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where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.


There’s no denying this year has brought on enough challenges to last a lifetime. And those we usually turn to in difficult times are now the individuals to which we’re advised not to get too close. With Thanksgiving just around the corner to kick off the holiday season, it’s natural to want to spend time gathering and reconnecting with family and friends, and feeling even just an ounce of normalcy in what has been a topsy-turvy 2020. 

But with that feeling also comes the looming shadow of the surging pandemic and the worries of spreading COVID-19. You feel conflicted, and that’s completely understandable. In the midst of rising cases across the country, and at a time where many folks are thinking about getting together with loved ones, the CDC has provided some helpful guidelines for celebrating the holiday season safely. There’s a lot of valuable information on their webpage and I certainly urge you to read through all the essential recommendations in helping to prevent the continued spread of the virus. This includes avoiding air travel if possible, wearing a mask, continuing to social distance oneself, limiting gatherings to household members only, hosting get-togethers outdoors, diligently washing your hands, minimizing exposure to at-risk individuals, and more.

Why not consider more lower-risk Thanksgiving activities? What would that entail? The way I see it, this season is a unique opportunity to try out some fun, new traditions while keeping everyone safe and healthy. Here are just a few:

Virtual Thanksgiving… Where Pants Are Optional?

One benefit to not having to sit around a formal dining table? No one can call you out on wearing your nice holiday sweater while sporting some stretchy sweatpants or your favorite pair of shorts down below.

Recipe Swap - Fewer Cooks in the Kitchen

How to engage with friends and family without being able to see them in person or getting Zoom fatigued? Share some of your favorite recipes ahead of Thanksgiving! It’s almost as if they’re right there in your kitchen telling you that you’re folding in the cheese all wrong.

Don’t Be A Stranger, Send Food to an At-Risk Neighbor 

I’m sure we all know of at least one friendly neighbor who is isolated from family this season and could use a nice home-cooked meal. Safely deliver contactless traditional turkey day meals to a friend or neighbor and remember to sanitize as you prepare!

Take a Hike, Literally.

Why not try swapping out chaotic airport travel, sitting in neverending traffic, attempting to quell yet another heated family debate, and being forced to eat 4 days of leftovers, with a touch of the great outdoors? Your mind and body (and pup) will thank you.

So, as we go into the holiday season, let’s all remember to share the love but not the germs. We are all feeling the pandemic fatigue, but we can all still partake in slowing the spread of the virus just by making a few adjustments to our traditional plans. Stay safe and healthy out there!

Happy Thanksgiving from the entire pMD family!


To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


The United States has surpassed yet another devastating milestone in the ongoing COVID-19 pandemic; 250,000 Americans have now died from the virus. Case numbers are exploding at the beginning of what is expected to be a difficult winter of illness in America. Hotspots are popping up all across the country and new highs for the number of cases and hospitalizations continue to rise significantly.  Read More

Patients’ overall health continues to suffer due to the pandemic, with more than a third of primary care physicians reporting that their patients with chronic conditions are in noticeably worse health resulting from the pandemic. A primary driver for the increase in negative health burdens is due to delayed or inaccessible care during the pandemic.   Read More

As COVID-19 hotspots spring up across the country, hospitals must once again grapple with how to take care of patients while keeping other services open safely. Many health systems have completely stopped or significantly reduced scheduling elective procedures in order to free up beds for COVID-19 patients.  Read More

• The FDA has approved the emergency use of the first rapid coronavirus test that can be performed entirely at home and delivers results in 30 minutes. This represents an important step in efforts to expand testing options for COVID-19 beyond health care facilities and testing sites. However, the test will require a prescription, likely limiting its initial use.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, and care navigation software.

I’ve worked in health care for many years, and while providers face their fair share of challenges, there’s one question that I’ve noticed almost always bubbles to the top - who do I ask about coding questions? This can be especially distracting as they attempt to focus their efforts on providing the best medical care.

