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Newsletter 2014 Q4

A Smarter Approach to Navigating Chart Audits

Audit is not a medical professional’s favorite word. Audits often leave providers with anxious thoughts of their work being scrutinized by another party. This is understandable in an environment of increased government regulations and scrutiny of medical claims, continuous demand to control costs, and the need to operate efficiently. While there are many negative connotations associated with the audits, there are also many benefits to performing internal audits or reviews. Internal reviews of your providers’ coding accuracy, procedures, and policies can help ensure your practice is complying with regulations, operating efficiently, and being reimbursed appropriately for the work being performed.

Internal reviews can help your practice:

  • Ensure medical charts are coded accurately to reduce risk of payer or government audits

  • Verify claims are being billed appropriately

  • Reduce income loss due to claim under-coding

  • Identify reimbursement deficiencies and opportunities to improve collections

  • Protect itself against fraudulent claims and billing activity

  • Educate providers and staff on best practices

  • Find opportunities to enhance office workflow processes to operate more efficiently

  • Verify electronic health record (EHR) meaningful use compliance, if applicable

Before starting an internal review, it is important to define the scope of the audit including what services will be reviewed, how large the sample size will be, and what time period will be reviewed. Key players, such as who will be performing the audit, should be identified. Providers should be aware of the review and a part of the planning process.

The results of the audit should be compared to industry criteria and standards to understand how well standards were met, why some standards were not met, and identify areas for improvement. Summary spreadsheets or a dashboard should be prepared in order to present the findings to the providers and staff. Feedback and recommendations should be given and necessary changes made, starting with the most critical.

At an appropriate time, repeat the review to assess what changes have been implemented, if coding accuracy has improved, and overall progress since the previous review. As with the initial review, providers should be a part of the planning process and made aware of the results. Reviews are not a one-time event; internal monitoring should be a regular part of business to help strengthen operations.

While internal audits offer many benefits, they often are postponed. Keeping daily operations running smoothly within tight budgets and restricted timeframes often takes priority. Audits can also require dedicated resources and time, which may not be something smaller practices have available. If you are unable to perform an audit using internal staff, consider contracting with a consulting firm. In addition to being experienced in audits, external sources offer an independent perspective. Objectivity is important to ensure issues are not being overlooked and recommendations are unbiased. Consultants can also offer guidance in implementing changes.

With experienced and certified staff dedicated to conducting reviews, Alta Partners, LLC can reduce the stress and uncertainty around performing an internal review. Alta Partners’ reviews are tailored to your practice’s specific concerns and are focused on identifying opportunities, comparing performance, implementing change, and sustaining improvements. If you are interested in a Medical Chart Coding Review or would like to learn more on how a review could help your practice, contact one of our qualified healthcare consultants.

Lynn Bolin, CMPE
Director of EHR / Practice Manager
(440) 488-7324
Susannah Selnick, MBA    
Healthcare Consultant
(440) 808-3649


Dan Kasinec Selected as Incoming Vice Chair of the American College of Medical Practice Executives Certification Commission

Dan Kasinec, FACMPE, Principal at Alta Partners, LLC will be the incoming Vice Chair of the American College of Medical Practice Executives (ACMPE) Certification Commission. The ACMPE is the certification and fellowship authority of the Medical Group Management Association (MGMA) and has been certifying medical practice executives since 1956. Dan’s term will begin in October 2014.

MGMA-ACMPE is the leading association for professional administrators and leaders of medical group practices. In 2011, members of the Medical Group Management Association (MGMA) and its standard-setting division, the American College of Medical Practice Executives (ACMPE) voted to merge to form a new association. Since 1926, the Association has delivered networking, professional education and resources, political advocacy and certification for medical practice professionals. Through its national membership and 50 state affiliates, the Association represents more than 33,000 members who lead healthcare organizations nationwide. Learn more about MGMA-ACMPE.


Stan Kasmarcak Teaching at Cleveland State University

Stan Kasmarcak, CPA, principal of Alta Partners, LLC is teaching Healthcare Financial Policies, a course in the Health Care Administration MBA program at Cleveland State University (CSU), during the Fall 2014 semester. This is Stan’s 7th year teaching this course. The Financial Policies course focuses on the financial aspects of health care management including working capital management, capital budgeting, mergers and acquisitions, reimbursement methodologies, risk management, and managed care contracting.

Part of the MBA-Health Care Administration curriculum at Cleveland State includes a student internship program with area healthcare entities. If you have the need for a developing Healthcare MBA student to help your organization, please contact:

Lacy Sharratt    lks@altapartnersllc.com
Susannah Selnick  sks@altapartnersllc.com
Stan Kasmarcak   sjk@altapartnersll.com

About the Health Care Administration MBA program at Cleveland State University
The Health Care Administration specialization within the Master of Business Administration program is accredited by AACSB International, the Association to Advance Collegiate Schools of Business. The program is designed to provide graduate education for individuals interested in preparing for or furthering their careers in the management and administration of all health care delivery entities. The Health Care Administration specialization provides a comprehensive academic background in management theory and practice, together with the knowledge and skills associated with the field of health care administration, planning, and policy analysis. In addition, students are presented with the unique opportunity to gain valuable practical experience through professional site visits, shadowing, and an intensive administrative work experience, referred to as the internship. Learn more about the Healthcare Administration MBA program at Cleveland State University

Turn Frustrated EHR Users into Champions

Do you work with frustrated EHR users? Providers included? I am betting a lot of you are shaking your heads “YES”. I speak to individuals daily who are struggling to find solutions for their frustrated providers and users! Take a look at this presentation on the need for EHR optimization and utilization. I had the opportunity to present at the 2014 Allscripts ACE conference in Chicago in August on this topic, and was surprised at how many healthcare organizations are experiencing the same issues! Give me a call and let Alta Partners be a part of your solution.

