Valant Blog

E&M codes versus therapy CPT codes in mental health billing

Fri, 13 Apr 2012 09:03:06 -0700

Mental health providers frequently have questions regarding the possibility of using evaluation and management (E&M) codes to report their services for patients. The Centers for Medicare and Medicaid Services (CMS) gives very specific guidelines in two documents (the 1995 Documentation Guidelines for Evaluation and Management Services and the 1997 Documentation Guidelines for Evaluation and Management Services) on the elements of, and documentation required for, using E&M codes. Used in conjunction with the most current edition of the Current Procedural Terminology (CPT) publication, these documents provide the most accurate guidelines and instructions for coding services.

In brief, E&M services contain a history of present illness (HPI), examination, and medical decision making. The history can be brief or extended, which is determined by the number of HPI elements (out of a possible 8) addressed in the exam. The examination includes a verbal review of systems (ROS) and a physical examination of recognized body areas and organ systems, based on the chief complaint of the patient.

Recognized body systems are constitutional symptoms (e.g. fever, weight loss), ears/nose/throat (ENT) and mouth, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, integumentary (skin and/or breast), neurological, psychiatric, endocrine, hematologic/lymphatic, and allergic/immunologic.

Recognized body areas and organ systems are head, neck, chest, abdomen, genitalia, back, each extremity, eyes, ENT and mouth, cardiovascular, respiratory, gastrointestinal, genitourinary, musculoskeletal, skin, neurologic, hematologic/lymphatic/immunologic, and psychiatric.

The number of body systems addressed, and number of body areas and organ systems physically examined, help to determine the level of E&M code that may be billed. An assessment of the patient’s family and social history is also needed for documenting an E&M code.

Psychiatrists working in a multi-specialty practice may find they frequently do meet the documentation requirements for billing their services as an E&M code, and should bill their services at the appropriate level when this is the case. Mental health practitioners working in a strictly mental health clinic setting may more commonly find they are providing therapy services, and should bill their services as such. Non-prescribing mental health practitioners are not eligible to use E&M codes.

Top 10 Behavioral Health Conferences to Attend in 2012

Wed, 28 Dec 2011 13:27:04 -0800

Conferences can serve a number of important functions for those involved within the practice of behavioral healthcare. They allow practitioners to learn about pertinent research, network with other healthcare professionals, and learn about important advances in technology that impact the field. With 2012 just around the corner, we have created a list of ten important conferences to attend, listed in order of when they will occur.

1. Annual Meeting of the National Association of Psychiatric Health Systems

Focused on a systemic, holistic approach to behavioral healthcare, this conference hosts a number of influential individuals. It allows for ample networking and is focused on healthcare policy and implementation in addition to healthcare practice.

Date: 03/12-03/14

Location: Washington, D.C.

Website: https://www.naphs.org/annmeeting/index

2. 2012 American Association of Geriatric Psychiatry

With an aging population, geriatric care will become more important for practitioners. This conference, focused on geriatric behavioral healthcare, offers many opportunities in the form of workshops, exhibitions, symposiums, and research presentations.

Date: 03/16-03/19

Location: Washington, D.C.

Website: http://www.aagpmeeting.org/general.html

3. 33rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine

The theme for this conference is “Engaging New Partners and Perspectives”. As such, there will be many opportunities for behavioral healthcare professionals to foster new relationships with others in the field. In addition to potential networking, invited speakers will discuss advances in the field and provide input as to how behavioral healthcare can be expanded to better serve the needs of the public.

Date: 04/11-04/14

Location: New Orleans, Louisiana

Website: http://www.sbm.org/meetings/2012

4. 32^nd Annual Conference of the Anxiety Disorders Association of America

This conference is dedicated to the understanding and treatment of the anxiety disorders. It offers strong networking opportunities in addition to many presentations, workshops, and exhibitions.

Dates: 04/12-04/15

Location: Arlington, Virginia

Website: http://www.adaa.org/resources-professionals/32nd-annual-conference

5. 42^nd National Council for Community Behavioral Healthcare Conference

This conference brings together a number of different professionals, from CEOs to academics, social workers to psychiatrists. With a diverse group, there will be a plethora of opportunities for networking, continuing education, and exhibitions for those involved with behavioral healthcare.

