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Utilizing the Latest Best Practices for Better Patient Outcomes

Posted by Samantha Serfass on March 18, 2020 in Blog, News

Utilizing the Latest Best Practices for Better Patient Outcomes

The amount of time it takes to perform research and clinical trials to putting new best medicines and best practices into use is considered to be called the time from “bench to bedside”. The average time from bench to bedside is 17 years.  

During these years, two major phases occur.  The first phases consist of the conversion of knowledge from basic science research into a potential clinical product/process for testing, while the second phases consist of clinical trials (testing new products and process with patients) and putting new practices and products within a health system.  

There are, however, many delays along the way which contribute to the 17 years average. 

  • Grant awards
  • Ethical approval
  • Clinical trial execution
  • Drug approvals
  • Publication of test results and absorption

Although clinical trials are a lengthy endeavor, you can see from the latest efforts to fight the coronavirus steps can be taken to dramatically shorten the delay.  The first phase of the coronavirus took only a few short months, as it was declared an Emergency. However, there are more than 20,000 clinical trials registered every year at 16 national & regional registries. 

Historically less than half of all the trial results are published, and there is concern about the quality of the trail and the effectiveness of drugs. Companies like Good Pharma Scorecard ranks new drugs on a range of criteria. This includes the quality of the testing during clinical trials.  However, once test results are published, the new best practices are not always put into use.

There are approximately 49 different major specialties in North America (with hundreds of sub-specialties).  If a physician were to just read the publications within their specialty, they would need to on average read 4 publications each week in order to keep up. To effectively put the publication results into practice would require physicians to remember the symptoms, comorbidities and the test group for each of the studies published. They then would need to recall and act on the recommended best practice.  This provides to be a challenging course of action. 

A number of different initiatives could be implemented in order to help the physician’s stay informed.

  1. Governance focused on clinical quality outcomes
  2. Evidence-Based Medicine (EBM)Tools
  3. Effectively Leveraging the EHR

Governance should be focused on the health system’s specific performance and their patient population.  By effectively leveraging evidence-based medicine (EBM) tools and utilizing the EHR system, health systems will be able to reach and accomplish their goals. Companies like Elsevier and ProVation can be integrated with EHRs to bring best practices (based on EBM) to the healthcare providers. Coordinating Governance goals and optimizing and configuring the EHR to leverage the latest tools is key.

Earlier in 2020, Epic implemented updates to help screen and identify patients with the coronavirus. While this is an important step in better identifying the patients, workflows must be able to support initiatives and new updates to an EHR.  

Knowing the latest feature and functionality of your EHR, coordinating workflows changes, identifying governance goals, and leveraging EBM are all important factors that need to be addressed.   By leveraging the latest EBM and EHR functionality, our team has the experience and expertise to help configure your system to meet the organizational goals.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

ENSURING A WELL-ROUNDED CODING QUALITY MAINTENANCE PROGRAM

Posted by Samantha Serfass on February 25, 2020 in Blog, News

ENSURING A WELL-ROUNDED CODING QUALITY MAINTENANCE PROGRAM

Is your coding quality maintenance program well-rounded?

While the depth and detail of coding quality maintenance programs vary depending on an organization’s specific needs, frequent audits using a mixture of chart selection methodologies will result in the most complete, well-rounded coding quality maintenance program. Performing one annual coding audit of 30 randomly selected records per coder is too limited and does not support a well-rounded plan. 

The benefits of coding audits

Organizations should strive for a complete and accurate clinical database.  While accurate coding is vital to reimbursement, accurate and complete coding is also imperative for:

  • Accurate case mix index (CMI)
  • Accurate reflection of the severity of illness (SOI)/risk of mortality (ROM)
  • Support of medical necessity for services rendered
  • Support of decision to admit/medical necessity for inpatient status; correct place of service status
  • Ward off government and payor scrutiny in the form of RAC, OIG, ZPIC, MIC, MAC, etc.
  • Improved comparison studies and profiling/scorecards
    • e.g., HealthGrades, Leapfrog, state comparison studies, PEPPER reports, PQRS
  • Support of resource consumption and length of stay
  • Support of contract negotiations (payors for managed health care)
  • Decreased number of rejections and denials, including
  • Hospital Acquired Condition/Present on Admission concerns and discharge disposition issues
  • Assistance with research, outcomes analysis, quality of care, critical pathway development and wellness initiatives
  • Reduced penalties related to 30-day readmissions; the excess readmission ratio includes adjustments for factors that are clinically relevant, including comorbidities
  • Accurate planning for population management and accountable care data analytics

One way to assure a complete and accurate database is to perform periodic coding and documentation audits through a well-rounded coding quality maintenance program.

