1

Blue Button Initiative Offers a Glimpse into the Future of Sharing Health Data

The most exciting thing for me about being in healthcare today is the contrast between steep challenges the industry faces on so many fronts – and the vast potential offered by biological and information technology. We do have some dragons to slay, but we also have amazing tools: genetic research, stem cell therapies and nanotechnology, alongside the potential for insight gleaned from mountains of big data. It’s an exciting time, to be certain, and with so much change happening on so many fronts our work is in the spotlight more than it has been in a long time.

We don’t have to wait for exotic technologies or highly educated software to make a positive difference in patient care and outcomes. Often the most empowering tools for the patient are the simplest to use. If engagement is the holy grail of patient-centered care, then it has to be our goal to make that engagement simple and effective. In the United States especially, with an aging demographic and a generation behind it accustomed to slick consumer-driven technology, it is not enough for new treatments to be powerful – they also have to be approachable.

Blue Button Initiative Logo

One of the most interesting ways this is being done right now is at the Department of Veterans Affairs (or the VA) with the Blue Button Initiative. The project has given veterans the ability to click a “blue button” and download their own health and military service records into a simple text file or pdf.

“Blue Button gives veterans complete control of this information – without any special software – and enables veterans to share this data with their health care providers, caregivers, or people they trust.”  – from the VA’s Website

This project works in conjunction with the My HealtheVet Personal Health Record, which has been online since 2003. My HealtheVet allows veterans to access and store their own health data: from lab reports from VA hospitals to self-entered data like weight and vital signs taken as part of regular care, plus food and activity journals for veterans trying to control weight.

By clicking on the Blue Button, patients can get their entire PHR (Personal Health Record) from My HealtheVet (or only information of a specific type, or from a specific time period) and immediately have control of their data. The beauty of the Blue Button is its simplicity – simple to download, and simple to share, too. The text file created by the Blue Button is machine readable, so it is easily read by a computer program, and simple to view on any computer or mobile device regardless of platform or software.

The Blue Button concept can work the other way as well. Once patients have their data, they can easily share it: with paramedics in emergency situations, with their own doctors at appointments, or between appointments to track progress, and with caregivers in the home. By allowing a way for health information to be shared simply and without worrying about the platform on either end of the transmission, the Blue Button opens the door for some amazing advances down the road. Blue Button data could easily be de-identified and used in clinical research trials or community health projects. Public Blue Button repositories of this data could allow patients to compare their health statistics to those with similar demographics and histories to track their own health goals. And on top of all of this, the patient becomes more experienced, knowledgeable and confident about accessing, controlling and sharing their own data.

The Blue Button Initiative has now expanded to partner with other large repositories of Personal Health Information to expand the Button’s capabilities beyond just the VA. Both government agencies and private insurers as well as data repositories have added Blue Button access to their online portals so that their own patients can easily capture and control their health data. Just last week United Healthcare announced they would add Blue Button functionality to their customers online records for 500,00 of their members in Nevada. The company plans to roll out the technology to 26 million members by the middle of 2013.

When the benefits of simple technologies are powerful for everyone in the system: patients, provider and payers alike; simple ideas can have a profound affect on large scale problems. With the Blue Button Initiative the VA, Centers for Medicare and Medicaid Services and many private partners are achieving just that.




The Dog Days of PECOS: CMS Publishes the Short Form (Paper) for PECOS, plus Consultant David Zetter Walks You Through It Online

NOTE: The date has been changed to July 5, 2011 has been delayed indefinitely.

************************************************************************************

Many managers have told me they know their providers are in PECOS but they’re not on the list OR they never enrolled their providers but they are on the list OR they’ve sent their paperwork and have not heard back for 2, 4, 6 weeks – should they be worried?  The CMS website says “It is possible that it could take 45-60 days, sometimes longer, for Medicare enrollment contractors to process enrollment applications,” so I guess we all need to chill out a little.

