Maximizing Physician Compensation at Your Medical Practice

The financial pressure is on for physicians to get compensated not just fairly, but well, at their practices, and Shawn Harkey's medical group is no different.

"We definitely keep a close eye on both fixed and variable components," says Harkey, the financial services director of Texas Retina, an ophthalmology practice with 13 locations in the Dallas-Fort Worth area. "Medicare payments aren't necessarily increasing and we're fighting that battle because the high majority of our patients are over [the age of] 60. That's forcing us to become leaner, more efficient in providing patient care.

" Harkey's practice, which has been using its NextGen EHR for six years and its accompanying practice management system for three years, has already seen improved efficiency (physicians can see patients in a more timely manner) and a reduction in overhead costs, such as paper, storage, and staff time spent manually pulling charts.

Today, the practice is also using its Navicure claims clearinghouse technology to verify patient insurance in advance of appointments to avoid a cash-flow slowdown.

"We see a high volume of patients every day so we make sure we have everything checked, such as benefits and referrals, and we use a number of high-cost drugs so we can make sure there's no issues in place with payers," says Harkey.  The state of physician pay is not only changing, but it is also challenging, as Harkey and our annual Physician Compensation Survey respondents would attest. But by taking a proactive approach — taking stock of the trends and seeking new ways to maximize compensation — physicians can not only stay alive, but they can also thrive, financially.

 * (To see the data, check out the details of our 2013 Physicians Compensation Survey here.)

The state of physician compensation

Today's physicians are under increasing pressure to make money and see more patients.

While more than two-thirds of the 1,474 physicians who answered our survey told us their income is, to some degree or entirely, tied to productivity, just one-third of physicians said their income is tied, at least in part, to value-based metrics. Twenty-four percent of physicians told us their income relies in part on patient satisfaction.

"[Value-based reimbursement] is growing at a small level, and the reason is that there is not funding available for it," says Kenneth Hertz, a Medical Group Management Association healthcare consultant. "If you're earning $250,000 per year and your practice wants to put in place this value-based reimbursement, quality metrics, and other performance metrics, the practice will need to secure additional funds to pay you. Right now, the payers are not providing additional significant dollars to do this. In most cases, practices are having to carve out a pool of money from the current funds available to pay physicians, and then pay those that meet the quality metrics out of that pool."
Regardless of the basis of their payment, more than half of docs in this year's survey — 53 percent — said they were either "slightly" or "highly" disappointed with their income.

"I think there are financial pressures [such as] the changing payment models, the increase in expenses, the reduction in reimbursement in practices," says Hertz. "If you're in private practice you're seeing your expenses go up, and you're seeing reimbursements go down."
Today, many specialists are making more while primary-care physicians are staying flat, income-wise, adds Tommy Bohannon, divisional vice president of recruiting at Merritt Hawkins, a physician staffing agency.

Article By Marisa Torrieri Courtesy of:
 http://www.physicianspractice.com/physician-compensation-survey/maximizing-physician-compensation-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=06122013

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You Need to Adapt in Order to Survive: How Your Medical Billing Service Can Prosper During the Healthcare Industry Chaos

How Your Company Can Prosper During the
Healthcare Industry Chaos

By Patrick Phillips

The healthcare industry is facing a state of complete disorder and confusion: Uncertainty surrounding the implementation of the Affordable Care Act, the looming switch to ICD-10, EHR and "meaningful use" deadlines, hospital acquisitions of physician practices, new HIPAA rules, and Health Insurance Exchanges... the list goes on. It seems like a challenging time for medical billing companies – and it is.

 

The good news is that not only can you prosper, you can bring hope and financial stability to struggling practices and salvage some that would otherwise collapse and shut down (or get swallowed up by a hospital or other acquisition entity). How can you assure your and your clients' continued prosperity and growth?