Developing a coding quality maintenance program

Detailed planning is needed in the creation of a well-rounded coding quality maintenance plan.  Various details that should be considered include:

  • The frequency of audits: daily pre-bill, monthly, quarterly, semi-annual, annual
  • The scope of what will be reviewed: 
    • Inpatient DRG validation only or full coding quality review,
    • MS and/or APR DRG    
    • Which outpatient service types to include and if the review will include injection and infusion services and facility E/M
    • Professional fee specialties to include
  • The volumes to review
  • The chart selection methodology
    • Concurrent/pre-bill or retrospective
    • Dates of service of the encounters to review
    • Which payers to include 
    • Random versus targeted

How the audit sampling is selected is one of the most important considerations.  Various methodologies, each with their benefits and limitations, can yield differing returns.  To maintain a well-rounded approach, a coding quality maintenance plan should include a variety of audit sampling approaches. 

Approaches to sampling for coding audits should include:

  • Random selection of encounters across all coders and payers
  • Random selection of inpatients from the top MS-DRGs by volume and random selection of outpatient or professional fee encounters from the most frequently reported APCs or CPTs or diagnoses
  • Targeted sampling based on high-risk DRGs as identified from prior review results, PEPPER reports, OIG and RAC targets

By alternating random and targeted chart selection for each review, organizations can achieve the benefits that are offered by the separate audit sampling approaches.   

All health care organizations should maintain a robust coding quality compliance plan with ongoing monitoring and evaluation, strong coder feedback and education to promote consistency in complete and accurate reporting of a facility’s patient population.

Choosing a coding audit vendor:

A trusted business partner can be invaluable in helping your organization develop and maintain a robust coding quality maintenance program. When choosing a vendor to perform coding audits, consider the following:

  • Range of services – Choose a partner with the ability to perform a wide variety of audit types including inpatient, outpatient, and professional fee.
  • Reporting capabilities – Make sure the vendor will offer statistical findings that will help identify patterns and trends in coding and documentation.
  • Education –  The vendor should have the ability to identify specific areas of educational needs with the ability to offer the education needed.
  • Audit process – Review the audit and communication process with the vendor to ensure it includes a strong coder involvement in the audit process, allowing for coder comments with a dispute resolution process.
  • Auditors– Request information about the vendor’s audit staff in terms of their experience, credentials, education, tenure and training.
  • References – Ask for and check references.

Lisa Marks, VP of HIM Services

Leveraging Technology: Increasing the Quality of Care

Posted by Samantha Serfass on February 14, 2020 in Blog, News

LEVERAGING TECHNOLOGY: INCREASING THE QUALITY OF CARE

Technology continues to help healthcare professionals make significant strides, but is it all for the better? An article titled “Why Doctors Hate Their Computers” published by the New Yorker describes the high percentage of dissatisfied physicians and the burn out rates related to their use of EHRs. Many healthcare providers finish their documentation after hours due to extensive work schedules. This overload of attention required by the EHR has negatively impacted many physician’s work/life balance.

A scribe could help eliminate several negative factors affecting a physician’s workload. A key advantage to utilizing a scribe is decreasing the overall time the physician spends collecting information and documentation. However, there are well-known downsides to using a human scribe. With the advances technology continues to make, a future scribe could be an Artificial Intelligence (AI) component of the EHR.

The system will integrate with motion detection to identify a physician is checking a heartbeat and provide an overall physical assessment.  While documenting the exam, the physician can tell the EHR system to re-order meds and/or create a referral consult to a specialist. The system will then verify back to the provider the medicine to reorder and which doctor they would prefer to refer the patient to.

The future EHR will automatically collect information and document the EHR based on actions and verbal communication.  The physician will then review and correct each documentation. By leveraging AI, the system will be able to identify each correction and remember the documentation for future documentation.

