Projects Archive

CHALLENGES

Doctors are sometimes too shy of billing accurately to avoid coding audits – in this case, they under-code using Level 1s and 2s of coding. There are others who wish to take a chance and view coding as a means to make more money. They over-code typically using Levels 4s and 5s. Both practices are incorrect.

Doctors using higher codes have usually been misguided by EHR vendors that excessive documentation justifies higher codes. In the pre-Obamacare era, several vendors used this line as a sales tool to justify a costly EHR purchase. Nothing can be further from truth.

Incorrect coding can put you and your practice at risk. What insurances look for are trends in coding across physicians of the same specialty in a specific region. For example, if you are a gastroenterologist in Nassau county in New York – you will be compared with other gastroenterologists in Nassau and other neighboring counties New York. This provides a comparison of you versus others like you who might be facing similar patient encounters. You can use this tool called Treatment Tracker developed by ProPublica to get a sense of the kind of information that Medicare reviews about you.

RECOMMENDATIONS

Here’s a simple method we recommend that doctors use to keep themselves in check. Analyze all your office visits across various years and curve them – insurances are typically seeking a bell curve. This can change from time to time but if you routinely are on one side of the curve then know that you might be out of the norm. There’s no way of saying whether this would put you at risk of an audit. What’s important is the real encounter that happened with the patient and whether you strongly believe that the encounter justifies a certain type of code. If you do then you simply need to store the necessary medical documentation.

Coding less out of fear and coding more out of greed are both wrong approaches to billing. Attend a sound coding class and develop a sense of coding right and incorporate a practice of storing suitable documentation that allows you to defend yourself if ever there’s an audit.

BACKGROUND

New York is a highly competitive market for providers. Getting paid inaccurately can sometimes mean doctors going out of business. As with several doctors, one of our clients does not participate with all insurances offered in the region. Therefore, some of her patients come from insurances that are par (short for participating) and some others from non-par (short for non-participating).

CHALLENGES

While non-par payments can be negotiated, there’s no guarantee that the physician would get paid. This puts the physician in a precarious situation where she does not know if she would get paid for the next patient she’s about to see. A lot of doctors waste time and money in trying to get paid after seeing non-par patients and eventually write those claims off. It’s a better approach to decide what’s your strategy for handling non-par claims before hand rather than after the fact.

WHAT WE DID

We developed a system for this client to categorize all patients seen on any given day into par and non-par. We also conduct real-time eligibility on patient’s insurances to guarantee payment for services that are going to be rendered. The client then decides whether to go forward with seeing a patient knowing that she would get paid by insurance or by the patient. She sometimes chooses to offer services for free but she does so knowing fully well what she’s doing instead of getting hit by a denial much later in the billing cycle.

ABOUT

The client provides advanced gastroenterology services in New Jersey.

CHALLENGES

We discovered that a client we started working with had registered the practice under two names (one that said MD PC and the other as just MD) but was not aware of the same. During the revalidation process from Medicare, the insurer decided to terminate the contract with the practice.

WHAT WE DID

We worked with Medicare and identified the name that was associated with the doctor’s IRS account. After receiving appropriate information from the IRS, we recredentialed the physician with Medicare as though he was just getting started. While this definitely disrupted payments until the credentialing was complete, it ensured long-term compliance with Medicare without any loss of income.

CONCLUSION

Medicare and other insurers have a variety of ways to ensure compliance from the name of the practice to qualifications of the provider. Often a compliance and credentialing expert is required to ensure that a provider is accurately credentialed. As this case highlights, inaccuracy can result in cash flow disruption sometime in the future too. Do not compromise on your compliance status.

BACKGROUND

A client received a letter from Medicare that they had paid the practice incorrectly for three years and therefore would be recouping $60,000 back. This triggered a great amount of confusion regarding the reason for recoupment, which the letter did not clearly specify. Was this a billing error? Could it have been avoided? How do we know when the amount is fully reconciled?

WHAT WE DID

We stepped in to work with Medicare to analyze the reasons for recoupment. It was system error in their software. While the electronic remittances were sent to Dr. Y, the money was sent to our client Dr. X. We helped the doctor reconcile the excess payments by matching them with paid EOBs, helping understand the reconciliation process.

CONCLUSION

So can Medicare pay you wrongly? Yes, they can. They can also have systemic errors like we faced. The best way to counter such issues is to analyze EOBs periodically against actual payments received.

