Author Archives: karen

Early Actions of 2022: CMS, HRSA Continue to Drive Support of FQHC/RHC’s and Remote Care Management

(shared from MD Revolution) Government payers continue to invest in programs that improve equitable access to health care for the medically underserved, geographically isolated, and economically vulnerable.

With the highest slated Chronic Care Management (CCM) reimbursement rate of 2022 committed to FQHC’s and RHC’s, and recent news that HRSA Slots $13M to Expand Rural Behavioral Healthcare Access, government payers continue to assert their support of expanding access to care through remote care delivery.

FQHC/RHC’s are not like other providers, by way of pay structure and patient populations with a high concentration of Medicare and Medicaid patients. Through Care Management programs, FQHC/RHC’s have a unique opportunity to provide significantly higher continuity of care. CMS has enabled FQHC/RHC’s to offer CCM on a much larger scale, saving money, expanding care, and delivering quality.

Backed by knowledge and significant experience, RevUp is a customizable solution for any FQHC/RHC with any budget, specializing in HRSA grants for Remote Patient Monitoring. RPM is an effective way to ensure populations with chronic conditions receive the continual care they require–whether they’re at home or in the clinic. By offering Chronic Care Management and Remote Patient Monitoring together, all integrated within your EHR, RevUp provides Federally Qualified Health Centers and Rural Health Centers with an opportunity to maximize grant dollars for RPM and now, behavioral health services, and fuel revenue through significantly increased Care Management code G0511.

What does this mean for your FQHC or RHC?

Medical practices have been continuously faced with higher cost of delivery and lower reimbursement in Fee for Service. Coupled with the unique challenges faced by FQHC/RHC’s, such as revenue diversification, accessibility to rural and low-income communities and increased competition from new sources (Federally Qualified Health Centers Troubled by Rising Competition), FQHC/RHC administrators face exceptional challenges maintaining their long-term financial viability. Care Management programs like CCM, RPM and AWV have emerged as an excellent opportunity to capture time spent and higher reimbursement with an often underserved, existing patient base. 

CMS is incentivizing providers to expand their reach to patients with chronic conditions, economic vulnerabilities and geographical challenges, and rewarding providers furnishing care coordination and virtual care. FQHC’s and RHC’s offering both RPM and CCM services have a unique opportunity to diversify revenue streams, mitigate risk, and provide a complete care management program to their chronically ill patient population.

“Medicare has validated what we have known all along; care management works,” said Paul Huffman, VP of Sales and Business Development at MD Revolution.  “As we move forward in 2022 we are excited to expand our services, help more patients, and get connected devices into homes.”

Chronic care management is currently a valuable, revenue-generating service. The actions CMS has taken and continued HRSA grant distribution in 2022 will only further enhance this value. 

To learn more about expanded 2022 CMS Care Management reimbursement, download the guide.  

Farewell 2021, Hello 2022

Don’t let the year-end and new year tasks and responsibilities become overwhelming. Proper planning, execution, and education are essential when closing out the year and preparing for the upcoming year. Use this checklist to help set your practice up for long-term success.

Fee and Allowable Fee Schedules

  • Review and update fee schedules and allowables for January 1, 2022.
  • Review documentation for E&M Coding changes in 2022.

    Tip: Contact payers (at least your top five payers) and request your 2022 allowable schedule.

Schedule Review and Management

  • Review and update your appointment schedule template to reflect 2022 working hours of your providers.
  • Consider alterations to schedules to proactively adapt to changing healthcare landscape (i.e., telehealth visits, sick/well visits, in-office testing, hospital procedures).

Fully Work Receivables, Collections, and Overpaid Claims

  • Identify and resolve any outstanding Accounts Receivable issues and start 2022 with up-to-date Accounts Receivable.
  • Review overpaid claims and issue credits as appropriate.
  • Review and verify collection agency information.
  • Identify the office policy/procedure for working delinquent patient accounts (especially if you’re not working with a collection agency).
  • Review bad debt, collections policies, and update.

Self-pay

  • Consider adjusting self-pay balances of a certain age to bad debt or send the balances to your Collection Agency (per your office policy).
  • Consider new office policies for no shows, cancelations, etc. and communication via statements or other methods.

