A Glossary
by Cheryl Nash
This year is certainly bringing a lot of changes to the world of healthcare. I am pressed to think of any aspect of this industry that is not going to be significantly impacted by at least one if not all of these new requirements. The Affordable Care Act, Meaningful Use, PQRS reporting, PECOS enrollment, ICD10, EHR, the list is long. At times it seems to be that meeting any of these requirements will take superhuman effort and a degree in law to boot.
As confusing at it all seems, it is best to try and understand that each is a part of a whole system. The healthcare industry is in a lot of ways quite outdated. While technology has taken leaps and bounds in the way providers care for patients, it has stagnated in the realm of electronic reporting. The inefficiencies generated by this are compounded and the overall cost is staggering, reflected in the overall rising cost of healthcare to the population.
It is helpful to understand the terms.
ACA, the Affordable Care Act- affectionately called ObamaCare. I don’t think this needs any further explanation. Think what you may about this legislation, it is here and needs to be learned and understood for each practice to minimize the financial impact.
Meaningful Use- This is a general term that refers to a set of standards, defined by CMS, that governs the use of EHRs. The goal is to achieve better clinical outcomes, have increased transparency and efficiency, and allow for more robust research data through newer health systems. There are 3 stages to the meaningful use implementation, and 2014 begins stage two. If your practice currently uses an EHR, your software will typically have resources to assist your practice in meeting these requirements.
EHR- the requirements for utilizing an EHR go hand in hand with the Meaningful use stages. There are currently payment incentives for meeting each stage in the timeline set by CMS, but there will also be penalties levied for not meeting them in the future. A payment adjustment of 1% of the physician fee schedule will begin on January 1 2015. This is the current timeline and the information can be found at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html.
PQRS- This stands for Physician Quality Reporting System. This is still another aspect to the current EHR/ Meaningful Use payment incentive. Not all providers are eligible to participate in the PQRS pilot, and not all specialists will be able to meet the core requirements. These can be found at:
https://www.cms.gov/eHealth/downloads/CMS_PQRS_ParticipationDocument.pdf.
PECOS- This stands for Provider Enrollment Chain and Ownership System. This system replaces paper enrollment, and allows a provider to maintain and update their information electronically. It is a requirement, even if you are already enrolled in Medicare. If you have an NPI, chances are you already have a PECOS account, however, it is very common that the information has not been updated in the recent past, and Medicare requires this to be done. If it is not, Medicare payments will be suspended until the profile is current.
ICD10- in brief, this will replace the current ICD9 diagnosis reporting system. The system consists of a much larger code set to enable the practice to report a much more specific set of diagnosis. For more information on this specific to phlebology, see last month’s article. I will be hosting a webinar in May and June that will be ICD-10 phlebology specific. You will be able to register for the webinar on our website by mid-March.
There are multiple resources available on each of these topics, along with a number of articles already written. My personal preference for accurate information starts with CMS.gov. They are the source for most of the mandated changes, and have an extensive set of helpful links, documents and webinars to assist any size practice in meeting these requirements. Once the changes are understood, like all things generated by the government, it looks a lot more complicated than in fact it really is.
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