EMR & EHR Blog for Physicians

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This time I decided to write this post about a slightly different topic - Coding Compliance. As we discuss below, when physicians implement EMR or EHR, the need for a good compliance plan will not disappear contrary to what some physicians may believe.

While most physicians would like to avoid an coding audit, it is a fact of life in today's healthcare world. To lessen the stress and potential penalties, preventive maintenance is the key. Regular internal and external audits should be part of every compliance plan.

The OIG (Office of the Inspector General) states: "The best evidence that a provider's compliance program is operating effectively occurs when the provider, through its compliance program, identifies problematic conduct, takes appropriate steps to remedy the conduct and prevent it from recurring, and makes a full and timely disclosure of the misconduct to appropriate authorities." To identify problem areas, utilization of internal and external audits is key.

As most EHR Vendors proclaim, Electronic Health Records help physicians maximize billing in the following two ways:

1. When using paper charts, to be on the safe side of the law, many physicians down code (use a lower billing code), rather than use an appropriate level of code. Providers who use EHR software can increase revenues by using System recommended E&M billing codes that are based on the service accurately documented within the EHR, without the fear of an audit, or if an audit occurs, being confident that their coding is compliant with their documentation. Medical Economics magazine has estimated that physicians, who routinely down-code to avoid audits, lose an average of $40,000 annually.
2. EHR software allows physicians to produce adequate supporting documentation that complies with CMS guidelines and supports the appropriate level of service to be billed. Accurate coding speeds up the reimbursement process and results in fewer rejected claims from insurance companies. Even better, an EHR Software helps produce clean claims the first time, significantly reducing the number of rejected claims!

The question that often arises when we talk to Physicians is: We are investing money in an EMR or EHR. Do we still need to have a Coding Audit or Coding Compliance program? The answer is "YES".

February 2010 edition of American Academy of Professional Coders' (AAPC) Coding Edge magazine states, "The goal of the EMR is to improve the efficiency of the physician in documenting services and ensuring all work performed is capture in the record." While EMRs can help with speeding up reimbursement, they will not prevent a physician from receiving denials. EMRs can improve coding and documentation, but physicians need to take the time to document services in order to meet medical necessity standards.

Physicians sometimes fail to realize that coding is more than just code selection and needs to consider items like Commercial payer rules, local coverage determinations, mitigating circumstances, government health programs and numerous other variables introduce rules, exceptions to the rules, and more. How many EHR Solutions can automate all the aforementioned complex rules which are forever in a state of flux and keep changing frequently? My guess is that by pareto's principle, EHRs can probably code 80% of the encounters accurately while balance 20% of the encounters need to be reviewed and/or coded appropriately by experienced coders. An example of this would be modifier selection and proper use of modifiers. These would need to be manually entered by either the physician or a certified coder.

Our experience reveals that when a Practice implements an EHR, the extent of coding audit required may decrease but nevertheless every Practice still needs to implement coding audits. You can choose to conduct the audits internally or use external auditors. Internal audits are a valuable tool, but are limited by the auditor's knowledge and expertise. Internal auditors may already be overwhelmed by their daily duties of running an office. They may not have the time between scheduling patients, ordering supplies, etc...to conduct a thorough audit. Regulations change constantly, which means a designated employee must be assigned to read publications, attend seminars and share this information with physicians and coders in their practice. Auditors should be certified and competent. An auditor is not just a Certified Coder. It takes many years of experience and education to be a thorough auditor. It is a separate skill from coding.

For these reasons, an annual external audit is invaluable for objectively analyzing billing and coding operations. It can uncover documentation deficiencies that an internal auditor may overlook and identify missed revenue in the process. Professional billing companies with dedicated teams of auditors can provide this service in a cost effective manner.

It takes physicians years of education to successfully practice medicine and even more to specialize in one area, plus stay abreast of changes and advancements in medicine. With the billing and coding requirements of today, it takes a specialist in that field to provide the same level of expertise. External auditors will also take the time to provide one-on-one feedback to individual physicians utilizing their own charts as examples and can pinpoint precise documentation deficiencies.