Deductibles

  • Remind staff of high January deductibles.
  • Be sure you are collecting as much money as possible at the time of service.

Patient (paper) forms and questionnaires

  • Review and update patient forms and questionnaires to ensure none of the hard-copy forms include the year 2021.

Quality Management

  • Satisfy all Quality submission tasks for 2021.
  • Review CMS’ announcement of Extreme and Uncontrollable policy (EUC) and determine if it is applicable to your practice.

Plan Your Hard Close Date

  • Ensure you have a plan to “hard close” your month/year. This process locks financial transactions so that they cannot be changed without creating an audit trail and ensures the financial integrity of your system and the accuracy of your reports. 

    Tip: Best practice recommendation is to close at least once per month. Keeping your “hard closings” current will protect your financials!

Software and Security  

  • Keep your software and security measures up to date. This is critical to protect your data from ransomware, malware, and other malicious attacks.
  • Collaborate with your vendor to plan your next upgrade.
  • The end of the year is a good time to do an audit of the “users” in your system. If an employee is no longer there, speak to your vendor and inactivate them.

Other

  • Revisit the goals your practice set for last year. Adjust accordingly to see how your practice is tracking and schedule monthly or quarterly reviews.
  • Evaluate other product and service solutions that may improve efficiencies throughout the practice.

Patient Payment Options that Drive Revenue to Your Practice

Whether it’s a grocery cart full of food, an oil change at the car dealer, or a burger at a restaurant, you made a purchase and are expected to pay for the goods and services. It seems logical, right?

Now think about what happens when you need to see a doctor, get a diagnostic test, or even be admitted to the hospital. You will likely pay a co-pay, and there will be a patient due balance even after the co-pay and the insurance payment is posted. Sending electronic (and paper) statements has been the historical way to collect the money owed, but there are other payment options available today that should be considered regardless of practice size and specialty. Unfortunately, healthcare has been lenient when it comes to collecting patient-owed balances, and most will agree that it is time to change this long-overdue mentality.

Healthcare entities must be willing to adopt new technologies and implement financial best practice strategies. After all, it’s your money, and you need to collect what is owed to you. When it comes to collecting patient-owed balances, determine if your vendor offers one or more contactless payment options. Offering contactless payment options will surely prompt patients (consumers) to pay faster and will likely help reduce confusion.

In today’s digital world, people spend hours a day on their phones. It makes sense to provide them with options to pay their medical bills. Convenience is key.

Below are several patient payment trends to consider implementing in your practice:

Auto Pay – Authorize the patient’s credit card upfront and automatically charge the card after insurance has cleared. Not only is this convenient for patients, but it will also save staff time and reduce statement expenses.

Guest Pay
– There is no registration required. The patient statement would include a unique code that makes it easy for patients to pay online and avoid over/underpayments. This can make it easier for patients to quickly access their balance and pay their bills without having to set up a username and password.

Payment Plans – Staff and patients can set up automated payment plans to increase office efficiency. Automated payment plans make it easier for practices to collect money and allow patients to handle large statement balances without the uncomfortable feeling of calling. Set the rules and allow patients to set up a payment plan from the privacy of their home or facilitate it discreetly at your practice.

Text to Pay – Makes it convenient for patients to pay their balance. With over 98% of texts being read within 90 seconds, Text to Pay can speed up the collection process and reduce days in A/R.

Conclusion
Minimize the challenges around collecting patient balances. Look for options that make sense for your patient population and proactively market the convenience to your patients.

Prevent HIPAA Violations and Avoid Hefty Fines.

(shared from Medcurity)

Did you know that the HHS Office for Civil Rights (OCR) can fine an organization up to $1.5 million for breaking a HIPAA regulation? A fine from the OCR isn’t even the only cost associated with a HIPAA breach. Here are 5 key steps you can take to prevent common HIPAA violations and avoid penalties.

1. Properly store your Protected Health Information

It’s very important to guard all your documents containing Protected Health Information (PHI), whether it be physical or digital.

You should keep electronic protected health information (ePHI) password protected and encrypted. Encryption isn’t specifically required , but under the security rule organizations are obligated to “Ensure the confidentiality, integrity, and availability of all e-PHI they create, receive, maintain or transmit.” Industry best practices dictate that ePHI should be encrypted when possible. Encrypting your files can save you from a HIPAA breach in case of theft or a hack.

