How My Practice Knew We Were Ready for EMR

by Mary Pat Whaley http://www.managemypractice.com/

My current practice is getting ready to go live on Electronic Medical Records (EMR) in just two short months, but it’s taken us over a year to get here. When I first started this job, we were supposed to go live with EMR in two months. After I’d had a chance to speak with everyone, I just knew the timing wasn’t right for the EMR. We would need to be able to run, and at that moment we were just starting to crawl.

What were the signs we weren’t ready?

• communication problems with the vendor, who provided the existing practice management system and the new EMR
• issues with the practice management system which had been mis-identified as being support-related
• basic decisions had not been made: one shared medical record for all clinics or individual records for each clinic?
• no single point person who was keeping everything together
  lots of frustrated and worried faces – did we know what we were doing?

A sigh of relief…

Although we knew we wanted the EMR and we had already made the investment, we also knew it might be a train wreck if we didn’t get some other questions answered first. When I announced we were going to delay the go-live until we had some other issues resolved, there was a sigh of relief from all involved.

What did we do to get ready for EMR?

1. We attacked the support problems by rerouting all support issues through one person – me. I kept a detailed log of all support issues and the resolution of each. I found the vendor to be surprisingly helpful and issues relatively easy to resolve. As I asked questions and we fixed issues, we found that much of our problem was training-related.

2. We held a major training event where all non-clinical staff were retrained to use the practice management system and everyone was given new cheat sheets for the correct way to use the system.

3. We realized that staff were worried about the impact of the EMR because the providers were overwhelmed with the current workload. They didn’t know how we would get through the pre-live work, the huge challenge that is the go-live and first few months of adjustment. After some intense evaluation, we changed our scheduling strategy and moved established visits from 15 minutes to 20 minutes, adding four work-in appointments and setting rules for adding more than four work-ins.

4. We took the vitals out of the halls and into the exam rooms, making the office quieter and the patient interactions private.

5. We also got control of most of our paper processes that weren’t working. We color-coded messages, re-educated patients about new ways of communicating with us and we managed to bring our fax and phone call volumes down to a manageable number.

6. We assigned nurses to the providers and asked the provider-nurse duos to put their arms around their patient panels as a team. The patients love it. We moved a float nurse to a triage nurse position to start taking all requests for same day sick visits and scheduling them appropriately.

7. We are soon to add an answering service (I prefer the term “virtual receptionist”) to our phones. The virtual receptionists (1000 miles away!) will take calls for the nurses and providers, typing them directly into our EMR.

8. We also started a front-end collection system, bringing our accounts receivable under control by adding automated eligibility, a new financial policy, collecting co-pays at check-in, calling patients with old balances before they arrived for their visit, and instituting a discount for non-insured patients.

How will you know when your practice is ready for EMR?

• You are not overwhelmed on a day-to-day basis. If your practice isn’t running well without an EMR, it is not going to run better with an EMR. If you are having operational issues, consider having a consultant help you set up new processes to handle the hurdles you’re facing now. The EMR does not fix operational issues, with the possible exception of lost paper charts.
• Your staffing is stable. There will always be some employees coming and going, but if you are experiencing one of those cyclical shifts when you have several new staff at once (especially nurses), you might want to give them a little more time to get a handle on their jobs before introducing EMR.
• You have your practice management act together – your PM works well and is up-to-date.
• Your finances are in order. If it takes several months of lower productivity, followed by less collections, you can weather the storm because you are on top of the dollars.

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22 Ways You Will Use QR (Quick Response) Codes in Healthcare in the Future (if You’re Smart!)

by Mary Pat Whaley http://www.managemypractice.com/

A QR (Quick Response or Quick Read) Code is a two-dimensional matrix/bar code. Users hold their phone up to the code displayed on a sign, in a book, on a computer screen, tv, or almost anywhere. The phone camera snaps the code and takes the user to a website or video with more information – no typing needed – just point and click.

QR Codes are most common in Japan where they are currently the most popular type of two dimensional codes. (definition courtesy of Mashapedia = wikipedia and Mashable)

- Billboards advertising hospitals and medical groups will have QR codes so travelers can get more information about facilities or get directions to the closest Emergency Department, Urgent Care or family practice.