 

Focus on becoming a full-service revenue cycle management company.
In today's dynamic marketplace, billing companies that do not keep up with the constant changes will be left in the dust by companies that do. You must not only stay current with what is happening in the industry, you need to make alliances with other companies that can provide services to your clients that will help them solve cash-flow challenges beyond just their medical billing. The more services you can offer to your clients, the more you will be perceived as "the expert" who can solve their cash flow problems.

A brief review of the latest issue of Billing will introduce you to vendors that can be valuable to you in assisting your clients with medical coding questions, HIPAA compliance, EHR Meaningful Use attestation, online document management, patient portals, integrated payment channels, patient collections, and other revenue cycle issues. Do not forget that HBMA conferences will introduce you to technology partners that can help you keep up with changes in this dynamic industry.

Make sure you are using a billing system that is fully integrated with an EHR system.
Many outdated, server-based billing systems are trying to patch together a practice management system with one of the new electronic health record systems designed by a different company or on a different platform. The company that developed the practice management (PM) system creates an interface with an EHR system developed by another company. Chaos generally ensues.

If this is the case with your PM system, you are only asking for headaches and a possible loss of clientele. EHR companies are dropping by the wayside every day. Some of them are also server-based. Trying to get them to work together with billing software is like using "bubble gum and bailing wire" and will only lead to ongoing issues in your company. Two different companies, with two groups of programmers, trying to keep all the different parts of both systems running smoothly is almost impossible and can lead to turmoil in your company.

As painful as it may seem now, it may be a good idea to begin looking for a billing system that is totally integrated with an EHR system. That means that it was designed from the ground up by the same programmers in the same company. There are such systems available, and most of them are cloud-based (accessed securely 24/7 through a browser via the Internet).

Anything less than total integration of the two systems could be a disaster waiting to happen. Start your research now and find a system that will take you into the future, especially with any new clients you bring on. And, as part of your due diligence, make sure there is a way to import the data from your current system into the new system (at least the patient demographics). Then, begin to educate your current clients on why they need to start using an EHR, if they are not already, and why they might need to use a system that is fully integrated with your billing system.

Look for a system that has a way to electronically communicate with insurance company databases. You need one that checks for eligibility and automatically imports the patient data directly from the insurance company's database to create new patient charts. This will save you hours of data input and will help you keep employee costs under control. It will also prevent you from submitting claims that are sure to be rejected because the patient was not eligible for the service and it will keep the practice from spending time seeing patients that insurances will not cover. This will increase your revenue for that practice and will eliminate a large number of claim rejections as well.

 

Keep up with changes in the industry.
I can predict the success you are going to have in your business – and in life in general – if you will tell me just two things: the people you associate with and the books (and periodicals) that you read. Do not get bogged down in the details of your billing business. You need to set aside time to attend industry conferences at least once a year and to read industry newsletters and books.

The person who does not read is no better off than the person who cannot read, so set aside time each week to read about our industry and keep up with the constant changes. Change is what life itself is based on, and if you are willing to change along with the industry, you and your clients will prosper.

Do not assume you will have your current clients forever.
You won't. Things change in medical practices: staff turnover, new policies and procedures, new government rules and regulations, competition, updated technology, and the marketplace itself. All these things can cause you to lose a client from time to time. You must always be marketing.

Whether you realize it or not, your competition in this industry is not just other medical billing companies. The practice itself is your biggest competition. All it would take is for a new office manager to come into one of your practices and decide that they would rather not outsource their billing: they think they can do it themselves more efficiently and more economically. You must keep reselling your clients on your efficiencies and on your cost savings versus doing the billing themselves internally. Provide them with revenue reports that delineate what percentage of billed dollars (expected) are actually being collected. Show them you are the expert in this industry by producing and providing to them a professional newsletter with articles that show that you keep up with the changes in the industry. HBMA has a newsletter you can purchase and tailor with your company logo (www.hbma.org). 