ABOUT

The client is a gastroenterology practice based in Massachusetts. We have worked with the practice for eight years.

CHALLENGES

1) Tracking Remicade payments from Blue Cross Blue Shield (BCBS). Remicade is an expensive infusion drug typically given to patients of Crohn’s Disease. Any denials due to Remicade result in significant losses to the practice because they would’ve already purchased the drug. BCBS, a major insurer, underpaid on Remicade claims.
2) A really short EHR implementation. The client did not want to hold up his practice during the EHR rollout and preferred a faster implementation cycle.
3) EHR on an iPad, just like a paper chart. When we rolled out enki EHR for this client, he wanted to know if he could use only our iPad modules, while his staff could use the extended cloud-based version.
4) Navigating Meaningful Use. The client wanted to ensure Meaningful Use compliance every week.

WHAT WE DID

We work closely with the client to ensure his practice remains one of the best in the country in terms of payment accuracy, timeliness and technology use.

1) Remicade Watcher. We established a Remicade Watcher to ensure a close watch on all Remicade claims that resulted in 100% payments. This helped us flag lower than expected payments from insurer BCBS, which resulted in resubmissions that compelled the carrier to pay accurately.
2) enki EHR rollout in less than a week. We conducted an onsite implementation in less than a week. The practice has been live on enki, our cloud/mobile EHR platform for more than three years.
3) The Mobile First EHR. The client’s preference to use enki EHR mobile modules encouraged us to provide complete functionality via the iPad. This resulted in him achieve Meaningful Use Stage 1 compliance primarily through an iPad.
4) Consulting for Meaningful Use. Our Meaningful Use consultants track the practice’s success in compliance every week and provide feedback that’s critical to keep them on track.

LIFE WITH NEXTSERVICES

In a world where physicians are under increasing fiscal pressure to abandon their medical practices and take up jobs with hospitals, our client thrives through disciplined billing practices and using advanced technology.

ABOUT

We work with one of the largest cardiology groups in New Mexico. Its providers consult with patients in Albuquerque and various satellite locations.

LIFE BEFORE NEXTSERVICES

Here are four distinct types of challenges that the group faced:
1) EKG Mania. The doctors would send billing sheets for EKGs occasionally, which meant that they would pile up into huge batches. This not only created a bottleneck in billing but also risked their payments.
2) Scheduling for Nuclears. Various types of procedures required distinct scheduling requirements, particularly Nuclear studies but most practice management systems did not provide ease of customization for Nuclear studies.
3) Carrying suitcases to Satellite clinics. When doctors visited satellite clinics, they would carry suitcases filled with paper patient charts, which was not only a hindrance but also a risk towards HIPAA compliance.
4) I want to keep my transcriptionist. During the EHR rollout, a few doctors were not comfortable with entering information into a computer or a tablet device. They wanted to continue using their transcriptionists.

WHAT WE DID

Not only did we streamline their billing process and got their denials in control every day, we customized our services and software to accommodate for their specific needs. Here’s how:

1) Automating EKGs. We wrote custom software scripts that extracted billing information from EKGs in order to bill. This saved both sides a lot of time and curtailed the risk of denials due to timely filing.
2) Custom scheduler. We worked with AdvancedMD (the practice management software) to customize a scheduler that works for the group, especially so that they could accommodate for Nuclear medicine.
3) iPads instead of suitcases to satellite clinics. After enki EHR rollout, doctors are free to carry iPads and access their medical records instead of dragging suitcases to satellite clinics. It tremendously increased security and safety of patient information.
4) Making transcriptionists part of the team. As a cloud-based system, it was easy for us to create separate user profiles and notes modules for the transcriptionists. enki EHR’s security features helped us switch off the functionality that was not relevant for the transcriptionists. This helped them digitize the medical records in a manner that the doctors were used to. The doctors enjoyed the benefits of digital records without worrying about data entry into computers.

LIFE WITH NEXTSERVICES

The cardiologists enjoy the benefits of a modern EHR even while circumventing challenges that they would usually face. The administrators of the group are able to coordinate with various stakeholders with ease and get everyone paid accurately in time.

BACKGROUND

The client is a well-established gastroenterology group based in Massachusetts associated with the regional hospital. Having experienced various EHR platforms, the client was keen on using advanced technology to save time and money. He became one of the few doctors in the US to attain Meaningful Use Stage 1 incentives by largely using enki EHR on the iPad.

