Get Your Incentives for EHR and PQRS

Ideally, the only responsibility of a physician is to provide the best care to his/her patients.    Unfortunately, medicine is a business, so the topic of reimbursement will always rear

its ugly head.

Providers of Part B services on the MPFS can increase reimbursement and avoid future penalties by taking advantage of Medicare incentives for EHR and PQRS reporting.  Below you will find guidance on

both of these programs to help improve your bottom line.

To qualify for Medicare PQRS incentive payments, EPs must sufficiently report on the applicable quality information measures.  In the PQRS 2013 program, there are several hundred measures.

 To help navigate through this complex process, you can access the “Getting Started” page of the CMS PQRS website by clicking here.

Advanced Practice management software like Iridium Suite, has an integrated PQRS claim scrubber.  The practice can configure the medical billing system to automatically request that the physician sets up PQRS measures for each patient. The claim scrubber also recognizes which billing codes are potential PQRS denominators and automatically suggests the PQRS numerator codes that should be added to the claim. The biller simply accepts these suggestions and the claim scrubber automatically adds the proper PQRS charge codes to the claim.

  To qualify for the Medicare EHR incentive payments eligible professionals (EPs) must utilize certified meaningful use EHR technology. Proof of meaningful use can only be demonstrated by reporting clinical quality measures (CQMs) as well as the meaningful use measures.

Providers wishing to purchase certified EHR software can access a list of options on the CMS site by clicking here.

 In 2013, EPs may satisfy the meaningful use objective to report CQMs to CMS by reporting them through:

• Medicare and Medicaid EHR Incentive Programs’ web-based Registration and Attestation System

EPs who choose to report CQMs through the CMS Attestation system must still report information on individual quality measures or measure groups using one of the four reporting options in order to also participate in PQRS.

• Participation in the PQRS-Medicare EHR Incentive Pilot, which utilizes the 2013 PQRS EHR Measure Specifications.

 EPs who participate in the pilot may submit their meaningful use objectives through the CMS Attestation system, and then complete a single submission of CQMs to receive credit for both programs.

EPs who successfully participate in PQRS and EHR can receive an incentive in 2013 and avoid the 2015 payment adjustment for both programs.

Participating in both the PQRS and EHR programs in 2014 and beyond is being simplified by CMS with the alignment of several of key components.

Here are the changes affecting PQRS and EHR in 2014:

• PQRS and EHR programs will align on the same set of eCQMs (64 total) and the same electronic specifications
• All Medicare-EPs beyond their first year of demonstrating meaningful use will be required toelectronically report their CQM data to CMS for the EHR program
• Submitting data electronically using 2014 certified EHR technology will meet the standards forboth EHR and PQRS programs
• Participating EPs will have the option to submit patient-level data (via QRDA I) or aggregate data (via QRDA III) using the same reporting mechanism for electronic reporting for both programs.

Click here to read about how your EHR can communicate with your medical billing software.

September Is Healthy Aging Month

When you think of being old, I am sure certain visions come to mind:  less and/or grey hair, false teeth, eyeglasses, a cane or a walker, hearing aids.  Maybe you are an aging optimist “You are only as old as you feel.”  Well I guarantee, if you don’t pay attention to the things you do now, you will feel as old as you are someday, maybe even older.

The main focus of Healthy Aging® Month this September is to inspire and educate adults ages 50 and above to focus on the health of their physical, mental, social and financial lives.  That is a valuable goal; but why should we wait until 50?  A lot of damage could certainly be done by then. So, I say, start now, no matter what age, taking care of yourself today, is the best insurance for great tomorrows (and lots of them).

 

Ways to stay healthy fill store shelves and consume countless television commercial air time hours.  The keys to healthy aging can be very simple:

1.       Alcohol use:  Keep it at a minimum. Be aware that the recommended maximum consumption for:

Healthy men: 1 to 2 14 g servings per day, not to exceed 14 servings per week

Healthy (non-pregnant or breastfeeding) women: 1 14 g serving per day, not to exceed 7 servings per week.

2.       Diet:  Consume a healthy daily diet of fruits, vegetables and whole grains, with limits on foods with high calories, sugar, salt and fat. Follow recommended serving and calorie guidelines, find them here.

3.       Emotional bonding:  Love another living being and be loved.  This does not have to be a spouse/partner.  Friends, family, and pets are all important in nurturing our emotional side, and caring for others provides fulfillment as well.

4.       Exercise:  Find something you like to do and as Nike says “Just Do It”.  Participate in regular physical activity for a minimum of 2 and ½ hours per week (see recommended guidelines.) Walk your dog; he will love you even more.  Take a swim, ride your bike in the park.  Do it with someone else (see #3).  Whatever it is, get moving, both your body and your mind will thank you for it. 

5.       Intellect:  Read a book, start a new hobby, visit new places, see a foreign film.  Stimulate your brain; it makes you more interesting to friends and family (see #3).

