weeks. I recommend against using a dual system of paper charts and EHR. Make the break from paper and suffer through the transition. You made the purchase in order to get rid of the paper. In the end you will have devoted a great deal of time and some financial resources that will pay off for your practice. You will reap the benefits of change. You will wonder why you waited so long, and your beloved paper chart will be all but a bad memory.

Spirometry Billing (A Reimbursement Guide)

Who should have Spirometry Testing? In earlier times there was no any real concept that how to get reimbursement against the spirometry. Afterwards, in 1994, the American Thoracic Society published an official statement of “Standardization of Spirometry.” In this statement there was seen a potential indications for Spirometry, some of which may not be covered by Medicare or other payors:

• To assess therapeutic interventions (e.g., bronchodilator therapy, steroid treatment, management of CHF, etc.)


• To assess preoperative risk


• To screen individuals at risk of having pulmonary diseases (e.g., smokers, occupational exposures)*


• To assess health status before enrollment in strenuous physical activity programs*


• To assess patients as part of a rehabilitation program*


• To assess risks as part of an insurance evaluation*


• To assess individuals for legal reasons (e.g., Social Security. personal injury lawsuits)*

*These Indications are generally not covered by Medicare. What Codes describe spirometry procedures? What are the associated payment rates? The current Procedural Terminology (CPT) codes defined below are the most common codes used to describe spirometry procedures performed. The simplicity Spirometer does not perform a respiratory flow volume loop (CPT code 94375). Note: According to the Centers for Medicare and Medicaid Service (CMS) Correct Coding Initiative, none of the procedures described by the CPT codes listed below may be billed together on the same date of service. Please consult the latest version of the National Correct Coding Policy Manual to identify rebundling combinations. Edits may be reviewed at www.cms.hhs.gov/physicians/cciedits/default.asp

CPT Code **	Description	Unadjusted 2005 Medicare Allowable***
94010 (may not be billed with 94060 or 94375 on same DOS)	Breathing capacity test	$33
94060 (may not be billed with 94010 or 94375 on same DOS)	Evaluation of wheezing (pre-and post-bronchodilator)	$55
94375 (may not be billed with 94060 or 94375 on same DOS)	Respiratory flow volume loop	$36

** Most commonly used CPT codes for spirometry. Additional codes may be found in the Current Procedural Terminology (CPT) Manual published by the American Medical Association. All spirometers may not perform all procedures identified by CPT codes. The existence of CPT codes does not guarantee coverage of payment for any device by any insurance carrier of Medicare. Medical necessity must be established by the patient’s physician in accordance with specific coverage policy guidelines. *** Medicare allowable amounts vary by geographic region. What documentation is needed to support payment for spirometry procedures? Many Medicare Part B carriers have published Local Medical Review Policies (LMRP) that describe specific coverage guidelines for spirometry procedures. For example Upstate Medicare in New York offers the following list of ICD-9 codes, which may help support the medical necessity for spirometry testing. These codes may not be applicable in other regions of the country. For definitive coverage and payment information contact your local Part B carrier. What are general coverage guidelines for spirometry under the Medicare Program? · Local Medical Review Policies have been written by many Part B carriers, and copies may be requested through customer’s local Medicare Part B Carrier. · The appropriate combination of tests may be coded if proper clinical indication exists. Consult local medical necessity policy for Correct Coding guidelines and unbundling information. · The Medicare Program specifically excludes coverage for screening tests, including;

• Spirometric assessment of an asymptomatic patient, with or without high risk of lung disease;


• Studies as part of a routine examination; and


• Studies as part of an epidemiologic survey.

Reference:

1. American Thoracic Society (1995). Standardization of spirometry, 1994 update. Am J Respir Crit Care Med. 1995;152:1107-1136.


2. American Medical Association. Current Procedural Terminology. Professional Edition.


3. Physician fee Schedule: payment policies and relative units. Federal Register Vol. 69, No. 219, November 15, 2004.


4. Local Medical Review Policy. Pulmonary Function Testing. 2003. Update Medicare Division, New York.


5. American Medical Association. International Classification of Diseases, ICD-9-CM.