Take the practice administrator (or the doctor) to lunch from time to time and show them printed reports that illustrate the revenue collections from both insurance providers and patients. Hold "Lunch 'n Learns" on a regular basis with your clients to bring them up to date on what is happening in the medical industry. Position yourself as the expert. People want to do business with "the expert" in every field.

When you buy a home, you do not want the new real estate agent: you want the guy or gal who has sold 100+ homes. When you look for a CPA, you do not want one who just hung out his or her shingle: you search for one who pays less than double digits of their own taxes and has a number of clients who they service. The same is true of a doctor's office. They want to feel that they are dealing with the company that can bring in every last dime that is due to the practice.

Continue to network with other business people in the community and join your local BNI group or chamber of commerce. Get out once a week and let people know you can solve the cash crunch for doctors and help them build their practices through your contacts.

Set up an automated way of keeping in touch with everyone you come in contact with who is a prospective client. Let them know that you are the only company that they should do business with. When it comes time for them to decide to outsource their billing, you are the only choice that makes sense. People do not buy when you are ready to sell – they buy when they are feeling the pain. Be at the top of their list when they decide it is time for change.

Remind your current doctors and office administrators that you are looking to build your business. Assuming you have done a good job for them, ask them for a referral. You would be surprised as to how many billing company owners never ask their clients for referrals. Do not just ask for the name of someone. Ask your client to pick up the phone and call the other doctor or office administrator and tell them how pleased they are with your billing service and that they think it would be in their interest to meet with you.

You can shrivel up and die in this ever-changing industry, or you can make the choice to grow and prosper, starting right now!

 

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Pleasing Patients Best Marketing Strategy for Medical Practices

Making your medical practice easy to do business with will differentiate it from others, establish a competitive advantage, and make it highly appealing to patients. Here are some of the many ways that physicians can make it happen.

1. Create convenient hours

Many people have workloads or requirements that limit their availability for doctors' appointments during the traditional 9 a.m. to 5 p.m. work day. To accommodate this population, many physicians have office hours beginning at 6 a.m. or 6:30 a.m. to accommodate "early risers" on their way to work, or those coming off night. Others have evening hours ending at 8 p.m., 9 p.m., or 10 p.m. to accommodate commuters and others for whom daytime appointments are inconvenient or impossible.

There are also pediatric practices that are open from 5p.m. to 5a.m. The premise is that the need for healthcare services often occurs after doctors' offices are closed —necessitating a costly trip to the emergency room or a night of worry waiting until doctor's office reopens.

"Availability" for a target population that needs the convenience of extended hours, is a strategy that works.

2. Increase phone availability

Many practices have telephone access only from 9 a.m. to 5 p.m. and are "closed" for lunch. This makes no sense if early morning callers are working men and women who do not want, or are unable, to call from work. Others prefer not to have their coworkers overhear their medical problems (or birth date when asked for it) or may not have access to a phone at work. For similar reasons, some patients may prefer to call you during their lunch break or at the end of their workday after 5 p.m. New-patient callers (with any of the above restrictions) are not likely to call back.

Recommendation: Have an employee available to answer the phones approximately one hour before the office opens, one hour after it closes, and during the hour your office might be closed for lunch. The calls that you might otherwise miss (and the goodwill you'll generate by being available) will be worth it.

3. Use electronic health records

Utilize EHRs to reduce the need for patients to fill out the same forms at each office visit, provide electronic referrals allowing easier access to follow-up care with specialists, and have the convenience of e-prescriptions electronically sent to patients' pharmacies, among other benefits.

4. Establish a Web portal

Provide an easy-to-use Web portal so patients can schedule, reschedule, or if necessary, cancel appointments, and access and print health history forms that can be filled out prior to coming to the office. A portal will also allow your practice to view and update patients' contact, insurance, and other personal information. Patients can also make electronic payments, request prescription refills, receive test results, and exchange secure messages with doctors about lab-test results (eliminating telephone tag).