In closing, while implementing an EHR is a giant step in automating clinical processes, a good compliance plan that utilizes internal and external auditors shows your offices' desire to operate within the guidelines is equally important. If discrepancies are found, penalties will be less severe because you are showing due diligence to be in compliance.

(Parts of this blog post have been contributed by Kathy Husted, CPC, CPC-H, CPC-I, who works for Professional Billing & Management Services, an Affiliate of RevenueXL Inc.)

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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Here's a multiple-choice quiz with an answer that may surprise you:

What's the most expensive cost element when you implement new Electronic Medical Records?

a. EMR Software
b. Workstations and monitors
c. Training and Change Management
d. Customizing templates

If you answered "EMR software" - sorry, no cigar. While EMR / EHR software isn't cheap, it's a one-time expense.

If you chose "Workstations and monitors" you're still on the wrong track. Workstations and monitors with more than enough power for EMR cost under $1000.

If you answered "Training and Change Management," you may select the kewpie doll of your choice - you're absolutely right. This cost component is perennial and has no end!

Why is that true?

1. We've discovered that new staff usually needs to be trained not only on the EMR application, but also on basic computer skills like Windows, use of mouse, printing, creating folders, moving files, logging on and off, etc. If your staff is not comfortable with using computers with GUI (Graphical User Interface) for day to day operations, they will surely need training on that.
2. Implementation of Electronic Medical Records would involve use of devices like scanners, fax servers, etc. If the Clinic does not use such devices currently, staff will need to be trained on using these devices.
3. EMR software is a major application, thus most users will need to learn multiple new software functions. This takes time - learning a complex application requires lots of repetition until the new skills become second nature.
4. Initial training is often conducted in a tight time frame where the schedule is dictated by the EMR vendor and clinics find that they need additional training.

Here's another quiz question: what's the leading cause of failure for new EMR implementations? Studies show the failures are primarily related to inadequate training.

Clients often want to know the quickest, most cost-effective way to train their staff on EMR software. By avoiding the following 8 Cardinal Sins of EMR Training, you'll significantly slash your training costs, and improve your return on investment.

1. Big time gap between training and 'go live'

We've seen cases where the EMR vendor rushed ahead and trained staff on using EMR, even though the provider enrollment with various payers was far from complete. Big mistake! The training vendor went through the motions of training, collected a nice check, and went away. When the enrollment process was finally completed, 8-10 weeks later, and the clinic began using the EMR system - you guessed it, the provider and staff had forgotten how to use the application and were forced to purchase additional training days.

Here's our recommendation: insist on starting training after the setup process is complete, including all interfaces (lab interface, eRx, etc.).

2. Training everyone on everything

In a larger clinic (including multiple locations), clinic staff often play widely different roles, and therefore need to know very different parts of the EMR application. Training every staff member on every feature of the EMR won't optimize their skills on the parts that are most relevant to them. For example, only a few staff members will have access to the sensitive areas of the EMR (e.g., security administration).

Training plan must be based on roles. A better approach is to have the EMR vendor train a set of super-users ("Train the Trainer") who will have the responsibility to train and support the rest of the staff. They are the ‘go to' people when users have issues with using EMR (before someone makes a call to the Customer Support operations of the EMR vendor).

3. Assuming that training ends after implementation

Training doesn't end when the EMR system is up and running. Staff roles and responsibilities can change over time, and new employees will need training on the EMR software. Training never ends - but it's a lot cheaper to have one or more super-users on the staff who can train than others, than to bring back the training vendor each time. (See #2 above.)

4. Having the EMR vendor train staff in basic computer skills

Having the EMR vendor teach basic computer skills is a huge waste of money. If your staff members can't teach each other these simple skills, find an adult-education course, or hire a computer science student who'll do the job for a fraction of what the EMR vendor would charge. Plan to have the hardware installed well in advance, so that staff can be trained on basic skills before the EMR system arrives.

5. Assuming that training can be imparted remotely and effectively over Webex or other web conference media

Many EMR vendors offer remote training using remote Webex or GoToMeeting sessions over the Internet, without any on-site support during go-live. Remote training costs less but is never as effective as face-to-face training. Choose on-site setting, even if it means spending extra money. Also, insist on having an expert on-site during go-live.

