Getting Started with an EHR

HIMSS (Healthcare Information and Management Systems Society) issued a fact sheet with the following tips on how to implement an EHR system:

1. Getting Started
• Start by forming an EHR project team
• Write a mission statement
• The EHR project can speed up patient flow and add capacity
• The EHR can also reduce overtime by spending less time filling out paper form and charts.
  
2. Examine Workflow
• Examine how implementing the EHR will change your business. For instance the EHR may speed things up but change how you run your business
  
3. Select the Right Vendor
• Make a list of requirements that you need in an EHR
• Ask people you know what kind of EHR that they use and what their experiences have been with them
• Look on the institute of Medicine and their list for a "key capabilities" for an EHR
  
4. Negotiate a Good Contract
• Negotiate a contract that meets your needs for your EHR
• Ask for references from the vendor
• View the product at a company that uses the vendor already
  
5. Plan Carefully for a Successful Implementation
• Plan how to transfer existing paper based information and how the new documents transfer into the new EHR system.
• Train one "super-user" for every 25 people that will be using the EHR system in your company.

For the full article, please click the following link: Getting Started with an EHR

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page

Reducing Patient Wait Times

Health Leaders Media published an article on "How Physicians Can Reduce Patient Wait Times"  The basis of the article was a survey that was administered by Merritt Hawkins & Associates on patient wait times.  The survey studied the wait times for the following specialties: Family Practice, Cardiology, Dermatology, and Orthopedic Surgery.

Family Practice:
Longest Wait Time: 99.6 Days, Shortest Wait Time: 2.47 Days, Average Wait Time: 20.3 Days

Cardiology:
Longest Wait Time: 104.4 Days, Shortest Wait Time: 3.4 Days, Average Wait Time: 22.1 Days

Dermatology:
Longest Wait Time: 98.7 Days, Shortest Wait Time: 2.5 Days, Average Wait Time: 27.5 Days

Orthopedic Surgery:
Longest Wait Time: 59.9 Days, Shortest Wait Time: 2.9 Days, Average Wait Time: 16.8 Days

The article suggested that the following take place to address the wait times:

• Adopt modern tools (for example: EHR)
• Use creative and innovative scheduling models
• Have office hours that better accommodate patient's needs
• Look at quality measurements (such as patient demographics)

Some other solutions the article suggested were: 

• e-messaging, e-visits and groups clinics
• pilot programs - have one physician go around and teach the others to use new protocols.

To download the full article, please click here: How Physicians Can Reduce Patient Wait Times

For additional resources by specialty, please click the following link: Medical Reimbursement Resources Page

Denying Payment for Unnecessary Emergency Room Visits

KevinMD.com published an article on "Denying Payment for Unnecessary Emergency Room Visits".  This blog post highlighted Washington Medicaid Initiative which would deny Medicaid payments for unnecessary Emergency Room visits.

Some takeaways from the article were:

• Washington State is committed to pay for medically necessary care - but many patients go to the ER when they could just go to a primary care physician. 
• There is tremendous overuse and abuse of emergency rooms - at least $21 million dollars a year
• ER Physicians and Hospitals have had the state pay for non-medically necessary services in the Emergency Room.
• Everyone must be seen regardless of their ability to pay according to the EMTALA (Emergency Medical Treatment and Active Labor Act) of 1989.
• One idea that the state of Oregon did was assign a social worker to each of those patients who repeatedly go to the emergency room.  The intent of this is to divert patients away from the Emergency Room who they think are going for a "social problem". The time spent with the social worker costs less than what they would have to pay for the Emergency Room visit.

To view the full blog post, click here: Denying Payment for Unnecessary Emergency Room Visits

For additional billing and coding resources, please click the following link: Medical Reimbursement Resources Page

Referrals to Physicians

The New York Times published an article on patient referrals. Some key takeways from the article about referrals are the following:

• Studies suggested that physicians receive up to 45% of new patients by referrals
  
• Referral rates are so high because of the following reasons:
• Increased specialization
• Lack of time for the doctor to review complex cases
• Fear of lawsuits for not consulting an expert
  
• Specialists are paid better than primary care physicians but depend on other doctors for referrals
  
• One individual had a suggestion to implement bundled payments similar to what hospitals, nursing homes and dialysis centers do.

To view the full article, please click the following link: Referral System Turns Patients Into Commodities

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Patient Safety and Quality of Emergency Care

The American College of Emergency Physicians published an article on "Patient Safety and Quality of Emergency Care" which lists improvements on patient safety and quality of care.

