Portfolio

For regularly-updated/published content, please follow me on Twitter at “Lisa_Eramo” or view my Facebook page at “Lisa Eramo, freelance writer & editor.” Following are several samples that have been published recently:


Anthem BCBS, November 2018

Why you should consider vocational rehab services

By Lisa A. Eramo

Nearly one million individuals with disabilities received vocational rehabilitation services in 2016 — and over half of them subsequently found employment, according to the Rehabilitation Services Administration. Putting people to work, including those with short-term disabilities, is one goal. Another is to help employers gain access to qualified workers. Although employers may incur limited costs when providing vocational rehab and workplace accommodations, doing so often pays dividends in the long-run, enabling you to hire and retain employees who help your business thrive …


Go Practice blog (Kareo), November 2018

4 ways to embrace healthcare consumerism

By Lisa A. Eramo

“24/7 access, improved productivity, and fewer human errors are three examples of how technology has completely disrupted major industries,” said Brent Bowman, vice president of strategy and expansion markets at Kaiser Foundation Health Plan in Denver, Colorado. Unfortunately, healthcare isn’t one of them, he added. “We are striking out at meeting consumers’ needs,” said Bowman, who spoke at Medical Group Management Association’s (MGMA) annual conference, held in Boston Sept 30 – Oct 3 about how providers can become more consumer-centric …


Go Practice blog (Kareo), October 2018

Using data analytics and the EHR to improve population health

By Lisa A. Eramo

Managing population health is impossible without two things: good data and good analytics. Novant Health has both of these. As a result, the not-for-profit, integrated system that spans communities in the Carolinas, Virginia, and Georgia is making significant strides in an era of value-based payments and population health management.

Keith Griffin, MD, chief medical information officer, and Ryan Neaves, MHA, director of IT applications, shared their data-driven strategy at Medical Group Management Association’s (MGMA) annual conference held in Boston Sept. 30-Oct 3. In particular, they provided these five tips …


For The Record Magazine, October 2018

A targeted approach to EHR training improves success rates

By Lisa A. Eramo

Imagine a physician walking into an exam room where a volunteer patient awaits while an EHR trainer silently watches them navigate the entire visit using a new record-keeping system. This hands-on simulated learning environment is exactly what more than 1,850 clinical providers at MD Anderson Cancer Center in Houston experienced as the organization transitioned from a best-of-breed EHR to an integrated system in March 2016 …


Go Practice blog (Kareo), September 2018

How patient navigators improve care and lower the cost of healthcare

By Lisa A. Eramo

Improving patient outcomes has always been a priority for physicians, but now, these outcomes are increasingly tied to payments. Payers want to ensure that they pay for care that provides value to patients and helps them live healthier lives. However, one challenge of value-based payment models is that patient outcomes aren’t necessarily based on care provided in a single setting. In reality, patients often move through multiple disparate settings, each of which plays a role in whether they ultimately achieve positive results.

Without a guide on this somewhat rocky journey, some patients may not follow through with treatment or referrals …


For The Record, August 2018

Choose your words carefully

By Lisa A. Eramo

Words matter. It’s not only what you write but also how you write it that affects others. Words shape our perception of reality. They stir emotions both good and bad, and they invite action as well as inaction. This is true in a variety of settings, and health care is certainly no exception. In fact, a recent study conducted by researchers at Johns Hopkins University School of Medicine found that the words providers document in patients’ medical records affect how other clinicians perceive and ultimately care for those patients—and not necessarily for the better …


Medical Economics, July 2018

Coding tips: Level 3 vs. 4 evaluation and management

By Lisa A. Eramo

The difference between a level 3 and level 4 office visit might not seem like much, but to payers, these visit types each tell a completely different story about the work that’s required to treat a patient …


Medical Economics, July 2018

Coding tips: Chronic care management (CCM)

By Lisa A. Eramo

Payers and the Office of Inspector General (OIG) are starting to crack down on improper payments for CCM. The message to practices is: Focus on accurate coding, or run the risk of recoupments, says Kim Garner Huey, CPC, owner of KGG Coding and Reimbursement Consulting in Birmingham, Ala. …


Medical Economics, July 2018

Coding tips: Transitional care management (TCM)

By Lisa A. Eramo

Transitional care management (TCM) is also a payer target for auditing, which means practices need to focus on following the rules when billing this service …


Medical Economics, July 2018

Coding tips: Appealing denied claims

By Lisa A. Eramo

When it comes to appealing denials, knowing payer policies and regulatory requirements is critical. “Being smarter than your payers is the key to successful denial management,” says Michael Strong, CPC …