To make these interactions even more convenient, give patients the freedom to connect to your practice from their smartphones via a mobile app.

Recommendation: Make sure your website is HIPAA compliant and as secure as possible.

5. Provide Wi-Fi

Provide Wi-Fi, it's a nice extra. Patients can then use their smartphones, iPads, laptops, etc., while waiting. It doesn't eliminate the inconvenience of long waits but it does make them more tolerable.

The great jazz pianist and composer Fats Waller knew about being easy to do business with. He said, "Find out what people want, and how they want it, and then give it to them just that way." He was spot on.

Courtesy of Physician Practice By Bob Levoy, the author of seven books and hundreds of articles on human resource and practice management topics. His newest book is "222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices" published by Jones & Bartlett. He can be reached at blevoy@verizon.net.


http://www.physicianspractice.com/patient-relations/pleasing-patients-best-marketing-strategy-medical-practices?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=21112013

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New Measures in Pay-for-Performance Programs

Pay for performance, or P4P as it is more commonly known, is not a new concept and some plans have been using this type of initiative with providers for a decade or more. Those providers that participate in Medicare's Physician Quality Reporting System (PQRS) — which uses a combination of incentive payments and payment adjustments to promote reporting of quality information — as well as those participating in large Blues plans, will be most familiar with this model.

The shift What is new is the shift away from P4P as a "bonus" structure and a shift toward an "earning" structure. That is, the extent to which payers are incorporating P4P into their payment strategies means that a portion (or percentage) of providers' revenue is "earned" through meeting P4P targets or measures.  These new models are referred to as "value-based," shifting away from straight fee-for-service payments to some combination of performance- and fee-based compensation, which puts some of the financial risk on providers. The hope is this type of compensation model will improve the quality of care, reduce medical costs over time, and improve patient outcomes. So you can think of the newer P4P models as Pay for outcomes, or P4O.  Under Medicare  The Affordable Care Act expands P4P efforts in hospitals through the establishment of a Hospital Value-Based Purchasing Program begun last year, where hospitals are rewarded for how well they perform on a set of quality measures, as well as on how much they improve in performance relative to a baseline.  The healthcare law also extends the Medicare PQRS program through 2014. However, beginning in 2015 the incentive payments go away, and physicians who do not satisfactorily report quality data will see their payments from Medicare reduced. This marks the real beginning of P4O, in my view, due to the setting of a "quality care" baseline against which the ability to earn will then be tied.

By commercial payers For commercial payers, value-based contracts are springing up around Patient-Centered Medical Homes (PCMHs) and accountable care organizations (ACOs). However, new and negotiated contracts for generalized services — that is, practices that are not technically a PCMH or ACO — are now typically being crafted with P4P/P4O components that allow practices to "earn" additional dollars or year-to-year increases in multi-year contracts through meeting specific measures and targets.  Theses measure are typically HEDIS-based (Healthcare Effectiveness Data and Information Set) which is a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). Many of these measures are focused on high-cost conditions such as heart disease, diabetes, high blood pressure, as well as preventive measures like immunizations and medication management. New and changed measures for 2014 include breast- and cervical-cancer screenings.

 Commercial payers utilizing P4P measures typically have a combination of HEDIS-type "quality" measures as well as "self-reported" measures, where practices can report on items such as EHR implementation and use, and status in achieving NCQA programs such as Patient-Centered Medical Home (PCMH), diabetes, heart/stroke, and back pain recognition programs. In addition to NCQA measures, there is substantial investment underway by the Agency for Healthcare Research and Quality (AHRQ) and other public policy organizations to identify further evidence-based medicine practices that could be used for measurement. And the National Quality Forum (NQF) is leading focused efforts to collect and normalize data, and endorse additional performance measures.

