Welcome
Greetings to all of our Azalea Health Innovations friends and thank you for reading this month’s newsletter. We hope everyone had a wonderful Holiday and is looking forward to a prosperous 2012!

ONC Looks to Hollywood for Consumer Engagement Advice
The Office of the National Coordinator for Health IT has hired a production company out of California to develop a video that will voice to the public the need for EHR and other healthIT products. According to the ONC, it is important for the population to encourage their health care providers to become more technologically advanced. Many consumers do not understand the significance of having access to their health information and what this will enable them to do. The video short will convey the message of necessity for healthIT by describing features such as convenience, enhanced accuracy, and safer care.

Mobile Healthcare Information and Management Systems Society (mHIMSS)

Billing Tip: Medicare Pay Cut Postponed Again
Once again, Congress has enacted a last minute reprieve from the dreaded 27 percent physician fee schedule pay cut. The latest pay cut was scheduled to go into place on January 1st, 2012. According to the American Medical Association (AMA), the House of Representatives and Senate both passed bills putting off the pay cut for another two months until February 29th, 2012. In January, A House-Senate conference committee will convene to attempt a longer term agreement.

2012 Electronic Prescribing (eRx) Incentive Program Payment Adjustment Feedback Report Update
The Centers for Medicare & Medicaid Services would like to advise providers that due to the high volume of significant hardship exemption requests received, it is no longer technically feasible for CMS to provide a 2012 Electronic Prescribing (eRx) Incentive Program payment adjustment feedback report as originally intended.

As CMS continues to explore alternative means to notify eligible professionals that they are subject to the 2012 eRx payment adjustment, we urge you to review your remittance advices for claims submitted for dates of services on or after January 1, 2012.

Eligible professionals and group practices (GPRO) participating in the eRx GPRO that receive the 2012 eRx payment adjustment will see the term “LE” on their remittance advice for all Medicare Part B services rendered January 1-December 31, 2012.

The remittance advice will also contain the following Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC):

CARC 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

RARC N545 – Payment reduced based on status as an unsuccessful e-prescriber per the Electronic Prescribing (eRx) Incentive Program.
If an eligible professional or group practice that participated in the eRx GPRO receives the payment adjustment in error (e.g., the eligible professional or group practice submitted a hardship exemption request that is ultimately approved by CMS), the claim will be reprocessed to return the 1.0% and the remittance advice for the reprocessed claim will include the following codes and messages:

CARC 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

RARC N546 – Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
For more information on how the 2012 eRx payment adjustment will be assessed and applied, please refer to MLN Matters Article SE1141 for additional information. Or feel free to visit the eRx Incentive Program webpage at http://www.cms.gov/erxincentive on the CMS website.

Upcoming Events:
AHI will be exhibiting Azalea Labhub℠ at the CLMA ThinkLab’12 – Clinical Laboratory Management Association. The event is being held at the Georgia World Congress Center in Atlanta, GA on April 29 – May 2, 2012.

AHI will be exhibiting at the GPT- Georgia Partnership For Telehealth Annual Spring Conference. The event is being held at the Ritz-Carlton Reynolds Plantation in Lake Oconee, GA on March 14-16, 2012.

Thank you!

Azalea Health Innovations, Inc.
Azalea Health Innovations, Inc.
105 West Central Avenue
Valdosta, GA 31601
Toll Free: 877-777-7686
Local: 229-269-4620
Toll Free Fax: 866-683-8679
Web: http://www.AzaleaHealth.com
Email: info@azaleahealth.com

Click the links below to stay in touch:
http://www.facebook.com/pages/Azalea-Health-Innovations/145238319941?ref=ts
http://twitter.com/azaleahealth
http://www.linkedin.com/groups?gid=2791313&trk=myg_ugrp_ovr
http://www.youtube.com/user/azaleahealth

IN THIS ISSUE

* Welcome
* Beta Release of Azalea℠ EHR available December 1st or New Software Platform
* What is an ACO?
* How the Version 5010 Changes Modify Your Transition
* Billing Tip: 25 Modifier Usage
* Events

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Welcome

Greetings to all of our Azalea Health Innovations friends and thank you for reading this month’s newsletter. We hope everyone had a wonderful Thanksgiving and we wish everyone a happy and healthy holiday season in December!

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Beta Release of Azalea℠ EHR available December 1st

We are currently in the process of beta releasing the new Azalea℠ EHR and completely redesigned Azalea℠ PM to select beta clients.   For further information about our beta testing program, or for more information on the specifics of Azalea℠ EHR and Azalea℠ PM, please contact us at: http://www.azaleahealth.com/contact

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What is an ACO?