Go Practice blog (Kareo), June 2018

5 steps to ensure revenue integrity after implementing a new EHR

By Lisa A. Eramo

n the rush to implement EHRs for Meaningful Use incentives, many practices lost sight of what matters most for continued success—revenue integrity, says Joette Derricks, healthcare compliance and revenue integrity consultant in Baltimore, MD. Revenue integrity—the idea that practices must take proactive steps to capture and retain revenue—isn’t a novel concept. However, it’s becoming increasingly important for physician practices operating in a regulatory-driven environment, she adds …


Go Practice blog (Kareo), June 2018

5 ways to get paid under value-based payment models

By Lisa A. Eramo

Under value-based payment models, physicians don’t necessarily generate more revenue by seeing more patients or performing additional services. This is a stark contrast from fee-for-service payment models under which there’s a direct correlation between volume and revenue. Now, payers increasingly reward high-quality services that improve outcomes. They penalize providers for duplication and inefficiencies that drive up costs …


Medical Economics, May 2018

New cognitive assessment code promotes planning, generates revenue

By Lisa A. Eramo

Many internists don’t perform a thorough cognitive evaluation. Instead, they often refer patients with suspected cognitive impairments to a neurologist, or they order a CT scan that may not actually be medically necessary. However, it could be financially worthwhile to delve more deeply into patients’ cognitive problems.

That’s because starting in January Medicare began paying physicians an average of $242 to perform a cognitive assessment and develop a care plan to address functional limitations as well as neurocognitive and neuropsychiatric symptoms. Physicians can report this service using CPT code 99483 …


Go Practice blog (Kareo), May 2018

5 tips to boost your revenue cycle management

By Lisa A. Eramo

You’re working diligently, patient volumes are up, and staff are more productive than ever before. So why is your revenue suffering?

Something is clearly amiss with the practice’s revenue cycle management (RCM) strategy, said Dixon Davis, MBA, MHSA, CMPE, senior consultant at BSM Consulting in Incline Village, Nevada who spoke during AAPC’s HEALTHCON event held April 8-11 in Orlando, Fla. HEALTHCON offers educational sessions and networking opportunities for medical coders, billers, payer representatives, practice managers, attorneys, physicians, and other healthcare business professionals …


Medical Economics, May 2018

Boost MIPS scores while improving osteoarthritis patient management

By Lisa A. Eramo

Although there’s no cure for osteoarthritis, it’s certainly possible for primary care physicians to not only help their patients manage symptoms, but also improve reimbursement for doing so.

The debilitating chronic condition affects more than 30 million adults in the United States, according to the CDC. Functional and pain assessments—something many physicians perform regularly—are critical because they help target interventions that ultimately improve patients’ quality of life.

These assessments can also boost payments under the Merit-based Incentive Payment System (MIPS), one of two participation tracks under the federal law that seek to reform Medicare payments while improving outcomes and reducing costs …


Journal of AHIMA, May 2018

Leading HIM reimagined by example

By Lisa A. Eramo

TECHNOLOGY HAS TRANSFORMED almost every industry, and health information management (HIM) is no exception. Data used to be handwritten words on a page. Now, with the rise of electronic health records (EHR), data is becoming an organization’s most important financial asset. Human coders used to comb through medical records to assign codes. Now, computer-assisted coding is increasingly assuming that role, while coding professionals begin to serve as code auditors and validators. Underlying these changes is a growing risk of cybercrime that magnifies the need for data integrity, privacy, and security—all tenets of HIM’s expertise. Some HIM professionals have been able to expand their skillsets to keep up with these changes, while others have struggled to stay relevant. Experts agree that the industry must address the widening skills gap that could render some professionals unable to move into new and emerging HIM roles as older traditional HIM jobs eventually fade away …


Futurehealthindex.com, April 2018

Three ways asthma treatment is getting connected

By Lisa A. Eramo

We have grown accustomed to smartphones, smartwatches and a variety of other intelligent technology that collects and analyzes all kinds of data to help us understand how we interact with the world around us. Now there are smart healthcare devices, too. But these innovations aren’t mere gimmicks – they’re having a real impact on the way medical conditions can be treated and managed. Take asthma, for example, where smart technologies are helping those with the illness live healthier and more satisfying lives …


Go Practice blog (Kareo), April 2018

Combatting the opioid epidemic with improved documentation

By Lisa A. Eramo

On average, 115 Americans die every day from an opioid overdose. Since 1999, deaths from prescription opioids such as oxycodone, hydrocodone, and methadone have more than quadrupled.