- Television advertising for pharmaceuticals will have QR codes so viewers can get more information on the spot.

- Healthcare facilities will have QR codes for all types of information and videos that providers and nurses will instruct patients to scan based on their health problems.

- Magazines and newspapers will have QR codes that readers can scan to get health information and health product coupons.

- Scanning QR codes when exercising or purchasing healthy foods will get you reward points with your health plan, your doctor or your employer.

- Comparison of foods that you should or should not buy in grocery stores based on your individual health problems will be easy when you scan the food’s QR codes.

- Caregivers will scan QR codes to receive information and videos for caring for their loved one at home.

- When purchasing over the counter medications, vitamins and supplements, you will scan the QR to make sure the medication isn’t contraindicated for any prescription medication you are taking.

- Scanning the QR code on food or cleaning products will let you know if they contain anything that you are allergic to.

- At health fairs, attendees will scan QR codes for more information on health topics and your facility and services.

- Disposable diapers will each come with a unique QR code that Moms (and babies) can scan to get childcare tips, games, songs and medical advice.

- Urgent Care facilities and Emergency Rooms will have QR codes for instant access to wait times.

- QR codes in healthcare facilities will let users download helpful mobile healthcare applications like those that help you control your chronic illness or lose weight.

- In print advertising for physicians, potential patients will scan the QR code to view the physicians talking about their background, their specialties and their desire to have you as a new patient!

- Referring patients to facilities or specialty practices will be much easier when patients scan the QR code for the referral and receive information, instructions and directions to the appointment.

- Healthcare facilities will give out t-shirts and carrying bags promoting their services and the QR codes on them will spread the word to others. (Yes, people will scan each others’ t-shirt codes!)

- Patients taking home holter monitors and CPAPs will be able to scan the QR code on the machine to get a “how-to” video on using it.

- Patients taking home sample medications from physician offices will have QR codes on the bag to scan to remember how they are to take the samples.

- Temporary tatoo QR codes will identify those patients who won’t wear identifying bracelets, have dementia, or tend to wander away.

- Hospital patients will scan the menu broadcast on their TV to order their daily meals.

- If you are going to be late to your doctor’s appointment, you will scan a QR code to email an alert to the office that you are on the way. (Wait, maybe that’s too easy!)

- Pharmacies will have QRs loaded with prescription prices by insurance company plan on their website so providers can compare different drugs and chose the best drug for the patient at the best price.


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:::Holiday Hours Reminder:::

DataPlus corporate and support offices will be closed Monday, September 6th in honor of Labor Day. Normal office hours will resume Tuesday, September 7th. We wish you a safe and enjoyable holiday.

Guest Author Frank Trew from DataPlus: Ten Ways to Improve Your Bottom Line by Analyzing the Data from Your Practice Management System

by Mary Pat Whaley http://www.managemypractice.com/

The old saying “If you can’t measure it, you can’t improve it” certainly holds true in medical practices today. With falling payer reimbursement it is more important than ever to collect every single dollar your practice is due.

Most practices have sought additional income streams by adding ancillary services. Paying close attention to data can improve decision-making for such services and can dramatically improve revenue without adding any providers or even new patients!

Having ready access to the elusive data within practice management systems can be difficult, but most systems can report the basics. It is imperative that data is trended over a period of time so that trends can be spotted, benchmarks compared, and improvement plans developed. Measuring data and comparing it to the MGMA Cost Survey (find it at mgma.com) is one of the best places to start.

1. Collection Rates/Ratios: Two collection rates are measured in medical practices. One is gross collections and the other is net collections, the latter being the most important.

A gross collection rate is payments divided by charges and will depend on an artificial number – how high the charges are set above negotiated allowables – making it not particularly meaningful.

A net collection rate, however, provides a means to benchmark the health of collection efforts. Net collections, simply stated, demonstrate what percentage of collectible dollars (after negotiated contract write-offs) a practice is actually collecting. A net collection rate above 95 percent –when calculated correctly – denotes a healthy practice.

