Archive for the 'Meaningful Use' Category

Meaningful Use Stage 2: Hesitation could be costly

We often expect something we experienced before to be not as hard the second time around.     We are encouraged by software companies to not to think about MU2 until after we get the latest compliant version of the software installed in our system.       There are promises that if we have the software in place on day one of reporting that we will be able to attest.

Yet,  Meaningful Use Stage 2 has the potential to be the perfect storm.    

I have been on many calls and talked with other Meaningful Use SMEs (Subject Matter Experts) that are not just helping their clients through configuration, but working at warp speed both bailing the water and battening the hatches.   We can do it, we are great at it…but the frustrating thing is that we don’t have to let it get to this point.

Meaningful Use Stage 2 has a broader and deeper scope than Stage 1.       Many measures that at first glance look the same as last time around are actually much more specific in ways that affect how you organize your data and workflow – Computerized Provider Order Entry is a great example of this.   In Stage One, Providers just needed to be placing orders electronically, 90% of our clients were doing this so we were good.   In Stage 2 it becomes more specific about the types of orders and will be reporting a percentage for Medications, Labs and Imaging orders.     This means that we need to review those dictionaries and ensure that all Labs and Imaging orders are in the correct parent class and that there is nothing extraneous there that might alter our numbers.

“We’re not going to talk about MU2 until after the upgrade”    I have heard this from clients as well as software reps, and it’s maybe the most dangerous attitude that anyone on the team could present.    We are at a stage in this process that every Organization should have a Meaningful Use SME that they can call when implementing anything new and just ask “Is there anything I am missing here, what should I be thinking about in regards to MU?”

For MU Stage 2 specifically, we know that there is work to be done that is not dependent on the latest and greatest version of the software.   Dictionary updates, cleaning up the referring provider dictionary,  LOINC & SNOMED updates, identifying & thinking through the gaps between the present day workflow and future state workflow are among the items that can be done well in advance.

Most importantly, don’t rely on software timelines to drive your project.    MU2 work should start a full three months prior to the quarter that you want to attest, regardless of infrastructure timelines.     If you are planning on reporting in Q3 of this year, you should be looking at all of the measures and reporting requirements now.    If you are planning on reporting in Q4, then you should start your review no later than July first. If you doubt the need to start reviewing and configuring now, take a close look at the measure for closing the referral loop.  That should get you and your staff motivated to begin as early as possible.


HIE is here to stay

Galen Healthcare Solutions announced its strategic partnership with Orion Health in a past January article. Since then, Galen has been heavily involved in the recent boom of Health Information Exchange (HIE). What’s an HIE? In a nutshell, HIE is the “secure health data exchange between two or more authorized and consenting trading partners” (HIE Implications in Meaningful Use Stage 1 Requirements). On one end is the data supplier; on the other end is the data receiver. A third party – in this case, Orion Health – facilitates the data transfer to ensure quality control and necessary HL7 specifications.

I’ve spent the past few months working with two promininent HIE projects: hundreds of hospitals in each state sending demographic information, clinical documents, laboratory results, radiology reports, and immunizations to the state’s data repository. Providers from those hospitals are then able to access a portal that can display a patient’s full medical history from multiple hospitals on one profile.

Engaging in an HIE is one way for a hospital to meet Stage 1 Meaningful Use objectives. HIE engagement will only grow in the future as Stage 2 and Stage 3 Meaningful Use requirements are initiated. At its core, Meaningful Use is using EHR technology to promote patient engagement, care coordination, and health security. A breakdown of the 3 stages are as follows:

An important criteria for Stage 2 is that providers who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria to continue collecting government incentives. As eligible providers move into the next phase of meaningful EHR utilization, we can expect the trend of HIE to continue, with increased attention on advanced clinical procedures.

Bringing in the Money: Why to Implement the Charge Module

Implementation of the Charge module can seem like an overwhelming task for many organizations. A lot of you are already struggling with enforcing proper documentation standards, implementing patient portals and meeting Meaningful Use, CQM & PQRS measures; all while struggling to remain viable from a fiscal standpoint. So, the question remains, why would we take on one more project in the midst of this chaos?