Coded data is what drives these and many other statistics that help healthcare providers, researchers, and others understand the opioid epidemic and how to address it, says Jaci Kipreos, CPC, CPMA, CPC-H, CPC-I, president of Practice Integrity, LLC. “The easiest way to obtain global information is through claims and coded data,” she says. “That’s what codes have always been about—a way to capture information very easily. So, the emphasis becomes coding it correctly.” …


Medical Economics, March 2018

Psychiatric collaborative care management may improve outcomes, boost revenue

By Lisa A. Eramo

Although Kristine McVea, MD is an internist at OneWorld Community Health Centers Inc. in Omaha, Neb., she’s also often a “surrogate psychiatrist,” titrating and prescribing psychiatric medications for patients with anxiety, depression, and other mental health problems daily. These patients need access to psychiatric services. However, it’s not uncommon for them to wait months or longer to see a psychiatrist. 

The good news is that, as of Jan. 1, 2018, financial incentives exist for physicians and psychiatrists to collaborate when caring for patients with behavioral health disorders. In its 2018 Medicare Physician Fee Schedule, CMS created a new Psychiatric Collaborative Care Model that enables physicians to generate revenue when they co-manage patients with a psychiatrist or some other professionals trained in behavioral health and provide ongoing care management support …


Revenue Cycle Forum, HFMA, March 2018

BPCI Advanced improves care, physician alignment, and revenue

By Lisa A. Eramo

The Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) Advanced is a voluntary episode-based payment model that helps providers invest in clinical care innovation to improve quality and reduce cost. The program follows in the footsteps of BCPI 1.0 that included four broadly defined models of care. Applications to participate in BPCI Advanced are due March 12 and the program is set to launch on Oct. 1, 2018 …


Medical Economics, March 2018

Managing heart disease: Improving coding and quality scores

By Lisa A. Eramo

As the only primary care physician in her rural Wisconsin town—and the nearest cardiologist more than an hour away—Melissa Lucarelli, MD, manages patients with heart disease and identifies those at risk of developing it. Doing so isn’t only good for patient care, it also positions her for higher quality scores under Medicare payment reform …


Go Practice blog (Kareo), February 2018

5 essential questions every biller can answer using a robust analytics tool

By Lisa A. Eramo

In an era of value-based payment reform that demands greater efficiency, medical billers don’t have time to waste time. That’s why data should be at the heart of every billing analysis they perform. Without data—and the ability to glean immediate insights from it—biller professional are essentially in the dark, not knowing whether the resources they devote to a process improvement effort will boost revenue or help them achieve their desired goal for greater efficiency …


Futurehealthindex.com, February 2018

Five tech-driven cancer care innovations that made a mark in 2017

By Lisa A. Eramo

According to the World Health Organization (WHO), cancer causes nearly one out of every six deaths and, in the next two decades, WHO expects new cancer diagnoses to increase by approximately 70%. Raising cancer awareness is one of the many reasons why the WHO sponsors World Cancer Day every 4 February. Another reason is to encourage cancer prevention, detection, and treatment. Fortunately, new health technologies continue to emerge at lightning speed, providing empowerment and better disease management for patients …


Go Practice blog (Kareo), January 2018

Why clinicians need a 2015 certified EHR

By Lisa A. Eramo

What does “2015 Certified EHR” mean to practicing clinicians? The once-flooded EHR market is now whittling down to those vendors equipped to respond to regulatory and industry changes. The Office of the National Coordinator (ONC) for Health Information Technology listed more than 4,000 EHRs with 2014 certification criteria, according to the most recent data from healthIT.gov. And to date, only 200 EHRs have passed the rigorous 2015 certification criteria.

However, beyond the fact that 2015 is indeed the most recent certification criteria as issued by the HHS, why should medical practices care? …


For The Record, January 2018

Are you moving the CDI needle?

By Lisa A. Eramo

Review the record. Query the physician. Obtain the diagnosis. Repeat. Does this clinical documentation improvement (CDI) workflow sound familiar?

Productivity is the hallmark of a good program. Or is it? On the surface, CDI specialists take the proper steps, but do their actions ultimately translate into documentation that reflects the most accurate clinical picture? …


Medical Economics, November 2017

With new guidelines, hypertension diagnoses to rise

By Lisa A. Eramo

New guidelines from the American Heart Association and the American College of Cardiology mean 30 million more U.S. adults could now be classified as having high blood pressure.