2. Denials: Denials are a significant portion of the cost of running a practice in that services that are provided but not paid for reduce the profitably of those that are. Accurately identifying denials and the reasons for them can help prevent them in the future, thus increasing productivity and lowering expenses. Identifying denial trends by specific payer or payer group, by CPT code, and by origin – whether at the front desk, with coding errors, or in credentialing – is equally important.

3. Evaluation & Management (E & M) Bell Curve: “Overcoding” and “undercoding” are commonly used terms, but how are they measured? Bell curve trending of E&M data can quickly identify areas where providers may be under coding, resulting in lower revenues, or over coding, resulting in the potential for audits. The difference between a Level 2 and a Level 3 E&M code can mean thousands of dollars in losses per provider per year. Documentation is critical to demonstrating the level of care provided to each patient.

The traditional primary care bell curve below demonstrates that level 3 visits typically comprise about 50% of your established patient encounters, level 2 and 4 visits together about 20% each, and level 1 and 5 visits together about 10%. When plotted on a graph and drawing a line between each, the shape resembles a bell.

4. Bad Debt: Bad debt is defined as dollars that could have been collected, but were not. Break this category into controllable factors and non-controllable factors. Issues that you should have been able to control are timely filing write-offs, credentialing errors, lack of follow-up, and incorrect information provided by the patient. Non-controllable issues are bankruptcy, patient failure to pay, and payers retroactively denying coverage due to unpaid premiums.

Reducing bad debt by just two percent can mean tens of thousands of dollars to the bottom line of a practice. The ability to quickly identify bad debt trends facilitates the development of an improvement plan.

5. AR Days: AR (accounts receivable) days are a measurement of the average time a dollar stays in an accounts receivable before being collected. The ability to measure, benchmark, and lower AR days provides a means to a significant increase in revenue. Some best practices that reduce AR days are filing insurance daily, sending statements daily, collecting appropriately at check-in and check-out, working denials quickly, discounting self-insured for time of service payment in full, and using an eligibility tool to check every single patient’s insurance.

6. Encounters: Accurately reporting and separating encounters for most practices is an arduous task of counting fee tickets or using tick sheets. Few practice management systems accurately provide this information. An encounter is much more than a service code. Being able to segregate office encounters from surgical cases, and reporting by payer, time, and location can help identify opportunities for improvement.

7. Referral Sources: It is fundamentally prudent for specialty practices to know the origin of patient referrals. This data is rarely reliable or easily created in most practice management systems. Practices need to know not only the source of patient referrals, but also what type of patients (by insurance, by procedure, etc.) are being sent by those sources, and if the referrals from a particular source have increased or decreased over time.

8. Payer Mix: It is not uncommon for practices to drop payors due to perception, and not because of actual data or trends. Emotions sometimes come into play and can result in a provider demanding that a payer be dropped because their rates have changed (or other perceptions). This simply does not make sense. Being able to accurately produce and graph data on major payers without hours and hours of work is of high strategic value to a well-planned business decision. It can answer questions about the impact on a practice if a particular payer is dropped, or how those patient slots would be filled. Remember to keep adding payers to the practice when feasible; the loss of your largest payer can be minimized if many smaller ones are on board.

9. Under Payments: One of the more significant ways to improve a practice’s revenue is the swift and accurate identification of carrier underpayments. Identification of underpayments is not simply comparing the payment to an allowable fee schedule. Practice management systems that have any type of payment audit functionality commonly do not take into account circumstances such as modifiers, or multiple surgical procedures that payers routinely inaccurately apply, causing underpayments. Having a system to automatically and systematically apply these rules is essential. MGMA states that providers are underpaid an average of six percent of revenue. What does that mean to a practice? The numbers can be astounding to a surgical group, and the identification and collection of those underpayments can be insurmountable.

10. Fee Schedule Comparison: It can be difficult to determine what payers are reimbursing by contract for specific codes or ranges of CPT codes. The ability to have immediate and accurate access to this data is crucial in payer negotiations. It is important to remember that the payer already has this information and is betting that the practice does not!

It is now more important than ever for practice managers to have access to the critical information outlined above. It is also important to note that not just any one of the above Key Practice Indicators should be used to determine the financial health of your practice, but all, or a combination of them.