Article By Susanne Madden of physicians Practice http://www.physicianspractice.com/physician-compensation/new-measures-pay-performance-programs?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=31102013

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How Practices Can Recover From a Bad EHR Implementation

By Erica Sprey from Physicians Practice

You and your management team have practiced due diligence throughout the selection and implementation of your new EHR. You've done everything by the book. So what's wrong?

Melding technology and people is a complex process, involving many moving parts.

Is your clinical team talking to your IT support team? Is it responding in an appropriate way? Do you have a strong project leader?

Carolyn Hartley is president and CEO of Physicians EHR, Inc., a Cary, N.C.-based consultancy that assists practices in EHR selection through
detailed implementation and preparedness for quality incentives.  Hartley also serves as consultant to the 62 Regional Extension Centers operated under HHS.

Physicians Practice recently spoke with Hartley about her Medical Group Management Association Annual Conference presentation, "Seven Symptoms of a Troubled EHR Implementation and What to Do About It." Her session is scheduled for Monday, Oct. 7.

Q: Why is it that so many practices have troubles with EHR implementation?

A: We don't get calls from practices that say, "Boy, I love my EHR." We get calls from people who are so angry, that their practice is just about ready to implode. One of [our] physicians said, "Purchasing a system is like having a car delivered to you in a box. There's a car in there if you can figure out how to put together the pieces, but we forgot to include the manual."

Q: There's a lot written about interoperability as many systems don't work together. For example, hospitals are using one system and practices are using another. Do you feel that this is part of the problem?

A: You know, the message from the vendors changes almost every year, on why [practices] should purchase systems. Two years ago, the message was, "You have to buy our system if you want to be interoperable with all the other people in your community." Now the message is "Guess what? We are willing to work with anybody." The problem is you have to have a middle-ware. And by that I mean an algorithm or list of components — first name, last name — [that] when combined creates the patient's identity. We don't have a standard for that yet.

Q: So, practices have bought a system and they are not particularly happy with it — what are the signs of a bad implementation?

A: No.1 in our book is finger pointing. [We hear] "The vendor didn't tell us that," or, "We have one EHR system and one [practice management] system from the same company, and I'm telling you, there are things that are dropping, and we don't know where to go for help."

Another is finger pointing from within, and that is the most dangerous one. We try to get into these as quickly as possible, when the physicians are just mad at each other. If they are mad at each other, then the practice is ripe for getting sold. It's ripe for having key people leave the practice.

Q: What are some things that people can do to recover from this?

A: Well, the good news is that an EHR can be stabilized. There are best practices and they provide a pathway for stability and profitability. We're kind of the bee that's pollinating the forest. We're saying, "Guess what? This worked with these guys in nephrology with this particular system." But we need to take a look at what's best in that practice. Because one of those physicians has figured it out.

Q: Can you talk to me about stabilizing the practice/vendor relationship?

A: Vendors generally know how the system works. …There's a huge rush to get so much market share during meaningful use incentives. So we have this massive market acquisition to say, "Get my system in place." But there wasn't enough backup to support those installs. The vendors know, going forward, they've got to stabilize their clients. Because they are facing anywhere from 35 percent to 75 percent of users at risk of going to a different system.

I coach the regional extension centers [RECs]. They've tried to be consistent in selecting the [EHR] systems. They tried to vet the systems for their primary-care providers. They also responded to the vendors saying, "We're good for primary care." But those vendors are also kind of costly. So, if those primary-care physicians had to go outside of the REC recommendation, and many of them did [because of cost constraints], they go outside and purchase something that is more affordable for them. Now, as we are going into Stage 2 [requirements] of meaningful use and [some] certified vendors cannot meet [requirements for Stage 2] … You have to be a pretty ambitious vendor in order to meet those requirements. So, some of them have huge user databases, [and] they are going to continue. But those that don't have a huge database have to figure out, "What am I going to do in 2014?"