The updated guidance means primary care physicians will be having more discussions with patients regarding hypertension. Meanwhile, physicians who engage patients to monitor their blood pressure, make lifestyle changes and take their medications may receive a bonus for controlling long-term costs. That’s because hypertension is one of many conditions targeted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal law that seeks to reform Medicare payments while improving outcomes and reducing costs …


Medical Economics, November 2017

How to improve care, hit quality metrics for COPD patients

By Lisa A. Eramo

Patients aren’t the only ones who benefit from chronic obstructive pulmonary disease (COPD) treatment. Positive COPD outcomes also help physicians drive more money to their bottom line. That’s because by helping patients manage their COPD symptoms—and, ideally, prevent hospitalizations—physicians may receive a bonus for controlling costs …


Journal of AHIMA, November 2017

Health IT time out: Where is the U.S. healthcare system on interoperability and a quality strategy?

By Lisa A. Eramo

Think about what life would be like if we could occasionally hit pause, taking a “time out” of sorts to process information before acting. Unfortunately, we don’t have that luxury—but that doesn’t mean we shouldn’t reflect on the past before moving forward. This article brings together several leading healthcare, health IT, and standards experts to discuss and provide a status check on health IT adoption and standardization efforts, and their impact (if any) on healthcare delivery …


Go Practice blog (Kareo), November 2017

Are you getting paid for chronic care management?

By Lisa A. Eramo

Do you frequently review labs for patients with uncontrolled diabetes and educate them about self-management? Do you provide medication management support for family members whose loved one has Alzheimer’s disease? Do you provide ongoing support and education for patients with frequent acute exacerbations of chronic obstructive pulmonary disease?

If you answered ‘yes’ to any of these questions, you’re probably performing chronic care management (CCM)—a service for which the Centers for Medicare & Medicaid Services (CMS) began paying in 2015. But are you billing for it? …


Go Practice blog (Kareo), October 2017

5 physician fears about patient portals and how to overcome them

By Lisa A. Eramo

The good news is that patient portal adoption is on the rise. Seventy-two percent of more than 500 practices nationwide use a portal, according to the 2017 Physicians Practice Technology Survey. This number is up from nearly 62% just one year earlier. The bad news is that some practices continue to struggle with the operational challenges that portals can create, says Jake Fochetta, manager at ECG Management Consultants, Inc. in Boston. Others see these challenges as barriers to implementation and end up either activating only a few meaningful portal features or avoiding portals altogether, he adds …


Futurehealthindex.com, October 2017

Do doctors care about your wearable data?

By Lisa A. Eramo

Improving one’s health is the number one reason why people purchase a wearable, yet only 15 percent of physicians say they’ve discussed wearables or health apps with patients …


For The Record, October 2017

Is it possible to curtail copy and paste?

By Lisa A. Eramo

For years, health care experts and professional associations have warned providers of the dangers of copy-and-paste documentation within the EHR. Yet HIM professionals and others continue to talk about it, voice frustration, and reluctantly deal with the consequences of using it (eg, bloated documentation, inaccurate code assignments, patient safety risks, and more).

Might the conversation evolve as best practice strategies begin to emerge? What can organizations do to adapt documentation practices, and will the shift toward value-based reimbursement help steer the industry in the right direction? …


Go Practice blog (Kareo), September 2017

8 resources to navigate telemedicine parity laws

By Lisa A. Eramo

Telemedicine continues to emerge as a cost-effective alternative to face-to-face visits. But do payers reimburse physicians for providing these services?

The answer is increasingly ‘yes,’ but with several caveats, says Barry Herrin, attorney at Herrin Health Law, P.C. in Atlanta, Georgia. The good news is that many states have enacted telemedicine parity requiring certain payers to pay for telemedicine consultations just as they would reimburse face-to-face visits, Herrin explains …


For The Record, September 2017

Embrace risk adjustment

By Lisa A. Eramo

The question of who is most qualified to perform clinical documentation improvement (CDI) often causes tension among coders and nurses alike. This tension has continued to grow as physicians and hospitals try to determine who is best equipped to help them make the transition to quality- and risk-adjusted payments. Should it be a coder, a nurse, or both? …


Medical Economics, September 2017

How to manage hepatitis C patients under MACRA

By Lisa A. Eramo

Screening patients for hepatitis C and discussing treatment options are both important from a clinical standpoint. These tasks can also help physicians score highly in the Medicare payment reform program known as the Medicare Access and CHIP Reauthorization Act of 2015  (MACRA).

