Reed Tinsley, CPA

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EHR Incentive Program: 2014 Attestation Deadline for Eligible Professionals February 28

If you are an eligible professional participating in the Medicare Electronic Health Record (EHR) Incentive Program, you have until 11:59 pm ET on February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for CY 2014. The CMS Attestation System is open and fully operational, and includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Reminder: You must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

Payment Adjustments Payment adjustments were applied beginning January 1, 2015 for Medicare eligible professionals that did not successfully demonstrate meaningful use in 2013 (or 2014 for first-time participants) and did not receive a 2015 hardship exception. Medicare eligible professionals that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. The application period will open in early January 2015. For more information, please review the payment adjustment tipsheet.

How to Get a Copy of Your Prior Year Tax Information

There are many reasons you may need a copy of your tax return information from a prior year. You may need it when applying for a student loan, home mortgage or for a VISA. If you don’t have your copy, the IRS can help. It’s easy to get a free transcript from the IRS. Here are several ways for you to get what you need:

• Tax Return Transcript.  A return transcript shows most line items from your tax return just as you filed it. It also includes forms and schedules you filed. However, it does not reflect changes made to the return after you filed it. In most cases, your tax return transcript will have all the information a lender or other agency needs.
• Tax Account Transcript.  This transcript shows any adjustments made by you or the IRS after you filed your return. It shows basic data, like marital status, type of return, adjusted gross income and taxable income.

How to Get a Transcript.  You can request transcripts online, by phone or by mail. Both types of transcripts are free of charge. They are available for the most current tax year after the IRS has processed the return. You can also get them for the past three tax years.

Order online.  Use the ‘Get Transcript’ tool available on IRS.gov. You can use this tool to confirm your identity and to immediately view and print copies of your transcript in a single session for free. The tool is available for five types of tax records: tax account transcript, tax return transcript, record of account, wage and income and verification of non-filing.

Order by phone.  Call 800-908-9946. A recorded message will guide you through the process.

Order by mail.  The easy way to order your transcript by mail is to use the “Get Transcript by Mail” online option on IRS.gov. On the other hand, you can complete and mail Form 4506T-EZ to get your tax return transcript. Use Form 4506-T to request your tax account transcript by mail.

• How to Get a Tax Return Copy. Actual copies of your tax returns are generally available for the current tax year and as far back as six years. The fee per copy is $50. Complete and mail Form 4506 to request a copy of your tax return. Mail your request to the IRS office listed on the form for your area.

Delivery times for online and phone orders typically take 5 to 10 days from the time the IRS receives the request. You should allow 30 days to receive a transcript ordered by mail and 75 days for copies of your tax return. You can print tax forms online at IRS.gov/forms. To get forms in the mail go to IRS.gov/orderforms to place an order.

Is it "patient" or "customer"

Just read a pretty interesting article about patient vs. customer as the language being used in healthcare but not in any other industry.  The point was made that the word “patient” is now an antiquated term for healthcare consumer and in very real ways, patients are now customers shopping for care.  The origin of the word patient from the Latin means” one who suffers”….or more literally, “I am suffering”.

I can’t resist chiming in with my two cents on this discussion.  Having been a CPA and consultant in the healthcare industry for over 25 years; my first thought is that of the hundreds of physicians I have personally known not much has changed during my years.  Of course technology has revolutionized how physicians document and communicate about and with patients.  It has even changed how some specialties treat patients; but technology has not changed the vast majority of physician motivation.  

What motivates most physicians is two-fold and complex.  It drives their behavior both in and out of the office, hospital, OR, home.  They are driven to find ways to treat disease and eliminate suffering  in humans.  And they would like to make money while doing that.  It’s not that simple nor as easy to define, but for the sake of argument will use it.

I remember a pathologist client I worked for early in my career who while talking on the phone to a surgeon about a frozen section of a tumor, had on hold his stockbroker who was concerned about the diamond mines in South Africa the physician had holdings in.  The pathologist was totally committed to the surgeon who had a patient on the table and would give him nothing less than his very best trained and experienced diagnosis while at the same time talking to his broker.  