Date: 04/15-04/17

Location: Chicago, Illinois

Website: http://www.thenationalcouncil.org/cs/conference

6. American Psychiatric Association Annual Meeting

The APA consists of 36,000 members dedicated to the development and practice of psychiatry. Each year, thousands of people gather for the annual meeting to learn about novel research, to receive continuing professional and educational training, and to meet with other behavioral healthcare professionals. This year, there are an estimated 16,000 attendees who will flock to Philadelphia to take part in this conference.

Date: 05/05/-05/09

Location: Philadelphia, PA

Website: http://www.psych.org/MainMenu/EducationCareerDevelopment/Meetings/2012-Annual-Meeting.aspx

7. American Psychological Association Annual Convention

With over 150,000 members, this annual convention attracts many behavioral healthcare practitioners. It offers opportunities for continuing education so that treatment can be evidence-based and up to date. The annual convention also offers a strong exhibition where practitioners can find new products and services that are tailored toward behavioral healthcare.

Date: 08/02-08-05

Location: Orlando, Florida

Website: http://www.apa.org/convention/index.aspx

8. International Conference and Exhibition on Addiction Research and Therapy

Each year, this conference brings together leading researchers and practitioners from around the world to present and learn about addiction and its treatments. It is primarily for the doctor interested in continuing education or the researcher who wants to learn about the most current work in the field.

Dates: 8/20-8/22

Location: Las Vegas, Nevada

Website: http://omicsonline.org/addictiontherapy2012/

9. 2012 Institute on Psychiatric Services

Administered by the American Psychiatric Association, the 64^th Institute on Psychiatric Services will offer a number of different services for the practicing physician. These include workshops, symposiums, and poster presentations. The conference is estimated to attract 2,400 people this year.

Date: 10/04-10/07

Location: New York, New York

Website: http://www.psych.org/ips

10. 25^th U.S. Psychiatric and Mental Health Congress

This conference is for the practicing psychiatrist. It focuses on continuing education, meeting other healthcare professionals, and picking up new skills so that practitioners can deliver the highest quality care to their patients.

Date: 11/08-11/11

Location: San Diego, California

Website: http://www.cmellc.com/psychcongress/index.html

Planning ahead for 2012: Meaningful Use Checklist

Thu, 15 Dec 2011 15:34:33 -0800

The Push to Attest is On, Are you Prepared?

With 2011 coming to a close, the first year to attest for stage 1 Meaningful Use is also winding down. What do you need to do to be ready to qualify in 2012? There are many articles and resources to let a practice know the measures for meaningful use, but what should a practice be focusing on to make sure that when the time comes to attest they are ready? Listed below is a quick checklist to make sure that your practice is ready when attest time arrives.

1. Know Important Dates – Make sure you are aware of the drop dead dates (the last day to register, the last day to begin the 90 day reporting period, the date when payments begin to be mailed). If a practice is not aware of these dates, no preparation in the world will make them ready to Attest.

2. Stay Informed – Become familiar with the Medicare/Medicaid website. Updates and changes to the program are continuing to come out. Is a good place to keep up to date on Meaningful Use news.

3. Acquire the Needed Tools – One of the largest parts to Meaningful Use is having a certified Electronic Health Record (EHR). An entire checklist can be created just on this topic alone! If you are part of the 43% of office based providers without an EMR (iHealthBeat 12/7/2011), purchasing an EHR should be pretty high on the “to do list”. Regardless if you already have an EHR or not make, sure the one you choose has the functionality to track Meaningful Use measures. If it does not or is still developing the functionality, don’t be afraid to ask for the roadmap for when they will have this completed.

4. Evaluate and Plan - There are 25 Meaningful Use objectives. To qualify for incentive payments, 20 objects must be met (15 from the core list and 5 from the menu set of objectives). Take the time to evaluate the objectives and determine which ones meet your practice and your patient needs. Know which ones you will be focusing on to meet the requirements. This may mean adding processes to a patient visit. For example, one of objectives is to document vital signs. If you are not doing that now, but want to start, make sure to create a plan for the office to ensure this becomes a regular step in a patient visit.