There are some fairly compelling reasons to consider automating your charge capture process and moving away from the use of the paper encounter form. To begin with, if implemented correctly, use of the Charge module should help your organization see an increase in revenue & accelerated cash flow. It is a whole lot easier to track missing electronic encounter forms than to figure out where Dr. Smith or Nurse Jones left that stack of paper encounter forms on his/her way out of the office last night. Additionally, because it is designed to prevent users from submitting chargers if they have failed to input required information, the Charge module helps reduce the occurrence of improperly filled out encounter forms. The use of electronic charging means doctors will be required to make fewer corrections for tickets marked in illegible hand writing or completed incorrectly.

Next, the fact of the matter is, the quicker charges are submitted, the quicker reimbursement is received from your carriers. Money in the bank means liquidity and financial options for any organization. From an EHR perspective, once a provider has completed the encounter form, tasks can be generated for the billing staff to immediately review and submit charges, ultimately decreasing the posting to payment turnaround time from days or weeks to hours. If, after auditing and review of a provider’s billing and charge submission, the organization feels it is reasonable to allow the provider to progress to “direct submission” of encounters, the process will be expedited even further. Remember, faster submission equals faster reimbursement and money in the bank.

Proper analysis and follow through in the build process will result in a reduction in billing errors. There is a decrease in the risk of human error while translating a provider’s scrawl from the paper encounter form into the electronic billing system. Transposing digits, inadvertently keying the incorrect primary diagnosis, misusing a modifier or failing to include the correct number of units for a medication administration fee are all simple, yet common errors in a billing office that cost organizations thousands of dollars each year. Fortunately, with some of the built in rules logic available in the Charge module, clients typically see a dramatic reduction in billing mistakes along with the risk of regulatory noncompliance.

And lastly, your organization should see an increase in efficiency in a variety of ways. The elimination of dual entry allows billing staff to spend more time on coding and reviewing more encounters. Centralized, electronic creation of encounter forms alleviates the need to print practice-specific super bills which can be quite costly and time consuming to distribute. Updates can take place quickly to the master files with limited interference in provider and staff workflows. Finally, the automated generation of reminder tasks can assist end-users and management with easily identifying missing charges, workflow bottlenecks and charging trends across the organization.

The Countdown to ICD10

In late spring of 2013, an ICD10 readiness survey showed some alarming statistics.  It was the seventh in a long line of surveys performed by WEDI (Workgroup for Electronic Data Interchange) that indicated the lack of progress in the ICD10 journey to adoption. With the looming October 1, 2014 deadline quickly approaching, it seems that the extension granted has only delayed the prioritization of this mandate.


As the ICD10 compliance deadline is fast approaching, organizations are ramping up their efforts.  This cooperation between Providers, Payers, Electronic Billing Clearing Houses, and Software Vendors is a huge undertaking for any organization.  To assist on your ICD10 compliance journey, the follow checklist has been developed.

ICD10 Checklist 

  • ‚       Select an ICD10 Transition Team

It is vital that resources be chosen to transition from ICD9 to ICD10.  A multidisciplinary team representing clinical, financial, and administrative staff is advisable.  The size of this team, of course, should correlate with the size of the organization.  However, the steps that need to be taken, are the same, no matter how large or small the organization.

  • ‚       Perform a Readiness/Impact Assessment and Develop a Project Plan

CMS, AHIMA, & AMA all offer readiness assessments and high level project plans.  As a matter of fact, the internet is clogged with resources for this step.  Another, perhaps less thought about but valuable resource, is the Medical Society for your county or state. 

  • ‚       Contact Software Vendors

This is really part of the impact/readiness assessment, but since it can derail the timeline, it bears special mention. Practice Management and Electronic Health Records Software vendors have ICD10 compliant versions.  Since updating software versions can be as simple to applying a patch or as complicated as full projects that take months to complete, it is important to verify the specifications directly with the vendor. 

While we are discussing vendors, it also bears mention to document the charges capture process.  For example, is there a paper encounter form that is keyed in by the billing staff? If so, then any ICD9 codes would need to be updated.  If it is via electronic submission, then the PM/EHR dictionaries and interfaces would also need to be considered and tested.

  • ‚       Analyze the Payer Mix

Revenue interruption is a very real concern for administrators at this point.  It is vital to analyze the accounts receivable for position and mix of Payers.  This will allow the team to target the highest payers first during the testing phase to help reduce potential income interruption.