As Telehealth increases in use, physicians’ and patients’ satisfaction will also improve. The future Telehealth systems will be able to easily transition the patient between providers, ensuring provider is utilizing the highest-level practice within their licensure.  The future Telehealth system will create the documentation and billing claims based on the verbal communication between the provider and patient allowing the provider to again review the automated documentation.  

Until the future is here, there are still several factors we can implement now to improve physician satisfaction as well as increase the quality of care. The overall effort to address satisfaction while leveraging the system requires revisiting workflows, rethinking how we use technology, and how we support the system.  Addressing and streamlining documentation and creating better policies around messages to providers so they can be effective at the documentation and are not overwhelmed are also ways to improve satisfaction.

When Implementing technology to increase physician & patient satisfaction, the system should be dedicated to:

  • Evaluating add on apps geared to improve satisfaction
  • Providing voice recognitions and templates for specific specialties
  • Offering personal physician labs and continuing education

Current EHR’s are able to measure how effective specific physicians are at using the system.  Leveraging these reports and physician support team can continually look to utilize new features and functions. This will also provide support for physicians to become more efficient at documenting.  

Excite Health Partners has the experience and expertise to help increase physician satisfaction. Through these strategies and approaches, we will work with your team to improve physician work/life balance while still providing quality care to the patients.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

BREAKING IT DOWN: EGD WITH ENDOSCOPIC ULTRASOUND

Posted by Samantha Serfass on January 31, 2020 in Blog, General, News

Breaking It Down: EGD with Endoscopic Ultrasound

Esophagogastroduodenoscopies with endoscopic ultrasound examination can appear rather confusing, especially when additional procedures such as fine needle aspirations or injections of adjacent structures are also performed in tandem with the original procedure.

The first thing to remember is that all of the Upper EUS codes are subsets of the parent code, 43235 Esophagogastroduodenoscopy.  If you look at the code book, all of the codes under 43235 start with “with”.  Keeping this in mind, you will realize it is always assumed that an entire EGD has been performed (esophagus, stomach, 2nd portion of duodenum) prior to the insertion of the echoendoscope.  Also note that there is a separate code for esophagoscopy with EUS, meaning the stomach and/or duodenum is not entered with the scope.

For the purpose of the EGD’s with EUS, the GI system is broken down into three basic regions:

  1. Esophagus
  2. Stomach
  3. Duodenum (or surgically altered stomach where the jejunum is examined distal to the anastomosis)

The next thing to distinguish is the subtle verbiage differences in the code descriptions, namely AND versus OR, which helps identify the best code for the operative scenario.  For these procedures, the word “and” (esophagus, stomach, AND either duodenum or surgically altered stomach…) means that all three regions have to be evaluated using ultrasound.  When “OR” is used, the intent is to reflect that two out of the three regions are evaluated.  Typically, 43237 is used when the EUS probe is inserted through the esophagus and into the stomach, but does not reach the duodenum. 

Of note, it is also assumed that adjacent structures are always visualized during an ultrasound, even though the only codes that specifically state “and adjacent structures” are 43237 and 43238.  Adjacent structures is defined as not only the walls of the GI tract, but other structures such as the liver, biliary tract, pancreas, lymph nodes.

When determining the correct code assignment, remember that the code descriptions for endoscopic ultrasound refer specifically to the ultrasound probe, and the depth to which it is inserted.  A complete esophagogastroduodenoscopy has to be performed prior to the EUS in order to correctly choose a code from this section as evidenced by the code format contained in the CPT book.

CODES WITH THEIR DEFINITIONS:

43235 Esophagogastroduodenoscopy
43237 with EUS limited to esophagus, stomach or duodenum and adjacent structures
43238 with EUS with fine needle aspiration (Includes EUS limited to esophagus, stomach, or duodenum and adjacent structures)
43242 with EUS with FNA (includes EUs of esophagus, stomach, and either duodenum or surgically altered stomach where the jejunum is examined distal to the anastomosis)
43253 with EUS guided transmural injection of diagnostic or therapeutic substance (includes EUS exam of esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis)
43259 with EUS including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis

For additional uses for EUS, check out Excellent Endoscopy.