To deny that money doesn’t at all motivate physicians would be a mistake. To say money is the only motivator would be a bigger one.  None of us are simply motivated individuals.  Most of us carry dual roles and we call that normal. We are parents, spouses, friends, consumers while at the same time full time in the workforce.  What is different about doctors (at least the ones I have known) is that they are 100% committed to patients while at the same time wearing multiple hats as we all do.  We have never misunderstood why doctors make money in the past. Why do we now?  

Even with the current environment of patients being consumers and of course in many ways customers of healthcare. They are still patients to most of the providers of healthcare and are living better and longer to prove it.

Everyone reading this can immediately think of physicians they have known that they doubt the humanitarian side, so can I, but the vast majority are dedicated to their patients well-being and spend most of their lives ensuring that well-being and keeping suffering at bay.  

As long as there is suffering, I think the term "patient" still applies.

Medicare Learning Series - February 12, 2015

Join the CMS National Training Team as they review the annual Medicare calendar.

This session is designed for those who are new to learning about Medicare or for those who want a refresher.

CMS will take a close look at key dates including Medicare enrollment periods, beneficiary notices, star ratings and highlight when key data is released.

Join the webinar at https://webinar.cms.hhs.gov/ntplearnseriesfeb2015/ .

What does value based care really mean?

A new term is making an impression on healthcare…..”Value Based Care”.  What does value based care really mean?

“Healthcare is evolving from a proficiency-based art to a data-driven science, from freelance physicians to hospital-employed physicians, from one-size-fits-all community hospitals to vast hospital networks organized around centers of excellence. As more independent physicians begin to be hired by hospitals, the opportunity for large group practices and hospital consolidation grows. As consolidation expands, data and transparency become increasingly important, as a way to ensure that caregivers across the system are providing comparable care. All of this, of course, leads back to quality, which requires an effort to achieve standardization, reduce variation, and eliminate unpleasant surprises. Its analyzing processes, measuring outcomes, and changing practices until you get it right.”  At least that’s the way the Harvard Business Review has reported.  

The key factors that every practice can take away from the Harvard discussion are”

• More employed physicians
• More data mining for information to re-think medical decision-making
• Practice consolidation with other practices should be realistically considered
• Cost control does not have to mean compromise of patient care
• Providers will be paid less to deliver better care

And therein lays the rub!  How do you convince providers that it is in their interest to provide more cost effective and measurable care for less revenue?

The answer is probably in the age group of the providers.  For new providers, time off can bring value to them and should be considered in employment agreements as part of compensation.  For older providers, early retirement or part-time work is being considered by many of them.  20 years from now, most of the baby boomer providers will be retired and a new population of providers understanding new technology gains, and employment models will be equipped to embrace the Harvard scenario.  Until then, the business of healthcare will struggle with what will give patients better outcomes, reduce cost and continue to define value differently.  The gains will not be achieved through sweeping one time changes in protocols; but in consistent measuring and tweaking processes and changing habits that will bring meaningful change.

Data mining for better outcomes primarily means standardization.  The disparity between treatments among same specialties for very similar patients can be far-reaching.  The same diagnosis, the same patient geography and similar history can mean between $18,000 and $20,000 difference in treatment options.  Finding ways to standardize care through data mining and discovering ways to enhance outcomes based on large volumes of data to analysis will bring the largest gains in cost cutting. Large hospitals are doing this now as they utilize community health exchanges to accumulate data and analyze.

Compliance tip - Enable EMR tracking mechanism

Most EMR software programs include a tracking mechanism to help ensure patients have completed recommended tests and consultant referrals. However many physician practices do not use these systems or have yet to discover they even exist. These tracking systems can minimize exposure to allegations of failure to diagnose and can lead to better patient care. Specifically, these systems can provide a way for you to:

• Verify that the patient keeps the appointment or completes the test;
• Confirm receipt of a report;
• Prompt a call to the consultant, imaging center, or lab if a report is not received;
• Make sure the physician reviews the report;
• Communicate results to patients;
• Arrange for follow-up if needed; and
• Document all these steps with dates and electronic signatures.

How is your medical office's communications with your patients?

