Under the stimulus package, health care providers who demonstrate meaningful use of electronic health records will qualify for Medicare and Medicaid incentive payments (Conn, Modern Healthcare, 5/17).

Blumenthal wrote that NHIN is “not a network per se, but rather a set of standards, services, and policies that enable the Internet to be used for the secure exchange of health information to improve health and health care.”

NHIN Direct

He also acknowledged that some health care providers “may have simpler needs for information exchange, or perhaps less technically sophisticated capabilities.” He said such health care providers could benefit from NHIN Direct, which still is under development (Blumenthal letter, 5/14).

NHIN Direct is a basic version of NHIN that offers health care providers open-source software to develop a network for the electronic transmission of health information (Modern Healthcare, 5/17).

Blumenthal wrote that NHIN Direct “is meant to enhance, not replace, the capabilities offered by other means of exchange.” He added that the model could “complement existing NHIN exchange capabilities and strengthen our efforts toward comprehensive interoperability across the nation” (Blumenthal letter, 5/14).

In addition, Blumenthal wrote that ONC is “on an aggressive timeline” to develop standards for NHIN Direct so health care providers can use the framework to qualify for incentive payments.

He also called for greater public participation in the NHIN Direct project through blogs and a community wiki, which are available on the project’s website (Modern Healthcare, 5/17).

Cleveland-based Medical Mutual of Ohio is teaming up with its pharmacy benefits manager, Medco Health Solutions, for a pilot program that gives select doctors financial incentives to prescribe medications electronically.

Medical Mutual is signing up 250 of its network physicians who order the highest volume of prescriptions for the health insurer’s enrollees but haven’t switched to electronic prescribing yet.

The practice of ”ePrescribing” enables doctors to send their prescription orders through a secure connection from their computers to the pharmacy’s computer.

”Since the prescription is being sent electronically to the pharmacy, the member can get his or her prescription more quickly,” said Ed Byers, spokesman for Medical Mutual, which has about 1.6 million enrollees.

By prescribing prescriptions electronically, doctors also can immediately see which drugs are covered and at what level for their patients.

As a result, patients save money and the health insurer saves money ”because they see higher returns on generic dispensing and formulary adherence,” said David Fidler, director of ePrescribing for Medco Health Solutions. ”Everybody’s interests are aligned when you start talking about e-prescribing.”

Dr. James Dom Dera, a physician with Ohio Family Practice Centers in Fairlawn, recently switched to electronic prescribing for many of his patients.

”It’s just much easier,” he said. ”I can click and prescribe much faster than I could ever hand-write or print or fax a prescription.”

Dom Dera said he also likes the fact that electronic prescribing eliminates the risk of errors from misreading handwriting or improperly transcribing an order.

Still, electronic prescriptions aren’t for everyone.

At least for now, federal law forbids doctors from prescribing controlled substances electronically.

And some patients who like to shop around for their medications still prefer to take a paper prescription with them, Dom Dera said.

Medical Mutual’s pilot program started in March and continues through September.

Medical Mutual and Medco declined to release details about the financial incentives they are providing to physicians who reach targets for number of prescriptions ordered electronically.

In the study funded by the Agency for Healthcare Research and Quality, researchers at Brigham and Women’s Hospital, Boston, examined data from several units in the hospital as they rolled out a staggered implementation of an electronic medication administration record, or eMAR, with bar-coding technology. The use of a bar-code eMAR was associated with a 27% decrease in timing errors, such as late or early medication administration, and a 41% drop in the rate of errors not related to timing, which include incorrect dosages and administration without an order.

Also, researchers noted that the rate of potential adverse events associated with errors not related to timing fell from 3.1% to 1.6%—what they described as a nearly 51% relative reduction. Not surprisingly, use of a bar-code eMAR also eliminated transcription errors, which occurred at a rate of 6% on units that did not yet have the system in place.

Bar-code eMAR systems allow nurses to receive medication orders electronically from a pharmacist or from a computerized physician order-entry system, and then use a bar-code scanner to verify medications at the patient’s bedside.

The results of the study demonstrate that bar-coding can have a substantial effect on safety, according to Eric Poon, director of clinical informatics at Brigham and Women’s, and lead author of the study. Poon also expressed confidence that the observed improvements were due to the implementation of bar-code eMAR systems and not another factor.