The buzzword among practices today is “Dashboards.” The ability to have these Key Practice Indicators in one simple report is proven to increase efficiency, as well as provide a meaningful way to present information to providers. One example of a dashboard is below.

About the author: Frank Trew is the Founder and CEO of DataPlus and has over 25 years of practice management experience and has served in executive positions in large and small practices. In 1999, as the COO of a large orthopaedic group in Nashville, he was frustrated by an inadequate access to data that limited his ability to measure and improve the bottom line. The development of a data warehouse was the solution.

In 2000, after hearing how this data was a key practice management tool, many of Frank’s peers also wanted to use it improve their practices. DataPlus was formed as a result and has been providing MegaWest, HealthPort, and Centricity users with this unique tool ever since.

Employing a simple to use “point and click, drag and drop” reporting tool, along with an advanced Contract Management and Revenue Recovery System, DataPlus provides key management data across all specialties and throughout the United States.

Frank invites readers to visit the DataPlus website at http://www.mydataplus.com/. Frank may be contacted via email at ftrew@mydataplus.com or by telephone at (888) 688-3282.

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CMS Releases Record Retention Guidelines

by Mary Pat Whaley http://www.managemypractice.com/

State laws generally govern how long medical records are to be retained.

However, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 administrative simplification rules require a covered entity, such as a physician billing Medicare, to retain required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later. HIPAA requirements preempt State laws if they require shorter periods. Your State may require a longer retention period.

While the HIPAA Privacy Rule does not include medical record retention requirements, it does require that covered entities apply appropriate administrative, technical, and physical safeguards to protect the privacy of medical records and other protected health information (PHI) for whatever period such information is maintained by a covered entity, including through disposal.

The Centers for Medicare & Medicaid Services (CMS) requires records of providers submitting cost reports to be retained in their original or legally reproduced form for a period of at least 5 years after the closure of the cost report.

CMS requires Medicare managed care program providers to retain records for 10 years.

Additional information:

1. Providers/suppliers should maintain a medical record for each Medicare beneficiary that is their patient.


2. Medical records must be accurately written, promptly completed, accessible, properly filed and retained.


3. Using a system of author identification and record maintenance that ensures the integrity of the authentication and protects the security of all record entries is a good practice.


4. The Medicare program does not have requirements for the media formats for medical records. However, the medical record needs to be in its original form or in a legally reproduced form, which may be electronic, so that medical records may be reviewed and audited by authorized entities.


5. Providers must have a medical record system that ensures that the record may be accessed and retrieved promptly.


6. Providers may want to obtain legal advice concerning record retention after CMS-required time periods.

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21 Common Sense Rules for Medical Offices

by Mary Pat Whaley http://www.managemypractice.com/

There seem to be a lot of people searching for rules for medical offices. I’ve never heard of such rules, but since people are looking for them, I thought I’d write some.

1. Medical offices are professional workplaces and staff need to dress, speak, and purport themselves professionally.
   
2. Patients are customers and customer service should be paramount. Give all patients the utmost respect and practice compassion, compassion, compassion.
   
3. If it didn’t get documented (on paper or electronically), it wasn’t done. If it didn’t get documented, you can’t charge for it.
   
4. HIPAA. First of all, please spell it correctly. One P, two As. Secondly, know what it means and make it so!
   
5. Never enter an exam room without knocking.
   
6. Confirm patient identity (name, date of birth, etc.) before giving injections, taking specimens or performing a procedure.
   
7. Remove very sick or very angry patients from the front desk immediately.
   
8. Take the sick ones to exam rooms and take the angry ones to the manager’s office.
   
9. Do not use medical jargon with patients. If they don’t know what you’re talking about, they might be too intimidated to ask.
   
10. Wash your hands. Often. No matter what you do in the practice.
    
11. The office should be CLEAN, fresh and up-to-date. No dying plants, no magazines more than 9 months old, no dust bunnies behind the doors, no stained seating or carpets.
    
12. Train staff to apologize, and to apologize sincerely.
    
13. Complaints from patients and staff need to be addressed in 2 weeks or less.
    
14. Medical equipment is to be maintained and tested annually for safety and performance.
    
15. Once a medical record is finalized, the only changes to a paper record are single line strike-throughs with corrected information and initials, or addendums. There are no changes to electronic records, only addendums.
    
