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Are you ready for ICD-10?

Benchmark Systems Practice Management System is. 

Hopefully, by now your office has started thinking about the implementation of the International Classification of Disease codes, revision 10(ICD-10).  This classification of diseases and related health issues is supported and promoted by the World Health Organization(WHO).   Many countries around the world have already started using this latest classification.  In fact, countries like Australia and Sweden have been using this latest revision since the late 1990’s.

Now, it is time for the United States to jump on board.  CMS has determined that all practices and insurances companies start communicating using the ICD-10 format starting on October 1st of 2014.  But, it is never too early to start getting your practice prepared for the change.  Software companies, insurance providers and electronic clearinghouses are already in the process of testing and preparing their software and connections for this change.

In fact Benchmark Systems Practice Management software has just released the latest version of their software that fully supports upgrading your practice to, and the ongoing usage of the ICD-10 code set. 

 

What does this mean for you?

As a practice you need to first become familiar with the new ICD-10 code set.

The code set allows more than 14,400 different codes and permits the tracking of many new diagnoses. The codes can be expanded to over 16,000 codes by using optional sub-classifications.  The basic structure of the ICD-10 code is the following: Characters 1-3 (the category of disease); 4 (etiology of disease); 5 (body part affected), 6 (severity of illness) and 7 (placeholder for extension of the code to increase specificity).  In general  what this means for your practice is that a specific code that you might have used in the ICD-9 code set will usually translate to multiple codes representing the same disease, but allow for more specific and detailed identification.  It is highly recommended that your practice staff become familiar with the new code set.  There are several resources you can access to help you with this process. Access the WHO web site for several online training resources and additional information about ICD-10 (http://www.who.int/classifications/icd/en/)  CMS also has online resources to assist you with your transition to ICD-10 (http://www.cms.gov/Medicare/Coding/ICD10/Index.html).  There are also free online ICD books that will help you with the transition to ICD10.  ICD9Data.com(http://www.icd9data.com) is a site that allow you to search for and see information about an ICD-9 code. It also provides a link to the corresponding ICD-10 code(s) on the site http://www.icd10data.com.

As a practice you need to evaluate the readiness of your current practice management and billing software to handle the change to ICD-10.

Check out your software companies web site and contact their support department to determine what they have done and are doing to ensure their software is ready to help you transition to and support ICD-10.  If you have concerns about their readiness, start a search as soon as possible for software the will be able to support this new code set.

As a practice you need to determine a cut-over date for when you will start using ICD-10.

Once this date is determined, start using ICD-10 and don’t look back.  Depending on the process your software system allows, it would be best if you could start using the ICD-10 codes prior to the 10/1/2014 deadline.  This will help ensure there is no interruption of cash flow once we reach the deadline.   Now, it is true that many insurance companies will not accept the new codes until the deadline is reached.  But, if your software system is developed with the practices best interest in mind, it will have ways for you to start using ICD-10 and make the appropriate accommodation  to send the correct code ICD-9 or ICD-10.

As a practice you need to continue to monitor the readiness of all parties participating in your financial workflow.

You should continue to monitor your software systems web site, insurance company web site, clearinghouse web site and any announcements from CMS that pertain to ICD-10.  As you may be aware the deadline for usage of ICD-10 has already been extended once.  It is possible for this to happen again.  So, continue to monitor the situation to keep yourself informed.

A year from now, I hope we will all look back at this transition and think “what was the big deal?”  Then we can all move forward with using the latest code set that allows for much more clarity in identification of diseases, not to mention catching up with the rest of the world.  But, being prepared and informed as a practice will get us all closer to making my hopes a reality.


Meeting Meaningful Use

As you probably know by now, Medicare & Medicaid EHR Stimulus programs provide incentive payments to physicians if they can qualify for the Meaningful Use of a certified EHR technology.  Over 350,000 eligible physicians have registered with Medicare and Medicare for stimulus payments and over 3.7 billion dollars have been paid out since 2011.  In 2013, physicians can still get up to $39,000, payable over four years.  But if they decide to wait another year, the payment drops down to $24,000 in 2014 payable over three years.  Starting in 2015, there are no more payments. Practices that have chosen to remain on a paper system have and will continue to be penalized in their Medicare and Medicaid payment checks.