5. Communicate and Train Staff – Technology can only prepare you so much. Make sure to have the buy in from staff. To be the most successful, everyone in the office must be on board with attesting and meeting the goals of the office. Make sure they are given the tools to help you succeed. Discuss and schedule training on new processes and software that may be needed.

4 Important Questions to Ask When Shopping for an EMR

Thu, 08 Dec 2011 09:07:12 -0800

Searching for an Electronic Medical/Health Record (EMR/EHR) can resemble the painstaking task of shopping for a new car. You need to be sure you make the right decision; it not only meets your needs but comes with a positive recommendations, boasts of reliability, and fits conveniently within your budget. It can be rather difficult to set aside time in your busy schedule to make this decision, but if you are able to answer these following questions, your EMR search may end more swiftly and successfully.

First and foremost, what does your practice need?

Most likely you need a way to schedule appointments and upload patient information in an organized manner. An EMR allows you to keep all of your files and documentation stored electronically, so there is no need to waste paper and increase the office filing cabinet collection. In addition, consider whether your office needs billing or ePrescribing. Some systems integrate these functions with your EMR and allow you create charges directly from the calendar. Find out which software systems can accomplish this, as this will decrease time for you or your billing staff and shorten the amount of time until you are paid. Using e-prescribing will prevent you from having to hand write prescriptions and allow you to order refills more efficiently. As a prescriber, you also may be eligible for the Medicare or Medicaid EHR incentive programs that rewards physicians with cash incentives for using a certified EMR system.

Secondly, what is your capacity?

Many systems differ in access abilities and requirements, but an important thing to consider when choosing an EMR is its security. Be sure to avoid any HIPAA violations or costly audits by making sure your office follows protocol. Calculate ahead of time the number of providers, part time and full time, office staff, IT personnel, etc., that need access to your system and be sure to inquire about the system’s use of a unique secured login and password. Not only will this ensure you remain HIPAA compliant, but it also prevents important data from being altered and guarantees that the system will function properly without error.

Thirdly, is your practice ready to make the EMR switch? If so, what is your implementation time frame?

This decision is one that is best made after a couple months’ consideration, exploration and discussion. Be sure to examine your office abilities and choose an EMR system that you and your staff are most happy with. Examine your budget and make sure it is a cost that you can afford. Consider staffing needs, recognizing that training and adjustment to this new system will take some time.

Fourthly, consider your general preferences for mobility and performance.

Not every EMR system is web-based or compatible for every electronic device. Ask yourself if you prefer a system that requires instillation on a local server or is completely web based. Are you planning on using a mac or PC, and would you use the system on your iPad or notebook? Would you like to access your system on your smartphone and what are the limitations of the system’s mobile application? All of these technical questions are important for evaluating your software options, because not all EMR systems may be able to function at these levels.

Ultimately, your search for an EMR needs to be based on your needs and desired features. Create a list that answers these questions and ask to see a demonstration of a product before you purchase. Research the benefits this new system would have for your practice and be sure to include your office staff in the decision making process. This search may seem daunting, but the rewards of finding the right EMR for your practice is worth your time and effort.

Meaningful Use Deadline Delayed for Mental Health Providers

Fri, 02 Dec 2011 16:24:38 -0800

In July, we wrote about the speculation that Stage 2 of the Medicare incentive program was to be delayed until 2014. On November 30th, HHS Secretary Kathleen Sebelius confirmed that this would indeed be the case.

The original regulation would require eligible providers that attested to the Medicare EHR incentive program in 2011 to meet Stage 2 requirements in 2013. However, to encourage greater participation in the meaningful use program, HHS has delayed the onset of Stage 2 requirements for early adopters.

Providers who attest to Stage 1 requirements this year will not need to meet the Stage 2 standards until 2014, allowing them to collect the total incentive amount while meeting the less stringent Stage 1 requirements for an additional year.

The original source article is on iHealthBeat and can be read HERE.

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The Medicare and Medicaid EHR Incentive Programs offer financial incentives for the meaningful use of certified EHR technology to achieve both health and efficiency goals. By meaningfully using an EHR system, providers will reap benefits beyond financial incentives, including: a reduction in errors, increased availability of records and data, reminders and alerts, e-prescribing/refill automation, and clinical decision support.