16. Patients don’t understand insurance. Be the expert.
    
17. Shred confidential practice paperwork and patient-identified information on- site.
    
18. Keep medications (including sample medications) in locked cabinets and use a good inventory system to log the use and replacement of stock.
    
19. Strive to meet patients at their communication level. Use graphics, translated materials and interpretive services when needed.
    
20. Don’t expect patients to be on time for their appointments when the provider isn’t.
    
21. Don’t make copies from copies.
    
22. Give everyone the benefit of the doubt. There’s always more to the story. Okay, this is really a rule for life in general, but it works in medical offices too.
    

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Consultant Donna Izor: Ten Tips To Make the Patient Schedule Work for Your Practice

by Mary Pat Whaley http://www.managemypractice.com/

Many practices and providers take their patient schedule for granted. They overlook the opportunity to improve both productivity and effectiveness by managing their schedule. Here are ten tips for office managers to make sure that the patient schedule works for you and for your practice.


1. Evaluate the schedule template with the providers and nurse manager quarterly.

By using actual issues from the previous period, discuss what has worked and what has not. Have providers share their concerns and discuss their recommendations for change. Nursing often has many ideas to improve the flow of patients through the practice and is a valuable source of information. Keep track of changes made and evaluate their effectiveness at the following meeting.


2. Standardize visits types.

There are many reasons an individual provider likes their “own” schedule. As managers, we know that this makes it very difficult for the front desk staff to do their jobs. Standardization reduces the potential for errors and disruption that proprietary schedules may cause. Your role in the discussion with providers will be that of facilitator, staff advocate, and coach.

Bring forward options for standardized visit types. Many practices use a block template based on 10, 15 or 20-minute blocks of time. The number of blocks used per visit type are agreed to and used to fill the schedule. There may be additional restrictions placed on the schedule such as no more than one new patient per half-day session. Minimize the number of restrictions or ideally eliminate them to assure your days are as flexible as possible to meet your patient needs. You may also want to consider open access scheduling. Moving to this system often takes time and effort to eliminate the backlog of booked patients but once fully in place can be very successful.


3. Track scheduling errors and issues perceived to be scheduling errors monthly.

Errors in scheduling cause patient dissatisfaction, back up your waiting room, and lead to stress and possibly short tempers. Ask providers and staff to tell you when they think patients are scheduled incorrectly. Track this over time to determine if changes in the system are needed, how visit type use can be improved, and what training may be needed.


4. Know where scheduling bottlenecks are.

What is your average wait time in the office per provider? Do a time study on each provider and measure how long it actually takes for a patient to get through an office visit. Note the time they arrive for check in and registration functions, their time in the waiting room, when the nurse completes check in functions in the exam room, when the provider enters the exam room, when the provider leaves the exam room and when the patient exits the office. Overlay this on your schedule. The information you gather will help you identify bottlenecks and provide meaningful data to share with your providers when recommending a change in the schedule template.


5. Know how much a visit is worth in revenue.

Adding one visit per day by addressing schedule gaps, clinical start times, no-show appointments or changing the length of visits will increase your revenue. If your provider works four days per week and 48 weeks per year at an average visit reimbursement of $75, one additional visit per day will add $14,400 in annual revenue to the bottom line!


6. Train your scheduling staff and update the training regularly.

Training a new staff member often brings up questions the entire staff can benefit from. Be sure to keep track of questions and include answers in future written training materials as well as in staff meeting discussions. Develop a training checklist for scheduling staff and have both the trainer and new employee initial when each area is mastered. This checklist can also be used for annual performance reviews. For current staff, take a look at their computer terminals and see what “sticky notes” are posted there, indicating areas that need special consideration or additional training.


7. Have the schedule be a frequent agenda item for staff meetings.

Get the staff perspective on what is working and what is not on a regular basis. You may find that nursing can provide a great deal of information on how the schedule impacts patient flow from their perspective. Take time for staff to discuss “what if” scenarios and how they would handle a particularly difficult situation. The goal is to have a schedule that staff understands, is user friendly and is consistently used.