Some key takeaways addressing the problem of holding (or "boarding") the patients who have been admitted in the emergency room suggested the following solutions:

• Move admitted patients out of the emergency department to inpatient areas
• Coordinate the discharge of hospital patients before noon
• Coordinate the scheduling of elective patients and surgical cases

Takeaways from a survey that was administered on emergency physicians' concerns were:

• Seven out of ten physicians expressed concerns about the proposed physician measures for example - overcrowding.
• Two out of three said that the measures may increase the burden on the emergency department (who are at capacity).
• More than half said cost reductions could harm the quality of care

To read the full article from ACEP, please click here: Patient Safety and Quality of Emergency Care

For additional billing and coding resources, please click here: Medical Reimbursement Billing and Coding Resources

Guidelines for Office-Based Anesthesia

Interested in starting your own practice of ambulatory anesthesia (office based anesthesia), below are a few of the issues that the ASA suggested to follow in their guideline:

Administration and Facility

1. Quality of Care

• Should have a Medical Director
• Valid licenses/certificates for each individual to perform their duties
• All OR personnel should have appropriate education, training and experience
• Anesthesiologist should ensure they are up to date with quality improvement and risk management

2.  Facility and Safety

• Facilities should  comply with all federal, state & local laws, codes & regulations pertaining to the building construction.
• Policies and procedures should comply with laws and regulations

Clinical Care

1. Patient and Procedure Selection

• Patient's procedure should allow them to recover and be discharged from the facility
• Those with pre-existing medical conditions with risk of complications should be referred to appropriate facility

2. Perioperative Care

• Anesthesiologist should be present during and until immediately after the patient is discharged from anesthesia care
• Discharge is the physicians responsibility 

3. Monitoring and Equipment

• All equipment should be maintained, tested, and inspected
• Back-up power should be sufficient

4. Emergencies and Transfers

• The facility should have medications, equipment and written protocol for treating hypothermia
• Written protocols for internal and external disasters

To download the full article with additional guidelines, please click the following link: Guidelines for Office-Based Anesthesia

For additional resources on assisting your practice, please click here: Medical Reimbursement Resources Page

Bringing PAs and NPs on board

Have you considered hiring Nurse Practitioners or Physician Assistants? An article published by American Medical News offers some tips on what to consider:

• They suggest the first step to determine if the new hire (the NP or the PA) would indeed help your practice. You can also look into State regulations to make your decision.
• For example: nurse practitioners can prescribe in 50 states, but only 47 states for controlled substances
• Nurse practitioners can practice independently in 16 states.
• Some states require a physician to audit a percentage of the charts.
• Nurse Practitioners are regulated by the state board of nursing and physician assistants are regulated by their state's medical board.
• Physician assistants are usually hired if you want them to do "technical procedures"
• Nurse practitioners are usually hired if you want them to deal with more of the "evaluation and management" aspect.
• You will need to set up credentialing for the practitioner (which can take months)
• Background checks are important as well as a license check with the state board before you hire them
• Use the proper title for the person you are hiring - in the interview process as well as after they get hired - if you don't use their proper title it can confuse patients as to who they are seeing.

The number of NPs and PAs has increased over the years. Since 1996-2009 the number of nurse practitioners went up from 70,993 to 158,348 and physicians assistants went up from 29,161 to 73,893.

To view the full article, please click here: Bringing PAs and NPs on board

For additional billing and coding resources, please click here: Medical Reimbursement Billing and Coding Resources Page

ER Doctors Face Quandary on Painkillers

Many times Emergency Room doctors are faced with patients who come complaining of a toothache. There are many issues when this occurs. An article was published by the New York Times on Emergency Room doctors and dental patients.  The article discussed issues when patients come to the Emergency Room with a toothache.

Some issues may occur such as:

• They patient may simply going to the Emergency Room to receive narcotics
• How does the doctor really know if the patient is in pain or is telling the truth about their dental pain?
• The ED may lack the tools to properly diagnose the tooth pain.  
• They do not have a dental x-ray machine which would validate if they tooth pain is in fact an infected nerve and whether or not they should prescribe painkillers
• Most hospitals have patient satisfaction surveys and if a person is truly in pain this might have a negative impact one their responses.

Some solutions mentioned in the article are as follows:

• Have a drug-monitoring database which will tell you if the patient has had any painkillers filled recently
• 40 States have some sort of drug monitoring program
• One hospital in the article offers "dental blocks" yet many doctors do not want to do this.

To view the full article, please click here: ER Doctors Face Quandary on Painkillers

For additional medical billing and coding resources, please click the following link: Medical Reimbursement, Inc. resources page

Fewer Emergency Rooms Available as Need Rises

The New York Times published an article on the growing number of Emergency Departments closing.  The article was based off of a study published in the Journal of American Medical Association focusing on hospitals in the New York City area whom closed their Emergency Departments. The purpose of the study was to see why hospitals were closing their Emergency Department.

Some statistics on Emergency Room closing rates:

• Urban and Suburban area closing was at a rate of 25%
• Nationally there has been a decrease by 35% of Emergency Rooms

Some of the reasons why hospitals closed were:

• They served large numbers of the poor
• Were at commercially operated hospitals
• Were at hospitals with "skimpy profit margins"
• They operated in highly competitive markets

Even if an Emergency Room in your area isn't closing, it could have an impact on your Emergency Room since the people will have to find another ER to go to.  This could lead to longer wait times and the quality of care could decrease.