HIPAA 5010 Deadline Extended: What Does This Mean for Your Practice?

Tue, 22 Nov 2011 11:08:11 -0800

Image by Renjith Krishnan

Last week it was announced that CMS, the governing body for the new HIPAA version 5010 transaction standards, has extended the compliance deadline to March 31, 2012. The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (OESS) is delaying enforcing compliance in order to allow more offices the opportunity to implement this new billing coding standard, without incurring penalties. The 90-day delay does not affect the implementation date for the coding systems, which remains January 1, 2012 (January 1, 2013 for small health plans). Industry feedback played a major role in the decision to push back the compliance date. It was found that many covered entities are still awaiting software updates and were unable to meet the short deadline.

It should be noted that while the penalty date has been extended, OESS will continue to accept complaints associated with compliance during the 90-day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints (known as “filed-against entities”) must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period. Failure to comply with the HIPAA 5010 requirement means covered entities might not be paid for their services, as noted in their recent Press Release.

HIPAA version 5010 are the new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards.

Many offices are relying on their billing partners to ensure that they remain compliant; however there are some actions that you can take to ensure that your practice is not at risk.

Here are some tips to ensure your software vendors are ready to support the new HIPAA 5010 transaction standards:

• Confirm with your billing office to ensure they are prepared for the new regulation standards. Be sure to confirm their implementation plan as well as an official roll out date.

• Consult with your front office staff and make sure they are up to date on how these changes affect their daily activities.

• Perform an audit of your updated system once it is installed and confirm the new changes are taking effect.

Is your practice ready for these changes? Share with us how your office is prepping for the upcoming HIPAA 5010 changes in the comment section below.

*Quoted reference: CMS Press Release

Understanding Quality Measures for Meaningful Use

Thu, 03 Nov 2011 15:53:43 -0700

As you know, Quality Measures were primarily designed for general practitioners and hospitals, not for psychiatrists. As a result many of the existing quality measures will not apply to your practice. Over time, we expect NQF, the body that creates quality measures, to add more measures that are relevant to an outpatient psychiatric practice. As this occurs, we’ll shift our focus to supporting those measures.

Currently, you are not being evaluated on what you record in Quality Measures (or the quality of your care), but rather whether you can successfully report using certified technology. CMS has been very explicit that “0” denominators are acceptable when reporting on quality measures. What’s more, the denominators and numerators are automatically calculated in the Vālant EMR. So, you can rest assured that the Vālant EMR makes it simple to attest. Overall, reporting quality measures is really quite easy when it comes to demonstrating meaningful use.

For a breakdown of the steps to Meaningful Use, visit our Meaningful Use Monday section.

For futher explanation from CME, click here.

HIPAA Best Practices

Thu, 27 Oct 2011 12:27:15 -0700

HIPAA is an acronym that most clinicians are familiar with, but there is another term that every clinician should familiarize themselves with as they consider taking patient data into the digital age-HITECH. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA), was signed into law on February 17, 2009, to encourage the adoption and meaningful use of health information technology. An Electronic Medical Record (EMR) is the most common form of health information technology implemented by behavioral health care providers. When considering adopting an EMR it’s very important to consider the security of your data. Below are a few tips to maintaining the security of your patient data when using an EMR to comply with the enhanced security recommendations set forth in the HITECH act.

User Authentication

Access to electronic protected health information (ePHI) will require individual user identification and password authentication.
Make sure any system used to store ePHI has an automated lock-out for several failed login attempts

Minimum Necessary

This is a common term when discussing HIPAA security precautions. Simply stated, consider who in your office needs patient data complete their jobs and what data they need. Consider limiting access to patient data depending on what is needed to complete their individual job responsibilities.

Local Storage

Avoid storing ePHI on a local machine like a laptop or desktop
If ePHI is stored on a laptop/portable device, try to encrypt the date or store locally for only a temporary period of time
Any device that stores ePHI should be kept in a secure location as well as have password protected access
Make sure all data is stored in an encrypted format
Make sure all server locations are secure

Remote Storage (Using web-based EMR)

Adopting an EMR will impact the way you handle PHI, so make sure you know how the EMR program you select can help you comply with HIPAA and more specifically the HITECH protocols. Using the items above should help you narrow your search when considering EMR programs.

