Increasing Revenue USING KEY PERFORMANCE INDICATORS

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1 HOT IN AUGUST 2015 Increasing Revenue USING KEY PERFORMANCE INDICATORS View Article Preparing and testing for ICD-10 benefits all of us For those of you keeping track, there s less than two months left until the implementation of ICD-10. I understand this transition can cause significant anxiety in even the most prepared practices, even with the recent announcement of a one-year grace period for claims with incorrect ICD-10 codes. In light of this, I thought it d be a good idea to take some time to remind you of the ways Pulse has been working behind the scenes to ensure the transition is as easy as possible for you before, during and after October 1. You ve heard us talk about the new enhancements to our EHR and Practice Management solutions with new key features that allow you to simultaneously code in ICD-9 and ICD-10, search and select ICD-10 codes based on an ICD-9 code diagnosis, and enhanced safeguards in place to prevent you from selecting unbillable or unspecified ICD-10 codes. But what you may not know is that we ve also been testing our ICD-10 readiness like it s our job because, well, it is. Jennifer Barnhill, EDI Specialist, recently provided me with an update on the specifics of our testing activities that I wanted to share with you. She says:

2 We have successfully completed end-toend ICD-10 functional testing with CMS Jurisdiction J6(NGS), J5(WPS), JH(Novitas) and J11(Palmetto) by submitting up to 50 claims for actual Medicare patients with dates of service after October 1. I m proud to share that all claims were accepted with no errors and the payments and adjustments posted correctly to each patient account. We have also successfully completed testing with Mass Health Medicaid in Massachusetts and are currently testing with Blue Cross Blue Shield (BCBS) of Texas. Additional testing with ASK/BCBS of Kansas will begin this week. Additionally, we ve been working with Emdeon to identify additional payers we can test with as well as opportunities with additional laboratories. On the prescription and laboratory front, Pam Swyden, Project Manager, has been leading our successful testing efforts which have included LYNX drug charges and interfaces as well as LabCorp interchanges. Additionally, I m pleased to share that we have just received ICD-10 certification from Quest Diagnostics. So what does this mean for you? It means that as a Pulse client, you can be confident that you have the tools you need to be successful this fall. It means that our experts have already worked through many of the challenges that you may have otherwise faced during this transition and have developed solutions to mitigate the negative effect they would have had on your operations. And, it means that we take this change very seriously and are doing everything we can to support you and

3 your practice as you work towards a successful implementation and transition on October 1. We are proud of the success that our various teams have had in successfully developing quality solutions and testing with payers to give you comfort that you are ready to meet the challenges of ICD-10. While we re on the subject, we ll be holding several webinars specifically focused on ICD-10 throughout the month of August and September. You can read more about those here. I encourage you to attend, and please be sure to let us know if you have additional questions that we can answer for you. We are here to partner with you in your success. Let us know how we can help you! Jeff Burton President & Chief Executive Officer Pulse Systems, Inc.

4 Increasing Revenue Using Key Performance Indicators Metric #2 Percentage of AR Greater Than 120 Days Each month we speak about Key Performance Indicators (KPIs) and their importance in your office in terms of benchmarking, goal setting and changing workflow to create improvement. This month s KPI is one that represents the historical progress of your billing process: Percentage of AR Greater Than 120 Days. This KPI tells the story of managing your patient intake forms accuracy, of collecting and checking insurance eligibility and of preparing and sending a cleanly coded and scrubbed claim to the payer. If you manage your billing processes to minimize this metric, you are on your way to becoming master of your entire revenue cycle process, and you deserve to be in the MGMA s Best Practice metrics managers and receive the accolades of your physicians. Why is this KPI so important? Consider this: : The Percentage of AR Greater Than 120 Days represents a Practice s ability to get paid timely and to monitor old debts that are not getting paid. : It can also be a sign that a Practice has not established, or is not following, a disciplined credit collection procedure. : A good collection policy will define the number of attempts to collect from the payers then define the process of collecting from the patient when responsibility has been turned over to the patient.