HIGHLIGHTS

The doctor and his clinical staff have been enjoying enki cloud/mobile EHR for over three years now.
1) enki EHR was implemented onsite in less than one week.
2) enki EHR’s flexible design allowed the practice to break the modules up based on different users. For example, nursing staff used different modules when compared to the doctor.
3) Meaningful Use and Clinical Quality Measures dashboards allow the practice to keep track of their compliance on a daily basis and pay attention to areas that require improvement.
4) Unlimited remote training coupled with an easy to use design allows staff to train new staff members with ease.
5) We established a uni-directional lab interface between enki EHR and the hospital’s lab system to receive lab results instantaneously and digitally.

OUTCOMES

1) The practice has successfully remained paperless for 3+ years using cloud based software via a Chrome browser and iPads.
2) The doctor received complete Meaningful Use Stage 1 incentives primarily using an iPad.
3) Patients love the interaction they get to have with the doctor because he’s looking at them instead of into a computer.
4) enki EHR has helped the practice countless times to improve patient safety by providing access to medical records in seconds from anywhere.

BACKGROUND

The client is a large cardiology group based in New Mexico. Each provider had varying degree of computer skills – some loved maintaining their records digitally while few others feared touching even a mobile computing device. The administrator dealt with the challenge of bringing these various stakeholders and staff onboard without disrupting the workflow. Furthermore, the group did not wish to spend hundreds of thousands of dollars in a traditional EHR rollout but desired to use advanced technology for the benefit of their patients.

HIGHLIGHTS

The design of enki EHR allows great degree of flexibility that helps us accommodate various kinds of client needs.
1) Rollout within one week. We trained the administrator and key staff members as super users so that they can be available for doctors and nurses whenever they had questions in using the EHR. Additionally, we provided support round the clock that helped doctors quickly get up to speed in using the system.
2) We allowed doctors to be themselves by designing the EHR workflow around their needs. For example, one of the cardiologists wanted to continue using his transcriptionist of 20 years. We rapidly developed new modules and created secure user access to the transcriptionist. enki EHR allows the flexibility to switch off functionalities that are not relevant to a user, which we incorporated in this case. This allowed the doctor to enjoy the benefits of accessing digitized medical records even while not entering the information directly in the system himself.
3) A seamless experience. Various lab interfaces were developed for TriCore Reference Labs and Quest Diagnostics, which allowed the group to get lab results digitally and instantaneously into their iPads and computers.

OUTCOMES

1) The doctors received Meaningful Use Stage 1 incentives despite challenges of using computers.
2) Through our Meaningful Use consultant, the administrator kept track of Meaningful Use and Clinical Quality Measures compliance and guided the doctors to successful completion.
3) The group has successfully been a paperless organization for 3+ years.
4) The group has enjoyed implementing a cloud/mobile EHR without incurring cost over-runs that is typical of traditional EHR rollouts.

BACKGROUND

The client is a gastroenterology practice based in New York. Initially, the doctor was resistant to the idea of implementing an EHR fearing the operational disruption that would entail and the difficulty in adapting it to his clinical context. But he was keen to not be left behind with long term technology adaption.

HIGHLIGHTS

1) We trained the administrator of the practice as a super user who could always be available for the doctor when he had questions.
2) We created distinct medical templates that could be used in the clinical context of his practice.
3) The practice became efficient in tracking Meaningful Use compliance using enki compliance dashboards.

OUTCOMES

1) The practice achieved Meaningful Use incentives using enki EHR.
2) Our team coordinates both EHR use and billing information seamlessly so that the practice can benefit from a unified experience.
3) Implementation of enki EHR was completed in less than a week with minimal disruption to practice workflow.

BACKGROUND

The client is an OB/GYN practice based in Massachusetts. While starting up, she sought a cloud based EHR solution that would be easy to implement and not require her to spend lot of money upfront in servers and hardware. Further, she wanted to work with someone who could customize the EHR to her needs in OB/GYN.

HIGHLIGHTS

1) The client worked with the enki team to develop OB/GYN modules that helped her adapt to electronic health records seamlessly.
2) We developed uni and bi-directional interfaces with labs that she was associated with, making data available instantly.
3) We completed the entire implementation remotely without causing operational disruption of the newly established practice.

OUTCOMES

The doctor and her staff are completely paperless and have easily migrated to enki EHR cloud/mobile platform.

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