Robyn McCoart, RHIT

Managing Auditor, Excite health Partners

DATA- DRIVEN STRATEGIES: REDUCING DUPLICATE RECORDS

Posted by Samantha Serfass on January 21, 2020 in Blog, News

DATA- DRIVEN STRATEGIES: REDUCING DUPLICATE RECORDS

Improving analytics and implementing data-driven strategies are proving to be on the forefront of healthcare organizations agendas. Approximately 88% of hospitals have some sort of data-driven strategy with a dedicated analytic team (1). Value based payment models have forced provider organizations to invest more in data tools and strategies. Some organizations are even trying to monetize their data. New AI capabilities are taking advantage of the large data sets like never before. While a data-driven strategy is important knowing the quality of your data is key.

According to AHIMA, “most hospitals have between 5-10% duplicate medical records and health systems that are multi-facility have an average duplicate rate of 20%” (2). The more complex a health system is, the higher percentage of duplicate records can be found. A prime example occurred in Houston, TX. In 2016, Harris Health System reported 2,488 records with the name of “Maria Garcia”— of those records, 231 shared the same birthdate (3). Recording and analyzing the data is crucial to help identify and eliminate duplicate, incomplete or overlapping data from the system.

Reducing the amount of duplicate data can help reduce the total spend. The expense of a duplicate medical record costs on average $800 per Emergency Department visit and upward of $1950 per Inpatient stay. It can cost a hospital on average $1.5 million, and throughout the industry the cost is estimated at over $6 billion (4).

Identifying why the duplicate medical record occurred is vital to decrease issues. Duplicate medical records are created as a result of patient identification errors, which typically occur during the inpatient registration. However, errors in both the Emergency Department and Outpatient Clinics can contribute to the error rate. Although biometric devices prove useful to initially identify patients, the issue lies within the registration system.

Registration systems often do not leverage advanced logic to help identify an existing patient. A simple error such as a misspelled name can result in an incorrect, duplicated medical record. This error could potentially end up costing the hospital around $1950.

At Excite Health Partners, we understand the importance of quality data. We work to implement solutions leveraging advanced logic (similar to Google searches) to ensure the right patient is found within your EHR.

Regardless of the presence of biometrics, our team of experienced professionals work efficiently to integrate the solutions within your environment. Our approach reduces patient check-in time, producing a positive RIO for the organization. Improving the quality of data and decreasing the cost of errors, Excite Health Partners has the best fit solutions for your organizational needs.

Todd Klein

CIO VP of EHR Services & Digital Services

Sources:

  1. Health IT Analytics
  2. AHIMA
  3. Lab Soft News
  4. Black Book Market Research

SPLIT/SHARED SERVICES: THE IMPORTANCE OF PROPER DOCUMENTATION

Posted by Samantha Serfass on December 19, 2019 in Blog, General, News

SPLIT/SHARED SERVICES: THE IMPORTANCE OF PROPER DOCUMENTATION

When an E/M service is performed in the hospital inpatient (POS 21), hospital outpatient (POS 19, 22), or emergency department (POS 23) and is shared between a physician and non-physician practitioner (NPP) from the same group practice, the service may be billed as a split/shared E/M service.

The CMS definition of split/shared visits can be found in the CMS Internet Only Manual (IOM): Medicare Claims Processing Manual Publication 100-04, Chapter 12, Section 30.6.1 Split/Shared E/M Visit: 

“A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service.  A substantive portion of an E/M visit involves all or some portion of the history, exam, or medical decision-making key components of an E/M service.  The physician and the qualified NPP must be in the same group practice or be employed by the same employer.”

The following documentation requirements must be met in order to report the service as split/shared:

  • Both the physician and the NPP must provide a face to face encounter with the patient.
  • Each clinician must document a note in the medical record. Typically, the NPP note is more extensive, but that is not a requirement.
  • Physician must document at least one element of the history, exam, and/or medical decision- making component of the E/M service.  It is not sufficient for the physician to simply document “seen and agree” or simply countersign the non-physician practitioner (NPP) documentation. 
  • Physician must legibly sign the documentation.
  • Physician and the NPP must be actively involved in the Medicare Program and both have a valid provider number for reporting purposes.

The level of E/M service selected to report is based on both the physician and NPP documentation. 

If any of the above elements are lacking, then the service will be reported using the NPP’s NPI.  This will result in a reduction in payment for the E/M service as NPPs receive 85% of the fee schedule rate, whereas reporting using a physician’s NPI number will receive 100% of the fee schedule rate.

