implementation

Claims rejections through the roof with NPI requirement

Fri, 30 May 2008 06:59:58 -0400

Well, everyone knew the following was going to happen, but CMS plowed ahead anyway--though maybe it had to do so or risk never launching at all. As predicted, things have gotten really messy in the claims-processing world in the scant week since providers have been required to use their National Provider Identifier number to submit Medicare claims. Healthcare industry claims processors are reporting a fourfold or more increase in rejected Medicare claims and the same (or even higher) rates for Medicaid claims. Meanwhile, there's been a doubling of rejection rates for claims processed by Blues plans on May 23, the first day they were required to use the NPI.

If all of this happened within one week--one which included the Memorial Day holiday weekend--the next few could be pretty scary. Brace yourselves for some more heavy claims lifting, folks!

To learn more about the problem:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Providers want another NPI implementation delay
Smaller providers not ready for NPI
National provider identifier deadline extended

Federal judge smacks down CMS reg limiting Medicaid use

Tue, 27 May 2008 06:59:56 -0400

A federal judge based in Washington state has taken the side of hospitals in a dispute over the use of Medicaid reimbursement to subsidize safety-net services. In a move that the judge ruled was "deliberately designed to outfox a clear directive of Congress," CMS planned to issue a rule to tie Medicaid payments to provider-specific costs.

This would mean that states would no longer have the freedom to shift Medicaid dollars to hospitals providing indigent care or money-losing services such as trauma and burn care. However, a coalition of healthcare groups, including the National Association of Public Hospitals and Health Systems, the American Hospital Association and the Association of American Medical Colleges, brought suit to stop the implementation of the proposal. The judge held that the rule conflicted with Congress's intentions regarding Medicaid's design.

To learn more about the dispute:
- read this Modern Healthcare article (reg. req.)

ALSO NOTED: Provider groups ask CMS to delay NPI enforcement, again; Zyrtec marketers try something new; and much more...

Wed, 23 Apr 2008 06:59:50 -0400

> Several groups have asked CMS to delay the implementation of the National Provider Identification number, arguing that no one involved is really ready to move ahead. FierceHealthFinance

> To market over-the-counter Zyrtec, drug marketers have turned to a very old ad medium--fliers posted on telephone poles. FiercePharma

> Researchers at Johns Hopkins have come up with a cheaper, easier-to-deliver vaccine for NPV, strains of which are responsible for most cervical cancer cases. FierceVaccines

> Dallas nurses are mulling over whether they should join a labor union, the California Nurses Association. If they do it would be the first nurses union in the state since the 1970s. Article

And Finally... This sounds like something out of a cheap horror flick, but it really happened. Article

SPOTLIGHT: Mayo Clinic offers its Rx for health system change

Fri, 14 Mar 2008 07:59:52 -0400

After a year spent traveling around the country interviewing experts and officials, Mayo Clinic has officially taken a position as to what it feels needs to change in our struggling healthcare system. It's recommending that everyone in the U.S. be required to buy private health insurance--subsidized if need be--broad implementation of electronic medical records and a shift in Medicare payment which rewards high performance. Article

SPOTLIGHT: How to succeed with EHRs

Tue, 27 Mar 2007 20:01:32 -0400

Not sure your physicians will buy in to your EHR rollout? It's a reasonable fear. After all, they may not feel ready for the changes EHRs will require them to make. But a physician leader who's been there--and achieved 100 percent adoption of a CPOE system--suggests that if executives take the right steps, they can virtually guarantee that their EHR implementation will succeed. Column

Survey: Health IT on the rise in hospitals

Tue, 27 Feb 2007 19:01:38 -0500

A new survey of 1,500 community hospitals conducted by the American Hospital Association has found that, despite barriers such as cost and integration, implementation of health IT is on the rise in hospitals. Nearly half of all surveyed hospitals reported moderate or high use of health IT in 2006, compared to a response of 37 percent in 2005. Large, urban and teaching hospitals are at the forefront of this movement. In addition:

69 percent of responding hospitals have either fully or partially implemented EHRs.
Computerized physician order-entry (CPOE) is gaining ground, particularly in hospitals with EHRs.
Spending on health IT systems is high and growing.

The survey found that barriers still remain for its adoption, particularly the high costs involved in installing and maintaining IT systems. Other complications include the lack of trained staff to implement technology and problems with interoperability among systems.

For more on the survey:
- check out this AHA press release

HHS awards $103M to improve Medicaid programs

Thu, 25 Jan 2007 19:01:37 -0500

HHS has awarded $103 million to 27 states, supporting programs designed to improve the way Medicaid dollars are used. Congress has approved a total of $150 million for these "transformation grants," which will distributed over fiscal '07 and '08. States will be able to use the funds for a variety of purposes, including development of programs to encourage EMR, clinical decision support tools or e-prescribing; increasing utilization of generic drugs; implementation of a medication risk management programs and improving access to primary care and specialty physicians using integrated university-based hospitals and clinics.

To learn more about the Medicaid grant program:
- read this press release from HHS, which lists state awards
- get more background on the grant guidelines

SPOTLIGHT: IBM wins EMR deal

Wed, 21 Jun 2006 20:01:33 -0400

IBM signed a deal with the Canadian province of Alberta that sees the tech giant lead their transition from paper-based to electronic records. Big Blue wins a two-year contract worth $10 million to lead the implementation of the new system and train users. Alberta has pledged to create an electronic medical record for every resident by 2008. Article

SPOTLIGHT: Report criticizes NHS IT project

Thu, 15 Jun 2006 20:01:33 -0400

Britain's National Audit Office released a report warning that delays in the implementation of the country's massive health IT project may "hurt public confidence in the project." Meanwhile, the behind-the-scenes jostling between Cerner and GE Healthcare for control of the London phase of the project is continuing. Report (.pdf)

SPOTLIGHT: House to consider health IT legislation

Tue, 23 May 2006 20:01:33 -0400

The House is expected to take up legislation that would encourage the adoption of information technology in healthcare and establish national standards on privacy and the implementation of new systems. HR 4157 was sponsored by House Ways and Means Committee Chair Rep. Nancy Johnson (R-CT) and Rep. Nathan Deal (D-GA). Critics note that the new privacy standard would take precedence over existing state law in many cases. CQ HealthBeat reports that the legislation would increase the number of billing codes that providers are responsible for from about 20,000 to over 200,000. Bill