Archive for December, 2010

The Benefits of Outsourcing Provider Credentialing

Tuesday, December 21st, 2010

With many practices preparing for the impending 5010 changes, as well as having to invest thousands of dollars into a new EHR system, Practice Administrators are looking at various way to be more efficient and economical. In doing so, outsourcing credentialing may provide at least one easy way to achieve this. Gone are the days of filling out simple applications here and there, and your provider is “set” and ready to see patients. In today’s ever changing healthcare field, credentialing has become much more complex and time-consuming.

Much of successful provider credentialing or re-credentialing, is tracking and consistent follow-up. With medical office staff being stretched very thin anyway, it is difficult to find time to take care of this very crucial step.  Not to mention, for many practices credentialing is often not a “part-time” assignment anymore…it demands the full attention of trained staff that knows when and where to submit information to ensure that proper provider reimbursement begins or continues. In addition, when you consider that the average income of a trained Credentialing Specialist is $30,000 annually plus benefits, not to mention additional exposure to employee liability issues… it makes perfect sense to outsource credentialing to professionals who specialize in this niche.  Often, practices who chose to go this route find that their credentialing gets completed better, faster and cheaper than keeping this as an in-house task.

In the future, as quality standards for each practice are scrutinized more than ever before regarding EHR reimbursement and 5010 compliance, the last thing a practice wants is to have happen are providers incorrectly credentialed, or not credentialed at all with critical private payers in their area. Accurate credentialing the first time means maximum and timely reimbursement for services rendered.  These are all things to consider while putting together a plan and budget for the upcoming year!

EHR Incentives and Meaningful Use

Tuesday, December 21st, 2010

With the federal government now offering financial incentives for providers to purchase electronic health record systems, many practices have been exploring options with various software vendors. However, one concern voiced by many providers is that regulations on what type of EHR’s qualify for the subsidies has not been finalized. There are many questions around what is considered “meaningful use”…. which you will have to show in order to claim the funds. 

The good news is that in the interim, rules and proposed regulations are not likely to significantly change when they’re finalized in spring 2011.  It has already been established that in order to receive the federal incentives in 2011 you will need to have an EHR that meets the requirements for security, interoperability and privacy, as well as show that the EHR has been used “meaningfully”.

The basic way to qualify for government incentive funds are as follows:

1.)    Participate with Medicaid and/or Medicare. (If you participate with both, you must choose to participate in either incentive program…but not both.)

2.)    Participation in the programs ends 2015…after this time physician’s who don’t have EHR’s will actually receive penalties, and see reductions in their Medicare payments.

3.)    Each professional provider in the practice may qualify for bonus payments individually.

4.)    Use electronic prescribing

5.)    Use a system that has the ability to electronically exchange health information to improve the quality of care patients receive

6.)    Submit information about clinical and quality measures

7.)    Show “meaningful use”.

According to director of the Office of National Coordinator for Health Information Technology (ONC), the way to show “meaningful use” is through 15 requirements (with an 10 additional criteria, of which providers must meet at least 5). They are as follows:


  1. Record personal patient information
  2. Chart any changes in vital signs or test results
  3. Maintain active problem
  4. Maintain current medication
  5. Maintain any allergy information
  6. Record if patient smokes
  7. Provide patients electronic copies of their medical records
  8. Provider patients an overview of their clinical information
  9. Prescribe and transmit prescriptions electronically
  10. Order medication via “provider order entry”
  11. Implement checks and balances for any drug allergy and other prescription contraindications
  12. Implement and track compliance of a clinical decision support rule
  13. Assure privacy and security of patient data
  14. Have capacity to exchange clinical  information with providers and patient-approved facilities
  15. Report all ambulatory quality measure to the state or Medicare.



1.)    Drug formulary checks

2.)    Structured data to incorporate lab test results

3.)    All patients with particular medical conditions must be listed for at least one condition

4.)    Provide educational information to patients specific to their diagnosis

5.)    Reconcile medications

6.)    Provide patient summaries of transactions of care

7.)    Ability to provide data to public health agencies

8.)    Ability to provide data regarding patient immunizations

9.)    Provide patients with follow-up care instructions and preventative care measures

10.) Provide patients with timely electronic access to their health records.

The main things to keep in mind when shopping for an EHR are to really research the functionality of the product, and ensure the vendor meets or exceeds correct meaningful use criteria. For more information regarding meaningful use and reimbursement criteria, visit the CMS website under “Notice of Proposed Rulemaking on the HER Incentive Programs”.