There is another side to the Stimulus program. Many providers who purchased EHR software are not qualifying for Meaningful Use. As per the latest CDC study only 27%. The reason lies in the fact that although certified, most EHR’s won’t attest for the basic requirements of Phase 1 or Phase 2, which is more difficult.

To qualify for Stage 1 of Meaningful Use, eligible physicians must meet all 15 of the Stage 1 core objectives and 5 of 10 menu set objectives using certified EHR software. The reporting period for the first year is any 90 continuous days during the calendar year.  In order to meet Meaningful Use, EHR software must provide the specific fields needed to capture data and measure outcomes.  If any required data is missing because it can’t be or was not captured, Stimulus funds will not be paid.

The selection of an EHR is one of the most important decisions a practice will make.  The goal is to not only choose the correct software but the company behind it. Free and inexpensive solutions are usually too good to be true. The right company will provide the training, implementation, support, and help to pass attestation.

Many physicians now find themselves working with EHR software that is certified but has not been able to qualify for Meaningful Use! If you’re one of these physicians, it is not too late! There is still time to change to an EHR that will meet your needs and qualify you for at least $39,000 of Meaningful Use.

If you are in the search for the right EHR, this is your first and final chance to get it right.  Consider if the software vendor has references that have already met Stage 1 of Meaningful Use.  Here at Benchmark, we guarantee our EHR will qualify or we will pay the Stimulus dollars! If you go with Benchmark, you get paid either way.

Jacques Kreisler


Benchmark’s Reputation as Observed by Employees and Customers

I was hired about a month and a half ago as Benchmark’s new Marketing Intern. I am currently in my last semester at Liberty University earning my undergraduate degree. Before applying at Benchmark, I had no experience in healthcare apart from my yearly doctor’s office visits and my mom’s opinions as an experienced RN. My initial weeks here at Benchmark included a whirlwind of new information that I had no idea existed! The concepts of practice management systems, and electronic health records were completely foreign to me.

One of the first tasks I was given while working at Benchmark included gauging customer satisfaction in relation to the products that they have purchased. With a new and unbiased point of view without any prior knowledge about the software or healthcare industry, I was able to listen to customers and learn about Benchmark Systems from their point of view.

I learned that although Electronic Health Records and Practice Management systems seem complicated, the Benchmark employees and support have made it easy for customers to understand!

While interviewing the different clients, I was pleasantly surprised to find that the majority of the feedback was positive and true to what I have observed of Benchmark employees while working here. Many different phrases shared by the practices I interviewed included that Benchmark Systems provides solutions that are user-friendly, organized, and easy to train with. Many also said that the employees at Benchmark are supportive and very quick to respond because of their expertise in the specific systems.

During my interviews I asked the managers what their recommendations would be to others looking into purchasing a Clinical EHR or Practice Management System. Here are some of their responses:

Beth from New Market Medical Center stated,
“Benchmark is user-friendly and anybody who is not computer savvy can use it!”

Michelle from Houshang Makipour, MD stated that,
“From my experience working with other EMR’s in the past, Benchmark is by far the most user-friendly! It is the best quality EMR because although employees come and go, Benchmark transitions between those times.”

Diane from Kenneth Holling, MD stated,
“Support is awesome! Whenever I have a problem, a Benchmark employee always calls me back right away! The system is always user-friendly!”

Benchmark Systems is here to meet your practice’s needs and is eager to help you as much as possible!

Jaime Skilling
Marketing Intern
Benchmark Systems, Inc.