Creating a Strong Password for HIPAA

Thu, 20 Oct 2011 11:44:09 -0700

HIPAA Password Security

Though it might be enticing to use your pet’s name or your street name, you may be making your accounts more susceptible to a potential security breech. In order to maintain the privacy of patient data particularly when using an EMR, I have compiled a list of items to help you have the strongest possible password.

Creating a Strong Password

· Length: A general rule of thumb is the longer the password the harder to crack. All Valant passwords must be at least 6 characters.

· Character Types: Strong password usually include a mix of capital and lowercase letters in addition or numbers and alternative symbols (?, $, and %).

· Challenging: Try thinking of your password as more of a passphrase. Try substituting numbers for letters. Additionally, thinking of a phrase and converting it to be more difficult.

- Examples: 8 =B, 3= E

- Example: I love using the Valant EMR for my practice = i#UtV3MRfmp!

· Extra Protection: I cannot stress enough the importance of not sharing or exposing your password. Do not write down your password. If you experience difficulty remembering your passwords write an ambiguous hint to trigger you memory. Never store passwords electronically. Change your password often: we recommend every 2-3 months.

Avoid

· No Words: This includes proper nouns, foreign words even words spelled backwards.

· No Reusing Passwords: Using the same password on multiple accounts can make all of your information more vulnerable

· No Personal Information: Avoid using information that easily guessed; ex. address information, birth date, pets name.

A strong password could be one step that helps protect you and your practice against unauthorized access to your patient’s electronic health information (ePHI). It’s one small item that can make a very big difference.

EMR Incentive Program: It’s the Real Deal

Fri, 07 Oct 2011 08:32:09 -0700

When the government is advertising free money, it’s hard to say no. But when the incentive amounts for implementing an EMR system and/or attesting to meaningful use add up to a maximum of 44,000 for Medicare or $63,750 for Medicaid, one can’t help but wonder if it is all a scam. The requirements for obtaining the incentive money are not overly difficult, which is why many providers are struggling to believe that the government will follow through on their promised monetary reward.

As it turns out, the proof you are looking for can be found in a recent article published in iHealthbeat. According to data from CMS, Modern Healthcare reports that the federal government has distributed more than $653 million to health care providers participating in the meaningful use incentive program. Of that $653 million, $93.9 million in Medicaid incentives have been paid to 4,463 physicians, psychiatrist and other eligible health care professionals and $38.3 million in Medicare incentives have been paid to 2,129 physicians and eligible health care professionals (Conn, Modern Healthcare, 9/22).

And if you have had your doubts that anyone would ever actually see any money from the state and federal EHR incentive programs, doubt no further; Here is the evidence confirming that implementation of a certified EMR system, as well as demonstration of meaningful use can result in free money.

To read more about the recent distribution of incentive payments, visit iHealthBeat.

Or visit the CMS website directly to find out more or to register for the MU incentive.

How Fee Agreements Help You and Your Patients

Fri, 30 Sep 2011 16:24:12 -0700

Fee agreements for your behavioral health care practice are critical because it helps manage client expectations, gives protection for providers, and saves time in the long run.

Patient's Expectation

Patients need to make informed decisions about their clinical treatment - they need to (a) know the provider is able to meet their clinical needs and (b) the cost associated with the treatment is financially affordable. As a result of having all of a provider’s fees on a piece of paper that is then signed by the provider and patient, the patient’s expectations have been successfully managed. The agreed rate for services can be broken down by the patient who can then calculate and project total costs of services. During intake calls, the fees are often outlined over the telephone, however, that’s a significant amount of information that won’t necessarily register at the time of the visit. By having fees outlined on an agreement, a physical reminder is in place regarding the costs of services that the patient can see, and full disclosure is provided. Should your fees be considered out of reach to any potential patient, it’s better that they understand this before treatment has commenced. Insisting that a fee agreement is signed and in place before you begin any treatment ensures that both you and your patient are protected, and both parties understand the financial obligations for treatment.