Article by Erica Sprey, courtesy of: http://www.physicianspractice.com/mgma13/how-practices-can-recover-bad-ehr-implementation?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=04102013

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Revenue Cycle Management Is More Than Billing Patients

Revenue cycle management (RCM) is the lifeblood of any practice — private or nonprofit. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining practice viability. Before you can improve any process, you need to assess where you are now. Here are some questions you should think about:

• Do you know if you are achieving best practice standards in accounts-receivable management? • Does it take your practice too long to collect, and/or are your write-offs and adjustments too high? • Do you know your claim-denial rate on first submission (4 percent of claims or fewer is best practice)? • Have you determined that you are not leaving any money on the table with a reimbursement analysis? • What are your days in A/R? What percentage of your accounts receivable is more than 120 days old (10 percent or less is best practice)?

Patient registration The revenue cycle starts with patient registration. Patient registration begins with a phone call for an appointment request. Your front-desk staff should interview the patient on the phone to collect billing and insurance information;  invite the patient to go online to your website to complete their registration information; and follow up if registration isn't completed two days prior to the appointment — so that the patient's insurance coverage can be verified. You can use an in-office kiosk for patient check in and to collect demographic information. Some kiosks will automatically verify insurance eligibility too.  Charge capture Transferring patient charges from the EHR to your practice management (PM) system should be seamless — electronically transmitting data is an example of efficient workflow. But, if you are forcing your providers to first complete a paper visit-encounter form, and then transfer that information to the EHR, it can lead to inconsistencies, lost data, and redundant work processes. Furthermore, asking your check-out station to compare electronic patient information against the paper encounter form is burdensome and creates even more work when discrepancies arise.  Automatic payment posting Automatic payment posting can significantly reduce staff work, so why don't more billing staff embrace and drive implementation of auto-post opportunities? Holding tight to the status quo — manual payment posting and reconciliation — is an inefficient use of our most costly resource: staff. Routinely ask your payers, clearinghouses, and software vendors about new services coming online, and roll out every new payer as electronic remittance and auto-posting become available. Investigate a bank lockbox service that converts the paper explanation of benefits (EOBs) to electronic transactions (837s) for automatic posting to patient accounts.  Insurance eligibility verification Investigate and incorporate automatic insurance eligibility verification into your work flows. You can use your clearinghouse service to upload the appointment schedule a couple of days in advance, in a batch process. For walk-in patients, use real-time verification through your PM system. An integrated verification solution creates a history within the patient's record that supports follow-up collection efforts, if there are later discrepancies with the payer.

Article by Rosemarie Nelson - See more at: http://www.physicianspractice.com/billing-and-collections/revenue-cycle-management-more-billing-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29082013#sthash.Bbvb2ywQ.dpuf

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EHR Data Interface Issues for the Third Party Biller

 

Is the Industry Moving Away From Your Billing Model?

An article by Ron Sterling taken from the May/June issue of HBMA Billing.

Third party billers face a variety of business and technical challenges in interfacing with electronic health records (EHR) and other systems. Indeed, some of the initiatives in the healthcare industry will continue to complicate the establishment and maintenance of data interfaces for the foreseeable future.

Business Challenges

If you go back a few years before Meaningful Use, there were over 1,200 practice management system (PMS) vendors and a couple of hundred EHR vendors. During that time, the third party billers and/or practice management system vendors had the access to, and the attention of, physicians who needed to get their claims out of the door and paid. Consequently, it was the EHR vendors that would offer to accommodate interfaces with medical billing systems. Indeed, a variety of PMS vendors touted their systems as a gateway to a variety of EHR options for their physician clients.
Today, newly introduced integrated PMS/EHR products and EHR acquisitions by PMS vendors and vice versa have led to fewer, if any, billing system options for many EHR buyers. From integrated systems (that by design and business model do not interface with other products), to vendors that will not interface with other options, many vendors have established themselves as one stop shops for medical billing, EHR solutions, and, in some cases, RCM services. Indeed, some vendors have exclusive or "preferred" clearinghouse relationships for the handling of standard HIPAA transactions. In essence, more and more vendors want to position themselves as the only source for healthcare software solutions and services.