6. Not insisting on formal training material or not using desktop recording software to record the training session

Insist that the vendor provide formal training materials that can be used to train new staff. Ideally, the training materials will be tailored to your practice requirements. If no formal training material is available, have your staff capture snapshots and create a training binder for future reference. Better still, use a desktop recording software to record the video and audio (if possible).

7. Assuming that the training provided by EMR vendor will encompass all elements that are relevant to your medical practice.

Most of the time, the EMR Vendor may adopt a ‘one size fits all' approach as far as EMR training is concerned. It is in your interest to work with the vendor in designing the training sessions customized to your specific requirements. You may find that some portions are not covered at all while some easy functionality hogs valuable training time.

8. Not validating the credentials of the trainer provided by the EMR vendor in the medical specialty of your Clinic.

We recommend confirming the trainer's credentials before he/she comes on-site. It's very important that the trainer understand the unique requirements of your medical specialty, so the trainer can offer relevant tips to help your staff optimize their use of the EMR system.

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We would like to keep revising this list for the benefit of our future readers. Hence if you believe that there are other training sins that you want included on this list, please do leave your comments. We will have an updated list avaialble for free download soon.

Check out our downloadable spreadsheet on EMR Implementation Costs - an organized approach for getting a good EMR RFP or price quote and select the right-fit EMR Software for you Practice. Don't forget to contact us for a no-obligation 'Free' Selection consulting available to all bonafide buyers.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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1. Not taking the staff into confidence before starting the EMR selection process.

Your staff will be most impacted by the changes in your clinical environment. Hence it is imperative that you help remove the fear of the unknown from the mind of your staff by explaining how implementation of the selected EHR Software will make them more efficient and effective in their day to day operations.

2. Not drawing up the criteria for your decision making process that is objective with a measurable metric rather than basing it on gut feeling.

Criteria should be appropriately grouped and weighted so that you can arrive at a weighted score for each EMR being evaluated. If you are evaluating three or four EMRs and do not have the criteria well defined, chances are huge that some irrelevant issues will cloud your vision and impact your decision making.

3. Not following through with the references or not doing a thorough job with the references.

You may often believe that all references are going to speak highly about the EMR since they have been handpicked by the vendors. However, as we all know, physicians are a closely knit community and it is not difficult for you to validate or repudiate what the references told you about their experience with the EMR Software or Vendor.

4. Accepting at face value what EMR vendors tell you about all their EMR Software features and functionality.

For example, we have found some of the key differentiators claimed by some vendors had actually been decommissioned because they did not work as intended and were back to the drawing board for a re-work.

5. Assuming that larger and well known EMR vendors will be technology-wise more advanced, and customer-support-wise friendlier to your individual needs and situation.

This assumption could be quite misplaced because bigger is not always better as many of these vendors are too busy working on tying up bigger alliances with hospitals and IPAs trying to rope in hundreds of providers in one scoop. Thus, ramping up customer support for small practices almost always takes a back seat and therefore you may be left out in the cold when you need help right away. Larger vendors are less likely to hear you out in regards to your individual needs and even more importantly, make changes to the software to meet your genuine requirements.

6. Selecting a vendor who says that their EMR Software does not need much training and it is easy to pick up.

If you and your staff do not get adequate training, you will not be able to utilize the software to its full extent. There are no plug and play systems that can be implemented in a few minutes, few days, or even few weeks. Negligible amount of training built as part of initial implementation proposal is nothing more than a contrived method to win your business.

7. Being too focused on price early-on in your search or believing that there really is such a thing as Free EMR Software rather than focusing first on what you need for optimizing your clinical processes and workflow.

A lowest cost approach does not typically translate into saving a lot of money and a lower Total Cost of Ownership. Once you determine what you want and need, you may start drilling down into pricing the EMR Software alternatives you are considering. Don't get pushed into making a decision, be patient.

8. Selecting an EMR on the basis of current requirements alone and not considering your foreseeable or possible future needs.

Growth is generally inevitable and you may take on new providers (multi-specialty?), offer new services, or use devices that need to interface with the EMR.