To view the full article, please click here: Few Emergency Rooms Available as Need Rises

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Maximizing Patient Flow in Your Practice

How you manage your patient flow should be ongoing in order to ensure your practice is running as smoothly as possible. An article published by American Medical News (amednews.com) discussed a variety of suggestions in order to improve your patient flow.  Some of the solutions are common but may be looked over when the practice is running their day-to-day operations:

1. Have a variety of different solutions for patient flow
2. Increasing you revenue and patient satisfaction are key
3. Assess how the patients move through the practice
• One idea was to time patients as they move from arrival to departure and all the steps in between
• Another idea was streamlining all the processes
4. Changing how you schedule patients was also an idea
• One example shown was a hospital who had multiple new patients on the same day. Scheduling these new patients (who take longer) on separate days during the week could improve patient flow.
5. At the end of the appointment, make sure the patient knows what do next. (follow-up appointments or other procedures, etc)

To view the full article, please click the following link: "How to Maximize Patient Flow Through the Office"

For additional billing and coding resources, please click here: Medical Reimbursement Billing and Coding Resources

Handling HIPAA in the Emergency Room

Strategies for Nurse Managers published an article on HIPAA in the Emergency Room.  Since the Emergency Room is chaotic and stressful, following guidelines HIPAA may be harder to do. There are many ways the Emergency Room is different.  The following were some of the topics addressed addressed in the article:

• The main priority is obviously to save the person's life in the Emergency Room. Sometimes, the patient's condition prevents them with speaking to the patient and they have to release the information to the family or responsible party
• HIPAA also allows the doctor who is taking care of the patient to use their best judgement for the patient if the responsible party is not available at the time
• HIPAA considers communication in the Emergency Room as "incidental communication" which they don't consider a violation. 
• Trouble areas in the Emergency Room

In addition to the differences listed above, they also offered some "training tips" on how to handle HIPAA requirements while working in a chaotic setting such as the Emergency Room.

To view the full article, please click the following link: HIPAA in the ER: Exceptions, Suggestions for Compliance in a Chaotic Clinical Setting

For additional Medical billing and coding resources, please click here: Medical Reimbursement Billing and Coding Resources

Anesthesia Payment Policies

Washington State Department of Labor and Industries published a fact sheet on Anesthesia Services - Anesthesia Payment Policies. The fact sheet outlines the following:

Noncovered and Bundled Services

• Anesthesia Assistant Services
• Noncovered Procedures
• Patient Acuity

Payment for Anesthesia

• Certified Registered Nurse Anesthetists (CRNA)
• Medical Direction of Anesthesia Team Care
• Requirements for Medical Direction of Anesthesia
• Documentation Requirements for Team Care
• Billing for Team Care
• Payment for Team Care
• Anesthesia Teaching Physicians

Anesthesia Services Paid With Base and Time Units

• Anesthesia Base Units
• Anesthesia Time
• Anesthesia Modifiers
• CPT
• HCPCS
• Anesthesia Payment Calculation
• Anesthesia Add-on Codes
• Anesthesia for Burn Excisions or Debridement
• Anesthesia Services Paid By the RBRVS Method
• Modifiers
• Maximum Payment
• E/M Services Payable with Pain Management Procedures
• Injection Code Treatment Limits

To view the full document, please click the following link: Anesthesia Payment Policies

For additional billing and coding resources, please click the following link: Medical Reimbursement Billing and Coding Resources

Costs of Emergency Care

According to an article published by ACEP, emergency rooms are cost-effective.

Some statistics on Emergency Care:

• Emergency Care represents 2% of $2.1 trillion in health care expenditures in the United States
• The Emergency Room has multiple resources in same area including: 
• diagnostic testing
• laboratory testing
• pharmaceuticals
• access to other medical specialists
• 20-25% of the fee for the Emergency Room visit is for the physician
• Half of emergency services go uncompensated according to the CMS
• In 2006, more than 60% of emergency patients had some kind of government health insurance
• Those who are unable to afford regular medical care often go to emergency rooms for care
• Emergency Departments serve as a portal for 3/4 of the unisured patients who are admitted to US Hospitals.

To view the full article, please click the following link: Costs of Emergency Care

For additional medical billing and coding resources, please click the following link: Medical Billing and Coding Resources

Stemming Losses in Copays, Deductibles at Your Practice's Front Desk

Physician's Practice published an article titled: "Stemming Losses in Copays, Deductibles at Your Practice's Front Desk"  with advice on how to stop "lost" copayments and deductibles at the time of service:

1. When the Patient Calls to Schedule an Appointment:
• Get the patient's health plan
• Ask if they've paid their deductible for the year
2. Reminder Calls for Appointments:
• Remind 2 days before the appointment and if there is a copayment or a deductible
3. When the Patient Checks in at the Front Desk:
• Collect at the time of check-in (if you know their copayment amount)
• Collect after their visit (if you do not know the percentage they owe at check-in)

To view the full article, please visit the following link: Stemming Losses in Copays, Deductibles at Your Practice's Front Desk

For additional billing and coding resources, please visit the following link: Medical Reimbursement Billing and Coding Resources