Medical Billing Blog

The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) released documents detailing what physicians and hospitals must do to qualify for (EHR) incentive payments under the HITECH Act.  To qualify for incentives, physicians and hospitals must be using “certified EHR technology” in a “meaningful manner.”  These documents were released on December 30, 2009, one day before they would officially be considered late.

These documents provide a list of features physicians and hospitals need to have included  in their EHR technology and how these features are to used to meet the definition of meaningful use during the 2011 EHR adoption period.

There’s only one minor problem, there are no qualified organizations that can certify that your EMR is up to stuff including CCHIT.  That’s supposed to come later this year.  Instead of getting all puffed up about this I would say that the standard will have to be slimmed down and/or delayed, stay tuned.

The Office of the National Coordinator for Health Information Technology (ONCHIT) will soon release a description of the “meaningful use” of electronic medical records (EMR). Until HHS releases what it will require for a EHR user to receive the EHR stimulus money, then it’s anybody’s guess just what the heck meaningful use of an EHR actually means, please forgive the pun

I can think of a number of factors that may or may not be part of this aspect of the standard:

• The number of years the practice has used the system within the practice.  Part of the way the money is being passed out is to encourage early adopters, they actual get a bigger incentive to convert to an EMR.
• Does the data on the system get passed to other systems.  In other words, is the data transparent and can other systems export and import the demographic and clinical information.  A simple example is placing a lab test and recieving the results back into the EMR.
• Does the system improve the quality of care.  Well duh, but I bet this is the hardest part to quantify but isn’t this the most important factor.

But as I’ve read the healthcare blogs I’ve seen another thought about meaningful use.  The concept evolves around that concept that “meaningful use” should somehow measure if the user(s) is/are move effective in their practive of medicine with the system.  From a productivity vantage key to measure this would be great but even more difficult to define.

According to the  people at Software Advice earlier this year the NAHIT established definitions for EHR, EMR and PHR. Given their authority, and the Bush administration’s plan to build an interoperable health IT infrastructure, EHR has become the standard phrase to describe an electronic patient chart. However, the majority of physicians are still searching for an EMR, and software vendors haven’t renamed their products.

Software Advise wrote their article EHR vs EMR - What’s the Difference? to explain the difference between the two systems and help physicians understand what role the acronym should have in their purchase.

I don’t remember seeing this on any of the regular IT healthcare blogs but it’s really mute.  EMR is going to stick for sometime and I wonder if NAHIT only made things more complex by trying to pigeon-hole the definitions.

I heard from Google regarding the Aspirin vs. Plavix issue.  If you put in the full dose aspirin then the warning does show up.  As I said on the Google forum this is incorrect but I am not going to split hairs here this is not medical advise.

On to the next step, as it were.  I went to my pharmacy, which in my case is Target.  I decided to ask my pharmacist to get help to get my data into my Google Health record.

I just love what happened.  My pharmacist is a very careful person.  When I pickup medication for other members of my family she will often not discuss the other person’s health issues with me, this is as it should be.  I love picking up my daughter’s birth control medication, its like talking to a monk who’s taken a vow of silence.

I explained to the pharmacist that about Google Health and how I want to get Target’s cooperation in importing the prescription data into the PHR.  The reaction from the pharmacist was and I quote “Isn’t this against HIPAA regulations?”  I had to laugh, she knows that I am in the health care field and I explained that it was not.  She managed to get me the name of the manager further up the food chain in the pharmacy division.

So I make the calls and basically they had no interest in doing this.  Their first problem is that they don’t control the data, its a third party ISP.  They were willing to get me the name of the company but I don’t think I’ll have much luck as a single consumer.

I am going to switch gears and see if I can talk to my doctors and/or hospitals and see if I have any better luck.

Most Primary Care Physicians are more then familiar with CPT coding, or the Current Procedural Terminology (CPT) code set which is maintained by the American Medical Association.

These codes, mostly 5 digit numbers, represent the procedures that doctors, and other practitioners perform. These codes and are the basis on which payments from insurance and the Medicare are made.

This arcane system is normally reduced to a simple nomenclature based on the last digit in the CPT code. For example the CPT codes for new patient in-office visit are:

• 99201
• 99202
• 99203
• 99204
• 99205

These numbers go from 1 to 5 so they are normally referred to a Level number exam. The higher the number the more complete the examination will be. Healthcare professional will use the verbal shortcut and say “It’s a Level 3 exam”

But let’s look at what happens when its time to get paid for these services. The insurance carriers gather E&M codes on a per practice basis. They gather these statistics and then they establish ratios that they expect a doctor to maintenance for the higher coded exams. This is quota system, nothing more and nothing less.

It is not usual to our staff to establish a solid working relationship with their counterparts at the insurance company. As a large processor of claims we will often be given “advice” when a physician is getting too near the “quota” for the higher level exams.

What does this means? It means that a PCP has to be concerned with towing the carriers’ line or expect a request for further documentation or even an audit.

The Journal of the American Board of Family Medicine study, Accuracy of CPT Evaluation and Management Coding by Family Physicians study done in 2001 was quite through but came to the wrong conclusions. Physician under-code old patients because they are afraid that they will be punished for spending too much time on each patient, which is what the higher level codes actually represents.

Further, they “over-code” new patients because the higher codes are extremely restrictive. The Evaluation and Management Services Guide issued by the The Centers for Medicare & Medicaid Services (CMS) is a confusing document. Even the AMA’s CPT coding book has a section towards its back that tries to breakdown the different levels and explain them in plain English with specific examples.

Correct coding will decrease claims denials and speed up payments, as a billing company that’s what Preferred Health assists our practices to do. But if CMS and the major carriers want to move towards preventive medicine they need to move away form intimidation by CPT code.