8. Have a policy on the number of providers out at one time for vacation or holidays and follow it.

Everyone deserves time off but having many providers out at once can lead to a very hectic week for those remaining. Plan as much in advance as possible for time away. If you do end up with a number of providers out at once, remember that the person remaining will also be responsible for reviewing lab and radiology results for their colleagues as well as answering questions regarding patients that they may not know. Allow extra time in the schedule for this.


9. Know what changes in demand to expect during the year and plan for it.

Do you have more requests for acute visits in January, camp physicals in April, or school sports physicals in August? Minimize last minute adjustments to your schedule by knowing any seasonal trends in scheduling. Take a look at the schedules from past years to predict when you need more or less acute slots and adjust your schedule template for this. Manage the time you’ve allotted by marketing efforts in the office and local papers reminding your patients to schedule in advance.

You may also want to consider adding additional clinical hours during this time to make sure you can meet demand. Consider asking part time providers for extra hours per week or using per diem staff.


10. Deal with your patient no-shows.

Consider writing a policy on no-shows if you do not have one. If you have one, follow it. Make sure that your policy follows any state regulations to avoid patient abandonment claims.

Educate your patients. Develop a set of professional communications about your visit cancellation and no-show policy that begin with your welcome to the practice letter. Post a notice of your policy in your waiting room. Send letters following each no-show and then the termination letter stating the reason for the termination and that the patient is still responsible for their account balance. Be the contact person on the letter so that if the patient calls with questions, they speak with you rather than take up provider time or that of your staff.

If you have a patient that consistently no-shows but the providers do not want to terminate them from the practice, determine what other help you can provide to get the patient to the visit on time. Consider additional reminder calls, assistance with other services such as transportation, or offering the ability to come in and wait without a scheduled time. Though this may take more staff time, the revenue from the appointment should make it worth your while.

Donna Izor, MS, FACMPE is founder of West Pinnacle Consulting, LLC. Her 20 years of experience as a medical practice executive lends her special expertise in the areas of primary care and specialty practices, employed inpatient physicians, regulatory oversight, facility design, physician compensation and relations, and new program development. She has worked with academic, community hospital, and private practices. You can contact Donna at donna.izor@gmail.com.



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CMS and ONC Will Announce Final Rules on Meaningful Use, Standards & Certification 7/13/2010

U.S. Department of Health and Human Services
by Mary Pat Whaley http://www.managemypractice.com/

WHAT: CMS and ONC will host a press briefing to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.

WHO: Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services Donald Berwick, M.D, Administrator, Center for Medicare & Medicaid Services David Blumenthal, M.D., M.P.P., National Coordinator for Health Information Technology Regina Benjamin, M.D., M.B.A., Surgeon General

WHEN: Tuesday, July 13, 2010 10:00 a.m. EDT

WHERE: Great Hall, Hubert H. Humphrey Building 200 Independence Avenue, S.W., Washington, D.C. 20201
Call in: 800-857-6748 Verbal Passcode: HHS

Watch the webcast live here.


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Independent Diagnostic Testing Facilities (IDTFs) Can Expect Quarterly Letters From Medicare A/B MACs About January 2012 Accreditation Requirement

by Mary Pat Whaley http://www.managemypractice.com/

Medicare Learning Network (MLN) just released MM6912, effective August 2, 2010: Mailing To All Individual Practitioners, Medical Groups and Clinics and Independent Diagnostic Testing Facilities (IDTF) Who Are Billing or Have Billed For The Technical Component of Advanced Diagnostic Imaging Services.

What exactly is an IDTF?

Some suppliers that perform diagnostic tests, other than clinical laboratory or pathology tests, are required to enroll with Medicare as an Independent Diagnostic Testing Facility (IDTF). Not all suppliers that perform these diagnostic tests are required to enroll as an IDTF. Generally, entities can bill for the technical component of the diagnostic tests without an IDTF enrollment if it has the following characteristics:

• A physician practice that is owned, directly or indirectly, by one or more physicians or by a hospital.
• A facility that primarily bills for physician services and not for diagnostic tests.
• A facility that furnishes diagnostic tests primarily to patients whose medical conditions are being treated or managed on an ongoing basis by one or more physicians in the practice.
• The diagnostic tests are performed and interpreted at the same location where the practice physicians also treat patients for their medical conditions.
• If a substantial portion of the facility’s business involves the performance of diagnostic tests, the diagnostic testing services may be a sufficient separate business to require enrollment as an IDTF. In that case, the physician or physician group practice can continue to be enrolled as a physician or physician group practice but are also required to enroll as an IDTF. The physician or group can bill for professional fees and the diagnostic tests they perform on their patients using their billing number. Therefore, the practice must bill as an IDTF for diagnostic tests furnished to Medicare beneficiaries who are not regular patients of the physician or group practice.

