Wednesday, October 10, 2012

Increased Level Four and Five E&M Coding Under Scrutiny

Electronic health records are being blamed, in part, for the skyrocketing payments associated with level four and level five evaluation and management codes. Over the last decade, the additional costs for E&M coding increases are estimated to be in the billions.
Early in September The Center for Public Integrity and CMS released several reports detailing how auto-coding, record cloning, and EHR software prompts make it easy to achieve inflated upper-level coding and additional payment for services. It’s safe to assume that other payers are also analyzing claim submissions to determine if the number of level four and level five E&M codes are increasing for a provider or group.
Whether you currently have an EHR or not, there are some steps your practice can take to ensure that it is in compliance with Medicare standards, and lower its risk profile.
  1. If your practice doesn't have a compliance plan — get one. Call your specialty society or use the version available on the OIG's website called OIG Compliance Program for Individual and Small Group Physician Practices. You can download the article by clicking here.
  2. Whether you are using and EHR or paper charts, it is critical that you are actually doing chart reviews.
  3. If you are shopping for an EHR, be very wary of vendors who promise your patient encounters will come out at a higher level after you adopt their system.
  4. Run a productivity report of your E&M services for each provider before you adopt an EHR to determine a baseline of what percentage of your visits currently fall into the level four and five category.
  5. If you already have an EHR, running a productivity report quarterly is a must. Look carefully at your practice's use of level 1 through level 5 codes for new patients, consults, established patients, and hospital visits for each provider.
  6. Assess variations within your practice. Is there one provider whose visits all seem to be level four, while other providers’ codes are more varied?
  7. Audit your practice records to make sure that there is sufficient documentation to justify the level coded, whether using paper or electronic records. Look for evidence of cloning or carrying forward notes on physical exams and patient histories. For paper records, remember the rule “if it’s not documented, it didn’t happen.”
  8. If you are using voice recognition-transcribed notes, make sure that the final note makes sense. Voice recognition programs often don’t “hear” similar words correctly and “the eye” could be heard as “thigh”, etc…
  9. Consider turning off the "auto-coder." As many coding experts have pointed out, physicians still need to use their brains. Remember, the nature of the presenting problem will be looked at in an audit — as uncomfortable as an ingrown toenail is, it hardly qualifies as a level 4 problem in terms of complexity and medical decision making.
Most of all — be proactive. There's little reason to doubt that the OIG will be looking at the connection between EHR-prompted coding and overbilling for patient services. Make sure your patient records accurately reflect physician services

Wednesday, July 11, 2012

Top Challenges for Medical Practices

We wanted to share a good article highlighting some of the major challenges that providers face in running a successful practice in the current political and economic environment.

For information on how we may be able to help you navigate some of the challenges you are facing in your office, contact us today at 407-869-7737 or

Thursday, April 12, 2012

Meaningful Use Myth #1: "Congress can just cut off funding for Meaningful Use."

A common reason you may hear from providers as to why they are skeptical of ever seeing Meaningful Use dollars and therefore their excuse for not implementing an EHR is that they believe Congress could just cut off the funding for the $27 billion designated to pay providers who qualify and demonstrate Meaningful Use. It only takes a few seconds to do a Google search and find articles disputing that.

 One excellent article that clearly busts this myth contains states: "Now that the funding is flowing, this is an entitlement program, and it is next to impossible for anyone on Capitol Hill to stop this from going forward," Roberts said Wednesday in Ojai, Calif., at the 20th annual Physician-Computer Connection, the annual conference of the  Association of Medical Directors of Information Systems (AMDIS).

The article goes on to equate the Meaningful Use program to that of Medicare, another entitlement program. Congress can't simply strip the funding from the budget. They must vote to pass legislation that would either limit the scope of the program or completely kill it all together. Click here to read the complete article.

While we believe that Meaningful Use is a great incentive to implement an EHR, we also believe that the right EHR can produce improvements in patient care, staff efficiency, and reduced overhead that make it worth the effort regardless of whether the practice ever receives a dime of the Meaningful Use money. But hey, since there is still a chance to get your share of that $27 billion, why not go for it?