5 To calculate the Percentage of AR Greater Than 120 Days: % = $ of AR from 120 Days / Total from AR Aging Report Summarize the dollar amount of the receivables greater than 120 days old and divide by the total AR from the AR Aging Report. Calculations are based on per physician data. Source: MGMA, Cost Survey for Multispecialty Practices: 2014 Report Based on 2013 Data Important Notes: 1. Various factors that can adversely affect the Practice s AR aging over 120 days, which are the sole responsibility of a Practice and can adversely affect a DAR (Days in Accounts Receivable) calculation, include the Practice s: : Write-off policy : Turning a patient over to a collections agency : Frequency of sending patient statements 2. AR aging calculations are important to assure accurate results. For example, some IT systems age by date of service, some age by the date the charges are entered and others age by the date the claim was generated or sent to the patient. Understand the metric and be consistent in your calculations. 3. It is important to base your aging on the actual date the claim was generated since this is when the payer is responsible for the amounts. 4. If there is a secondary insurance, the aging should not be reset or re-aged to zero. This provides a false, or lower, aging number of days while waiting for the secondary insurance to pay.

6 5. In the case of the patient, aging for patient responsibility should be done when all insurance is adjudicated and the bill is sent to the patient. 6. Make sure a disciplined policy is followed so that the AR over 120 days is not inflated due to a failure to write off or turn to collections those debts that the policy has indicated are ready for collections. Next month s newsletter continues with KPI Metric #3 Gross Collections (GC) Rate and why this isn t such a gross metric, but still an important one in controlling revenue from payers.

7 Configuring an Appointment List Need to configure an Appointment List to a new user? Use the My Appointment List function to create and edit appointment lists available from the User Dashboard, Patient Dashboard and Pulse Mobile Device. Configure your appointment list in the Clinical Dashboard by completing the following steps: 1. Select My Appointment List from the Administration section of the Navigation pane 2. Select the New button on the toolbar 3. Type the Description for the Appointment List and then click Save 4. Select items from the Content pane and move them to the List Columns pane System Result: A sample list will display in the Sample Appt List Section. Optional You may change the order of items displayed or modify column settings and list settings as desired. 5. Select the View Appointment List tab to select the scheduling resources available in your appointment list 6. Click OK to save Appointment List details

8 ICD-10 Webinar Series ICD-10 represents one of the biggest changes in health information in decades. It is the only national standard that defines the patient s health state in data that crosses all health care enterprises. Pulse is providing an opportunity to participate in educational opportunities and information sessions to expand your ICD-10 knowledge. Please see the upcoming events for registration details

9 Identity Proofing Do you have a new provider joining your practice? Do your providers want to send controlled substances electronically? If you answered yes to either of the above questions, here is what you need to know: In order to comply with the Electronic Authentication Guideline (NIST Special Publication ), Surescripts now requires that all e-prescribing providers go through identity proofing every two years. Please be aware that Pulse did not set this mandate, however Pulse is required to follow this mandate in order to maintain our certification. The Pulse Implementation team is ready to help and guide you through this process. One of our team members will be able to provide you with step-by-step instructions on identity proofing. All providers are required to undergo identity proofing in order to send electronic prescriptions. Existing providers that have already been enrolled with Surescripts have been given a grace

10 period and are not required to go through the identity proofing process for the first two-year cycle. Pulse has partnered with IdenTrust to make the identity proofing process as seamless as possible. IdenTrust is the global leader in trusted identity solutions, recognized by global financial institutions, government agencies and corporations around the world. Frequently Asked Questions Q: What does identity proofing provide? A: It provides three key capabilities: authentication, encryption and digital signing. Authentication proves your identity, encryption safeguards content and ensures document integrity, and digital signing replaces the provider s wet signature and enables straight-through processing (paperless workflows). Q: What is my organization s grace period? A: Your providers have been grandfathered in for the first cycle (two years) which began when you received the new RX version 5.0. You can contact your Client Manager or Pulse Support to obtain that date. From that effective date, you will have two years to complete identity proofing. Q: How often do I complete identity proofing? A: The DEA requires the renewal of the identity proofing process every two years.