Who will receive a mailing?

Enrolled physicians, non-physician practitioners, including single and multi- specialty clinics, and IDTFs who have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and who continue to have Medicare billing privileges with Medicare contractors (carriers and Part A/B Medicare Administrative Contractors (A/B MACs)) are affected.

If you have billed the Medicare program for the technical component of advanced diagnostic testing services within the preceding six month period and continue to have Medicare billing privileges with Medicare contractors, you will receive a letter from your Medicare contractor advising you of the need to become accredited by January 1, 2012, in order to continue to provide these services and bill Medicare.

When more than one physician or non-physician practitioner is operating within a group, such as a single specialty or multispecialty clinic, only the group will receive the letter, not each of the individual physicians or non-physician practitioners working for the group.

What will the mailing say?

You must be accredited by one of the three Centers for Medicare & MedicaidServices (CMS) approved national accreditation organizations by January 1, 2012,in order to be eligible to continue to furnish the technical component of advanceddiagnostic testing services to Medicare beneficiaries and submit claims for thoseservices to your Medicare contractor.

Your contractor will be mailing the letter quarterly beginning with July 2010 through July 2011. If necessary, follow the instructions in the letter to become accredited by January 1, 2012, in order to continue billing for the technical component of advance diagnostic imaging services. Make sure that your office staffs are aware of these new accreditation requirements and begin the accreditation process as soon as possible to protect your Medicare billing rights for these services.

Why do IDTFs have to become accredited now?

Section 135(a) of the Medicare Improvements for Patients and Providers Act of2008 (MIPPA) amended section 1834(e) of the Social Security Act and requiredthe Secretary, Health and Human Services, to designate organizations to accreditsuppliers, including but not limited to physicians, non-physician practitioners andIndependent Diagnostic Testing Facilities, that furnish the technical component(TC) of advanced diagnostic imaging services.

What qualifies as an advanced diagnostic imaging procedure?

MIPPA specifically defines advanced diagnostic imaging procedures as including:

• Diagnostic magnetic resonance imaging (MRI),
• Computed tomography (CT), and
• Nuclear medicine imaging, such as positron emission tomography (PET).

MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound,and fluoroscopy procedures. The law also excludes from the CMS accreditationrequirement diagnostic and screening mammography, which are subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

How long does it take to become accredited?

Since CMS expects that it may take as much as nine months from the time you initiate the accreditation process to completion, you should begin the accreditation process for advanced diagnostic imaging services as soon as possible, but not later than March 2011.

Who are the accrediting organizations?

CMS approved three national accreditation organizations — the American Collegeof Radiology, the Intersocietal Accreditation Commission, and The JointCommission — to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only tothe suppliers of the images themselves, and not to the physician interpretingthe image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff.

If you have questions, contact your Medicare carrier and/or A/B MAC attheir toll-free number, which may be found here (zip file.)

The letter will look like this:

[DATE]

[Supplier Name and Address]

Dear Physician/Non-Physician Practitioner/IDTF owner:

In accordance with Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), suppliers, including but not limited to physicians, non-physician practitioners and Independent Diagnostic Testing Facilities that furnish the technical component (TC) of advanced diagnostic imaging services must be accredited by January 1, 2012 in order to continue to furnish these services to Medicare beneficiaries.

Our records indicate that you have furnished advanced diagnostic imaging procedures such as diagnostic magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging such as positron emission tomography (PET) within the last six months. If you are not accredited by one of the organizations shown below by January 1, 2012, you will not be eligible to bill the Medicare program for advanced diagnostic imaging services. This letter requests that you take the necessary action to become accredited by the January 1, 2012 deadline. Since we expect it can take up to nine months from the time you initiate the accreditation process to completion, we urge you to begin the accreditation process for advanced diagnostic imaging services as soon as possible.