An accountable care organization (ACO) is a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then provides care to a group of patients. The ACO may use a range of different payment models (capitation, fee-for-service with asymmetric or symmetric shared savings, etc.). The ACO is accountable to the patients and the third-party payer for the quality, appropriateness, and efficiency of the health care provided. According to the Centers for Medicare and Medicaid Services (CMS), an ACO is “an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.”

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How the Version 5010 Changes Modify Your Transition

90-Day Period of Enforcement Discretion for Compliance with Version 5010 Deadline
The Centers for Medicare & Medicaid Services (CMS) recently announced a 90-day enforcement discretion period for all HIPAA covered entities regarding the Version 5010 (ASC X12 Version 5010) transition.

The compliance deadline for the implementation of Version 5010 is still January 1, 2012; however, CMS will not initiate enforcement action until March 31, 2012. CMS made this decision based on industry feedback that many organizations and their trading partners were not yet ready to finalize system upgrades for this transition.

CMS encourages you to continue internal testing and external testing of Version 5010 transactions with trading partners to ensure compliance for Version 5010. Although enforcement action will not be taken prior to March 31, 2012, it is important that you continue to move forward to meet Version 5010 requirements as soon as possible.

During the 90-day enforcement discretion period, the Office of E-Health Standards and Services (OESS) will continue to accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards beginning January 1, 2012. HIPAA covered entities that are subject to these complaints must produce evidence of either compliance or an established plan to become compliant within the enforcement discretion period. In addition to testing, if you have not yet created a transition plan for Version 5010, you should do so in order to meet these compliance deadlines.

Please visit the CMS ICD-10 Website Latest News page for additional resources and more information on this enforcement discretion period.

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Billing Tip: 25 Modifier Usage

How do I know if I am utilizing the 25 modifier properly?

As a company that both develops practice management software and provides Revenue Cycle Management services, we often get questions about the proper usage of the 25 modifier. We like to refer to the “Use of Modifier 25” study released by the Office Of Inspector General (OIG) under the Department of Health and Human Services in 2006. This release (while 23 pages long) provides excellent insight into the proper and improper usage of the modifier as well as the documentation guidelines. We also like to reference Chapter 12 Sections 30.6.6(B) and 40.2 Of the Medicare Claims Processing Manual.

From the OIG Manual:

Guidance and Outreach
Modifier 25 is used to facilitate billing of evaluation and
management services on the day of a procedure for which separate
payment may be made. It is used to report a significant,
separately identifiable evaluation and management service
performed by the same physician on the day of a procedure. The
physician may need to indicate that on the day a procedure or
service that is identified with a [Current Procedural Terminology]
code was performed, the patient’s condition required a significant,
separately identifiable evaluation and management service above
and beyond the usual preoperative and postoperative care
associated with the procedure or service that was performed.

Required Documentation

• Clinical information confirming that the E/M service billed was above and beyond the E/M services included in the procedure,

• Information to support that the provider submitting the claims for payment is the same provider that furnished both the medical procedure(s) and the E/M service, and

• Information indicating that a single beneficiary received both the medical procedure(s) and the E/M service billed.

Keep in mind that Modifier 25 should only be used with the E/M portion of the claim and not on the procedure itself.

Example: Code a level 3 office visit for an established patient with a benign lesion excision, trunk, arms, or legs, excised diameter 0.6 to 1.0 CM

Correct Usage:
99213-25
11401

Incorrect Usage:
99213-25
11401-25
or
99213
11401-25

How do I know when to use modifier 57 vs 25?
It basically depends on the type of procedure (minor vs major surgery) being performed and its global period (0,10, or 90 days).

From Chapter 12 Section 40.2 Of the Medicare Claims Processing Manual:

You can use Modifier 57 in situations when:
Evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately.

If evaluation and management services occur on the day of surgery, the physician bills using modifier “-57,” not “-25.” The “-57” modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.

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Upcoming Events:

AHI will be exhibiting Azalea Labhub℠ at the CLMA ThinkLab’12 – Clinical Laboratory Management Association. The event is being held at the Georgia World Congress Center in Atlanta, GA on April 29 – May 2, 2012.

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Thank you!

Azalea Health Innovations, Inc.
105 West Central Avenue
Valdosta, GA 31601
Toll Free: 877-777-7686
Local: 229-269-4620
Toll Free Fax: 866-683-8679
Web: http://www.AzaleaHealth.com
Email: info@azaleahealth.com

Click the links below to stay in touch:
http://www.facebook.com/pages/Azalea-Health-Innovations/145238319941?ref=ts
http://twitter.com/azaleahealth
http://www.linkedin.com/groups?gid=2791313&trk=myg_ugrp_ovr
http://www.youtube.com/user/azaleahealth

IN THIS ISSUE

* Welcome
* Azalea Health Innovations, Inc. releases Azalea℠ EHR
* It’s Not Too Late to Benefit From the EHR Incentive Programs
* Billing Tip: Usage of Revised ABN Requirement extended to Jan 2012
* Events

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Welcome

Greetings to all of our Azalea Health Innovations friends and thank you for reading this month’s newsletter.