The massive undertaking of qualifying every single healthcare professional who refers/orders or provides medical services to Medicare patients in order to sift out those who would lie about providing goods and services is fraught with confusion, miscommunication and misunderstanding.  That’s okay, though, because CMS says no checks for services or goods will be withheld due to providers not being listed in PECOS, at this time. They know it’s a mess and it will take quite a while to get everyone straightened out, on the list and able to get checks from CMS if and only if their name is on the list.

Below is the CMS fact sheet published last week.

The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

Medicare Enrollment Guidance for Physicians that Infrequently Receive Reimbursement from the Medicare Program

Traditionally, most physicians have enrolled in the Medicare program to furnish covered services to Medicare beneficiaries.  However, with the implementation of Section 6405 of the Affordable Care Act, some physicians will need to enroll in the Medicare program for the sole purpose of certifying or ordering services for Medicare beneficiaries. These physicians do not send claims to a Medicare contractor for the services they furnish.

In the process of implementing the provisions contained in the Affordable Care Act, we have become aware of several unique enrollment issues for certain types of physicians or practitioners. Specifically, we have modified the process of enrollment to accommodate the special circumstances of the following individual physicians and practitioners:

  • Physicians employed by the Department of Veterans Affairs
  • Physicians employed by the Public Health Service
  • Physicians employed by the Department of Defense Tricare program
  • Physicians employed by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or Critical Access Hospitals (CAHs)
  • Physicians in a Fellowship
  • Dentists, including oral surgeons

This document provides guidance to those practitioners.

Q: How can I verify whether I am already enrolled in PECOS?

A: If a physician is concerned or uncertain about whether s/he is actually enrolled in the Provider Enrollment, Chain and Ownership System (PECOS), s/he can  review the Ordering and Referring file found in the download section of the “OrderingReferringReport” tab (click here) on the Medicare Provider and Supplier Web Site.

Providers and suppliers can check with the ordering or referring physician to see if the physician is currently seeing Medicare patients and the physician’s claims are being paid. Until we advise otherwise, your orders and referrals will not be rejected due to the lack of an approved enrollment record in PECOS.

Q: I am a physician employed by the Department of Veterans Affairs, Department of Defense Tricare program, by the Public Health Service, an FQHC, an RHC, or a CAH.  Do I need to enroll in PECOS to order and refer items or services for Medicare beneficiaries?

A: Yes, but we have abbreviated the enrollment process and documents for physicians employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an FQHC, an RHC, or a CAH. However, because this is a unique solution to enrollment for a specific set of physicians, our systems will not accommodate the abbreviated forms on-line. Therefore, any physician employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an FQHC, an RHC, or a CAH, who is not already enrolled in PECOS, must use the paper enrollment application process
and do the following:

Complete the following sections of the paper CMS-855I, “Medicare Enrollment Application for Physicians and Non-Physician Practitioners” and mail the completed form to the designated Medicare enrollment contractor:

  • Section 1  Basic Information (they would be a new enrollee)
  • Section 2  Identifying Information (section 2A, 2B, 2D and if appropriate 2H and 2K)
  • Section 3  Final Adverse Actions/Convictions
  • Section 4C/4E  Practice Location Information (same as section 2B)
  • Section 13  Contact Person
  • Section 15  Certification Statement (must be signed and dated””blue ink recommended)
  • Section 17  Supporting Documentation (cover letter stating the provider is only enrolling to order and refer services to a beneficiary)

Note: Physicians who are employed by the Department of Veterans Affairs, the Public Health Service, the Department of Defense Tricare program, an RHC, FQHC, or CAH are not required to include the Electronic Funds Authorization Agreement (CMS-588) or the Medicare Physician and Supplier Agreement (CMS-460) with the enrollment form.

Q: I am a  physician in a fellowship program.  Do I need to enroll in PECOS?