MIPPA expressly excludes from the accreditation requirement x-ray, ultrasound, and fluoroscopy procedures. The law also excludes from the CMS accreditation requirement diagnostic and screening mammography which are already subject to quality oversight by the Food and Drug Administration under the Mammography Quality Standards Act.

The Centers for Medicare & Medicaid Services (CMS) approved three national accreditation organizations – the American College of Radiology, the Intersocietal Accreditation Commission, and The Joint Commission – to provide accreditation services for suppliers of the TC of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician interpreting the image. All accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. The accrediting organization that issues your accreditation will notify Medicare once your accreditation is complete and approved.

To obtain additional information about the accreditation process, please contact the accreditation organizations shown below.

American College of Radiology (ACR)

1891 Preston White Drive

Reston, VA 20191-4326

1-800-770-0145

Intersocietal Accreditation Commission (IAC)

6021 University Boulevard, Suite 500

Ellicott City, MD 21043

1-800-838-2110

The Joint Commission (TJC)

Ambulatory Care Accreditation Program

One Renaissance Boulevard

Oakbrook Terrace, IL 60181

1-630-792-5286

If you have questions about this letter, contact [carrier or A/B MAC phone number/contact person].

Sincerely,

[Name of carrier or A/B MAC]

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

Supplier Billed Advanced Medical Imaging CPT codes for Section 135 (a) of the MIPPA to Receive Accreditation Requirement Notification Letter

70336 70540 71250 72125 73200 74150

70450 70542 71260 72126 73201 7416

070460 70543 71270 72127 73202 74170

70470 70544 71275 72128 73206 74175

70480 70545 71550 72129 73218 74181

70481 70546 71551 72130 73219 74182

70482 70547 71552 72131 73220 74183

70486 70548 71555 72132 73221 74185

70487 70549 72133 73222

70488 70551 72141 73223

70490 70552 72142 73225

70491 70553 72146 73700

70492 70554 72147 73701

70496 70555 72148 73702

70498 70557 72149 73706

70558 72156 73718

70559 72157 7371972158 73720

72159 73721

72191 73722

72192 73723

72193 73725

72194

72195

72196

72197

72198

72200

75557 76360 77011 78000 78811

75559 76376 77012 78001 78812

75561 76377 77021 78003 78813

75563 76380 77058 78006 78814

76390 77059 78007 78815

76497 77078 78010 78816

76498 77079 78011 78891

78015

78016

78018

78020

78070

78075

78099

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Medicare Changes Fee Schedule Mid Year...

As you are probably aware, Congress has changed the Medicare Fee schedule effective with dates of service on and after June 1, 2010. This represents a 2.2 % increase in the conversion factor.

We are aware of these changes and are working to get the new fee schedules loaded so you can make the necessary corrections to your contacts.

There are a few things you need to do before hand if you are using the contracts and fee schedules modules. If you do not use these modules, you may disregard this message.

1. For your Medicare 2010 Fee schedules that you have already created, change the contract stop date to May 31, 2010. Doing this will prevent showing false positives in your payment audit system. Any underpayments already in your payment audit system showing underpaid, will be automatically removed on your next update.

2. We will notify you by email, once we have made the new data available on our webservice, this could take some time, but we are working hard on the update.

3. Once you receive the email from us, stating that the new data is available, you will need to run the check for CMS updates from the Utilities menu, and then create new Medicare contracts with a start date of June 1, 2010. Please DO NOT simply delete, or update the current Medicare 2010 contracts with the new fee schedule amount! Our Payment Audit System looks at the date of service in order to apply to correct fee schedule amount, so you must have two Medicare Fee Schedules for 2010 for every payment type you currently use.

4. Once the new contracts are loaded, DataPlus will then go backwards and identify any new underpayments based on the new fee schedule.

As always, if you have any questions, please let us know, and we appreciate your business!


Sincerely,


Frank G. Trew
Founder / COO

ftrew@mydataplus.com