The following services may not be reported as split/shared services:

  • Critical care services-this is a Medicare rule.  Do not combine time for critical care services done by a physician and NPP, even when working in the same group, same specialty.
  • Procedures are performed by one person.  Report under the NPI number of the clinician who performed the service.

Remember that physician supervision alone is insufficient for split/shared services, proper documentation is the key!

Janice Spaulding, CCS CPC

Auditor, Coding Educator Excite Health Partners

Telehealth: The Importance of Utilizing the System

Posted by Samantha Serfass on December 16, 2019 in Blog, News

Telehealth: The Importance of Utilizing The System

Telehealth is the use of communication technologies, to access healthcare services remotely and manage your healthcare. These may be technologies you use from your home to access information or a provider. Providers use telehealth technology to improve the care services you receive (physician to physician consultation). 

There are 3 types of Telehealth/Telemedicine.

1) Synchronous or real-time Video doctor to home visits

2) Asynchronous, (AKA Store-and-forward) where a patient collects medical information and then sends it to a care provider

3) Patient Monitoring, where patients use wearables to collect information which is sent to a care provider

The ability to bill for Telehealth services and out of state licensure has been an obstacle for the growth of Telehealth.  Laws mandating coverage /reimbursement for Telemedicine have passed in 42 states.  On October 3rd, 2019, President Trump signed an Executive Order for Medicare Advantage (MA) plans to reimburse for Telehealth in 2020.  The American Telemedicine Association helps monitor telemedicine state policies and is working with others to help resolve licensure obstacles.

Telehealth is particularly beneficial for Americans with chronic clinical needs that require frequent visits to their physicians, primary care MD’s and behavioral health visits.  These are all areas were Telehealth has shown great strengths. Reducing remittance of patients with costly diagnosis such as CHF (Congestive Heart Failure) is also key to support a positive ROI.  Telemedicine has grown 250% from 2015 to 2017 and experts are predicting Telemedicine sector will grow into $130.5 Billion US Market by 2025, from the $21.2 Billion in 2018. 

Due to the complexities associated with implementation, Telehealth programs within large hospital systems often have difficulties utilizing the full services offered.  Frequently, Telehealth systems are developed by individual departments, resulting in virtual patient transfers to be difficult for providers. This virtual hand-off is required to help support each provider’s ability to work at their highest level of licensure.   It’s important to develop an implementation approach to ensure the Telehealth program meets the needs of the overall health system.  Workflows also need to be developed to address the acuity of the patient and the needs of the providers, while ensure charge capture is taking place. 

As with all Implementations stakeholder and champions are essential. Local coordinators/stakeholders also need to be engaged, trained and accountable so the system(s) can be effectively used and adoption can be sustained.   At the center of the implementation strategy should be the patient, followed by caregivers. Reports have shown Telehealth can increase patient and provider satisfaction, a goal that should be front and center.  Thus, the Telehealth implementation should be integrated with the overall patient engagement strategies of the health system.  

Excite Health Partners has the knowledge and experience to assist your organization ensuring your Telehealth program meets, and exceeds, your goals and expectations. We work with you to confirm your system can be sustained and thrive moving forward

Todd Klein

CIO VP of EHR Services & Digital Services

Sources: National Market & Global Market

In The Know: Introduction to the IOCE V20.3

Posted by Samantha Serfass on November 19, 2019 in Blog, News

All institutional outpatient claims, regardless of facility type, process through the Integrated Outpatient Code Editor (IOCE). The IOCE is a program utilized by Medicare Administrative Contractors (MAC) for outpatient hospitals both subject to and not subject to the Outpatient Prospective Payment System (OPPS).

The IOCE performs two major functions:

  1. Edit the claims data to identify errors and return a series of edit flags.
  2. Assign an Ambulatory Payment Classification (APC) number for each service covered under OPPS to be used as input to an OPPS PRICER program. For Non-OPPS claims, a series of Non-OPPS applicable edits are returned.

All applicable services should be submitted as a single claim record to the IOCE. The IOCE only functions on a single claim and does not have any cross-claim capabilities. The IOCE accepts up to 450-line items per claim. The IOCE software is responsible for ordering line items by date of service. The span of time that a claim represents is controlled by the From and Through dates identified on the claim. If the claim spans more than one calendar day, the IOCE subdivides the claim into separate days for the purpose of determining discounting and multiple visits on the same calendar day.