Legal

The fee agreement provides a contractual understanding between the provider and patient stating how much is owed for the services provided. By having a patient sign a fee agreement, they’re contractually agreeing to rates and ensure that a practitioner’s business model, ie: the foundation of the provider’s revenue, is legally agreed to by the patient. This agreement can serve to protect a practice from disputes that may surface throughout the course of treatment. And, should a patient not pay for service, the agreement can outline if and when collections agencies would be used, and when interest would be chargerd, thus providing a basis for sending delinquent balances to collection agencies.

Time

Having these fees in writing, that both the provider and patient have to sign before starting treatment, comes especially in handy when there are charges such as “Cancelled Ap’t without 24 hrs notice” or “Insufficient Funds Check” or “15 Minute Phone Appointment.” Often patients will be upset or frustrated when they receive their statement outlining a “Cancelled Ap’t without 24 hrs notice,” arguing such charges are “unfair” or “exceptions should be made.” When providers have a fee agreement, explicitly outlining such charges, and have the patients’ signature documenting their acknowledgement, the provider’s response to these “unfair” claims can be somewhat efficient. A provider can explain that full disclosure was provided on the fee agreement and the patient recognized such charges by their signature and dating of the document. In difficult situations, copies of the signed fee agreement can be offered to patients, clarifying the documentation and ensuring that the provider and patient are on the same page – figuratively and literally.

Meaningful Use Monday: That's a Wrap!

Mon, 26 Sep 2011 10:58:22 -0700

From ePrescribing to Clinical Decision Support, we've learned how to incorporate it all into meaningful use of EMR and EHR technology over the last 5 weeks!

While CMS has done a great job at encouraging the adoption of EHRs, they may not have always been clear about what was required for meaningful use. That's where we have stepped in, with videos about how to demonstrate meaningful use in your psychiatric practice.

This will be a good page for you to bookmark as you set out on demonstrating meaningful use.

Core Objectives 1-4
CPOE
Drug-Drug * Drug-Allergy Interaction Checks
Maintain Up-to-Date Problem List
Electronic Prescribing

Core Objectives 5-8
Maintain Active Medication List
Maintain Active Medication Allergy List
Record Demographics
Record and Chart Vital Signs

Core Objectives 9-12
Smoking Status
Clinical Quality Measures
Clinical Decision Support
Electronic Copy of Health Information

Core Objectives 13-15
Clinical Summaries
Exchange Clinical Information & Patient Summary Record
Protect Electronic Copy of Health Information

Menu Objectives
Implement Drug Formulary Checks
List All Patients Who Have a Particular Medical Condition
Reconcile Medications
Provide Summary Records During Encounters and Transitions of Care
Immunization Registries

Practice Finances & Quickbooks

Fri, 23 Sep 2011 15:04:41 -0700

Customers will often ask me, “Why can’t I just use Quickbooks for tracking patient balances?” Well, the answer to that question highlights the key distinction any practice should understand between Quickbooks and a Practice Management Solution (an EMR or EHR):Quickbooks is an application that will give you the tools to better understand your practice at a Macro Level, and an EMR or EHR will provide you with tools to better understand your practice at a Micro Level.

What is a Macro Level of understanding of your practice? This is a level of information that does not go into specifics about client balances. Instead it focuses on Revenue & Expenses that hit your practice’s bank account. So, Quickbooks will enable you to better understandyour Profit & Losses , what your liabilities are (credit cards), and a general understanding of what your margin is as a company at large. Quickbooks will help your practice make key decisions about what revenue sources yield the highest margins, what expenses need to be potentially decreased, and what trends need to be tracked over time.

What is a Micro Level of understanding of your practice? Specific, or micro level, “client based” data sources (such as copays, coinsurance, or deductibles), should be entered into an EMR or EHR, where you can track patient balances, and better understand collection ratios. Once patient payments are entered into an EMR, the aggregate collections amount should, then, be entered in Quickbooks – and that “deposit” amount should always match the amount listed by the bank in your monthly bank statement, which further allows for the most accurate practices in bookkeeping by reconciling your bank statement with the amount listed in Quickbooks - each and every month.