Coding appears to be a thorn in everyone’s side. Why is that? Well, imagine having to enter codes on patients 30+ times a day! Currently, to determine whether you’ve made the correct E&M (evaluation and management) code selection, providers must successfully meet each criterion of the 1997 Documentation Guidelines for E&M Services. Yes, you read that correctly, 1997! 

Let’s take a look at charge code 99213 as an example. While this may seem like a straight-forward, low-level subsequent visit, think again! To correctly select this code, you need to meet two of the following three requirements: 1) an expanded problem-focused history; 2) an expanded problem-focused examination; and/or 3) medical decision-making of low complexity. But, that’s not all. Now answer the following question; how do you define and determine expanded and low complexity? Each of the previously required components is broken down even further into several categories and elements that need to be considered.

As you can see there are many variables that go into selecting the correct code. The question many providers are left with is: who has time to reference the various guides and available resources when trying to complete a patient visit? Unfortunately, inaccurate coding can lead to significant penalties and lost revenue.

The good news is that changes are coming. Starting in 2021, time-based billing will be available for applicable services, dramatically reducing the complexity associated with code selection. CMS alone has reported a 9.2% monetary loss due to incorrect coding and 55.2% loss due to insufficient documentation in the CY of 2019. If you were to submit an incorrect claim to the government, this would violate the Federal Civil False Claims Act (FCA). Penalties may include substantial fines and even possible imprisonment. As frightening as those repercussions are, the most common consequence of medical coding errors is not receiving reimbursement from the insurance carriers. 

It’s about time we actually apply the infamous motto “patients over paperwork” and remove the providers’ burden of having to recite coding guidelines. Thus, eliminating the fear of possible sanctions due to inaccurate coding.

At pMD, we can create customized edits designed to prompt providers to select accurate codes based on specific parameters and requirements, such as charge code or diagnosis criteria, NCCI edits, patient demographics, and much more. This is a quick, seamless process that enables the provider and biller to feel confident in their code selection. Just a few extra clicks based on prompts can assist with accurate and timely claims submission. Additionally, it can result in quicker payment turnaround as well as the appropriate utilization of E&M codes. 

pMD is continuously evolving to serve the billing needs of practices. Contact us to learn more about how pMD can best assist you and your practice!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


The U.S. surpassed 10 million total COVID-19 cases this week, just 10 days after cases topped 9 million. Due to the steady increase in cases, experts predict the winter surge will be the largest, and perhaps deadliest, yet. In fact, the country could be on track to record one million daily coronavirus cases by the end of 2020 if average cases continue to grow 34 percent from week to week, as they are currently.  Read More

In the past couple of weeks, CMS has released or proposed five new rules concerning issues related to new payment reforms, price transparency regulations, and coverage of a COVID-19 vaccine. Included in these new rule updates are expanded add-on payments for new and innovative equipment and supplies to certain home dialysis machines.  Read More

A day after the FDA allowed emergency use of an antibody that helps the immune system fight COVID-19, CMS announced Medicare will cover all costs for the antibody infusions during the public health emergency. While Medicare won't pay for antibody products that providers get for free, they will pay providers to administer them.  Read More

Seriously ill COVID-19 patients are starting to fill up hospital beds in record numbers, and health care workers are bracing for even more patients to come in the wake of skyrocketing coronavirus infections. But the burden on hospitals is not evenly spread. Some communities, particularly in the West and Midwest are particularly hard-hit, with hospitals in these areas already brushing up against their capacity to deliver care.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, and care navigation software.

Electronic Health Records have greatly benefited health care. However, the wide adoption of EHRs did not come without certain drawbacks, especially for providers.  Do you remember what it was like to go to the doctor 15 years ago? You’d walk in and immediately see a lifetime supply of manila folders behind the front desk staff. When the provider entered the room, they were able to sit in front of you and have an engaging conversation. Today, a majority of providers are having to type into a computer in order to meet electronic documentation requirements. Although EHRs have propelled health care forward in many ways, unfortunately, they’ve added a new burden for providers: having to code from their patient visits with standardized code sets.