Most Doctors are not able to Qualify for Meaningful Use with their Certified EHR

While it had good intentions, EHR Certification has turned into a worthless list of 3,000+ products that could, may or probably will not pass accreditation for Stimulus funds. This has given physicians all over the country a false sense of security in selecting the proper EHR for their practice. This is not my opinion, this is a FACT. Let me document with independent studies from very respectable sources:

According to the most recent CDC study; in 2012, 27% of office-based physicians who planned to apply or already had applied for meaningful use incentives had computerized systems with capabilities to support 13, the bare basic requirements, of the Stage 1 Core Set objectives for meaningful use. For the full report visit http://www.cdc.gov/nchs/data/databriefs/db111.htm.

Other studies support similar findings:

A study published in Health Affairs finds that while 91 percent of physicians were eligible for Medicare Meaningful Use programs, only 11 percent of those intending to apply are in a position to take advantage of this incentive. This is irrespective of what kind of EHR they use; web based EMR or client server EMR. Drilling down a bit more, the study says only 11 percent of those intending to apply had enough EHR capabilities to support up to two-thirds of Medicare’s Stage 1 core objectives. This means their EMR system does not have the necessary capabilities.

“During 2011, the first year of the incentive programs, almost 124,000 eligible professionals, including physicians, had registered for Medicare incentives, and the Centers for Medicare and Medicaid Services had paid nearly $275 million to 15,000 participants,” study authors say. “Medicaid meaningful use incentives, which flow through states, totaled about $220 million and went to approximately 10,500 physicians.”

Those EHR/EMRs that seem too good to be true (ex. system is marketed as being free or a couple of thousand dollars up front with a few hundred dollars a month) are costing physicians the ability to get reimbursed for installing a real EHR. A large amount of money is being lost equaling $44,000 in 2012, $39,000 this year, and next year the reimbursement drops to $24,000! That is not even taking into consideration the penalties that will be assessed to a practice for noncompliance.

We stand behind our product and guarantee every dollar… Phase 1 and Phase 2.
Our guarantee is simple and to the point:

Eligible professionals who utilize  Benchmark Clinical EHR technology toward Meaningful Use certification, but do not achieve federal funding because of a failure of the Benchmark Clinical EHR product to meet Meaningful Use certification , will be compensated equal to the amount of lost stimulus funds that would have been paid during the Benchmark Clinical EHR compliance failure.

Who would you rather do business with?

Ernie Chastain
Vice President
Benchmark Systems, Inc.


A Professionals View of Training

I have seen two models – one where a vendor does not charge any ‘upfront’ fee, and another is where a vendor charges an upfront fee for training but their monthly fee is lower. Which one is better?

Before we look into “which one is better”, I’d like to talk about the fundamental differences in approaching Training that has a profound effect on how training is imparted.

Training works best if…

The Vendor and your Practice work in the spirit of ‘Partnership’ rather than an adversarial ‘client/customer/supplier’ relationship.

What does this mean? How do you determine whether or not a relationship is a true ‘Partnership’?

A good partnership begins with the first call to your web based software system supplier (prospective partner). Here are some examples of indicators:

  • When you call and leave a message, how are you treated? How soon is your call returned?
  • Does the company attempt to answer your questions, ask you about your concerns or just try to sell you their system?
  • Do you answer their questions in a professional manner? Do you return the sales person’s calls? If no, why not?
  • Do you show up on time for online demos and meetings? If no, why not? Don’t some practices charge patients for ‘no-shows’? So, let’s treat each other equally.
  • When trainers are there in your office or online, do you spare time for them and really give them full attention?
  • Does the Company support staff give you their best attention and care as you would to your patient?

No Upfront Fee model

If there is no upfront fee involved, a business tends to look at Training as a ‘cost center’ – an expense that a company has to deal with. We know that financial accountants and business owners try to minimize expenses. By direct implication, they cut corners. The quality of training tends to suffer. There is a general lack of ‘incentive’ for the management as well as employees since there is no ‘accountability’.

As they say, there is no free lunch. In spite of the ‘no upfront’ fee label, guess what, you’re paying for it- financially by raising the monthly fee or in terms of quality.

