Category: Integrated Cloud Based Solutions

Integrated Cloud Based Solutions

Learn How to Avoid the 2015 PQRS Payment Adjustment

Providers considered eligible and able to participate in the Physician Quality Reporting System (PQRS) may be subject to payment adjustments beginning in 2015. Eligible professionals (EPs) and group practices that fail to satisfactorily report data on quality measures during the 2013 program year will be subject to a 1.5% payment adjustment of their Physician Fee Schedule (PFS) charges beginning in 2015.
Individuals and group practices participating in PQRS must meet one of the following criteria to avoid payment adjustments in 2015.

Criteria for Individual EPs

EPs can avoid the 2015 payment adjustment if one of the following criteria is met during the 2013 PQRS program year:
1. Meet the requirements outlined in the 2013 PQRS measure specifications* (this will enable the EP to earn a 2013 PQRS incentive payment of 0.5% of their covered Medicare Part B charges)
2. Report at least:
One valid measure via claims, participating registry, or through a qualified Electronic Health Record (EHR) OR
One valid measures group via claims or participating registry
3. Elected to participate in the administrative claims-based reporting mechanism October 18, 2013

Criteria for Registered Groups (ACO/PQRS GPRO)

Group practices participating in the Group Practice Reporting Option (GPRO) can avoid 2015 payment adjustments if one of the following criteria is met during the 2013 PQRS program year:
1. Group meets the following requirements, outlined in the 2013 PQRS GPRO Fact Sheet
Report specific ACO/GPRO measures through the Web Interface OR
Report at least 3 registry measures (for 80% of the group’s eligible patients for each measure) for the GPRO outlined in the 2013 PQRS Measure Specification for Claims/Registry Reporting of Individual Measures
2. Report at least one valid measure through the Web Interface OR participating registry
3. Elected to participate as a GPRO in the administrative claims-based reporting mechanism by October 18, 2013

Note: Administrative claims-based reporting is not available to ACO GPROs

View the PQRS Payment Adjustments Tip Sheet for more information on how to avoid the 2015 payment adjustment.
For more information or support on the PQRS program, please visit the PQRS Incentive Program website or the Help Desk.
*Note: The asterisk indicates resources are in a zip file.

Integrated Cloud Based Solutions

ICD-10 Walking Through the Workflow

With less than a year to go until the ICD-10 code set implementation deadline, physician practices should be pursuing a comprehensive plan designed to ensure a smooth coding transition with minimal cash flow disruption.

A key step in any ICD-10-CM transition strategy is to conduct a detailed assessment of existing workflows and processes to determine which elements will require modification, according to Bess Ann Bredemeyer, a consulting director with McKesson Business Performance Services (BPS).

By identifying each point in the claims lifecycle that ICD-10- CM will touch, appropriate adjustments can be made and simulations conducted to test the new processes against real-world conditions.

“The best way to proceed with an assessment is to begin at the patient encounter and then move through to the claim drop and denial management,” Bredemeyer said. “That way you won’t miss anything.”

Clinical Documentation  Whether the clinical documentation is sent directly to a coder or to data entry personnel, it is also important to ensure that any changes in National Coverage Determinations (NCDs) and payer’s Local Carrier Determinations (LCDs) are incorporated and reflected in the claim. A good approach includes:

  • Identifying the top 50 most utilized diagnoses codes
  • Evaluating where additional documentation will be required
  • Mapping out modifications to support appropriate reimbursement
  • Updating charge tickets, super-bills and other revenue cycle tools

This is a Test  With all the elements theoretically in place, it is critical to begin testing your new workflow to determine if it can handle ICD-10-CM. Code audits can assess both clinical documentation and coding to determine whether the claims should come through clean or not. A real-world testing process may also reveal previously unknown problems that would otherwise remain hidden until the ICD-10 go-live.

Don’t Be Denied  Because of the complexity of ICD-10-CM and the sheer magnitude of the change, it’s reasonable to assume that even the best-laid plans may encounter some unexpected problems. For that reason, it makes sense to be prepared for a rise in denials. For physician practices, that means ensuring that staffing is adequate to manage an increase in volume, and that problems will be quickly identified and remediated.