9. Believing that you or an appointed member of your practice has all the time, knowledge, and experience to handle almost a monumental responsibility for undertaking the research, screening, selection, negotiating, and implementation of the best suited EMR Software for your practice without guidance from an experienced EMR consultant. There are too many decisions to be made and if you stop and think about it, you may realize that you truly do not know all about the good, the bad and the ugly, about EMR selection, implementation, price negotiation, hardware selection and more. Engage with an EMR Consulting company to assist and work with you.

10. Not having a true picture of how the EMR will help create a true paperless office and what components will or will not be addressed by the vendor directly as part of implementation.

You must ask the EMR vendor to adequately demonstrate that their EMR Software will in fact increase efficiency and translate into increased revenues.

11. Not taking enough time to discover and evaluate the initial and recurring costs of implementing EMR.

This also includes understanding the technology underpinnings required to support the selected EMR. It would also greatly help if you define and require the line items expected on the proposal from every EMR vendor you are considering so that you can make the best apples to apples comparison between different EMR Software.

12. Not clearly understanding what the vendors always mean by that or this is included at no additional charge.

A good example of this is not clearly defining what they mean by a bi-directional interface with labs. There are actually two costs involved in setting this up and usually EMR Vendors mean that their side of the cost is included and that they can accommodate the connection but, someone (you) will have to pay for the other side of the connection.

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We would like to keep revising this list for the benefit of our future readers. Hence if you believe that there are other blunders made often by Physicians in EMR selection process, please do leave your comments. We will have an updated list avaialble for free download soon.

Learn about the top 10 EMR Software features that you should be looking for. Download our free article on Top 10 Electronic Medical Records features for every physician.

RevenueXL can not only help you select the right EMR Software, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

If you like this post, please subscribe to our Email Subscription to read our new posts in your email.

While there is a lot of talk these days about stimulus incentive for this and stimulus incentive for that, the fact is, many specialties are not really included in those Medicare offerings.  Take a look at Pediatrics for example, how many Medicare patients do you see sitting in a Pediatrician’s exam room waiting to be seen? That’s right, Zero! So why then are so many Pediatricians transitioning to EMR Software and at perhaps, an even faster rate then some other specialties whom have a big financial incentive from Uncle Sam to do so?  The answer is quite simple really, technological evolutionary progress, and after all , that is the American Free Enterprise way, right?  Right!

So, in the words of a famous sports ware maker, Just Do It!  And that is exactly what Pediatricians are doing when it comes to adopting well-developed Pediatric EMR Software.  This is especially noteworthy because unlike most of the more prevalent Baby Boomer generation specialties, Pediatrics has some pretty unique requirements that not many EMR vendors can satisfy, but those that can, are, and needless to say, they are extremely busy.

Here are the Top 11 Pediatric EMR Software features that Pediatricians are looking for when selecting an EMR Software for their practice:

1.  Easily access and incorporate into your chart notes age andgender specific growth charts with a single click.

2.  Immunization tracking.  See what has been given and what needs to be given. Health Maintenance and Preventive Care reminders and reporting for improving patientcare.

3.  Able to quickly print out consent forms and capture parent’s signature electronically.

4.  Perform well child exams through the use of knowledge-based templates or pre-populated intuitive learning software design.

5.  Easily document and access developmental milestones.

6. Document and review birth history and prenatal history.

7.  Fully integrated access to up to date pediatric dosage calculator and drug interaction checking and alert system to ensure appropriate patient treatment and safety. Prescriptions can be printed, faxed, or electronically sent to the pharmacy of choice including an updated national pharmacy database.

8. Fully integrated bi-directional electronic lab interface for ordering labs and receiving results that are easily attached to patients electronic chart. Lab orders can also be printed or faxed.

9.  Easy access to printable return to school forms, camp physical forms, or sports physical forms, all at the click of a button.

10. The ability to electronically chart notes or input vitals and other data with several on-the-fly ways including, point-and-click, voice recognition, handwriting recognition, or through the use of customizable and printable patient and doctor specific forms.

11. Interface with State Vaccine administrations for participating States.

As a 'by the way, but of course' #12, is that your EMR Software must have fully integrated electronic Medical Billing including easy tracking, posting, reporting, A/R management and, the option to process paper billing. 