That is not to say that there are not EHR vendors who are eager to interface with a variety of practice management systems. However, the industry is moving to fewer interfaced solutions and more integrated offerings. Indeed, the majority of "new" solutions are integrated PMS/EHR offerings.

Healthcare Industry Changes

Related to the business challenges, the Meaningful Use initiative will affect interface strategies for all PMS and EHR products. For example, Stage 2 Meaningful Use core (required) measures include secure messaging with patients and providing electronic access to patient medical information. In most cases, this requires the use of a patient portal.

Patient portals can provide both medical billing and clinical interactions with patients. As importantly, most patient portals are designed to interface with one product line of medical billing and EHR products (such as Centricity PMS/EHR or NextGen EPM/EHR). Patient portals are not typically designed to interface with one vendor's practice management software containing billing data and a different vendor's EHR that houses clinical information. If the patient portal is separately interfaced with a PMS from one vendor and an EHR from a different vendor, the patient portal may not "know" how to properly route the message. In practice, however, patients may exchange secured messages with the practice on both billing and clinical issues.

A strategy that may include a separate patient portal for clinical issues and one for medical billing purposes presents a variety of operational challenges, including coordinating patient access and even accurately routing information. As importantly, separate patient portals will undermine support for the Patient Centered Medical Home and Accountable Care Organizations. For example, a patient who accesses the medical billing patient portal may not be reminded about a clinically-driven patient service issue.

Technical Challenges

Most interfaces are based on the Health Level 7 (HL7) structure. However, various aspects of HL7 are open to interpretation by vendors. Indeed, a variety of PMS and EHR vendors do not strictly support the HL7 standard. For example, some vendors use general HL7 messages instead of designated HL7 messages to send information. In other instances, the information in a message is not placed in the expected place but in a comment or supplemental area. Indeed, some vendors do not use the standard code sets, and instead use text fragments. In each case, the effort to establish the interface may require a painstaking evaluation of the vendor's "HL7" implementation.

Even after achieving success, the interface may have to change to address evolving coordination of information requirements between the medical billing and clinical record functions. For example:

• The Meaningful Use Stage 1 measures require ethnicity and race information that is commonly captured in the PM systems but is needed by the EHR to track provider performance and qualify for the EHR incentive payments from Medicare or Medicaid.
• Meaningful Use Stage 2 will require sharing of contact information and email addresses.
• The HIPAA omnibus rules will affect the information needed to track HIPAA Privacy and Disclosure as well as support exchanges with patients. As a practical matter, most medical billing and EHR interfaces do a poor job of coordinating HIPAA privacy and disclosure status for patients.

In light of these increasingly complex business and technical challenges to interfacing medical billing and EHR products, third party billers may need to establish their own preferred relationships with EHR vendors. However, such relationships will be under increasing competitive pressure and user demands to provide a more coordinated approach to patient service and provider relationships.

Right, wrong, or indifferent, the healthcare industry is moving towards comprehensive solutions to meet patient service challenges and optimize provider performance. Consequentially, the PMS/EHR vendors are addressing those needs. A myriad of changes that affect physician relationships with patients and the expectations of patients and payors will complicate the use of interfaces with EHR products and inhibit the efficiencies needed to manage patient care and service. As importantly, interfaced systems may complicate reporting for quality, operational, and management purposes.

Therefore, interfacing between PMS and EHR systems may present a tactical solution to meet physician needs in these relatively early stages of the transition to EHRs, but present a strategic challenge to address evolving healthcare business and patient service models. Third party billing organizations need to recognize these business and service issues in order to provide a clear strategic path for how your services and products will evolve to meet the new demands that your clients are facing.

Courtesy of: http://www.hbma.org/news/public-news/n_ehr-data-interface-issues-for-the-third-party-biller

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