“There is no denying that the transition to the new code set will require planning and resources to mitigate the burden of change,” Bredemeyer said. “That’s why you should get started now on developing a workflow analysis impact assessment that will help you develop a detailed ICD-10 timeline and budget.”

Article Resource:

ReveNEWS, Industry Spotlight, “Walking Through the Workflow- An Important First Step,” November 2013 edition located on the McKesson ReveNEWS website


Integrated Cloud Based Solutions

Government offers model notices of privacy practices

The US Department of Health & Human Services (HHS) and the Office of the National Coordinator have released model notices of privacy practices in three customizable styles for healthcare providers and health plans. New rules for notices of privacy practices as required by the HIPAA Omnibus Rule go into effect on Monday, September 23.

Access the model notices and more information on the notice requirements at the HHS website.

Integrated Cloud Based Solutions

CMS Releases Stage 2 Guide for Meaningful Use

CMS Releases Stage 2 Guide for Meaningful Use

“CMS has released a new resource, An Eligible Professional’s Guide to Stage 2 of the EHR Incentive Programs, which provides a comprehensive overview of Stage 2 of the EHR Incentive Programs for eligible professionals. The guide outlines criteria for Stage 2 meaningful use, 2014 clinical quality measure reporting, and 2014 EHR certification.”

Integrated Cloud Based Solutions

Providers:Read the fine print in your EHR contracts.

We all have a tendency to skip over the fine print sometimes; the car rental agreement, the parking garage receipt, etc. I’ve seen firsthand plenty of patients who don’t bother to read their HIPAA Notices of Privacy Practices.

So it’s particularly interesting to read that physicians are upset that electronic health record vendor Practice Fusion launched a feature in its EHR software to send emails to patients asking them to rate their doctors. According to a recent blog posted by John Lynn, founder of the blog network, more than 9 million emails have been sent to patients and the vendor has received about 1.8 million reviews.

The problem is that the emails look like they were sent by the physicians themselves, and many of them were unaware that this activity was occurring. Lynn notes that many physicians feel that Practice Fusion violated their trust.

Practice Fusion responded to Lynn’s post, apologizing for the confusion but stating that its practices are not a violation of HIPAA. The company also stated that it provided physicians notice about the emails.

I don’t know whether Practice Fusion will see its business impacted by the negative publicity it’s now receiving. According to the comments to Lynn’s post, the vendor has also removed negative comments about the emails from its own website forum, and is being accused of populating Lynn’s blog with emails against Lynn. There already has been talk that many providers will be switching EHR vendors this year. Without knowing more, I also don’t know whether the email activity is truly HIPAA compliant.

And physicians certainly have enough on their plates between treating patients and running their practices, so I can see where they may have glossed over a vendor notice about the implementation of a new EHR feature.

The real issue, though, is whether the physicians ever gave Practice Fusion permission to engage in this kind of activity. According to the comments to Lynn’s post, Practice Fusion’s user agreement does allow it to send emails to patients, although I have not had a chance to corroborate whether the vendor contract actually permits as much.

This is one of those instances where people really need to read that fine print. You’re not only dealing with a vendor relationship; you’re dealing with legal terms.

It’s one thing if you know that such a provision is in there and you make a decision that you can live with it or take your business elsewhere. As one commenter stated, “For anyone to think that free is free in an EHR has their head stuck in the sand.” Another said that the physicians are “getting what they paid for.”

But if you don’t bother educating yourself about what you’re signing, then you’re not doing yourself any favors. It’s important to trust your EHR vendor, but if you gave it permission to do something in your contract–even if you didn’t realize it–you’re out of luck.

The Office of the National Coordinator for Health IT does a good job of preparing providers for just such a situation in its new guidebook on evaluating EHR vendor contracts. But it only works if physicians actually read them.


Integrated Cloud Based Solutions

New HIPAA has teeth

The HIPAA Privacy and Security final rule — also known as the HIPAA Omnibus Rule — became effective March 26. One expert predicts enforcers will have a heyday with expanded ability to crack down on providers and their business associates.