Hyperlink to presentation will be in body of article

Lynn Bolin, CMPE
Director of EHR/Practice Manager/Consultant
Phone: (440) 808-3703
E-mail: nlb@altapartnersllc.com

Lacy Sharratt Achieves Certification with the Healthcare Financial Management Association

Lacy Sharratt, CHFP, Healthcare Consultant at Alta Partners, LLC has earned the professional designation of Certified Healthcare Financial Professional (CHFP) from the Healthcare Financial Management Association (HFMA). The exam is structured to test whether a candidate has the knowledge and skills essential to the health care finance profession. Six content areas are covered in the exam: revenue cycle, disbursement, budgeting/forecasting, internal control, financial reporting, and contact management.

About HFMA
The Healthcare Financial Management Association (HFMA) is the nation’s premier membership organization for healthcare finance leaders, with more than 40,000 members nationwide. At the chapter, regional, and national level, HFMA helps healthcare finance professionals meet the challenges of the modern healthcare environment by:

• Providing education, analysis, and guidance.
• Building and supporting coalitions with other healthcare associations to ensure accurate representation of the healthcare finance profession.
• Educating a broad spectrum of key industry decision makers on the intricacies and realities of maintaining fiscally healthy healthcare organizations.
• Working with a broad cross-section of stakeholders to improve the healthcare industry by identifying and bridging gaps in knowledge, best practices, and standards.  Learn more about the Healthcare Administration MBA program at Cleveland State University

Medicare Updates and Resources

Throughout the course of the year, Medicare updates its policies and procedures and publishes provider resources. Below are some recent changes and useful resources currently available.

  • Medicare Announces Change to Modifier 59 for Distinct Services
    On August 15, 2014 CMS released Transmittal 1422 which outlines the changes to Modifier 59, effective January 1, 2015. In the transmittal, CMS references the 2013 CERT Report which projected $2.4 billion in MPFS were made on lines with modifier -59 with a projected $320 million error rate. The more precise coding options coupled with increased education and selective editing is believed by CMS to be necessary to reduce the errors associated with this overpayment.

    CMS has created four new HCPCS modifiers to identify subsets of Modifier 59, collectively referred to as –X {EPSU} modifiers.

    • XE – Separate Encounter: A service that is distinct because it occurred during a separate encounter.

    • XS – Separate Structure: A service that is distinct because it was performed on a separate organ/structure.

    • XP – Separate Practitioner: A service that is distinct because it was performed by a different practitioner.

    • XU – Unusual Non-Overlapping Service: The use of a service that is distinct because it does not overlap usual components of the main service.

The transmittal explains that there may be instances when modifier 59 is still reported, but it should not be used when a more descriptive modifier is available.

  • Fingerprint-based Background Checks
    The Centers for Medicare and Medicaid (CMS) announced that fingerprint-based background checks would begin starting August 6, 2014. These checks are required for individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into CMS’ high risk category and is currently enrolled in Medicare. The program will be conducted in phases; notifications will be sent to those required to complete the fingerprinting. If you receive a notification, you will have 30 days from the date of the letter to be fingerprinted; the company contracted to perform the checks can be reached through their website.  

    For more information on the fingerprint-based background checks,click here.

  • CMS Finalizes Rule on Meaningful Use Flexibility
    On August 29, 2014 the Department of Health and Human Services published a press release that allows providers more flexibility to meet meaningful use in 2014. The rule finalized the extension of Meaningful Use Stage 2 through 2016 and the delay of Stage 3 until 2017. The rule provides certified electronic health record technology (CEHRT) flexibility by allowing eligible providers to use 2011 edition CEHRT or a combination of 2011 and 2014 edition CEHRT to meet Meaningful Use during the 2014 reporting period. All eligible professionals, eligible hospitals, and CAHs are required to use the 2014 Edition CEHRT in 2015.

  • Review Your 2014 PQRS Interim Claim Feedback Data
    Eligible professionals who have reported at least one Physician Quality Reporting System (PQRS) quality measure this year via claims-based reporting can now view the status of their claims-based measures through the 2014 PQRS Interim Feedback Dashboard. Providers can access the information quarterly to monitor and review their PQRS data. The Dashboard can be accessed through the Physician and Other Health Care Professionals Quality Reporting Portal.

    CMS has provided these additional resources to help providers access and utilize the Interim Feedback Dashboard.

  • HIPAA Privacy and Security Basics for Providers
    The Medicare Learning Network has published an overview of  HIPAA privacy and security rules that includes a summary of the regulations, who is covered under HIPAA, and additional resources.

  • ICD-10 Resources: Road to 10
    To help with the transition to ICD-10, CMS has created a free online resource, Road to 10.  The site includes an overview of ICD-10, webcasts covering various topics to aid in the transition, a “Build Your Action Plan” section, and additional resources to assist your practice in preparing for the changeover.

  • 2014 – 2015 Influenza (Flu) Resources for Health Care Professionals
    The Medicare Learning Network (MLN) published an influenza resource listing for professionals for the 2014 – 2015 flu season. Resources include quick reference guides, educational material, links to additional CMS resources and websites of various government agencies for additional tools and information that may be useful during the 2014 – 2015 flu season.

To sign-up for Palmetto GBA Medicare e-mail updates, click here.