If you would like more information on the Meaningful Use program, or if you would like to see a demo of WorkflowEHR, which has had more than 80% of it's providers who are eligible for Meaningful Use successfully receive their first payments, contact us at or 407.869.7737.

Monday, April 2, 2012

Are EHR incentives really being paid to providers? Yes!

The announcement a few years ago that providers would receive incentives for implementing and using electronic medical records was met with skepticism from many in the healthcare community. Would anyone ever actually receive those incentive payments, or would be yet another government program that failed to deliver what was promised?

It looks like there may be reason to let go of some of that skepticism after all. Incentive payments began trickling out to providers last year and are showing a steady increase in the number of providers registering to participate.

A recent report published by CMS provides some specifics on how the incentive program is progressing:

· 20,000 new MU registrations by practices in just the month of February 2012 alone

· Total registrations is 211,667

· Incentive payouts in the month of February 2012 alone was $863 MILLON

· Total incentive payouts to date is $3.65BILLION

Our partner, has had more than 100 providers qualify for Meaningful Use incentives using their software, WorkflowEHR and we have personally assisted several clients of JBS Of Central Florida in registering for the program using WorkflowEHR. We have several other clients in the process of implementing WorkflowERX and WorkflowEHR who will be registering for the incentive program as well. If you would like informatin on either of those products email us at

To read the complete article, click on the link below.

Sunday, March 18, 2012

Making Sense of the Medicare ePrescribing Penalties and Incentives

You may have recently received a letter from CMS/Medicare indicating that you will be subject to a 1% penalty/adjustment on your Medicare payments due to failure to successfully meet the requirements for the 2011 eprescribing program. As is common with a lot of communication from CMS, the language of the letter can be somewhat confusing and has left a lot of our clients wondering what they can do to avoid further penalties and to recoup the 1% that they are starting to see being withheld on their Medicare EOBs.
Below is a very simple summary of the 2012 eprescribing incentives and penalties that will help clarify what you can do to make sure you are not subject to the 1.5% penalty next year and to qualify for the 1% incentive for 2012.
We also wanted to be sure that you know that JBS of Central Florida can assist you with implementing an ePrescribing solution in time to avoid the June 30, 2012 penalty deadline. Click here for information on our preferred ePrescribing solution, WorkflowERx.
What to know about ePrescribing for 2012
Incentive payment is equal to 1 percent of total Medicare Part B allowed charges (Eprescribing incentive not available to professionals receiving incentives from EHR Incentive Program for 2012).
  • The CMS ePrescribing program has two reporting periods: penalty (January 1 to June 30, 2012) and incentive (January 1 - December 31, 2012).
  •  Eligible professionals need only report 25 separate electronic prescribing events during the reporting period (2012 calendar year) to receive the incentive and just 10 times before June 30, 2012 to avoid the 2013 penalty. 
  • In order to get credit for successfully ePrescribing, you must report data on those encounters to CMS. The simplest way to report is using your Medicare Part B claims. You must report the G8553 code with a charge amount of .00 (or .01 if your billing software requires) along with a qualified CPT code for the encounter. You can NOT go back and report the G8553 code separately if you have already submitted a claim for the encounter. It must be submitted on the same claim.
The following CPT codes are elligible for submitting with the G8553 code:
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109
If you have further questions about the ePrescribing program or would like information on how to get started with WorkflowERx in time to submit the 10 eprescriptions required by the June 30, 2012 deadline, contact us at .

Welcome to our new blog!

Your Practice Management Resource

Welcome to the new JBS of Central Florida Blog! We hope that you will find valuable information that will help you manage your practice more efficiently and increase revenues while decreasing the frustration and challenges of dealing with insurance companies and government entities.

JBS of Central Florida is a Value Added Reseller (VAR) for Medisoft Patient Accouting, WorkflowEHR, Gateway EDI and ZirMed. We provide sales, support and training on products that we have chosen to represent and are always looking for products and services that will be beneficial to our clients.

For more information on JBS of Central Florida and the products and services we offer, visit our website at .