So how do you find an EMR Software with all these qualities?  My advice, find a good EMR Consultant to help you select the best-fit EMR Software for your Pediatric Practice.  In fact, find one that will do this at no cost to you. 

CLICK HERE to find and speak with a reputable EMR Consultant who, at no cost to you, will help you find and select the best-fit EMR Software for yourPediatric Practice

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

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You probably spent several months in EMR vendor selection process. Right? Did you realize that you need to spend at least as much time in planning your EMR implementation, if you want to ensure a successful Electronic Medical Records implementation.

Unfortunately, we have found that this phase is often overlooked or underestimated resulting in poor satisfaction levels with EMR implementation.

No EMR Software implementation can be successful without a close working partnership between the EMR vendor and key members of the medical office. Moreover EMR implementation involves several parties - EMR vendor, Networking technician, IT expert, Billing staff, Nursing staff, Physicians, and more. Therefore, our strong recommendation is for potential EMR customers to insist on an EMR implementation project plan with detailed tasks, roles, responsibilities and dependencies clearly defined upfront.

EMR / EHR Software implementation can take anywhere from 10 weeks to several months depending upon many factors including number of locations and number of physicians, nursing staff, billing staff etc. who need to be trained.

While some EMR vendors offer onsite EMR implementation with their staff available during ‘go-live', others EMR vendors offer a completely offsite implementation assistance. It is our experience that EMR implementation is best handled by a judicious mix of offsite (or remote) and onsite implementation effort. As expected, onsite EMR implementation effort involves travel costs and therefore adds to implementation costs. Therefore work with the EMR vendor to work out a plan that assures successful EMR implementation. Some of the EMR implementation best practices include pre-implementation workflow analysis and re-design, not scrimping on training, customized training depending on roles, responsibilities and user profile, conducting go-live immediately after EMR training, etc.

Part 1 - Are you on the path to Guaranteed Failure in implementing an EMR Solution?

Learn more about the top 5 mistakes committed by the Practices who are on the path to guaranteed failure in EMR implementation. Download free article on Top 5 Project Management mistakes that you must avoid at any cost.

RevenueXL can not only help you select the right EMR csetificate, but also guide you in implementing your chosen EMR Software a.k.a. EHR Software.

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.

If you like this post, please subscribe to our Email Subscription to read our new posts in your email.

If you are out there trying to take on the daunting task of researching and finding an Electronic Medical Records Software solution (EMR) all on your own, the prognosis is bleak, the toll is high, and you will have a very bumpy road to travel. There is good news though, and all you have to do is take the Easy Street exit, just ahead. That's where you will find the right professional help to guide you through your EMR Selection Process, and save you a lot of time, money, and frustration. Good EMR Consulting Companies are hard to find, simply because there aren't many.

So, don't be fooled by some of the internet based so called EMR consulting companies that list dozens of EMR Vendors on their web site and claim that they will match you up with a list of EMR Vendors that will meet your needs. You cannot and will not find the best-fit EMR for your practice by checking off a bunch of little questionnaire boxes about your practice and what features you are looking for.

Once you get a list like that, then what do you do? Which one do you start with? How long will it take to go through the list and see a Demo of each one to find the best one? How will you know about all of the features and functionalities that are available, and which ones are appropriate for your practice? How will you know what an EMR costs? What about set-up, training, and implementation launch, hardware, software, and this list goes on and on.

The reality is, you are really no better off than when you started, as you might as well have done a simple google search, and wound up with virtually the same list, and most likely, you probably already did that anyway.

So my advice, find a good Independent Certified EHR or EMR Consulting Company to help select the best fit EMR for your Practice.  In fact, find one that will do this, at no cost to you.

Want to learn more?  Visit www.revenuexl.com and get the experienced help you need in finding the best-fit Electronic Medical Records Software solution for your practice and, at no cost to you.  

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RevenueXL Inc. assists medical practices in the assessment, selection and implementation of Medical Software including EMR Software (also called EHR Software), Patient Portal, and Practice Management or Medical Billing software. RevenueXL offers a free consultation session to review your current challenges and answer open questions revolving around EMR and revenue cycle.