Compliance and Process Management in Software

Take a look at how new regulations are highlighting outcomes-based patient care, and how you can work hand-in-hand with your EHR technology to effortlessly maintain compliance within your practice.

A provider’s EHR software system is a central part of their practice. And because of its leading role, it should play the part to assist the practice in maintaining order, consistency, accuracy, and most of all—compliance.

With a constant onslaught of new programs, mandates, code sets, and formats, it can be hard to keep up with the ever-changing regulations littering the health care landscape. Here we’ll simplify the facts surrounding the formidable EHR Incentive program audit, the PQRS program (which can pay you back for your efforts), and how an EHR software system can help make adhering to the rules and participating in outcomes-based, compliant patient care a few clicks easier.

Should I be worried about EHR Incentive Program audits?

Although non-participation in the EHR incentive program comes with a Medicare reimbursement penalty beginning in 2015, many providers seem just as concerned about the possibility that participating will invite an audit as they are of acquiring a reimbursement.  The fact of the matter is that as long as your software is EHR certified and you keep adequate and accurate documentation on-hand, audits shouldn’t be preventing you from stepping forward to receive that incentive.

Currently, pre- and post-payment audits are performed on about 20% of participating providers. Simply keeping documentation on file for six years that supports your attestation data for meaningful use objectives, payment calculations, and clinical quality measures will help you breeze through a potential audit with flying colors.

What is PQRS?

In addition to gaining a stimulus reimbursement through the EHR Incentive program, chiropractors can use their meaningful use quality measures data to take advantage of the PQRS (Physician Quality Reporting System) Incentive Program. This program offers payments of 0.5 percent of Medicare reimbursements through the 2014 calendar year, and can help providers avoid penalties in subsequent years.

The Physician’s Quality Reporting System (PQRS) represents efforts by CMS to implement a quality measure reporting program for Medicare providers. The program was mandated by Congress as part of the Tax Relief and Health Care Act of 2006 (TRHCA). It’s important to note that participation in Medicare’s PQRS program is mandatory beginning in 2015. If you did not successfully participate in PQRS during the 2013 calendar year, expect to face a penalty of 1.5% of your Medicare reimbursements beginning in 2015. In 2016, the payment penalty will increase to 2%, so keep in mind that you can still prevent penalties in 2016 and beyond by starting now.

What does PQRS mean for the chiropractic profession?

Participation in PQRS can help demonstrate that doctors of chiropractic are patient-centered and concerned about providing value-based care, as the program requires close attention to outcome assessments. Outcome assessments are being highlighted to help digital practices better characterize successful outcomes and compensate doctors for the outcomes they produce rather than simply the treatments they perform.

Chiropractors can participate by successfully performing both measure #131 and #183, and by placing G-codes on claims with every visit in which they bill a 98940, 98941 or 98942 with the AT modifier. Keep in mind that you must report Measures 131 and 182 on every visit for every Medicare patient 18 years old or over. Want an easier way to maintain compliance? Let your EHR system do the heavy lifting. For example, the ChiroTouch software system makes it easy with macros that automatically post the appropriate G-code charges for each patient visit, helping you complete the proper reporting automatically.

EHR implementation isn’t all about avoiding penalties. An EHR software system can help you streamline your documentation and increase your coding compliance, prepare your practice for an audit, reduce errors with automatic checks for contraindications, provide clinical alerts and reminders to help you perform routine or problem-specific care, improve aggregation and analysis of relevant patient information, support evidence-based decision making, and demonstrate and record adherence and compliance with current government health care standards.  Contact ChiroTouch to learn more about how we can keep your practice running with a comprehensive approach to billing, compliance, and industry standards.