A: If you are a physician in a fellowship, and licensed in the State, you can enroll in Medicare for the sole purpose of ordering or referring items or services for Medicare beneficiaries. To enroll as a “referring and ordering physician-only” you would need to complete the abbreviated enrollment application form in the same way as other physicians (VA, DoD, PHS, FQHC, RHC CAH) who are enrolling to order and refer only (see previous question.) If you elect to enroll to order and refer only, you would not be enrolled in Medicare for the purpose of providing Medicare services to Medicare beneficiaries. In order to provide covered services to Medicare beneficiaries, a physician would need to complete the full enrollment application either on-line or in hard copy.

Q: I am an Oral Surgeon or Dentist. How do I Enroll in PECOS?

A: Dentists, including oral surgeons, must enroll in the Medicare program to receive reimbursement for services furnished to Medicare beneficiaries or to order covered items or services for Medicare beneficiaries. Oral surgeons would complete the same paper forms, or on-line application, as any other practitioner enrolling in PECOS.
If you elect to enroll as a “referring and ordering physician-only”, you would need to complete the abbreviated enrollment application form in the same way as other physicians (VA, DoD, PHS, FQHC, RHC CAH) who are enrolling to order and refer only (see previous two questions.)  If you elect to enroll to order and refer only, you would not be enrolled in Medicare for the purpose of providing Medicare services to Medicare beneficiaries.

In order to provide covered services to Medicare beneficiaries, a dentist, including oral surgeons, would need to complete the full enrollment application either on-line or in hard copy.

Note:  In completing the enrollment application portion dealing with specialty, oral surgeons would check the “oral surgery (dentist only)” box found in section 2 of the Medicare enrollment application and any other dentist would check the box titled, “Undefined Physician Type” and specify that they are a dentist in the space provided.  In the near future, we will revise the Medicare enrollment application to add “Dentist” as a physician specialty.

Internet-based PECOS

Physicians and practitioners who are employed by the Department of Veterans Affairs, the Defense Department, the Public Health Service, an RHC, FQHC, or CAH must complete the paper enrollment application that has been modified and shortened to accommodate the special situation of these professionals. All other physicians and practitioners who furnish services to Medicare beneficiaries must enroll in the Medicare program to receive reimbursement and order/refer in the Medicare program.  For those physicians and practitioners using the on-line process, we have developed a document that will help you through the PECOS enrollment process.   It will be easier to complete the process if you review this document before you begin the enrollment process.

  • The document titled, “Internet-based PECOS — Getting Started Guide for Physicians and Non-Physician Practitioners” can be found here.
  • Although you are permitted to complete your enrollment application in hard copy, it will be easier and quicker if you use the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to complete the Medicare enrollment process.  The Internet-based PECOS application is completed via the web here.
  • After submitting an enrollment application via Internet-based PECOS, you must:
    • Print, sign and date (blue ink recommend) the Certification Statement(s), and
    • Mail the Certification Statement(s) and applicable supporting documentation to the designated Medicare contractor (no later than 7 days after you complete the online portion.)
    • NOTE: The Medicare contractor will not be able to begin to process your enrollment application until it receives a signed and dated Certification Statement.

 

Additional Medicare Enrollment Information

To ask a provider enrollment question, contact the Medicare contractor for your State. Medicare provider enrollment contact information for each State can be found here.

To report Internet-based PECOS navigation, access, or printing problem with Internet-based PECOS, contact the EUS Help Desk at 1-866-484-8049 or send an e-mail to the EUS Help Desk to EUSSupport@cgi.com

For additional information regarding the Medicare enrollment process, visit the website here. Of course, if you have any additional questions about the Medicare enrollment process, you can contact the designated Medicare contractor for your state.

********************************************

If you haven’t started yet but plan to use the online process to enroll your providers or yourself, here’s a really excellent SlideShare presentation by David Zetter that steps you through the enrollment process by showing screen shots of each step.  You can contact David Zetter here.

PECOS Enrollment Process