According to Jorge Rey, an associate principal and the director of information security and compliance for Kaufman, Rossin, the biggest difference in the new rule is a change in breach notification. Under the old rule, providers were presumed innocent of harming patients when a breach occurred – until they proved otherwise. Under the new rule, providers are presumed guilty of harming patients when data is breached. They will have to prove their innocence.

Providers and their vendors and subcontractors have “in theory,” 180 days to comply before the Office for Civil Rights begins enforcement of the Omnibus Rule, beginning Sept. 23, 2013, Rey warns. But this doesn’t mean providers shouldn’t beware. They still will be held accountable under the old HIPAA rules until then, he says.

The addition of business associates under the Omnibus rule could catch some companies and providers unaware and unprepared, Rey warns. “A lot of business associates didn’t plan for this,” he says of the expanded HIPAA rule. “They have never had to comply with HIPAA before.”

According to Rey, OCR has already prosecuted five covered entities, with the settlements ranging from $50,000 to $1.7 million. The smallest OCR enforcement action involved the breach of fewer than 500 records. “I think they are putting out the message that they are serious about enforcement. They are going after small and large cases,” Rey says.

He said he had  received emails from OCR indicating the agency is starting to hire enforcement officials. “There’s going to be a lot of enforcement going forward,” he says.

How to prepare? Reys says small provider groups, short on resources, can rely on parent organizations or even government programs to help them do risk analysis. “Don’t take this lightly. The main reason covered entities ran into big problems with OCR last year, was they didn’t conduct risk assessments,” he says. “Providers should identify all of their vendors with access to personal health records and ensure they are protecting it according to the new HIPAA rule.”

In addition, “create a visual map of your data; understand where your data is,” Rey says. Encrypt data in laptops and determine if data might best be kept safer in a centralized location. He points out that PCs and servers are also vulnerable to breaches.

Published on EHR Watch (

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Patient portals and stage 2 meaningful use.


Offering a Patient Portal for Meaningful Use Stage 2

Although you can’t begin attesting to  Stage 2 Meaningful Use  until 2014, you may be either preparing to implement or have already implemented a patient portal to meet the patient engagement requirements.

In order for providers to show meaningful use of their EMR software and qualify for federal incentives, eligible professionals will need to:

  • Provide electronic access to clinical summaries to more than 50 percent of patients
  • Use secure, electronic messaging to communicate with at least 5 percent of patients on relevant health information

Both of these requirements can be easily met through an online patient portal, provided healthcare professionals can convince patients to access it – an easy feat?  It  is really going to depend on your patient demographics.   Don’t judge by age, necessarily.  The baby-boomer generation,  is just as tech-savvy as any 20 year old today.  Look in your waiting room-who is texting on their smart-phones or reading on a Kindle?  Those are the folks to market a patient portal to.  It’s the “getting the horse to water, but you can’t make it drink” analogy.   You can offer it, but how are you going to get your patients use  it?

Healthcare organizations have petitioned the Centers for Medicare and Medicaid Services (CMS) to remove these objectives from its meaningful use stage 2 guidelines; however, officials have yet to do so. Instead, CMS officials have hinted that the requirements could be revisited should they prove to be too difficult for providers to attest to.

In the meantime, look at what your existing EHR has to offer in terms of a patient portal.  If you aren’t already paying for this service, the cost to start up a portal is nominal.  Start promoting this now to your patients so when you do your attestation in 2014 this will be one of the core objectives that is a “no-brainer” to meet!

For additional information, please contact a sales representative at Sunrise Services, LLC.  Our toll free number is 888-880-0384, or on the web at

