With healthcare’s shift towards value-based reimbursement models and an emphasis on quality of outcomes over quantity of services performed, there is also a push for physicians to dig deeper into their reporting. In order to encourage improved quality measures reporting, the Centers for Medicare & Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS). The program, created in 2007, has both non-reporting payment penalties and reporting payment incentives for physicians who treat patients covered by Medicare Part B. Those who don’t participate in 2014 face a 2.0 percent payment penalty for Part B claims which will be assessed in 2016. Likewise, those who do report quality measures via PQRS are eligible to receive a 0.5 percent payment bonus on all claims in 2014. At first glance, the list of quality measures that can be submitted to PQRS is daunting, and many do not apply to specialty practices. Luckily for most specialty practices, the respective trade associations have done the legwork and have pulled out the applicable measures that can be used for submission. As such, specialty practices should check their association’s website for guidance in navigating the submission process.

As many in the industry noted, Stage 1 Meaningful Use (MU) was largely geared toward general practices, and has been described as a “one size fits all” approach that did not take into account the varied nature of specialty providers. Although there were exemptions that specialty practices could qualify for in Stage 1, the initial confusion surrounding the guidance created challenges for many providers. CMS has now provided guidance on Core, Menu and Clinical Quality Measures (CQM) exclusions. CMS has been very clear that potential exclusions are not based on a particular specialty, but rather on the specific data that a practice does not collect because it is not relevant to their practice. They note that there are no “blanket” exclusions for any type of provider and that the physician is responsible for “evaluating whether they meet the exclusion criteria for each applicable objective.” After receiving numerous comments from medical societies, industry associations and other stakeholders, it seems that CMS is listening to the concerns that have been raised by specialty providers. With MU2, providers have more clarity regarding the process for reporting Core, Menu and Clinical Quality Measures. For example, CMS has published a Meaningful Use for Specialists Tipsheet.

Nextech has been committed to supporting our clients through the challenges of attesting for Meaningful Use Stage 1, and we’re now prepared and dedicated to assist with Stage 2. We have been hard at work to ensure that our solutions, including Nextech with NexERx version 11.0, Nextech with NewCropRx 11.0, Nextech 11.1, and Nextech 11.2, are compliant with the ONC 2014 Edition criteria, and we’re pleased to announce that they have been certified as Modular EHRs by the Certification Commission for Health Information Technology (CCHIT®). For the past 17 years, Nextech has been the leader in technology for specialty practices and has supported more than 7,000 surgeons and physicians and more than 40,000 staff members. Our clients trust us to provide technology that increases the efficiency of their practices and allows them to stay in regulatory compliance.

Healthcare professionals are bracing for a big change in 2014. Beginning October 1, providers across the nation will make the switch from ICD-9 to ICD-10 diagnostic code sets, a move that hasn’t been made since 1979. With no grace period allotted by the federal government, physicians are charged with coming up with a plan of attack for implementing ICD-10 and getting their staff fully functional by the Oct. 1 deadline. Integrating ICD-10 into daily practice operations will need to start with a complete understanding of the major differences between ICD-9 and ICD-10. The most obvious change buzzing throughout the industry is the vast difference between the number of codes provided by ICD-10. Under the new system, codes will increase from 18,000 to more than 140,000. Federal healthcare regulators say the upsurge of codes will allow for more specific documentation during patient visits. For example, physicians documenting a patient who broke their arm will be asked to specify whether the right or left arm was broken, a detail not provided with the basic ICD-9 code sets. Another difference providers will notice immediately: code structure. As opposed to ICD-9 codes, the ICD-10 code sets will include numbers as well as letters. The length of the code will also change. ICD-10 diagnostic codes will range from 3-7 characters while procedure codes will include 7 alpha-numeric characters.

It’s a new day in the medical industry. As of Sept. 23, new changes to Health Insurance Portability and Accountability Act (HIPAA) regulations have been sweeping the healthcare field, forcing physicians to keep a closer eye on the security of protected health information (PHI). The new revisions, also referred to as the “Omnibus Final Rules,” place added pressure on doctors to protect medical records with the threat of stiff fines for violators. Stemming from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the new HIPAA regulations were announced Jan. 17, 2013, by the U.S. Department of Health and Human Services (HHS). The revamping of HIPAA’s rules comes as the federal government continues its push for early adoption of electronic medical records (EHRs). With billions of dollars in incentive payments going toward early EHR adopters, federal legislatures are working to clamp down on security breaches when it comes to PHI. Operating as the enforcers of new HIPAA sanctions, the Office of Civil Rights (OCR) will work to ensure compliance through investigating complaints and conducting audits of businesses and organizations covered by the rules. Doctors found to be outside of compliance could face hefty fines ranging from $100 to $50,000 per violation with a maximum fine of up to $1.5 million in 12 month period.

Those looking to attest Meaningful Use (MU) for the first time ought to be on the lookout for a fast approaching deadline! The final reporting period to attest Stage 1 of the Electronic Health Record (EHR) Incentive Program, without penalty, begins October 1, 2013. Practices must show they have successfully, and effectively, implemented their EHR and have a solid 90-day record of its use. Preparing to attest MU can be a daunting task. NexTech EMR Specialist Kathy Claytor helps clients prepare for attestation. She offers the following tips: Pay attention to deadlines Claytor advises working closely with your NexTech EMR Specialist to get a complete understanding of requirements and due dates. Although the clock starts ticking October 1, 2013 for a 90-day reporting period, physicians have until February 28, 2014 to attest MU for 2013. “The last thing you want to do is be on the attestation website and realize that you did not capture everything you needed to properly attest,” says Claytor. Prepare for an audit, just in case According to the Centers for Medicare and Medicaid Services (CMS), 1 out of every 20 physicians participating in the MU program will be audited. Claytor recommends all participating practices be prepared to provide checks and balances in the event they are audited. Claytor says a thorough account of your EHR from implementation to attestation will make auditing a smoother process. “We help prepare offices when setting up their EMR by having them take screenshots of implementation in case they get audited,” states Claytor. Don’t confuse your staff … keep it simple Proper MU training for your staff is critical to attestation. Claytor advices all of her clients to designate one person, perhaps the office manager, to be the “go-to” person on all things MU related. Your new office MU champion will be charged with learning the EMR software inside and out, then designating specific responsibilities to staff members. “Once everything is set up and the staff is trained on their areas of responsibility, each department has their own part to play and knows what they have to worry about,” explains Claytor. NexTech is ONC Certified to support MU. All EMR Specialists are equipped to properly assist clients in their attestation process for receiving incentive payouts. NexTech clients, to date, have received more than $14 million in MU incentive payments. Contact your representative for more information on getting started.