Ensure that all PHI is only being accessed by personnel when necessary for treatment or payment. If you have PHI in a hard copy document, it needs to be securely locked away in a cabinet, desk, or office. Don’t risk getting fined for simply throwing away a document instead of following proper HIPAA compliant shredding procedures.

Ensure that necessary data is backed up, and test backups regularly. Remember, under HIPAA you are required to maintain Designated Record Sets (which include medical records and billing information) for 6 years. State regulations sometimes require that covered entities retain medical records for a longer period.

 2. Stay on top of your BAAs

HIPAA Business Associate Agreements are required under HIPAA anytime a covered entity grants an outside party access to PHI in the course of their work. The BAA will specify how your vendor will use PHI and what steps they will take to comply with the HIPAA Security and Privacy Rules.

A BAA helps ensure that the OCR won’t hold you responsible should your business associate have a data breach that involves your PHI. Review your BAAs annually or biannually to ensure the agreement remains appropriate.

3. Conduct a comprehensive HIPAA SRA each year

The HIPAA Security Rule requires that both covered entities and business associates regularly conduct a Security Risk Analysis (SRA). The SRA assesses the physical, administrative, and technical safeguards you have in place to protect your ePHI. It’s an important opportunity to uncover any vulnerabilities in information security plan and make any necessary remediations. It also allows you to document all of the good compliance work you’re already doing.

The OCR had repeatedly emphasized the importance of the SRA. If you experience a breach and do not have a current and comprehensive security risk analysis, the OCR is likely to view this as negligence. You are more likely to incur a high penalty as a result.

If you need assistance with your SRA, Medcurity is here to help. Use our intuitive HIPAA platform, or have our HIPAA compliance experts come to you.

4. Create a strong policy program

Strong HIPAA Privacy and Security Policies and Procedures are fundamental to HIPAA compliance. You need thoughtful policies to outline how your organization will handle everything from disciplinary action to social media.

These policies act not only as guidance but also documentation, which is important. It’s critical to be able to demonstrate compliance in the case of an OCR audit.

 5. Train your employees

Most HIPAA violations begin with human error. Educating your personnel to understand their role in HIPAA compliance is key.

HIPAA employee training should take place during initial on-boarding and then recur annually. Employees should attest that they have reviewed your organization’s policies and procedures. Healthcare continues to be a top target for cybercrime, and 90% of data breaches begin with human error, so make sure your HIPAA training includes cybersecurity education as well.

Proactively complying with these requirements are important steps to protect your patient’s sensitive information. It also protects your organization from HIPAA fines and other financial consequences that can follow noncompliance. Even if your organization does experience a breach, the OCR will consider if you have taken appropriate privacy and security measures.

If you have more questions about HIPAA or information security, check out this resources page.

Expand Your Reach and Improve Convenience with ezTelemedicine

Note: Be sure to check our website calendar as new webinars are being added.


Quatris Healthco understands the need to protect patients and staff during the COVID-19 outbreak. In an effort to limit the disruption and exposure, practices are considering adopting telemedicine in their practices while still monitoring and triaging patients.

Our HIPAA secure ezTelemedicine solution enables you to expand your reach and improve convenience, all while being fully integrated with athenaPractice. We invite you to learn more about ezTelemedicine via the webinars we have scheduled for this week.

Included below are FAQ’s to further explain this affordable solution: 

1. Do I have to have the ezAccess portal to use ezTelemedicine? No. ezTelemedicine can be installed/deployed either as an add-on module to ezAccess or as a stand-alone solution. It is not necessary to replace your current portal to use ezTelemedicine.

2. Which versions of athenaPractice/athenaFlow are supported? ezTelemedicine works with all versions and configuration of athenaPractice/athenaFlow: 

1. athenaPractice PM only (SQL)
2. athenaPractice EMR only (SQL)
3. athenaPractice PM/EMR (SQL)
4. athenaPractice PM (SQL) & athenaFlow (Oracle)
5. athenaFlow only (Oracle) 

3. Do I need any special equipment to use ezTelemedicine? In most situations, all you need is an internet connection and the audio and camera that comes with the device (desktop, laptop, tablet, or mobile phone). In cases where you are accessing your athenaPractice/athenaFlow system from a Terminal Server (TS) or Citrix environment, you may need an extra piece of software to make the local video and audio connections recognizable from within the TS or Citrix environment. 