“We took measurements within a pretty small time frame, and the implementation was the main project we were doing at the hospital during that time period,” Poon said.

Still unclear, however, is whether hospitals with limited resources should implement a CPOE or bar-code eMAR system, Poon said, adding that Brigham and Women’s has had a CPOE system in place for many years. The two systems catch different types of errors and complement one another, he said.

For instance, a CPOE system is more likely to prevent errors related to incorrect judgment or insufficient clinical knowledge when choosing a treatment plan, while a bar-code eMAR usually catches errors associated with lapses in memory or mental slips, the study said.

“If a hospital can only afford one, we need to know which one makes the most sense to implement first,” Poon said. “That question is still unanswered.”

Quite often there have been instances when the in-house billing staff does not have the sufficient experience and does not possess the sufficient in-depth knowledge about coding. This will result in loss because claims cannot be made properly and may require rebilling. Moreover, instances of many scandals in this area of health sector have been rampant. Considering the various risks it is a must to outsource the medical billing to a trustworthy and reliable professional billing company.

Before signing a contract for outsourcing of medical billing with a company a proper enquiry about the company and its history is essential. Also checkout the following information from the outsourcing company and see how good they are.

* Do they provide reports?

* What is their collection rate?

* What is their specialty?

* Do they use a HIPAA-compliant format?

* Are they well staffed?

* Do they code also? (not preferred)

* What percentages are accounts receivable?

* Do they follow up on delayed /denied claims?

* Have they had face to face meetings with clients?

Encounter forms are usually completed and sent to the billing company along with the insurance card, registration cards on a weekly or daily basis. Most of the medical billing companies have medical billing software to prepare the bill and then submit it for claims. Bills to Medicare and other bigger insurance companies are generally sent via a clearing house. Many companies use doctors to scan the encounter forms.

How much does medical billing service cost for a physician? Billing companies charge doctors a percentage of what they collect and the rate depends on the doctor’s specialty. Specialists are charged lesser than the primary doctors because specialists mean lesser claim and bigger amount.

“Health IT experts agree that HITECH stimulus funds are likely to improve how physicians practice medicine for Medicare and Medicaid beneficiaries and, ultimately, for advancing patient-centered medical care for all Americans. However, there is an evidence gap about patients’ preferences and perceptions of delivery of health care services by providers who have adopted EHR systems in their practices,” the HHS’ May 14 notice in the Federal Register stated.

According to the notice, the goal of the proposed Patient Perceptions of EHR study is to help policymakers understand how primary care practices’ use of EHRs affects consumers’ satisfaction with:

* Their medical care,
* Communication with their doctor
* Coordination of care.

“The research questions for the proposed study are motivated by a concern that patients may have negative experiences as practices begin to use EHRs,” the agency wrote.

HHS plans to survey 840 patients about their opinion of their medical care when their primary care physicians use EHRs, according to the notice, which can be read here.

“These pioneering communities are going to lead the way in bringing smarter, lower-cost healthcare to all Americans through use of electronic health records,” Biden said in a prepared statement. “Because of their early efforts, doctors across the country will one day be able to coordinate patient care with the stroke of a key or pull up life-saving health information instantly in an emergency–and for the residents of these communities, that future is about to become a reality.”

The 15 communities, stretching from eastern Maine to the Big Island of Hawaii and encompassing urban, suburban and rural areas, were selected from among 130 applicants, according to the Office of the National Coordinator for Health Information Technology. In their applications, the communities had to spell out measurable goals for improving quality, efficiency and population health, and the federal dollars will support specific programs to bring together providers, health programs and patients to meet those goals with the help of EHRs.

The states and their grant amounts are: New Jersey, $4.93 million; Louisiana, $1.85 million; Maryland, $1.37 million; and Minnesota, $1.04 million.

Since November 2009, 39 states, Puerto Rico and the U.S. Virgin Islands have shared nearly $67.6 million in planning grants, according to news release information on the CMS website.

The stimulus law provides a 90% federal match to cover the cost of state planning efforts for the Medicaid EHR subsidy programs. According to federal estimates, the government estimates it could spend as much as $27.3 billion on the EHR subsidies under Medicaid, Medicare and Medicare Advantage programs.