The IOCE identifies individual errors. Each edit is unique, as it directly links the reason the edit is returned, any related information at the line or claim level, and the action required indicated by the edit disposition. The IOCE performs all functions referencing HCPCS codes, modifiers and ICD-10-CM diagnosis codes. Since these coding systems are complex, the centralization of the direct reference to these codes and modifiers in a single program reduces effort and reduces the chance of inconsistent processing of claims.

The current version includes 111 edits. We highlighted 27 edits below of specific interest to outpatient coders.

Edit Edit Description Reason for Edit Generation Disposition
1 Invalid diagnosis code The principal diagnosis field is blank, there are no diagnoses entered on the claim, or the entered diagnosis code is not valid. RTP
2 Diagnosis and age conflict The diagnosis code includes an age range, and the age reported is outside that range. RTP
3 Diagnosis and sex conflict The diagnosis code includes sex designation, and the sex does not match. This edit is bypassed if condition code 45 is present on the claim. RTP
5 External cause of morbidity code cannot be used as principal diagnosis The diagnoses reported is considered a morbidity code and cannot be used as the principal diagnoses RTP
6 Invalid procedure code The entered HCPCS code is not valid for the selected version of the program. RTP
8 Procedure and sex conflict The sex of the patient does not match the sex designated for the procedure code reported. This edit is bypassed if condition code 45 is present on the claim. RTP
12 Questionable covered service The procedure reported is flagged as a Questionable covered service. Suspend
17 Inappropriate specification of bilateral procedure The same inherent bilateral procedure code occurs two or more times on the same service date. This edit is applied to all relevant bilateral procedure lines, except when modifier 76 or 77 is submitted on the second or subsequent line or units of an inherently bilateral code. Note: For codes with an SI of V that are also on the Inherent Bilateral list, condition code G0 will take precedence over the bilateral edit; these claims will not receive edit 17. This edit is also bypassed if the bill type is 85x. RTP
20 Code2 of a code pair that is not allowed by NCCI even if appropriate modifier is present The second procedure reported is part of an NCCI pair, which will cause the generation of edit 20 to LIR even in the presence of a modifier. LIR
21 Medical visit on the same day as a type T or S procedure without modifier 25 One or more type T or S procedures occur on the same day as a line item containing an E&M code, without modifier 25. RTP
22 Invalid modifier The modifier is not in the list of valid modifier entries and the revenue code is not 540. RTP
23 Invalid data The service date and/or the from and through dates are invalid. Or the Service date falls outside the range of the From and Through dates. This edit terminates processing for the claim. RTP
27 Only incidental services reported All line items are incidental (status indicator N). If edit 27 is present no other edits are performed. Claim Rejection
37 Terminated bilateral procedure or terminated procedure with units greater than one A modifier 52 or 73 is present, as well as: an independent or conditional bilateral procedure with modifier 50 or a procedure with units greater than 1. RTP
40 Code2 of a code pair that would be allowed by NCCI if appropriate modifier were present The procedure is identified as part of another procedure on the claim coded on the same day, where the modifier was either not coded or is not an NCCI modifier. Only the code in column 2 of a code pair is rejected; the column 1 code of the pair is not marked as an edit. LIR
42 Multiple medical visits on same day with same revenue code without condition code G0 Multiple medical visits (based on units and/or lines) are present on the same day with the same revenue code, without condition code G0 to indicate that the visits were distinct and independent of each other. RTP
43 Transfusion or blood product exchange without specification of blood product A blood transfusion or exchange is coded but no blood product is reported. RTP
44 Observation revenue code on line item with non-observation HCPCS code A 762 (observation) revenue code is used with a HCPCS other than observation 99217-99220, 99234-99236, G0378, reported. RTP
48 Revenue center requires HCPCS The bill type is 13x, 74x, 75x, 76x, or 12x/14x without condition code 41, HCPCS is blank, and the revenue center status indicator is not N or F. This edit is bypassed when the revenue code is 100x, 210x, 310x, 099x, 0905-0907, 0500, 0509, 0583, 0660-0663, 0669, 0931, 0932, 0521, 0522, 0524, 0525, 0527, 0528, 0637, or 0948; see also edit 65. RTP
60 Use of modifier CA with more than one procedure not allowed Modifier CA is present on more than one line or Modifier CA is submitted on a line with multiple units. RTP
70 CA modifier requires patient discharge status indicating expired or transferred CA modifier requires patient discharge status indicating expired or transferred. RTP
73 Incorrect billing of blood and blood products Blood product claims lack two identical lines (of HCPCS code, units, and modifier BL), one line with revenue code 38x and the other line with revenue code 39x. RTP
74 Units greater than one for bilateral procedure billed with modifier 50 Any code on the Conditional or Independent bilateral list is submitted with modifier 50 and units of service are greater than one on the same line. RTP
79 Incorrect billing of revenue code with HCPCS code The revenue code is 381 with a HCPCS code other than packed red cells (P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9057, P9058) or The revenue code is 382 with a HCPCS code other than whole blood P9010, P9051, P9054, and P9056). RTP
84 Claim lacks required primary code Certain claims are returned to the provider if a specified add-on code is submitted without a code for a required primary procedure on the same date of service (edit 84). Add-on codes 33225, 90785, 90833, 90836 or 90838 are submitted without one of the required primary codes on the same day. RTP
86 Manifestation code not allowed as principal diagnosis A diagnosis code considered to be a manifestation code from the Medicare Code Editor (MCE) manifestation diagnosis list is reported as the principal diagnosis code on a hospice bill type claim 81X, 82X. RTP
92 Device-dependent procedure reported without device code A device-dependent procedure is reported without a device code. RTP