What are standardized code sets?

Providers are expected to document within different sets of billing and clinical terminologies. Simply put, these are standardized vocabularies that allow representation of the same health concepts between different health information systems. You can think of health care terminologies as the building blocks that support the entire health care documentation process. They allow patient data to be transferred in a way that can be understood and consumed universally, which is necessary not only for individual patient records but also for public health reporting, statistics, and billing.

ICD-10 and SNOMED-CT

You may be wondering: why is this a problem for providers? To dive in, let’s focus on two code systems often used by providers: 

ICD-10 (International Classifications of Diseases, 10th Edition) is often used for the backbone of diagnoses. The issue is that the coding hierarchy was built for billers and therefore is not provider-friendly. A lot of the terms aren’t expressed in everyday provider language (ie - “myocardial infarction” instead of “heart attack”), and there aren’t enough codes to capture the specificity of many clinical concepts. In general, ICD-10 is appropriate to be used as the backbone for billing but lacks the specificity needed for clinical documentation. 

SNOMED-CT (Systematized Nomenclature of Medicine – Clinical Terms) is a clinical term that includes diseases, clinical findings, etiologies, procedures, and health outcomes. It was the terminology required to meet Meaningful Use Stage 2 certification standards back in 2014 and is what providers typically use to document clinically in the EHR. Although this is a more comprehensive, clinical-based terminology, it still forces providers to document using the language of the code system rather than being able to document using their everyday language. There are several complexities to each code set - such as having to post-coordinate on a term to make it more clinically specific. 

This is burdensome because providers are, on top of their growing list of patient responsibilities, now tasked with learning multiple coding languages - which was something that was previously handled exclusively by billers and coders. With the wide adoption of EHRs, it moved the clerical task of coding to the providers, which shows that EHR technology is not assisting the providers, but rather the providers are assisting the technology. Why make providers learn all of these different code languages instead of allowing them to document clinically in the way they were trained?

Are there any solutions?   

Thankfully, there are solutions that help to ease this new coding burden on providers. Here at pMD, we accomplish this on the charge capture side by making the diagnosis and charge lists extremely customizable - not only to each practice but down to the individual provider. We can rename ICD-10 and CPT terms based on the provider’s preference, float important terms to the top, and delete terms that are not necessary. By offering a highly customized pick list, we eliminate the need for providers to memorize multiple coding languages. 

There are also clinical interface terminology solutions that serve as a bridge between code sets and providers. These companies offer expansive clinical vocabularies that have multiple synonyms and ways of documenting each term (ie - “type 2 diabetes,” “t2dm” and “diabetes, type II” would all be options for documenting the clinical concept of type II diabetes mellitus). They are very helpful to providers documenting in the EHR where more in-depth documentation is required. Overall, EHRs have helped propel health care forward, but pMD helps to take the coding burden back away from providers. 

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


• The U.S. set a new single-day high for COVID-19 cases this week, surpassing 103,000 in one day. Experts have warned that we are entering the "deadliest wave” of the pandemic as cold weather sets in and people begin hunkering down indoors. So far close to 9.5 million Americans have been infected and over 233,650 have died.  Read More

The Department of Health and Human Services (HHS) issued a new proposed rule to review regulations and eliminate those that are outdated or no longer needed. This proposal, the boldest and most significant regulatory reform effort ever undertaken by HHS, would require the department to review regulations every ten years and sunset burdensome regulations unless their necessity is adequately demonstrated.  Read More

While telehealth usage has skyrocketed during the COVID-19 pandemic thanks to expanded insurance coverage and relaxed restrictions, the future of virtual care in the U.S. health care system will rely on permanent reimbursement practices and continued tech innovations. CIOs from hospitals and health systems across the country share their predictions for what telehealth will look like at this time next year.  Read More

While efforts have been on-going for years to provide further access to health information and create a smoother process in delivering care, COVID-19 helped expose the lack of interoperability in the U.S. health care system, underscoring the need for payers, providers, and federal agencies to work together. In 2021, CMS is set to introduce a new Interoperability and Patient Access final rule, aimed to empower patients and improve interoperability, while reducing the burden on payers and providers.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, and care navigation software.