What I fail to understand is why do providers fall for this?

In fact, I venture to say that Training and implementation is more important than the software system itself. A bold statement, yes, but I want to stress on the importance of not compromising Training, because Quality and Quantity are both important.

Upfront Training Fee model

I urge you to look into this model because of two very simple reasons.

  1. The company is accountable and responsible for doing adequate training within a timeframe. Since this is a source of ‘revenue’, they are liable to hold their employees accountable for the quality of training satisfaction.
  2. Second, it holds you and your staff accountable – you have a set number of hours to get trained in. You and your staff better pay attention and learn as much as you can.

How much Training?

Here’s a guideline that I have created and found useful after many years of experience. This is based on practice sizes of 1-5 providers. There is variability for individual experience with technology, tech savviness, etc.

8-16 hours: Before starting with the system, but after the system has been setup and customized
4-8 hours: 1 month after going live
4 hours per month: Months 2-6
2 hours per month: Months 6-12

What this means is that in the first year, you need between 44-56 hours training.

So, don’t skimp corners when it comes to training and, please, strive to establish a true partnership. If there are genuine financial reasons why you can’t afford a system that you truly like, tell them. They may work out something for you. But at the very least, have the courtesy of telling them why you can’t partner with them. No one is going to hound you for your decisions. There may be a few ‘used car sales people’ out there, but by large, they want to help you.

Chandresh Shah

http://webbasedemr.com/author/admin/


‘Tis the Season

It’s this time of year that I find myself reflecting on the year and my life, finding myself thankful for everything I have.  I have parents that have sacrificed so much in their life to provide for me through my youth and even now.  I have friends that I can turn to for anything: advice, support, fun, etc.  I live in a country that is, frankly, the greatest country in the world.  We have folks risking their lives all over the globe to keep us “regular” people safe and free.

I am also a very lucky person to have a job in an economy that is struggling.  But not just any job; I have this job!  I am an Implementation and Training Specialist at Benchmark Systems.  What an amazing position to be in!  I graduated college 8 years ago with a B.S. in Business Administration and a B.S. in Computer Information Systems.  I get to use both degrees.  While in high school, college, and since, I have been on-stage for over 20 theatrical performances, giving me confidence to speak in front of hundreds of people without fear.  Now I get to utilize those talents every time I pick up the phone or travel to a practice to train the staff on Benchmark’s software products.  I have been an active leader in several groups throughout my life, most recently with United Way’s Young Leaders Society.  I have the opportunity to work with people, from all different walks of life and careers, coming together to work on projects for an awesome cause.  And as great as that is, I then get to take those experiences and apply them to my career with Benchmark by being a leader for those practices and their projects I am working with.

All of those things – from school, to theatre, to community involvement – all have one thing in common: meeting new people.  I have discovered that this is the main reason I have enjoyed all of those experiences in my life.  This is also why I love my career here at Benchmark Systems.  I’m not just training practices how to use Electronic Health Records or Practice Management systems.  I’m not just talking to Office Managers, Nurses, Doctors, etc.  I’m meeting real people!  I am meeting folks from North, South, East, and West.  And our discussions do not start and end with medical software.  I’ve been onsite at a practice the day a young lady found out she was pregnant.  I’ve been on the phone with a doctor who was working through having a parent in poor health.  I’ve been visited by an Office Manager and her family from a practice while they were visiting Lynchburg, VA to drop off their son at college.  I have even been a part of a practice’s Holiday celebration because of our great relationship we developed due to my position here Benchmark Systems.

I have so much to be thankful for in life, and the people I work with on a daily basis, both internally at Benchmark and our customers, are a large part of that.  Without the customers – you, reading this blog – and my co-workers, I would not have this career that I look forward to every day I wake up.

Thank you all!  Everyone have a happy and safe holiday season.