———-
Azalea Health Innovations, Inc. releases Azalea℠ EHR

VALDOSTA, Ga — October 24, 2011 — Azalea Health Innovations, Inc. is proud to announce the release of their cloud-based Electronic Health Records system, Azalea℠ EHR. Azalea℠ EHR is a suite of Azalea Health systems that includes advanced medical systems including Azalea℠ EMR, Azalea℠ PM, Azalea Labhub℠, Azalea℠ PHR, Azalea℠ eRx, and Azalea℠ Pre-Cert. Azalea℠ EHR is the latest product developed by Azalea Health Innovations, proving themselves as a company that is continuously on the cutting-edge of medical technology. By using the ONC-Certified Azalea℠ EHR, physicians who are Eligible Providers can easily meet the guidelines for ‘Meaningful Use’ and can benefit from the Medicare and Medicaid EHR Incentive Programs.

The Azalea℠ EHR  system works seamlessly to allow the user to operate their paperless practice with the continuity and confidence that have become the hallmark of Azalea Health Innovations. The simple, web-based Azalea℠ EHR encompasses the entire spectrum of a medical practice from scheduling, charting, e-prescribing, billing, online CPOE, online personal health records and Meaningful Use certification. Azalea℠ EHR features a dashboard that makes it easy to track how close providers are to meeting ‘Meaningful Use’ requirements. Azalea℠ EHR also provides access to patient education and a secure messaging system between the patient and his/her provider(s) that is fully HIPAA compliant.

Because Azalea℠ EHR is built with modern web standards there is no need to purchase additional hardware or software, thereby making it an affordable solution for the healthcare community. “We designed Azalea℠ EHR to make the process of meeting Meaningful Use as easy as possible”, said Baha Zeidan, CEO of Azalea Health Innovations. “Our company is committed to developing the best software possible while keeping it financially accessible to every type of practice and physician. Because Azalea℠ EHR is web-based, implementation of our systems is cost-effective and simple.”

For more information, please visit http://www.azaleahealth.com/ehr

To sign up for a free 3 month trial visit https://www.azaleahealth.com/ehr_registration

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It’s Not Too Late to Benefit From the EHR Incentive Programs

Even if you haven’t adopted a certified EHR for your practice yet, you can still benefit from the EHR Incentive Programs for Medicare and recoup the full $44,000 in incentive money. If  you are an Eligible Provider and you start using your certified EHR  by January 01, 2012 and begin demonstrating ‘meaningful use’, you can still receive the maximum benefits of the incentive program. The timeline for receiving your benefits will only be pushed back one year, meaning that you will receive payments starting in 2012 and ending in 2016. You can still participate into 2013 or 2014 but the incentive payments will be reduced. Take full advantage of the EHR Incentive Programs for Medicare and being the process of selecting a certified EMR today.

To view the CMS Medicare and Meidcaid EHR Incentive Programs Milestone Timeline, click here
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Billing Tip: Usage of Revised ABN Requirement extended to Jan 2012

Previously the Centers for Medicare & Medicaid Services (CMS) set a requirement that all providers (including labs, physicians, practitioners, and suppliers) begin using the revised ABN by November 1st 2011. Medicare has extended this requirement to January 1st of 2012. ABNs are to be used in situations where it is expected that Medicare will deny payment for a certain service or supply. If such a situation occurs, the patient signs the ABN as an acknowledgement that the services or supplies they are about to receive may not be covered and that they may receive a bill from the provider if in fact the claim is denied for non-coverage.

We have provided the above mentioned revised ABN in PDF formats along with the instructions as provided from CMS.

• PDF ABN (english version)
• PDF ABN (spanish version)
• ABN Instructions

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Upcoming Events:

AHI will be attending the HomeTown Health 12th Annual Fall Conference at Callaway Gardens in Pine Mountain, GA this November. The conference is from November 16th – November 18th and promises to be a great time to meet with a network of rural hospitals, healthcare providers and best practice business partners.

AHI will be exhibiting Azalea Labhub℠ at the CLMA ThinkLab’12 – Clinical Laboratory Management Association. The event is being held at the Georgia World Congress Center in Atlanta, GA on April 29 – May 2, 2012.

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Thank you!

Azalea Health Innovations, Inc.
105 West Central Avenue
Valdosta, GA 31601
Toll Free: 877-777-7686
Local: 229-269-4620
Toll Free Fax: 866-683-8679
Web: http://www.AzaleaHealth.com
Email: info@azaleahealth.com