Amid this pandemic, vaccines are a topic that is at the forefront of health conversations and news. Everyone is looking forward to the day that a COVID-19 vaccine is available to help us start returning to “normal”. However, there’s another aspect that perhaps only some have considered: proof of having received the COVID-19 vaccination.

Typically, the only situations requiring vaccination records are grade school and summer camp attendance, being a member of a sports team, military enlistment/deployment, and employment in the health and safety industries. However, 2021 could be the first year where average people need a way of presenting proof of vaccination in situations ranging from attending a game at a sports venue to boarding an airplane. There is even historical precedent of the U.S. government mandating vaccinations. Even employers have the legal right to enforce vaccination requirements for their employees. It’s not farfetched to imagine a future where employers make proof of COVID-19 vaccination a condition of new or even continued employment.

This possibility fits neatly into the health care industry’s trend of encouraging patients to take a more active role in their own health care. One way patients can take a step towards that goal is to know if they are up-to-date on their vaccines and maintain an easily accessible vaccination record. The CDC’s vaccination schedule for adults is more involved than most would think, e.g. specifying repeated doses of vaccines like TDAP every 10 years. Personally, I would like to know I’m up-to-date on my vaccines without having to sift through old paper records or contact multiple health care providers such as pharmacies and general practitioners. 

Even in this day and age of technology, one of the CDC’s official recommendations for recording your vaccinations is to use this PDF. You’re instructed to print it out, take it with you every time you are vaccinated and have your provider fill it out. This inherently comes with all the downsides of a paper-based solution, ranging from the potential for human error when recording the information to damage or loss of the entire record itself. The vast majority of health care providers have incorporated some form of electronic health system for storing patient data, often with a patient portal. This gives patients the means to more easily access or even download copies of their health records. These copies can then be viewed at any time by using cloud storage solutions such as Dropbox or Apple’s iCloud Drive, which allow access to those files from whatever device is on hand. 

pMD already has the capability to assist patients with retrieving their vaccination and health records. Patients can securely message their practice from the app and request for their records. Practices can then directly send health records to their patients in a HIPAA-compliant manner using the attachments feature in our messaging platform. Even obtaining access to the patient portal of providers’ electronic health record systems can be simplified through pMD via chat communication, allowing login information to be shared securely. With such an easy tool available to get a handle on your vaccination and health records, why not start today?

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


With potential vaccines on the horizon, CMS says that Medicare and most private insurers will cover FDA-approved COVID-19 vaccines at no cost to beneficiaries. The interim final rule also implements parts of the CARES Act to ensure swift coverage of a COVID-19 vaccine by most private health insurance plans without cost-sharing during the course of the public health emergency.  Read More

Federal agencies warn that cybercriminals are escalating their extortion attempts against the health care sector even as hospitals are facing a nationwide surge in COVID-19 cases. Several U.S. hospitals have already been targeted in ransomware attacks this week as malicious groups are expected to continue attacks that could lead to data theft and disruption of health care services.  Read More

The future potential of telehealth may hinge on how it's reimbursed. While virtual care may be popular among both practices and patients, if providers can't get paid for their services, it will make it extremely difficult to continue to provide them. Most experts believe telehealth is here to stay, but in what capacity will depend largely on establishing clear standards and reimbursement guidelines.  Read More

Large retail companies like Walmart, Walgreens and CVS are increasingly offering health care services at their locations across the U.S. as well as online. Retail clinics have a big opportunity to capitalize on the consumer demand for services such as disease prevention, chronic disease management, wellness and behavioral health, while also streamlining care delivery.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, and care navigation software.


