Posts Tagged electronic medical records

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Your Practice Management Software Is Only As Good As Your Practice Management

The Robot Practice Manager

 

A colleague of mine has been part of a well-known PM/EMR company’s software support team for 10 years. She often tries to steer people to me when she cannot solve a client’s problems with a software solution. Even though she was once a practice administrator herself, she is a software support person now and the problems she sends to me cannot be solved with software. “Mary Pat,” she asks me, “Why do they think I can solve their practice management issues? All I am empowered to do is to help them use the software.”

Earlier in my career (before EMR) I heard someone call “Practice Management” software “Billing” software and I remember being offended for some reason. I thought “Billing” was such a narrow description of what PM software did – but they were right. That software is meant to deal with everything billing. It all comes down to billing – whether it is the actual billing/claims management itself, running reports to diagnose billing problems, or capturing recalls so patients get reminded to come in for a service and…get billed. Before you unload on me in the comments let me be clear that I am not saying that healthcare is all about billing, I am only saying that Practice Management software was developed to handle the financial side of the house.

Practice Management software cannot “do” practice management. It cannot figure out your workflow so you capture data in the most efficient way, and it cannot analyze your reports and tell you what to change to increase efficiency or decrease overhead. It certainly cannot tell you the best way to schedule, or how much to charge your self-pay patients. It is only a billing tool.

I have worked in healthcare long enough to have helped practices go from manual billing (you typed or hand-wrote claim information on a 1500 form and mailed it in) to their first practice management system. I did a lot of practice management consulting even though that’s not what I was there to do. I had to get them in shape on paper so they could handle the software. I had to get their workflow optimized so the software would make things better – not worse.

An implementation of Practice Management software is not intended to do anything but set-up the system and train you to use it. Sometimes that perfectly rosy future the salesperson paints is nothing like the painful first steps (and cash flow jam) of a new system. An implementation will not fix the issues that are existing in your practice that have nothing to do with the functionality of your billing system.

 

Your Practice Management Software can:

    • Automate your registration process so patients can register and check-in online, or at a kiosk in the practice.

But your Practice Management Software cannot:

    • Train staff to greet patients and make them welcome in the practice.

 

Your Practice Management Software can:

    • Check the patient’s eligibility for active insurance coverage.

But your Practice Management Software cannot:

    • Automatically choose the correct insurance company/payer to attach to each patient account (one of the biggest problems I hear about in the field!)

 

Your Practice Management Software can:

    • Calculate the days since the patient’s last physical, the days left in a global period or visits left in annual cap. 

But your Practice Management Software cannot:

    • Help the patient understand their benefit plans and understand their financial responsibility.

 

Good practice management has a lot to do with attracting, training, coaching and retaining the right staff, as well as providing them with the tools to do the job you hired them to do. Getting the software right is a must, but don’t expect your software trainers to be able to solve any of your staffing, communication, workflow or cultural problems. That’s up to you, the Practice Manager!

(Photo Credit: baboon™ via Compfight cc)

Posted in: A Career in Practice Management, Collections, Billing & Coding, Day-to-Day Operations, Finance

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Medicare to Providers “Tell Us More”

What's In Your Brain?

 

 

Medicare recently started denying an increased number of claims because documentation submitted for diagnostic tests does not include signed test orders or evidence of intent (MD progress notes listing tests needed) and evidence of medical necessity (description of clinical conditions and treatment showing the need for the testing.)

Most of us who have gone through the implementation of a EMR realize that electronic medical records (EMRs) do not always “tell the story” of a visit in the way that paper records used to. Encounters are documented without the glue that allows an auditor to understand what went on during the visit. Here are three ways to make sure that your documentation meets requirement for Medicare and other payers.

 

Establish Medical Necessity: Make sure the test is attached to the right diagnosis

Some providers attach all diagnoses assigned to a visit to any/every test ordered and performed. This is incorrect. All diagnoses can be attached to the Evaluation & Management (E/M) code, since all were addressed during the visit. Don’t list any diagnoses from previous visits that were not addressed at the current visit unless you note their impact on your decisions for care at the current visit.

Remember that screening tests and diagnostic tests are two different things. A screening test is ordered when you are looking for something with no provocation. Wikipedia states that a screening test “may be performed to monitor disease prevalence, manage epidemiology, aid in prevention, or strictly for statistical purposes.”

A diagnostic test is ordered when there is a sign or symptom that prompts the provider to look for the cause. Wikipedia defines a diagnostic test as “a procedure performed to confirm, or determine the presence of disease in an individual suspected of having the disease, usually following the report of symptoms, or based on the results of other medical tests.”

According to Medscape, the 5 main reasons for any test are as follows:

      • Screening: Screen for disease in asymptomatic patients. For example, a prostate-specific antigen (PSA) test in men older than 50 years.
      • Screening: A test may be performed to confirm that a person is free from a disease or condition. For example, a pregnancy test to exclude the diagnosis of ectopic pregnancy.
      • Diagnostic: Establish a diagnosis in symptomatic patients. For example, an ECG to diagnose ST-elevation myocardial infarction (STEMI) in patients with chest pain.
      • Diagnostic: Provide prognostic information in patients with established disease. For example, a CD4 count in patients with HIV.
      • Diagnostic: Monitor therapy by either benefits or side effects. For example, measuring the international normalized ratio (INR) in patients taking warfarin.

 

Reveal your decision making in the record

      • Need add’l tests to est. xxxxxx. Plan to…
      • Return in 3 wks and repeat test to establish…
      • DM worsening – will….
      • Consider d/c xxxxxx medication if fatigue persists.
      • Hypothyroidism vs. anemia?
      • Fatigue most likely sec. to HTN meds – r/o electrolyte abn.
      • DM stable, continue current regimen, recheck in 3 months.

 

Don’t forget the signatures!

A signature log can be as simple as entries on a document such as:

Provider Name (printed): ______________________

Full signature (written by provider): ______________

Initials (written by provider): ___________________

(Photo Credit: deadstar 2.1 via Compfight cc)

Posted in: Collections, Billing & Coding, Compliance, General, Medical Coding Education, Medicare & Reimbursement, Medicare This Week

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Are Your Physicians Crying About Your EMR?

A new report suggests that 2013 may be the year of the great electronic medical records (EMR) vendor switch given that many EMRs are falling short of providers’ expectations.Crying About An Underperforming EMR

To come to that conclusion, Black Book Rankings polled roughly 17,000 active EMR adopters – and found that as many as 17 percent may switch out their first-choice EHR by the end of the year.

The reason: In light of Stage 2, provider demands are increasing, and EMR users are reporting that many EMRs aren’t living up to expectations. In fact, those polled cited numerous cases of software firms underperforming badly enough to lead them to lose market share.

As a result, 31 percent of survey respondents indicated they were “dissatisfied enough” with their EMR to consider switching. Of those users, the reasons cited for the potential switch were as follows: (more…)

Posted in: Day-to-Day Operations, Electronic Medical Records

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Dr. Peter Polack of Medical Practice Trends Podcast 24: Scanning Paper Records into Your EMR

Dr. Peter Polack has a new 8 minute podcast on “Scanning Paper Records Into Your EMR System: Setting Up An Action Plan” with yours truly. We discuss some tips and best practices including:

  • The importance of ‘storyboarding’ your strategy for paper chart conversion
  • How to decide if you need more employees for your conversion process
  • Scanning vs. indexing
  • When to know if you need to outsource the scanning process
  • How much of the old paper record do you need to convert?

Click here to listen.

 

Posted in: General

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