With Quickbooks, a practice can take all the credit card transactions for the day (sum them up) and all the checks/cash received in a day (sum them up), and will make a couple “entries” into Quickbooks as deposits into “Revenue” accounts. However, not every check that was received in a given day should be entered into Quickbooks, as it’s not designed to be able to receive and track such complex billing categories.

Understanding both the macro and micro level of your practice finances will help you stay on top of your bookkeeping, making changes to areas of your practice as necessary. However, it is important to keep in mind that they are distinctly separate processes that require distinctly separate tools.

Clinical Summaries and Meaningful Use: The Real Story

Thu, 22 Sep 2011 11:30:26 -0700

It looked as if Core Measure 13, Clinical Summaries, was going to be the hardest objective to meet in meaningful use. And what's more, patients would in many cases not benefit from, or want to receive, the summary. Well, we have good news! Our contacts at CMS have clarified for us that as long as an offer is made to provide the clinical summary, the measure is satisfied, whether or not the patient declines to receive it. So it's way easier than we thought it would be. This is just another reason to jump in and achieve meaningful use in 2011.

Meaningful Use Monday: 5 Menu

Mon, 19 Sep 2011 14:14:17 -0700

We finished the Core Objectives of meaningful use last week, so this week we are moving on to the Menu Objectives!

As a brief refresher on the Medicare & Medicaid EHR incentive programs: you must choose 5 Menu Objectives, in addition to the 15 required Core Objectives, to demonstrate meaningful use on in order to receive an incentive payment.

The objectives for meaningful use of EHR/EMR technology were very much wrtiten with general practitioners in mind. With that said, we have compiled the 5 Menu Objectives that make the most sense for psychiatrists to demonstrate and attest on. We like to call them the "No Brainers," because it just makes sense to choose these 5!

Menu Objective 1: Implement Drug Formulary Checks

Menu Objective 3: List All Patients Who Have a Particular Medical Condition

Menu Objective 5: Reconcile Medications

Menu Objective 6: Provide Summary Records During
Encounters and Transitions of Care

Menu Objective 8: Immunization Registries

Meaningful Use Monday: Core 13-15

Mon, 12 Sep 2011 17:59:39 -0700

This week we are wrapping up the Core Objectives for meaningful use of EMR/EHR technology!

Be sure to check out my other blog articles on meaningful use for the Medicare and Medicaid EHR incentive programs:

Core Objectives 1-4

Core Objectives 5-8

Core Objectives 9-12

Core Measure 13: Clinical Summaries

Core Measure 14: Exchange Clinical Information & Patient Summary Record

Core Measure 15: Protect Electronic Copy of Health Information

Get the Most Out of Your EMR Training

Wed, 07 Sep 2011 09:17:22 -0700

Valant offers free and unlimited training and support! It is important to us that our clients are comfortable with the EMR and use it as effectively as possible. We have found that our most successful implementers are those that make the most of their introductory training and keep in close contact with their Account Manager throughout the implementation process, asking questions along the way. Here are some tips we hope you find helpful:

1. Make sure your computer is properly configured prior to your training session

You will receive a welcome email from Valant when you sign up. This email contains instructions for downloading Microsoft Silverlight and configuring your web browser. It is important that you do this prior to meeting with your trainer so that you can really make the most out of your training time. Also, our trainings are web-based, so make sure you have a reliable internet connection. If you have questions, our support team is just a phone call or email away.

2. Find uninterrupted time for training

We understand you have a busy schedule and that finding an hour of free time can be difficult. That being said, our clients that are able to carve out 60 minutes of quiet time without distractions are the ones that catch on to the program the easiest.

3. Select a point person for your practice

We want everybody at your practice to feel comfortable with the system. The strategy we have found most effective for group practices is selecting a point person. This person works with their Account Manager to become an EMR expert. Since they know how to navigate around the EMR and understand all of the different program functionalities, they will be able to provide in-the-moment support and training for your team. Should they need support, they have a personal Account Manager that knows your practice and can offer additional help. Streamlining communication helps us help you.

4. Take notes and ask questions

Be sure to take notes during your training and ask questions on how to customize the EMR to fit your practice needs. During training, try to picture your standard workflow and how you can use the EMR to make your life a little easier. Your Account Manager will be able to offer support and guidance as well as share some best practice suggestions.