Here's The Latest in Health Care:


When the COVID-19 pandemic hit earlier this year, health system executives had to shift their priorities to fast-track innovations such as virtual care services and artificial intelligence tools. But the quick implementation of telehealth solutions in response to the pandemic highlighted areas needing improvement—in particular, integration gaps, especially with platforms not built for healthcare workflows.  Read More

There is no one-size-fits-all approach to running a successful physician practice, but a new report has found that top-performing organizations have a couple of characteristics in common. Practices performing the best related to operations, profitability, productivity, and value invested more in staff, facilities, and operations compared to the median of all multispecialty practices.  Read More

Surgery has undergone a great deal of fluctuation amid the COVID-19 pandemic. As the country grappled with a relatively unknown virus and raced to learn more about it, hospitals suspended elective and non-urgent surgeries. But as states reopened, surgery service lines did as well, and now many organizations are working to adjust surgery services to the new normal.  Read More

According to a recent survey, health system execs expect it will be at least 2022 before their operations return to anything resembling a pre-pandemic "normal." Nearly three-quarters of respondents said they were moderately or extremely concerned about the financial viability of their organizations in the absence of an effective COVID-19 vaccine or treatment.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, and care navigation software.


Injuries are tough. For student athletes, it can mean missed seasons, time spent on the bench, a distraction from classes, and sometimes...extra semesters to make up for it. And for the average adult, an injury can cause serious disruptions to everyday life, like less time playing with the kids, having to take off work, reduced mobility, and even loss of independence. 

Though for many patients, injury rehabilitation can be as much an obstacle as the injury itself. 

Certainly, navigating the web of providers and care settings can be a daunting and difficult task. For student athletes, this may mean coordinating care between doctors, physical therapists, athletic trainers, or some combination thereof. Similarly, injury rehabilitation for the average patient will likely involve coordinating care between some combination of doctors, physical therapists, chiropractors, or potentially even a home health care provider, depending on the severity of the injury.

In each of these cases, the sheer number of appointments, providers, and coordination that must occur can leave many patients feeling disillusioned, confused, and “out on their own” -- left to navigate this intricate web and direct their recovery themselves. What’s more, the siloed nature of this landscape leaves many opportunities for patients to “fall through the cracks” on their road to recovery. For more minor injuries, this intimidating landscape might be enough to convince patients that their injury rehabilitation can wait. 

Although the severity of the injury, the patient's circumstances, and the combination of providers needed to treat the injury are unique to each case, a commonality between any injury rehabilitation situation is that the patient serves as the vector of coordination between all points or providers. Patients are oftentimes physically carrying documents, forms, and their own PHI (protected health information) from one provider’s office to another. Certainly, this system is neither efficient nor free from error. The lack of communication and coordination in this setting makes both patient and providers' lives more difficult.

Here at pMD, our mission is to improve patient lives, and in the process, make doctors’ lives easier. pMD’s secure messaging solution was born out of a need for providers within a practice to be able to communicate with each other. But over the past 5 years, we’ve expanded the platform, to allow providers to communicate with other providers outside of their practice, as well as with patients directly. Just recently, we introduced group messaging to our platform, allowing for an even higher degree of coordination between patients, providers, and caretakers.  

In the case of injury rehabilitation, pMD’s secure messaging platform gives patients the opportunity to communicate and coordinate directly with their providers, ask follow-up questions related to their rehab plans, and send and receive documents from their providers. Providers, in turn, are able to control conversations with patients, share secure documents, communicate about PHI freely, and coordinate with other providers, all while keeping their personal contact information private. 

In today’s ever-complicated health care landscape, communication and coordination are key to a quick recovery. pMD’s communication software serves as an elegant solution to many of the nuanced problems associated with injury rehabilitation and care coordination that currently plague this environment. In the process of improving system efficiencies within and between practices, we hope to make patients' lives better, so they can have that time back with their kids, get back on the field, or get back to work. Because that’s what really matters!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.