Updated: 11:00 PM Mar 10, 2011Azalea Health Innovations: Eye on BusinessEye on Business report heads to Valdosta.Posted: 10:54 PM Mar 10, 2011Reporter: newsEmail Address: news@wctv.tv

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Azalea Health Innovations Friends Newsletter – March 2011

IN THIS ISSUE

* Welcome
* 2011 Electronic Prescribing (eRx) Incentive Program Reminder: Avoiding the Adjustment
* Billing Tip: 25 Modifier
* ICD-10 and HIPAA 5010 Compliance
* HIMSS: Nearly half of hospitals ready for Stage 1 of meaningful use
* New Features
* Upcoming Events

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Welcome

Hello to all of our Azalea Health Innovations friends. Thank you for reading this month’s Newsletter. We hope you all enjoy!

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2011 Electronic Prescribing (eRx) Incentive Program Reminder: Avoiding the Adjustment

In November, the Centers for Medicare & Medicaid Services announced that, beginning in calendar year 2012, eligible professionals who are not successful electronic prescribers based on claims submitted between January 1, 2011 – June 30, 2011, may be subject to a payment adjustment on their Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether or not the eligible professional is planning to participate in the eRx Incentive Program.

From 2012 through 2014, the payment adjustment will increase each calendar year.  In 2012, the payment adjustment for not being a successful electronic prescriber will result in an eligible professional or group practice receiving 99% of their Medicare Part B PFS amount that would otherwise apply to such services.  In 2013, an eligible professional or group practice will receive 98.5% of their Medicare Part B PFS covered professional services for not being a successful electronic prescriber in 2011 or as defined in a future regulation. In 2014, the payment adjustment for not being a successful electronic prescriber is 2%, resulting in an eligible professional or group practice receiving 98% of their Medicare Part B PFS covered professional services.

The payment adjustment does not apply if <10% of an eligible professional’s (or group practice’s) allowed charges for the January 1, 2011 through June 30, 2011 reporting period are comprised of codes in the denominator of the 2011 eRx measure.

Please note that earning an eRx incentive for 2011 will NOT necessarily exempt an eligible professional or group practice from the payment adjustment in 2012.

How to Avoid the 2012 eRx Payment Adjustment

Eligible professionals – An eligible professional can avoid the 2012 eRx Payment
Adjustment if (s)he:
- Is not a physician (MD, DO, or podiatrist), nurse practitioner, or physician assistant as of Jun 30, 2011 based on primary taxonomy code in NPPES;
- Does not have prescribing privileges. Note: (S)he must report (G8644) at least one time on an eligible claim prior to June 30, 2011;
- Does not have at least 100 cases containing an encounter code in the measure denominator;
- Becomes a successful e-prescriber; and
- Reports the eRx measure for at least 10 unique eRx events for patients in the denominator of the measure.

-Group Practices – For group practices that are participating in eRx GPRO I or GPRO II during 2011, the group practice MUST become a successful e-prescriber.
Depending on the group’s size, the group practice must report the eRx measure for 75-2,500 unique eRx events for patients in the denominator of the measure.

For additional information, please visit the “Getting Started” webpage at http://www.cms.gov/erxincentive on the CMS website for more information; or download the Medicare’s Practical Guide to the Electronic Prescribing (eRx) Incentive Program under Educational Resources.

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Billing Tip: 25 Modifier

The 25 modifier is one of the most commonly under used and over used modifiers for medical billing. The exact definition and proper usage of the modifier often get misinterpreted.

Definition:
Significant, separately identifiable Evaluation and Management services by the SAME provider on the same day of the procedure or other service.

Modifier 25 indicates that on the day of a procedure, the patient’s condition required a significant, separately identifiable E/M service, above and beyond the usual pre- and post-operative care
associated with the procedure or service performed.

Example:
New patient presents to the office with a suspicious lesion located on his right leg. During the visit the physician notes the symmetry and discoloration of the lesion. The physician then discusses with the patient the necessity of ruling out skin cancer by performing a biopsy. The patient consents and the physician performs the biopsy. Documentation supports a Detailed History, Expanded Problem Focused and Moderate Medical Decision Making.

This is a good example of an appropriate situation in which the usage of modifier 25 becomes necessary. When coding the claim for these services, the 25 modifier is appended to the E/M code and NOT the procedure code. In most cases the usage of the 25 modifier will allow for payment on both the E/M code and procedure code on the same date of service. Not using the 25 modifier will likely mean the procedure will be paid and the E/M visit denied as bundled or incidental to the primary procedure. It is important that the medical record support your usage of this modifier.

Often medical practices will use modifier 25 inappropriately. Examples of inappropriate usage include:
1. A physician who performs the E/M services is not the physician performing the procedure.
2. Documentation shows the amount of work performed is consistent with that normally performed with the procedure.