  • ‚       Communicate with Electronic Billing Clearinghouses

Testing claims to reach the Billing Clearinghouses is a crucial step in the end to end testing of claims.  Once successful transmissions have been accomplished, the team can move on to the Payers specific testing.

  • ‚       Contact Payers for Their ICD10 Readiness and Testing Schedules

Full end to end life cycle testing of claims will need to be performed for each Payer.

  • ‚       Audit Current Documentation Practices

There may be some good news on this item.  On the surface, moving from ICD9’s 17,000+ codes to the 141,000+ codes of ICD10 sounds intimidating.  However, consider that the concepts are not new to Providers.  In fact, approximately 1/3 of the codes are the same with expanded details of those problems. Some examples are:

-  Initial, Subsequent, or Sequela Instance

-  Acute or Chronic

-  Laterality- Right, Left, or Bilateral

-  Normal Healing or Delayed Healing

-  Nonunion or Malunion

Many providers have been documenting these details within their notes already as matter of best practice patient care and to limit liability.  Auditing current documentation will assist in developing a training plan for providers.

  • ‚       Staff Training

The internet is flooded with training options.  Accurately identifying who needs training will dictate the amount of training needed.  For example, certified coders would certainly require more training than a front desk staff verifying insurance eligibility.  Minimally, the following groups of staff members will need training consideration

-          Providers

-          Front Desk Staff, prior authorizations,

-          Coding/Finance Department Staff

-          Any other Staff who use ICD9’s Currently

After spending the last 20+ years witnessing the day to day challenges facing providers, I am not surprised with the findings of the survey.  Delaying the inevitable has just left more room for other issues battling for attention in today’s medical practices.  Balancing competing initiatives such as EHR adoption, Meaningful Use Objectives, not to mention making sure patient care is a first priority, has made the healthcare environment very challenging.

How will your organization rapidly address the day to day challenges you are facing?  Galen Healthcare Solutions provides a full support system, wealth of experience, and solutions for your EHR journey with the various services we offer.  Our Technical, Upgrade, Project Management, and Implementation Professionals are available for large projects, as well as incremental solutions.  Let us help you raise the bar in patient care for your organization.


Galen Healthcare Solutions is excited to announce its new partnership with Orion Health to support Orion’s Health Information Exchange solution and Rhapsody Integration Engine. Together, we will work to enable caregivers, within large integrated delivery networks, increase healthcare communication in a paperless world. The partnership aims to help providers with solutions that improve patient outcomes through value-based medicine practices and to meet the requirements for “Meaningful Use” of electronic health record systems by 2015 as mandated by the federal government.


Galen will support Orion’s clients that use Orion’s HIE (Health Information Exchange) Solution and Rhapsody Integration Engine, thereby connecting healthcare organizations and maximizing interoperability. HIE is the act of sharing health-related information among participating organizations with the intent of promoting data standardization and consolidation across statewide, regional, and national initiatives. By utilizing Galen’s certified engineers, healthcare organizations achieve meaningful use requirements and obtain maximum incentives in quality care and data management.


To support this highly demanded healthcare need, Galen has increased its focus on Orion products to provide our technical expertise to Orion Health’s clients. Galen’s staff are Rhapsody certified and are connecting healthcare organizations participating in HIEs throughout the United States.


Joel Splan, Chief Executive Officer of Galen, said, “Galen is thrilled to partner with Orion Health, which plays such a vitally important role in the new, rapidly integrating future of healthcare in the US. With its proven reputation for flexibility and scalability, Orion Health Rhapsody and Orion Health HIE are compatible with the most widely-used platforms in healthcare today, Allscripts, Epic and Cerner, making it possible for doctors in different care venues to communicate with one another about the patient’s state instantly, no matter what EHR system they may have chosen.”


Splan added, “By providing our technical expertise and insights to Orion Health’s clients, we will be driving the forefront of our evolving healthcare system. Change is here, and it is having a profound impact on how practitioners use technology. Galen’s mission will be to assure that patients and providers receive real value from these changes, that technology effectively communicates with patients, reduces readmissions, increases use of evidence-based guidelines, improves disease surveillance, and much more.”


Special thanks to Bing Chen for her contributions to this article.

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