Physician and patient communication is at the heart of empowering positive outcomes. As payment models shift from payment for activity to payment for outcomes how to be a more effective at communication should be at the top of physician lists to improve.

The basics of communication continue to consume the priorities of writers, and old books about “how to” like How to Win Friends and Influence People continue to be best sellers. Regardless of how language and thought about communication has changed; the basics have remained.

Between physician and patient, there has never been a more important time to get communication right. While visiting a physician with my 88 year old father recently, several things struck me about communication and how it played a significant role in the visit.  The advent of the EHR has changed the patient visit dynamics.  During this particular visit, a nurse came in to get a full history.  The lap top was placed on a counter and the nurse with her back to the patient, my father, began to ask questions.  Repeatedly, my dad used non-verbal communication in reaction to a question……which of course the nurse did not see nor react to.  Like the question  “describe your pain”......there was a pause as my dad shrugged his shoulders …….the  nurse asked again, “describe your pain…on a scale of 1-10 1 being no pain And 10 being unbearable.”  Again a shrug of the shoulders and a numeric response.  The nurse was in her 20’s and while technically proficient, didn’t realize she was speaking to the “no pain” generation patient. She could have gotten a significantly more realistic answer if she has been watching and reacting to the non-verbal communication.

Hint number 1:  You can’t really communicate with a person you are not looking at.

As the nurse quickly ran through a list of diseases asking was there history, dad looked at me as she was going so fast, he really didn’t have time to answer before asking a second time.  

Hint number 2: Don’t rush conversations especially with elderly patients, give patients time to absorb the questions and to answer in their language.

Frequently, the nurse who was looking at the computer screen missed answers and had to ask for them to be repeated.  Now of course, giving the nurse the benefit of the doubt, learning to work with an EHR is no simple task and requires concentration and organized thoughts.  New technology brings new challenges and work flow changes that must be learned over time.  But….

Hint number 3:  Pay attention to the patient. Actively listen.

This may also require one to ask clarifying questions. Actively try to understand not only what the patient says, but what they mean. At the conclusion of the nurse interview, she said to dad…..”I’m going to repeat back what I heard you say was your chief reason for being here today, you tell me if you agree.”   That was right on…..right out of how to effectively communicate 101.

Hint number 4: Repeat back what you believe you heard.

All this takes time and a focused effort to hear and be heard.  But with outcomes depending upon patients understanding their roles and responsibility in this patient provider dance, and revenue streams increasingly dependent on outcomes, isn’t it worth it?

Taking your EHR to the next level in your physician practice

Your practice has bought an EHR system.  Although you have struggled with implementing, providers and staff are now familiar with the product and you are using daily in your practice.  What’s the next step?  How can you use digital records to decrease cost and improve clinical outcomes? Here are some ideas:

• Have patients fill out forms online instead of paper forms in the office.  This will decrease wait times, give the patient to complete all the requested data without feeling rushed, allow patients to answer all the questions without skipping sections not having access to information.  Some practices are even charging for not using on-line forms.  While this may seem over-bearing, providers have found that creating a digital expectation of patients serves both the patient and the practice well.
• Lab and x-ray results can be posted in the digital record.  Upon review, the provider can email (via a secure patient portal) patient with instructions or changes in medications.  This will require patients and staff to use the EHR on a regular basis and may present a learning curve for both; but using on a regular basis will dramatically reduce phone calls and time on phone.  This may provide opportunity to reduce front-end staff.
• No more paper charts mean a more organized and instantly retrievable chart.  No more time spent hunting down pieces of paper, reading someone’s writing, or waiting for someone to finish with chart so others can chart or look at data.  Multiple persons can both look at chart and record in chart at the same time.
• Downloading data from patients with similar conditions can help a provider more easily identify efficacy of treatments and medications. From data collection to treatment options now becomes a realized practice.  Data manipulation and analysis will be the next big step for practices.

Medicare claims for post-op care being denied as a billing error

When reporting claims for post-op care, the date of surgery is the date of service. Also, if there is a range of dates of service, report the range of dates in block 19 of the 1500 claim form or the electronic equivalent. Be sure to report an appropriate modifier to indicate that you are billing for post-op care.