For more information on the index, check out CMS.

Lisa Marks, VP of HIM Services

WEARABLE SOLUTIONS: FINDING THE BEST FIT

Posted by Samantha Serfass on November 12, 2019 in Blog, News

WEARABLE SOLUTIONS: FINDING THE BEST FIT

Wearable technology is making big impacts in the Telehealth field.  Wearable technology collects patient data outside of the hospital and clinic walls and report back to care providers information based on measure data, instead of human memory & recall.  

Departments throughout hospital systems see advantages to wearable technology, specifically chronic disease and geriatric health management. Heart attack and heart failure patients are also a targeted demographic for wearable technology.

With the adoption of Current Procedural Terminology, CPT, codes for Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) by CMS, healthcare providers are more able to be reimbursed by Medicare for implementing patient wearables. The reimburse model can not only pay for a wearable, but it can also show an ROI addressing high risk and costly patients within the healthcare system.

Engaged patients are healthier patients and they reduce the cost needed to support a population within an ACO. By combining wearable technology and patient engagement, health systems are able to reduce the risk in a risk adjustment payment model all while collecting important clinical data.

Collecting a patients clinical data outside hospital walls can help increase patient engagement through text messages and secure messaging alerting the patient to their specific health information.  Patient engagement strategies can incorporate displaying personalized care plans on smart phones, remind patient to take medications, perform prescribed activities, measure vitals, etc. The wearable solution should be integrated with the healthcare organizations patient engagement solution.

It’s important to collect the data over a period of time to ensure patients are staying on track with their care plan. The type, time and frequency of messaging with a patient can be automated and crafted for the specific wearable and targeted outcome – allowing patients to receive critical information in real time.

There are many types of wearables on the market, what type and how the wearable is worn can dramatically impact the quality of the data collected by the wearable. Below is an example of the different types of wearables, their functionality and where they are worn. 

Source: Piwek L, Ellis DA, Andrews S, Joinson A. The rise of consumer health wearables: promises and barriers. PLoS Med. 2016;13(2):e1001953.

There are several factors to consider when looking at a wearable solution; quality, usability, comfort, durability and arguably most important – accuracy. Not all wearables require FDA approval, some devices can even report measurements with a significant deviation from the true reading so it’s important to research the options extensively.

There are many things to consider when entering into a patient care model that extends into the patients home. The patient experience can be greatly improved via nursing and informatics’. Nursing can make sure upon discharge that the patient knows how important the data is, how to wear the devices, and who to call with questions, this should be considered the basics. 

Home Health services can provide follow up support ensuring the patient knows how to use the devices and is collecting accurate data, this can be a key part to reducing readmission rates.

At Excite Health Partners we can help you identify areas of opportunity to utilize wearable solutions.  We start with a phased approach to ease your health system into properly using wearable technology and collecting the data.