Your Friend,
Brandon G. Cyrus
Sr. Implementation and Training Specialist


People Make the Difference

I consider myself a regular person – wife, mom, friend and now, once again a professional.  I earned my degree in the early ‘80s and immediately embarked on a career as a salesperson in the healthcare industry selling practice management systems.  I was diligent, I paid close attention to detail, and I learned quickly and soon rose to the top of the ranks in our company.

After about a decade and a half of a very successful career, my focus changed.  By then, I was married with a toddler and another baby on the way.  We had moved out of state for my husband’s job and although I could continue working for a sister company, due to logistics, lack of appropriate child care, and distance from my family and their support, we made the tough decision.  My husband and I tightened our belts and our budget; although it was very scary and we wondered how we would make ends meet, I joined the ranks of stay at home moms.

It was the best decision we ever made.  It was rewarding and I would not trade one minute of it.  My days were full of potty training, play dates and as my boys grew, volunteering at church and school and I even had the opportunity to train and run a marathon with my then 12 year old son.  I was so proud.  I savored every minute of being there for both of them – what a blessing.

I stayed in shape, was an avid reader and a news junkie.  Although I could see the rewards of staying home, in the back of my mind, I questioned my worth, wondered what my contribution was to my community and my family.  I saw successful women on the morning talk shows and was beginning to question my value.

As my boys entered high school and no longer welcomed my volunteering at their events and the thought of the quickly approaching college tuition popped into our heads, my husband and I decided it was time for me to re-enter the work force.

I was mortified!  Now middle aged and re-entering a field where technology changes in a few short months, I had been away for over a decade.  Luckily, I had stayed in contact with several work associates and soon had a job offer, blessed again.  Like a re-birth, I emerged refreshed and energetic, more mature but with the same strong work ethic.  Although the technology had changed drastically, many things stayed the same.  I found our business is still about relationships.  Today, I enter a practice, meet the office staff and the doctors and they are like me.  They are mothers and fathers and sometimes young people just getting started; I must say, there are many more female doctors than there were in the 80s.  Their goal is still to provide good service and good care to their patients.

I listen, evaluate and recommend a system that will help them be more efficient, more productive, and ultimately help accomplish their goal – provide better patient care.  Today, our emphasis is more on Electronic Health Records but Practice Management is still important and the patient is always the main focus. With the emergence of EHR, our support staff have rededicated themselves to prompt and efficient service; our clients rely on us to help them provide the highest level of care possible.  We’ve expanded our services and our methods of deploying software vary because of the technology available today.  We deploy on client servers in the doctor’s office but more often than not these days we deploy the software over the internet.  In many cases it proves to be more easily accessible and less expensive.

It all comes full circle; technology changes, software advances but what stays the same is the people; it’s all about relationships and providing quality service.  In today’s world technology may take priority over a personal approach but in the long run it’s the people that we rely on that make all the difference.  I guess the world hasn’t changed so much after all.

 

Micki Brizes
Project Manager at Benchmark Systems


Benchmarking Data

As insurers continue to ratchet down reimbursement rates and deductibles continue to climb, medial practice will require more business management. In easier times, the success of a practice could be measured by its ongoing solvency, number of patient visits and the satisfaction of its patients and physicians. In today’s world, revenue and collections need to be monitored daily.  Practices that manage by looking backwards at the bottom line after the month closes will find themselves seeing ever decreasing revenue. Rising deductibles, copays and lapses in insurance coverage within your patient base makes patient pay an area that needs to be monitored carefully.  Success hinges on managing performance indicators that are vital to a practice’s long-term health. Practices need to have guidelines as to how are they are performing in comparison to the other like practices. Then, all the above needs to be reviewed by the managing physicians easily and quickly every morning as part of the daily routine. Precise timely data is the key to surviving and excelling in today’s ambulatory healthcare. Data and trending comparison within the practice and within the industry can easily be done today. Benchmarking is a proven management technique that allows practices to understand exactly how they are performing so that problems can be identified and corrected quickly. Equally important, benchmarking facilitates goal-setting that is essential to financial health for any medical practice.

