Software Solutions/EHR

Three Uses of EHR: Data Reporting, ICD-10 Transition & ACO Participation

By Bryan Rogoff, OD, MBA, CPHM

SYNOPSIS

Use your EHR system to meet the critical goals of health care reform: data reporting, transitioning to ICD-10, and equipping your practice to participate in accountable care organizations.

ACTION POINTS

USE EHR FOR DATA REPORTING. Receive incentives for taking part in the Physician Quality Reporting System.

GET STAFF ON BOARD WITH NEW CODING. Use EHR to train staff on inputting more detailed documentation.

USE EHR TO EQUIP TO JOIN ACO. A fully-implemented EHR is a requirement to coordinated care in an Accountable Care Organization.

Your EHR system can help you achieve several basic goals of health care reform, all related to the general goal of improving patient outcomes. First, this includes participating in the Physician Quality Reporting System, which designates you as a doctor who delivers quality care and enables participation in the narrowed networks created by the Affordable Care Act. Second, your EHR system can be a great training tool for your practice’s transition to the ICD-10 coding system that takes effect in October 2015. Finally, having an EHR system, and optimizing its use, is a prerequisite and great selling point in helping your practice to join an Accountable Care Organization (ACO).

USE EHR TO PARTICIPATE IN PHYSICIAN QUALITY REPORTING SYSTEM

Health care reform mandates that health care professionals report patient data into aggregate data bases that employ computer analysis to identify patterns and best practices of treatments. Your EHR system is essential to this process.

The Centers for Medicare & Medicaid Services (CMS) offers a number of incentives and payment adjustments to eligible professionals. First, you are eligible for financial rewards if you successfully participate in the Physician Quality Reporting System (PQRS). PQRS for optometry is to improve reporting of diabetic, glaucoma and macular degeneration patients in your practice. The original deadline to participate was 2013 to avoid penalties in 2015, but it was extended through 2014.

If you already bill Medicare electronically, you do not need to register to participate in the program, rather you only need to modify your procedure codes slightly. A good EHR program will automatically adjust the coding for PQRS measures by changing certain settings.

You can also earn another 0.5 percent incentive from the PQRS program if you participate in the “maintenance of certification” (MOC) program. There are steps and requirements to participate in this program successfully, which are outlined on the CMS web site, a site with comprehensive information about the federal EHR incentive program. The MOC program can be a difficult, timely and expensive process, but there aren’t any penalties if you do not participate–so you have nothing to lose, but potential money to gain.

Click HERE for more information about the federal government’s EHR incentive program, including a timeline of meeting needed requirements to receive the incentives.

USE EHR TO SUPPORT TRANSITION TO ICD-10 CODING

Starting October 2015, the traditional ICD (International Classification of Diseases)-9 codes will be replaced with ICD-10 codes. ICD-9 has been around for 30 years containing outdated terms, and is out of date with today’s standard of care. The new coding is a 3-7 digit system that has 69,000 diagnostic codes to generate more description and allow growth within the system. Because ICD-10 is more descriptive, documentation via EHR is essential to determine reimbursement, such as: diagnosis, whether treatment was medically necessary, need for additional testing, etc. However, CPT (Current Procedure Terminology) codes are not affected and remain unchanged. It is imperative that your office staff is trained with the new coding, and that your office’s super-bills are updated. A good EHR will assist transitioning your office to these new ICD-10 standards.

To optimize your EHR to transition to ICD-10, be sure your coding and billing staff member(s) not only are skilled at the new coding formula, but that they also understand how to use your EHR to input the needed documentation.

Most EHR systems now have the ability to help translate ICD-9 codes into ICD-10, easing the transition.

USE EHR TO FACILITATE JOINING ACCOUNTABLE CARE ORGANIZATION

A critical part of future delivery of health care for optometrists are Accountable Care Organizations (ACOs). This is an untapped source of revenue for optometry and may be difficult for independent practitioners to enter initially. ACOs are designed to keep costs contained by coordinating care amongst physicians in the group. The ACO group is collectively responsible for quality of care and to reduce redundancy of unnecessary tests, case histories and other forms.

A fully-implemented EHR is a requirement to coordinated care in an ACO. ACOs bring together individual practices to oversee and coordinate all care for the patient, including inpatient and outpatient specialties. The care is coordinated through a primary care provider who is currently treating 5,000 or more Medicare beneficiaries. Optometry practices that become involved with ACOs need to demonstrate their office efficiencies, increase access to clinical and patient information, demonstrate the utmost ability to handle and coordinate care of difficult cases, practice evidence-based medical optometry, and reduce office visits. Physicians of an ACO are required to have a written legal structure that outlines the distribution of the cost-savings bonuses from CMS to the providers.

But before thinking about becoming part of an ACO, your EHR must be efficient allowing you and your staff to be the most productive. This reduces your overall administrative costs to a minimum and increases your ROI. With the decreased reimbursements of managed vision care and health insurances, EHR is a perfect tool for coding and billing to minimize errors and receive your accounts receivable on time, while allowing your practice to handle the influx of patients gaining healthcare from the Health Exchanges. A good EHR’s scheduling, coding, and billing allows your practice to handle a higher capacity of patient load while maintaining quality of care.

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Bryan Rogoff, OD, MBA, CPHM, is an ophthalmic practice and healthcare consultant who specializes in best operational, financial and clinical practices. To contact him: bmrogoff@comcast.net

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