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ICD-10 and HIPAA 5010 Compliance

As most of you are already aware ANSI 5010 and ICD-10 conversion deadlines are approaching. Currently, HIPAA requires a 4010A1 transaction standard for healthcare claims, remittance advices, eligibility, claims status, referrals, and NCPDP version 5.1 for pharmacy claims. However, the new 5010 transaction standards are mandated by the Centers for Medicare and Medicaid Services as an industry upgrade, designed to increase transaction uniformity, support pay-for-performance, streamline reimbursement transactions, and support ICD-10 codification.   Through implementation, the data submitted with claims, as well as the data you receive in response to your electronic inquiries, will change substantially.

Here is a list of the important dates for ICD-10 and 5010 implementation:
- January 1, 2012: 5010 compliance begins. Current formats including print images and 4010A1 will be accepted, for now.
- October 1, 2012: ICD-10 codes are set to replace the ICD-9 code set, following 5010
implementation.

ICD-10 are coming along in response to ICD-9 Clinical Modification (CM) codes that are nearly 30 years old, with many of its diagnosis categories full, preventing further expansion. ICD-9 also is not a flexible coding system to quickly incorporate emerging diagnosis and procedures. ICD-10 CM codes are more detailed, allow ample space for capturing new technology and devices, and have a logical structure with clear and consistent definitions.

Providers need to make sure that they are prepared for the implementation of these standards. Azalea PM™, through Gateway EDI, can leave you assured that the implementation of HIPAA 5010 transactions will run smoothly in your practice. Also, Azalea PM™ already allows for the most up-to-date ICD-9 and CPT codes, and ICD-10 codes will be no different.

Contact Azalea Health Innovations today to find out about implementing a more compliant and capable practice management system for your practice at sales@azaleahealth.com or 1-877-777-7686.

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HIMSS: Nearly half of hospitals ready for Stage 1 of meaningful use

According to a new survey released this past month at the Healthcare Information and Management Systems Society’s 2011 conference, nearly half of hospitals are ready to meet Stage 1 meaningful use requirements. Out of the hospitals responding to the survey, 44% stated they are “most likely” or “likely” to meet Stage 1 meaningful use measures and objectives. Further, from the 44%, 58% said they expect to achieve all of the meaningful use core measurements by May 2012.

The data from the survey illustrates how financial incentives are being tied to the successful implementation of electronic health records. To qualify under the Centers for Medicare and Medicaid Services EHR Incentives Program, facilities must successfully demonstrate meaningful use of EHR technology by 2013. The survey was conducted by HIMSS Analytics, a nonprofit subsidiary of HIMSS, and the organization began collecting data in May 2010. The annual survey included more than 5,000 hospitals across the country.

Are you ready for meaningful use? Find by looking at the Government Incentives Center on our website:  http://www.azaleahealth.com/incentives.

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New Features

At Azalea Health Innovations our goal is to keep our clients up-to-date with the most innovative technology by providing them with the highest quality products and tools necessary to succeed.  Due to the dynamic nature of the medical industry, we are constantly updating and enhancing our software. One of the major advantages of utilizing our web-based applications is that all new features and upgrades are available to our clients in real time. Over the past couple of weeks we have added even more components to Azalea PM™, making our system even more efficient and user friendly than before. We appreciate all our clients’ requests, as their feedback is important for the growth and optimization of our products and services. In case you missed out on last month’s New Features email we invite you to visit the following link, New Features - February 2011, to catch up on the features added last month. Look out tomorrow for our New Features – March 2011 email to learn how to best utilize the newest features developed to enhance your practice management system!

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Upcoming Events

AHI will be showcasing a variety of products and services, including Azalea PM™ and Praxis EMR, at the MGMA/ Winter Conference in Birmingham, AL. The conference will be held at the Wynfrey Hotel, March 2-4, 2011. We will be located at booth #35. Come by and say hello!

AHI will be exhibiting Azalea PM™ and many other products and services at the upcoming MGMA/ Annual Conference in Orlando, FL. The conference will be held at the Caribe Royale Resort, May 9-10, 2011.

AHI will be showcasing Azalea LabHub™ at the CLMA ThinkLab 2011 Conference in Baltimore, MD. The conference will be held at the Baltimore Convention Center, May 22-24, 2011. We will be located at booth # 325. Come by and say hello!

AHI will be promoting Azalea PM™, EMR solutions, and our Revenue Cycle Management
services at the Alabama Academy of Family Practitioners (AAFP) 2011 Annual Meeting and Scientific Symposium. The conference will be held June 23-25, 2011 at the Sandestin Resort in Destin, FL.

AHI will be exhibiting our Azalea PM™ product, Revenue Cycle Management Services, and much more at the MGMA / Summer Conference in Destin, FL. The conference will be held at the Hilton Sandestin Beach and Golf Resort. August 1-3, 2011.

We hope to see all of you at our upcoming events!

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Thank you!

Azalea Health Innovations, Inc.
100 North Patterson Street
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

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