 We help identify solutions specific to each facility needs. Below is a common phased approach we use:  

  1. Using existing hardware (such as iPhones) and automated reminders  
  2. Addition of one wearable device and integration into one EHR
  3. Secure messaging to improve patient engagement
  4. Adding additional EHR integration and additional Wearables

Through the phased approach, organizations are able to ease into wearable technology and its benefits and a low cost with immediate results. We have the experience and expertise to identify the best fit solution for your organization while increasing patient engagement, quality outcomes, and reducing costs with a healthier patient population.

Todd Klein, CIO VP of EHR Services & Digital Solutions

PROTECTING YOUR NETWORK AGAINST CYBER ATTACKS

Posted by Samantha Serfass on October 8, 2019 in Blog, News

PROTECTING YOUR NETWORK AGAINST CYBER ATTACKS


With security as an increasing focus in the healthcare space, CIO’s and CTO’s spend significant time ensuring the safety and privacy of patient information. However, the varying degrees of security attacks and privacy concerns leave IT specialists and stakeholders with a never-ending list of concerns.

Types of Security attacks (although not an all-inclusive list):

  • ADVANCE PERSISTENT THREATS (APT) – a security threat to the network remaining undetected for an extended period of time, most common when the data is of high-value.
  • AI ATTACKS – an attack which can automate identity, crack passwords and DOS making these attacks much more formidable.
  • DISTRIBUTE DENIAL OF SERVICE (DDoS) – the goal is to deny access to the server by overwhelming the target system by flooding it with network traffic.
  • MALWARE – a stealthy approach, without end-users knowledge, to put code on a device (i.e.: Trojan Horse).
  • PASSWORD ATTACK – an unsecured source attempting to break in or obtain a user’s password.
  • PHISHING – Social engineering to obtain information or approval to run code on a device.  C-suite you’re a Favorite target for an attach like this.
  • PHYSICAL SECURITY & DRIVE BY ATTACK – an unsecured wireless environment allowing threats to easily attack the system.
  • RANSOMWARE –blocks access to date with the threats to permanently compromise the data unless a ransom is paid.

Social engineering is the foundation of several attacks. These attacks occur when a source acts as a trusted advisor gaining access to codes and passwords for various devices. These attacks provide the source with the ability to obtain damaging information and/or create a foothold in the network to further exploit security issues.

IT and cyber-attacks in the healthcare industry rate as one of the most damaging and costly occurrences compared to other industries. As a whole, the healthcare industry spends an estimated $6 billion dollars a year dealing with security attacks and breaches.

According to one of the latest Becker’s reports, more than 5 million US patients can be accessed online by just a basic web browser. The below diagram published by the HIPAA Journal, shows rise in the number of reported data breaches.

Image from: HIPAA Journal

Steps to prevent a security break and ensure the privacy and safety of information is secure is a fraction of what an organization could lose in a cyberattack. Addressing these five items can help to eliminate the possibility of future threats and attacks.

  1. NETWORK ACCESS: Access to the network can be as easy as identify the SID (Security Identify) and a password breaker available on the internet for free. Make sure the wireless connection doesn’t advertise the SID and that communications are encrypted.  Using an advanced authentication protocol as the environment will handle like a Kerberos and Network Encryption protocols like IPsec will help safeguard the network.
  2. PROFESSIONAL INSTALLATION: Hiring highly qualified staff to administer the network and DMZ (the entry way into your network from public networks). This will ensure firewalls, protocol and port analyzers are proactivity looking for breaches. Conducting a penetration by a 3rd party will also confirm safety measures are correctly in place.
  3. SECURE DEVICES: Ensure the network and PC devices are locked down. Leveraging bio identification technology or a 3rd party code generator for two-factor authentication will help improve overall security of the system. Utilize a three-factor authentication and additional security to access addition data or performing sensitive activation (i.e. ordering narcotics) is also another way to safeguard high-valued information.  Lastly, having end-users security policies in place and enforced will also increase protection.
  4. 3rd PARTY ASSISTANCE: Use 3rd parties who specialize in healthcare security when necessary. It’s important to include security that covers the protection of medical devices and patient devices/wearables such as heart monitors.

At Excite Health Partners we use consultants and partners who specialize in Healthcare IT.  We can perform assessments to ensure the environment and the patient’s data is well protected. 

Todd Klein, CIO VP of EHR Services & Digital Solutions