6.       Joy:  Sounds easy right, but how many folks do you see every day walking around looking “mad at the world”.  Joy can be found in the sound, sights, smells, tastes and touch of each and everything around us.  You just have to stop and take the time to notice.  It also goes hand in hand with #’s 3, 4, and 5.

7.       Medical care:  Prevention, prevention, prevention.  See you doctor when you should, have the screening tests that are recommended, and follow prescribed treatments.  Those folks from #3 want to keep you around a long time. 

8.       Sleep:  The current recommendation for adequate sleep for adults is 7 to 9 hours a day.  Follow it so you can have energy for #4, a clear head for #’s 5 and 6, and studies show help with #11.  For more sleep related information, click here.

9.       Sun exposure:  Sun exposure does help a vital nutrient Vitamin D, so some is good.  It is important to be smart with sun exposure as current estimates are that one in five Americans will be diagnosed with skin cancer in their lifetime. This link offers information on lowering you skin cancer risk. 

 

10.   Tobacco use:  NONE, ZERO, NAUGHT, NIL, ZILCH is how much tobacco you should use.

11.   Weight:  Follow your physician recommendations on a healthy weight.  I bet if you follow #’s 1, 2, and 4, this one will be a breeze. 

Hopefully, you can take this list and start today with one or two of these healthy lifestyle tips.  Once you get going, no one can stop you from aging healthy!

As part of Healthy Aging Month, CMS is encouraging healthcare professionals to utilize Medicare-covered preventive services when addressing the health and quality of life of their patients.

Some of the preventive services covered under Medicare Part B include:

Alcohol Misuse Screening and Behavioral Counseling Interventions in Primary Care

Annual Wellness Visit (Providing Personalized Prevention Plan Services)

Cardiovascular Disease Screening

Depression Screening in Adults

Diabetes Screening

Initial Preventive Physical Examination (IPPE) (also commonly referred to as the “Welcome to Medicare” Preventive Visit)

Intensive Behavioral Therapy for Cardiovascular Disease

Intensive Behavioral Therapy for Obesity

Tobacco-Use Cessation Counseling

For More Information:

MLN Preventive Services Guide for Health Professionals

CMS Prevention General Information Website

Preventive Services Quick Reference

Infographic: Ovarian Cancer

“Sit still and pay attention!”

I am of an age where kids that didn’t pay attention and/or couldn’t sit still in class were just called “hyper” and corporal punishment was okay.  I can even remember one specific little boy from my First Grade class, a skinny little kid with a mop of unkempt blonde hair, super thick glasses and the need to get out of his chair during class.  The teacher was the seasoned, no nonsense type and how do you think she dealt with this unruly youngster? 

She tied him to his chair.  Yep, you heard me, right to the chair in the middle of class.  It probably didn’t help him learn any better, but at least he wasn’t running around disrupting class.  She had teaching to do!  She improvised and did the best she could for the rest of us. Looking back as an adult this seems really sad and mean, but in a way I am thankful.  I was there to learn and that wasn’t going to happen with him running around the classroom.  

If you are wondering,” why bother with this story?”  Well, it is National Attention Deficit Hyperactivity Disorder Month and thinking about that, made me think of that hyper little boy and that challenged, frustrated teacher.  I am sure like most people, I equate hyperactivity to ADHD, but this is not always the case.  

So in respect to that boy and probably many others that were at one time tied to their school desk chairs or even sent to the principal’s office for a paddling, I would like to share some enlightening facts about ADHD.

1.       It is estimated that 11% of school aged children in the US have ADHD and it can continue on into adulthood.

2.       ADHD is more often diagnosed in boys.

3.      Those who have ADHD do not misbehave on purpose; they typically are trying to behave the best way that they can.

4.      There are three ADHD Types: 

A.      Combined ADHD (the most common subtype), which involves symptoms of  both inattentiveness and hyperactivity/impulsivity

B.      Inattentive ADHD (previously known as ADD), which is marked by impaired attention and concentration

C.      Hyperactive-impulsive ADHD, which is marked by hyperactivity without inattentiveness

5.       Details for the three ADHD symptom categories: Inattention, Hyperactivity and Impulsivity.  Children with ADHD can present with symptoms from just one or multiple categories.  each with some unique symptoms, difficulties and advantages: 

A.      Inattention symptoms can include: unable to focus on details, makes careless mistakes, does not listen when spoken to, inability to follow instructions and complete tasks, disorganization, frequently loses belongings, forgetfulness

B.      Hyperactivity symptoms can include: inability to sit still or stay seated when needed, difficulty working/playing quietly, excessive talking, running around at inappropriate

C.      Impulsivity symptoms can include:  difficulty waiting for turn to speak or to play in a game

Fortunately, working with or around the symptoms of ADHD no longer include being tied to a chair or paddling.  For many families, behavioral therapy examines disruptive behaviors and provides instruction to both the children and parents on how to encourage/develop healthy behaviors. Support groups can help the patient and family connect with others who have similar problems.

Healthcare professionals have developed viable tools to assist teachers and parents both when encountering a child diagnosed with ADHD.  