11 Q: Can new providers be enrolled with Surescripts without completing identity proofing? A: No. New providers will need to complete identity proofing with IdenTrust prior to enrollment in Pulse Rx. IdenTrust sends the provider a credentialing serial number that Pulse needs to enter into PulsePro as part of the enrollment process. Q: Do I have to pay for IdenTrust identity proofing? A: Yes. There is an IdenTrust fee of $99 for the IGC Basic Assurance Unaffiliated Certificate. IdenTrust offers a three-year purchase plan; however, the DEA requires the renewal of identity proofing to occur every two years, so you choose the two year option. Q: Are there any other identity proofing costs associated depending on the role I play in my clinical practice? A: If the user needs two factor authentication for electronic prescribing of controlled substances (EPCS), there is an addition fee assessed by IdenTrust for a USB token device, bringing the total costs to $157. Two roles will require this device - the prescribing provider and a DEA Registrant (usually the office administrator or another provider at your practice).

12 Q: Why do I have to add personal credit card and address information for identity proofing? A: The personal information will be checked against independent data sources to verify your identity. Only your full name and address will appear on your certificate. All other personal information will be maintained by IdenTrust and will not be shared with any third party without your prior consent.

13 Tip of the Month Do you need a quick, easy way to adjust your patient balances that are less than $5? If so, you can use the Small Balance Write-off module. The Small Balance Write-off module will allow you to take multiple line items or a patient balance and adjust them at one time. Once you have completed the small balance adjustments, you will be able to run the Adjustment Transactions report and select the SB reason code. This will provide you with a report showing all the accounts, for the specified date, with a small balance write-off. TIP: This should only be completed once you have completed Pulse Best Practices, posted all undistributed payments and worked the Unassigned Balances. 1. AR Management > Ledger Workbench > Select the purple hand

14 2. Select your criteria: : Select line balance or patient balance : Double click on the Age Date field to populate the above field : Double click on the Amount field to populate the above field 3. Next, select the Fill List button. This will populate a list that will allow you to review the Ledger and check off the accounts to include in the small balance write-off. By clicking on the Generate Adjustments button, it will automatically create a verified Small Balance adjustment on the ledger. It will also include an internal note. TIP: You can assign the accounts to a worklist and assign the worklist to a user. This will allow administration to monitor the progress of the worklist.

15 On July 6, the Centers for Medicare and Medicaid Services (CMS) announced a one-year grace period for claims with incorrect ICD-10 codes, which will still go into effect on Oct. 1. During the first year of ICD-10 implementation, Medicare claims will not be denied, and eligible professionals will not be penalized under PQRS or Meaningful Use, based solely on the specificity of the diagnosis codes, as long as they are from the appropriate family of codes. In addition, CMS will authorize advance payments to physicians should Medicare contractors be unable to process claims as a result of ICD-10 complications. CMS also announced plans to create a new communication center to monitor and resolve issues as quickly as possible, as well as an ICD-10 Ombudsman to assist providers. In a separate announcement, CMS indicated that nationally it accepted 90% of claims from more than 1,200 submitters who participated in CMS third round of ICD-10 front end (acknowledgement) testing. Although this grace period will greatly reduce denials, knowledge and implementation of ICD-10 coding is still vital. Pulse is hosting several ICD-10 readiness webinars throughout the month of August to prepare for the Oct. 1 launch date, and we encourage you to attend!

16 Accidental Encounter of the Third Kind Have you ever created an encounter note on the wrong patient? What about the right patient and the wrong date of service? If you haven t, it s a high probability that you will in the future. When this happens, you will want to know how to fix it. The good news is that there are steps you can take before calling support to fix the problem on your own. First thing s first: be sure that you are the owner of the document. If you are NOT the owner, save the encounter note In-Progress, under your name. After you save the note, double click on the note to open it. At the top left part of the screen, click the button that says Select. After you click Select, click Encounter, and then click Delete. Once you have deleted the encounter, you will need to exit the patient chart and go back in to see the encounter fall off of the list. Using this workflow will allow you to delete any accidental encounter(s) on your own, saving you time and keeping your charts clean and accurate. Use the workflow below to practice on a test patient to get the full picture of how this is done. Note: Patient example is a fictional patient, on our test server, to avoid breaching HIPAA.