Benchmarking is the process of comparing performance. Most medical practices conduct simple internal benchmarking, such as comparing the annual revenue per physician within the practice to identify the top performer and to see how other physicians compare to that individual. While such information may be useful, external benchmarking (comparing the performance of an organization against its peers) provides a much better picture of how well the practice is doing. Indeed, benchmarking is a standard and ongoing activity for many of the world’s biggest companies. Xerox used benchmarking to understand why it lost market dominance to Japanese competitors in the 1970s and to regain its global leadership position in the industry. Historically, few medical practices have used external benchmarking to systematically analyze their performance. However, external factors such as a changing payer mix (or, in some specialties, changes in the practice’s modality or test mix), rising salary and benefit costs, increasing malpractice insurance rates and new audit threats present new challenges to medical groups and require the use of innovative management techniques and tools. Savvy practices are starting to use external benchmarking as a key component of their strategic planning. By comparing a group’s processes and performance against its peers, practice leaders can understand strengths, weaknesses, industry trends and proactively adjust.

 

Ernie Chastain
Vice President at Benchmark Systems


The Heartbeat of Every Practice

At the heart of every practice that Benchmark is fortunate enough to serve is quality patient care. I’m always working with our staff to be aware of the fact that we have to offer that same level of care on the business side of things to each of these doctors and practices. I enjoy working with perfectionist and it does tend to set the support bar high, that’s a good thing. I also get the fact that doctors and clinicians are 100% focused in taking care of their patients, that’s the calling and they/you have a deep seated drive to do that.

I also know that the heartbeat of every practice should be cash flow with proper accounting procedures and analysis. The difference in a private medical practice and most other privately owned businesses is; one owner focuses on fixing the patient and the other owner focuses on the profits. I’m actually quite comfortable with my doctor focusing on me, it should be that way. What bothers me is the fact that in most cases doctors don’t focus enough on the business side of things. Again, I get it; I understand why….but someone needs to.

So here is the dilemma. If the doctor doesn’t have the time to run the business, is someone with an MBA or at least a BBA hired to manage it? The answer is no, in at least 80% of the ambulatory practices in the U.S., because 80% of those practices in the U.S. are 5 doctors or less and can’t afford an MBA manager. Then ask yourself, could your existing staff run a division of a Fortune 500 company? If that sounds ridiculous to you, think again. They may need help running the business side of your practice. If you look at a 2010 MGMA survey on employee embezzlements, it’s a frightening read with frightening numbers. Then I think for a minute and I don’t have one close friend who is a medical doctor who hasn’t had this happen in his or her practice. Don’t get me wrong, I’m not saying your staff is dishonest, but this survey states, odds are someone will be someday if no one is closely watching. Too many patients, too little time, and not enough attention to the business side……….Not good!

Private practices are now back to the trend of being purchased by the hospitals and large healthcare delivery systems. When this occurs it does take away some of the business stress, but usually leads to a very angry parting of the ways a few years down the road simply because the goals of the doctor don’t match the goals of the hospital. You don’t have to be a mental giant to see that one coming…..….Not good again!

The not so obvious answer is leveraging management costs across multiple practices. Doctors keep doing what you/ they do best. Make a few tweaks to the clerical staff and rather than trying to afford a full time manager with the proper degree, experience and track record hire that profile with a partial FTE structure. Utilize the internet. Today that person doesn’t have to be sitting in your office every day. They are every bit as effective being wired in. Weekly management reviews with structured reports will give you total control and insight, probably better than you have now. You just raised the bar for your existing staff by having a high level employee in the ranks and most will step up to the challenge.

If anyone is interested let me know, I would be ecstatic to put you in touch with each other and even help structure an arrangement. I just want you to be paid extremely well just like the pilot in my next cross country flight. This is no place to be cutting corners for professional services or management. I want the privately owned medical practice to thrive, not become part of a big conglomerate.

Ernie Chastain


The Deductible Season

The first 4 months of the New Year can be a cash flow struggle for medical practices due to the high deductible insurance policies that are in use today. (more…)