Without the use of automation it will be nearly impossible for hospices to meet the rapidly changing compliance standards.
(PRWEB) March 31, 2014
Presenting the top 3 reasons why all hospices need to fully automate workflow to meet demanding regulatory compliance requirements in 2014, Greene Health Care Inc. discusses the various updates being made in to their vendor’s hospice software, including the new Medication Management Solution to satisfy the constantly changing requirements for hospice care in 2014.
Streamlining the various processes involved in hospice care while ensuring that the ever-changing compliance standards are met requires smartly designed, intelligent, and more importantly user-centric EMR software. Greene Health Care clients have moved to an EMR software to automate their workflow while providing a robust reporting system, certifications, admissions, referrals, visit logs, level of care tracking, census tracking, A/R, revenue, medications management, among others. The hospice software also supports clinical charting for all disciplines, provides comprehensive assessments, customizable care plans, staff communications, certification tracking, claims/billing services, customizable alerts, IDG reporting, and a lot more.
In 2014, several changes impacting the hospice industry are creating the necessity to automate workflow. Without the use of automation it will be nearly impossible for hospices to meet the rapidly changing compliance standards.
A few of the immediate updates that make EMR software automation for hospices an immediate necessity in 2014 include:
Change Request (CR) 8358 reissues by CMS (Centers for Medicare and Medicaid Services) – Additional Data Reporting Requirements for Hospice Claims: CR-8358 defines additional data reporting requirements for Hospice Claims in order to support hospice payment reform as authorized by Section 3132(a) of the Affordable Care
Act. It requires Line-item visit data for hospice staff providing general inpatient care (GIP) to hospice patients in skilled nursing facilities or hospital setting, Injectable and non-injectable prescription drugs and infusion pumps Medication Data, Post Mortem Visits, and Facility Details be displayed on Claims with dates of service on or after April 1, 2014.
New Standard Set for Quality Reporting: The Hospice Item Set (HIS)/Hospice Quality Reporting Program (HQRP) are quality requirements defined by CMS. The Hospice Item Set will contain Admission and Discharge Assessment Data for all Medicare and Medicaid patients and must be submitted less than 30 days after an Admission or Discharge Date. The timeframe for the data submission requirement is July 1, 2014.
The HIS data submission is mandated by section 3004 of the Affordable Care Act. Failure to submit data for fiscal year 2014 and each subsequent year results in a 2% reduction in the CMS Annual Payment Updates (APU).
Mandatory ICD-10: On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification) is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.
Hospices need to use their Fiscal Intermediaries (FI) local coverage determinations (LCDs) guidelines when determining the principal diagnosis and all other diagnoses. From October 1, 2014, a principal diagnosis of Adult Failure to Thrive (AFTT) or Debility are not to be used as principal diagnoses on the hospice Medicare claim form when a related definitive diagnosis has been established or confirmed by the provider. Effective for claims submitted on or after October 1, 2014, on a hospice claim will cause the claim to be returned to provider (RTP) for clarification (use of an appropriate principal diagnosis).
To prepare for the requirements due for CR 8358, the EMR software will require collecting the mandatory data during clinical charting and will create alerts for any missing codes needed from patient medications to ensure proper billing can be submitted. A Medications verification process will be available, allowing a comparison between the patient's Medication list and Medication Fill list so a user can review this data prior to billing to ensure all Medication Fills are complete. Claims for patients with incomplete Medication data may be suspended until issues are resolved. To prevent Medicare claim rejections specific facility types are required to contain a nine digit zip code and an NPI. GIP visits will automatically be reported in each visit on a separate line and by the unit for GIP not in a Hospice Unit on claims.
As stated above, the timeframe for the data submission requirement to ensure that the Hospice Item Set (HIS) contains Admission and Discharge Assessment Data for all Medicare and Medicaid patients is July 1, 2014. Fields within the EMR system have been enhanced to gather the specific data that has been defined.
Our EMR software provides the added ICD-9 diagnosis codes through clinical charting to ensure proper billing is submitted and compliant at the clinical level. The ICD-9 database/catalogue will be replaced with the new ICD-10. Use of ICD-10 will be similar to the way it currently works in the EMR system. Users can enter codes or keyword search, in addition, the EMR software includes all LCDs (Local Coverage Determinations) provided by the FI (Fiscal Intermediaries such as Palmetto NGS, CGS, Cigna) as criteria for hospice eligibility to help hospices determine hospice eligibility by a patient’s prognosis and not their diagnosis. Beginning October 1, 2014 the EMR system will prevent the use of AFTT and Debility as a primary diagnosis. By placing the selection of diagnosis code in the hands of physicians and clinicians improves clinical documentation necessary for choosing the most specific and appropriate codes.
Managing the transition from paper-based to an automated workflow environment is a necessity for hospices. Meeting the rapidly changing compliance standards in 2014 requires an EMR system with the built-in capabilities to seamlessly integrate billing. An electronic medical record (EMR) system coupled with automated coding and billing allows hospice billing needs to meet the new standards and regulations.
A partner of Consolo Service Group, Greene Health Care Inc represents the company in California, Nevada, Utah, Colorado and New Mexico. They offer services that are designed specifically to address and resolve high-priority business issues and collaborate with clients to integrate technology into business critical functions in innovative and productive ways. The company also offers Hospice Billing Services to more than one third of their existing clients and they have teams of dedicated professionals with extensive experience and training in all aspects of hospice billing, compliance, and claims.
About Greene Health Care Inc (GHC):
Established in 2009, Greene Health Care Inc, a partner of Consolo Service Group, a leading provider of hospice solutions including web based EMR software, billing and consulting services. They facilitate health care convergence through secure cloud- based portal technologies enabling health care organizations to serve the needs of their patients, employees, physicians, and partners.