5. Explore on your own

Once you complete training, your Account Manager will provide you with your username and password. Our clients continually tell us how intuitive our program is but also say that the more time they spend clicking and exploring, the easier implementation becomes.

Meaningful Use Monday: Core 9-12

Mon, 05 Sep 2011 15:03:35 -0700

Last week we covered Core Objectives 5-8 of meaningful use of EMR/EHR technology. Despite it being a government holiday, meaningful use waits for no one! So, I bring to you the next installment of our series: Core Objectives 9-12.

Core Measure 9: Smoking Status

Core Measure 10: Clinical Quality Measures

Core Measure 11: Clinical Decision Support

Core Measure 12: Electronic Copy of Health Information

5 Tips for Demonstrating Meaningful Use for Psychiatrists

Fri, 02 Sep 2011 14:00:05 -0700

1. Look at the CMS attestation work sheet, followed by any other recommended training from your EHR vendor. In my experience, there is nothing that reduces anxiety about meaningful use faster than walking through the attestation work sheet. It turns something amorphous, abstract, and sometimes overwhelming into something quite manageable and concrete. Try it; you’ll see what I mean.

2. Set up a training with your EHR Account Manager or Meaningful Use consultant. If your EHR vendor does not have experts on meaningful use for psychiatry, try other vendors and see if they will help you even though you are not using their product.

3. Develop a strategy before you start with your Account Manager

a. Know which core, if any, for which you will attest to an exclusion. Some psychiatrists will attest to exclusion on the vital signs measure (page 2, #8 on the attestation worksheet).

b. Decide how you will handle quality measures. It makes a difference whether or not you bill E&M codes (992xx codes) as it will have an impact on which denominators are zero. CMS has been quite clear that it’s OK to have zero denominators. They are not monitoring quality but rather reporting of quality measures. This one is easier than you think.

c. Know your “no brainers” in the menu measures and choose your discretionary menu items. You need to attest to 5 out of 10 menu measures and we’ve identified 4 that will be easy. We call them the “no brainers”. Out of the remaining six, 3 are “discretionary” and 3 are a little harder. Your Account Manager can help you decide which of the discretionary you’ll want to track and attest to. It’s as simple as that!

d. Make work flow adjustments. The most difficult core measure will probably be the requirement to give a clinical summary for 50% or more of visits. Decide how you want to accomplish this early on and then make sure that your system is working with the help of your Account Manager.

4. Monitor progress on a weekly basis and set up biweekly check-ins with your Account Manager. Think of your Account Manager as your “Meaningful Use coach.” You will be grateful for the structure and extra help.

5. Seek help if you are not hitting your targets. You should be able to see this in the EHR’s meaningful use report. Your Account Manager will help you identify the problem in areas where you are falling short of the target and brainstorm solutions with you. At times you may both need to get creative in areas where you consistently fall short of the target.

Good luck with demonstrating meaningful use! Please let me know how it goes.

Meaningful Use for Psychiatrists: The Importance of EHR Customer Support

Wed, 31 Aug 2011 09:05:43 -0700

I’ve talked elsewhere about how quality customer support can make a powerful EHR optimally usable. This is especially true for the features of an ONC Certified EHR that are required for demonstrating meaningful use. Your Account Manager (yes, you’ll need one of those to help you navigate meaningful use!) is going to be your best friend long before you receive your $18,000 check from CMS.

This is because it is your support Account Manager who will make what seemed daunting quite easy and intuitive. You may already be a whiz and be quite familiar with the 15 core measures and 10 menu measures, but you will likely still need help deciding which of the core measures psychiatrists might typically exclude and which 5 of 10 menu measures are the best ones for a psychiatrist. In addition, quality measures will seem overwhelming before your Account Manager works out a strategy with you for breezing through them.

It’s all easier than you think, but it helps to have an expert, who understands both meaningful use and the psychiatric private practice, to walk you through it. Such an expert might make the difference between getting incentive payments in 2011 or playing by Stage 2 rules in 2013.

Good luck with Meaningful Use! Please let me know how it’s going for you.