Some of these tools include:

1.       Maintaining a consistent daily schedule, including regular times for homework, meals, and outdoor activities. 

2.       Providing advance notice to schedule changes.

3.       Providing an environment with as little distraction as possible.

4.       Ensuring the child receives proper nutrition and required sleep.

5.       Showing appreciation for the child’s good behavior.

6.       Setting rules that are enforced consistently. 

7.       Frequent and open communication between the child's teacher and parent.

As each child is unique, so will the plan of treatment be.  In some cases more than just techniques to accommodate inattention, hyperactivity, or impulsivity are required.  In these instances, prescription medication treatment can be indicated.  The most common medications that are used for ADHD are in the category of Psychostimulants; even though they are stimulants, they actually have a calming effect in people with ADHD.

Any medical condition, requires all involved parties to be well informed, therefore it is imperative to consult with the proper medical authority.  The best way to guide a child through the challenges of ADHD, is to be on the right path.  It may be a slightly bumpy path, or even a mountainous one, but reaching the destination successfully can be accomplished.

Flu Season Approaches!

The kids are back in school, the days are becoming just a little bit shorter and maybe a slight cooler.  You may be seeing pumpkins and Halloween candy in your local market.

It’s obvious, fall is approaching, and with it…. cold and flu season, UGH!

                                                                                                                                                                                                                                                                                                         

 Things to know about flu (and colds):

Colds and flu share many symptoms, but fever, body aches, extreme tiredness, and dry cough are more common and intense in cases of the flu. Whereas, colds tend to produce a runny or stuffy nose.

Tests during the first days of illness can detect influenza and may be indicated for those considered high risk to flu complications. 

Seniors and people with chronic health conditions—like asthma, diabetes, and heart disease—are at a higher risk for serious complications from the flu.

Based on research predictions, the upcoming season's flu vaccine will protect against these three influenza viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Even though the timing and duration of flu seasons can vary, for those living in the US, winter is the time typical time with some outbreaks as early as October. Most of the time flu activity peaks in January or later. 

You can be contagious 1 day before any flu symptoms occur and you may be able to pass on the flu to someone else up to 5 to 7 days after becoming sick.

It will take approximately two weeks after vaccination for your body to develop the antibodies to protect against influenza virus infection.

Everyone 6 months and older should get a flu vaccine each year.

                                                                                                                                                                                                                                                                                                         

Flu and Pneumonia Stats:

According to the Centers for Disease Control and Prevention:

In a 30-year study period, from 1982-2012, flu activity most often peaked in February (14 seasons, or 47% of the time).

In a 30-year period, from 1976-2006, annual flu-associated death estimates ranged from a low of about 3,000 to a high of about 49,000 in the US.

The 2012 season deaths related to flu and pneumonia were the highest in nearly a decade, and people 65 years and older accounted for half of all flu-related hospitalizations.

                                                                                                                                                                                                                                                    
                                                      
 So let’s refresh our memories on the coding and reimbursement guidelines for Influenza Virus and Pneumococcal vaccinations.

If you are not submitting the correct diagnosis and procedure codes you will not receive the proper claim reimbursement.

The vaccine procedure code should be chosen based on the description of the drug and the age of the patient.

Each vaccine code should be billed with the appropriate administration code as well.

                                                                                                                                                                                                                                                                                                          

The following procedure and diagnosis codes are used for influenza virus vaccinations:

CPT/HCPCS Code	Description
90654	Influenza virus vaccine, split virus, preservative free, for intradermal use
90655	Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use
90656	Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657	Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use
90660	Influenza vaccine, live, for intranasal use
90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)
Q2034	Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Afluria)
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)
G0008	Administration of influenza virus vaccine

Diagnosis Code	Description
V04.81	Influenza vaccination with dates of service 10/1/2003 and later
V06.6	Influenza and pneumococcal vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

                                                                                                                                                                                                                                                                                                  
The following procedure and diagnosis codes are used for pneumococcal vaccinations:

CPT/HCPCS Code	Description
90669	Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670	Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732	Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use
G0009	Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

Diagnosis Code	Description
V03.82	Pneumococcal vaccination
V06.6	Pneumococcal and influenza vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

                                                                                                                                                                                                                                                      


Coding Hint: Based on CCI edits, when performing an unrelated E/M service on the same date as the vaccination, append a “25” modifier to your E/M service procedure code to prevent denials of your immunizations.

                                                                                                                                                                                                                                                    

CMS has available on its website numerous resources to assist providers and will be posting Season 2013-2014 updates to their website soon.

Facts on Influenza, Pneumococcal, and Hepatitis B Immunizations: http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/Immunizations/

The 2012- 2013 Immunizers’ Question & Answer Guide: http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf

Current pricing information: http://www.cms.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp#TopOfPage

                                 

                                                                                                                                                                                                                                                    

If you are not administering flu shots, recommend this free tool, HealthMap Vaccine Finder to help your patients locate a local vaccine provider.