17 3. In the patient chart, select the tab that houses your encounter notes. Scroll to the right until you see the Own By field. 3. If you are the owner, then you can proceed. If not, you need to re-save the encounter note under your name. After this has been done, you can open the encounter note and select the Select button. 3. Then select Encounter to open a submenu and then select Delete.

18 AOA Grows and Changes with Pulse over 15 years Mary Wine, Practice Administrator More than 15 years ago, Advanced Orthopaedic Associates (AOA) of Wichita, Kansas, was looking for a Windows Platform that would support their practice management needs. Mary Wine, Practice Administrator, says it seems funny now to think about it, but at the time, the practice was worried about Y2K. However, they were pretty sure this Internet thing was really here to stay. We narrowed down our search to about two or three companies, including Pulse, Mary says. But when our current vendor sold his business to Pulse and we became more familiar with the leadership team, it really sealed the deal. Mary says the transition came with its own set of challenges especially given the newness of technology at that time. Mary held training sessions to teach her staff how to use a mouse and introduced their transcriptionists to Microsoft Word. She also had to convince her physicians and referring physicians that changing from a snail mail referral note to a faxed note would save time and money.

19 If I hadn t had the tremendous support from Pulse during that time, we would have never made it through such a fundamental change in our environment. As a long-time Pulse client, AOA has seen plenty of changes both at Pulse and in the health care industry and it has been Pulse s commitment to take the next step in technology when needed that has kept them as satisfied customer. The medical environment is changing so quickly and often it seems like technology is trying to keep up, says Mary. Pulse has always been there to take the next step and has worked aggressively and steadily to improve their programs. For example, our practice had been using an outside service for patient reminders and collection calls, but just finished implementing Pulse Engage. Staff love the integrated reminders. I feel like we have personal relationships with the Pulse team, and we don t plan on leaving anytime soon!

20 ICD-10 Enhancements With the release of Pulse Complete EHR version on July 24, Pulse delivered a simplified workflow in support of easy ICD-10 adoption by introducing an ICD-10 selection dialogue based on familiar ICD-9 codes. In August, we will provide an additional round of enhancements to better support workflows through problem lists. For more insights into what changes are being made to the product, please see the various ICD-10 events detailed in this newsletter in the section. PQRS 2015 Pulse offers the 2015 Qualified Registry to report Physician Quality Reporting System measures to the Centers for Medicare and Medicaid Services (CMS). The 2015 PQRS Module is integrated as part of the Pulse Complete EHR product application and can be utilized by any provider using Pulse Practice Management for billing. In August, we will continue to deliver PQRS 2015 measures. The remaining 2015 PQRS individual measures and measure groups will be

21 delivered in future releases. Please send an to and identify your desired measures to help us better assist you. Pulse Mobile Since the official release of Pulse Mobile 2.0 in July, we are beginning a series of rapid releases, each evolving the product a bit further. The first new feature will be access to the patient encounter note, which is planned for August. Additional features in the works are access to documents and images, tasking, and the release of the product for the Android platform.

22 August ICD-10 Webinar Series ICD-10 represents one of the biggest changes in health information in decades. It is the only national standard that defines the patient s health state in data that crosses all health care enterprises. Pulse is providing an opportunity to participate in educational opportunities and information sessions to expand your ICD-10 knowledge. Introduction to ICD-10 (August 5, 2015; 4:00pm CST) Register Now! ICD-10: How to Get Started (August 12, 2015; 4:00pm CST) Register Now! ICD-10: Clinical Documentation (August 19, 2015; 4:00pm CST) Register Now!

23 ICD-10: Vendor and Payor Readiness (August 26, 2015; 4:00pm CST) Register Now! ICD-10: Implementation (September 2, 2015; 4:00pm CST) Register Now! August ICD-10 Focus Group Please join us in this interactive virtual focus group for an opportunity to contribute your thoughts around a few additional workflow enhancements that we have planned to provide a smooth transition to ICD-10. Note: If you attended the July 23rd session, this will cover the same information Pulse ICD-10 Workflow Enhancement Focus Group (August 6, 2015; 6:00pm CST) Register Now!