4. Once we decide to purchase ezTelemedicine, how long until we are up and running? If you are already an ezAccess client, the timeframe should be rather quick. If you are a new client, we will need 2-3 days to get your VPN set up and tested. 

5. Where is the data stored? Our portal and telemedicine solutions are cloud-based, and we access your PM/EMR system through a VPN tunnel. All portal and patient data is stored within your system, whether that be local or hosted by a 3rd party. We use custom tables in your database to store the data we need. 

6. What are the upfront and ongoing costs? Upfront costs include set-up and training, and the price is determined by practice size. Training is typically 3-5 hours. Ongoing costs include a monthly subscription fee per provider/other provider/clinician. Please contact us at qhco@qhco.com if you would like us to follow-up with you and provide a quote. 

7. Do you charge for every provider in our practice, even if only some wish to use it? No. The number of providers/other providers/clinicians enabled for ezTelemedicine does not have to match the total number of providers/other providers/clinicians in your practice.

NOTE: $500 million in mandatory spending has been authorized for telehealth services under Medicare in addition to the $6.497 billion authorized for the Departments of Health and Human Services.

MIPS Tips (November)

Are you ready to finish strong? The Merit-based Incentive Payment System (MIPS) 2019 reporting year is now in its last few weeks.

Category Corner – Cost performance category of MIPS.
Although the Cost category is not tracked in CQR and is entirely claims-based, it is still important for providers to understand how it is scored as it accounts for 15% of the overall score in 2019. Reference the 2019 Cost Performance Category Fact Sheet for more information.

Program Perks – New and important updates from CMS on the Quality Payment Program.
CMS released the 2020 Final Rule on November 4, 2019, via a QPP Listserv announcement (reference the 2020 QPP Final Rule Fact Sheet for more information). 2020 QPP Final Rule Policy Highlights and key finalized policies for 2020 include:

  • Maintaining the weights of the Cost (15%) and Quality (45%) performance categories.
  • Increasing the performance threshold from 30 points to 45 points.
  • Increasing the data completeness threshold for the quality data that clinicians submit to 70%.
  • Increasing the Improvement Activity performance category participation threshold for group reporting from a single clinician to 50% of the clinicians in the practice.
  • Revising the specifications for the Total Per Capita Cost (TPCC) and Medicare Spending Per Beneficiary (MSPB) Clinician measures.
  • Updating requirements for Qualified Clinical Data Registry (QCDR) measures and the services that third-party intermediaries must provide (beginning with the 2021 performance period).

Measurement Metrics – Specific measures and how to improve your scores.

  • Support Electronic Referral Loops by Receiving and Incorporating Health Information – this specific measure requires the Regulatory Hotfix: Click here for more information and to see if your practice needs to take action.
  • Security Risk Analysis – If you are not reporting the PI category of MIPS, you will not have to complete a Security Risk Analysis for 2019. We still recommend that a Security Risk Analysis be done annually to ensure HIPAA compliance.

Toolbox Tactics – Tips for how to use CQR, the Quality Reporting tool to manage and monitor your progress. 
Providers and administrators can find the CMS specifications for various measures or Improvement Activities for MIPS via CQR.

  • Promoting Interoperability Measures – Under the “Measure name” column, click the blue measure name (example, “Supporting Electronic Referral Loops by Sending Health Information” will take you directly to the CMS specification for the measure).
  • Quality Measures – Under the “CMS #” column, click the blue measure number (example, “CMS69,” and this will take you directly to the CMS guidance for the measure). Below the CMS guidance, it will outline how the measure is being calculated using athenaPractice and CQR for the Initial Patient Population, Denominator, Numerator, Exceptions and Exclusions.
  • Improvement Activity – under the “Activity ID” column, click the blue activity ID (example, “IA_PM_16,” and this will take you directly to the CMS definition of the Improvement Activity).

MIPS Consulting
Quatris Healthco offers quality consulting services to all of our customers. For information, contact mkeller@qhco.com. Note: The content of this email may not apply to your practice. Contact your EMR vendor on processes for support and quality reporting program.