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Practice Choice EMR

7 Value Propositions of McKesson Practice Choice


1.      Lowers Cost of traditional EHR/PM Technology ·
         Avoid costly servers and IT staffing using a Web-based solution
         Learn, setup, & maintain one integrated solution
         Practice Management
         Health Records
         Patient Portal
         Claims Engine including ERA, Electronic Eligibility Checking & Relay Health EDI.
         Low-hassle rolling upgrades always keeps your practice current and compliant
         Automatic backups & security
2.    Is Intuitive, Designed for the Small Independent Medical Office
         Be at ease with McKesson – a leading healthcare company that’s been in the EHR space for over 20 years
         Be confident in an built-from-the-ground up investment using Microsoft’s latest technology stack designed specifically for the independent practice
         Be efficient with our multiple role layout. We studied this space specifically, and laid out the software considerate of the many hats you wear during the day
         Learn easily and train new staff with integrated training videos, guides, and online help.
        Share best practices online chatting with other Choice practices like your own
3.       Protects Cash Flow
         Check patient eligibility real-time to guarantee reimbursement
         Ensure recommended procedures are performed to benefit patient health and encourage visit volume
         Improve collections by taking visit and account payments at check-in
         Embedded Claim/ERA services with auto-posting keeps cash moving
4.    Helps you Go Electronic without compromising Patient Care
         Avoid excessive clicking with single screen documentation that mimics paper
         Smart Notes design enables clinicians to pull and push data from the chart while you build the note
         Gain efficiency using natural terminology to search codes
         Care for patients with a powerful cross sectional chart summary
5.       Creates New Efficiencies with Technology
         Make patient care simpler via electronic prescriptions with clever interaction checking
         Maximize reimbursement with insurance-preferred labs automating when creating an order
         Save time eliminating paper lab results via an electronic connection
6.    Enhances Patient Touch
         Supplement patient-provider interaction with electronic messaging
         Give patients and their providers a consolidated health summary in-hand or electronically
         Quickly manage refill requests online
         Keep patients informed via patient education material summaries
7.       Gains Visibility to the Health of your Patient and Practice
         Speedily generate patient lists and reminders to communicate with the right audience
         Benchmark yourself against Meaningful Use performance and clinical quality measures
         Interrogate your financial health with comprehensive report generation

For additional information please visit our website at or call 502-538-4665.

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EMR in the clouds…what does that mean anyway?

If I had a nickel for every time someone asks me what SaaS means (and I see you, scratching your head now trying to come up with what that acronym means), I’d be richer beyond my wildest dreams.

According to Wikipedia, “Software-as-a-Service (SaaS, pronounced sɑs), sometimes referred to as “on-demand software”, is a software delivery model in which software and associated data are centrally hosted on the cloud. SaaS is typically assessed by users using a thin client via a web browser.”

What does that mean exactly?

It means, you would log on to web browser (Internet Explorer, Firefox, Chrome, etc.), type in a web address, and enter a username and password to access your data. If you file your income taxes, for example, using an online service you are essentially using a SaaS based program.  Your practice could be portable in the sense that you could log on anywhere you have an secure internet connection.  The disclaimer here is you wouldn’t want to go to Starbucks and run your practice (not secure).  Efficient-I think so, but SaaS may not be for everyone.

Some factors to consider when looking at a SaaS based EMR are:

1. Does your practice have good internet speed?  If not, check with your internet service providers to see what is available.  Make sure to factor this in when calculating your monthly fees.

2. Does your practice have a reliable internet connection?  Speed is one thing, but if you live in an area where the internet connection is choppy, you may want to either consider switching providers or looking at a server-based product.  There is nothing worse than not being able to get on the internet to access your charts.

3. Are you a small practice without an IT staff?  The greatest thing about having a SaaS based EMR program is that you are not going to be down when your server needs to be upgraded.  Keep in mind that not only will your EMR software need to be updated your Windows software will also need to be updated from time to time.  Factor in the cost of hardware when considering which way to go.  Servers are no immortal-they have a life span like everything else.

If you answered YES to all of the above, then having a SaaS based EMR program may save you both money and headaches.

If you would like additional information please log on to

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Integrated Cloud Based Solutions

Four Great Reasons to Implement an EMR Before the End of 2012

December is upon us and the year is flying by and yes, we all have a lot of things on our plates.  So let’s look at four reasons that you need to move ahead with implementation of an EMR in 2012.


1. Tax Code 179 –  Both the ‘Tax Relief Act of 2010’ as well as the ‘Jobs Act of 2010’ that passed in late 2010 affected Section 179 in a positive way for this 2012 tax year. To take advantage of this deduction, your Section 179 Qualified Financing and your equipment must be in place on or before December 31, 2012.  Read More


If you would like additional information on EMR products visit our website at or call one of our experts at 888-880-0384.