In particular, MACRA’s Merit-based Incentive Payment System (MIPS) track provides physicians with either a bonus or penalty starting in 2019, depending on the quality data related to hepatitis C and other diagnoses that they submit. MIPS measures for hepatitis C are relatively easy to satisfy, with the help of technology and a willingness to communicate with sensitivity …


Go Practice blog (Kareo), July 2017

Population health: What providers need to know about risk-adjustment documentation

By Lisa A. Eramo

When it comes to accurate population health-based payments, three factors go hand-in-hand: Risk adjustment, documentation, and quality, says Marian J. Wymore, MD, CPC, CRC. Wymore, a California-based physician documentation improvement consultant, spoke recently at HEALTHCON 2017 about how physician documentation directly affects capitated payments. Thorough and specific documentation not only makes good clinical sense, but it also tends to support quality measures and risk-adjusted payments, she adds …


Medical Economics, July 2017

How to improve patient engagement through technology

By Lisa A. Eramo

Primary care physician Frank Maselli, MD, is somewhat of an anomaly. That’s because his New York City-based practice has continued to gain in efficiency since implementing an electronic health record (EHR) system in 2001 and switching to a new vendor in 2009.

What’s his secret? Patient engagement.

By engaging patients with the EHR-based portal since 2010, Maselli’s practice has reduced patient phone calls, streamlined in-house workflows and decreased postal costs. The portal allows patients to view clinical information, schedule appointments, pay bills and ask for prescription refills or referrals. Patients can also download a mobile app to easily access the portal on their cell phones …


For The Record, June 2017

Discover the auditor within

By Lisa A. Eramo

When it came time to bring the auditing function in-house, Renee Petron, RHIA, hit a seemingly impassable roadblock. “We did not have a robust pipeline. The candidates we saw had little to no auditing experience. And those who did have the experience just didn’t align with our compensation package,” says Petron, director of coding quality review at Parallon Business Performance Group, a subsidiary of Hospital Corporation of America …


Go Practice blog (Kareo), May 2017

Can medical coders save the healthcare industry?

The scoop from HEALTHCON 2017

By Lisa A. Eramo

Medicare reform, risk adjustment, and the expanded role of medical coders in today’s physician practices were among the many topics discussed during HEALTHCON 2017 sponsored by the American Academy of Professional Coders (AAPC). More than 2,500 billing and coding professionals attended the event that took place in Las Vegas earlier this month.

This year’s agenda included a wide variety of sessions covering denial management, evaluation and management (E/M) challenges, auditing, HIPAA, practice management, and various specialty coding topics that went beyond coding basics to include anatomy, pathophysiology, and an in-depth discussion of procedures and treatments. An overarching theme throughout many of these sessions? The value that credentialed coders bring to physician practices—especially during the transition from fee-for-service to value-based reimbursement …


Medical Economics, May 2017

How to improve diabetes outcomes under value-based care

By Lisa A. Eramo

Visitors to the office of Sandra Adamson Fryhofer, MD, might notice it contains a few surprising features.

First are the two yoga mats—one for her and one for her patients—that she uses to demonstrate stretches. Second are the brochures listing local gyms and community health programs. Sometimes she even downloads and prints upcoming gym class schedules during appointments—all with the goal of empowering patients to control their diabetes. 

“When you give people specifics, I really feel that this makes a difference,” she says. “I try to use the office visit as an opportunity to not only talk about what they need to do, but also how they can do it.”

Working diligently to motivate patients—especially those with diabetes—is something that primary care physicians must do if they want to be successful under Medicare payment reform. In particular, physicians must help patients achieve and maintain a healthy hemoglobin A1C level and focus on care coordination with specialists. Doing so helps boost a physician’s Merit-based Incentive Payment System (MIPS) composite performance score, which translates directly to additional reimbursement …


For The Record, February 2017

Know thy docs: To avoid a multitude of headaches, organizations must maintain a clean provider directory

By Lisa A. Eramo

Over the last decade, Minnesota-based Allina Health has migrated patient and provider data from several EHR systems into a single EHR. During each of these transitions, the organization made a concerted effort to clean up patient duplicates. Over the last year, HIM professionals and others have begun to turn their attention to a similar but different problem: resolving provider duplicates …


Medical Economics, February 2017

Wearables and EHRs: 5 essential questions

By Lisa A. Eramo

Wearable fitness devices such as smartwatches, activity trackers and other biometric sensors continue to grow in popularity. Physicians must determine whether and how to incorporate device-generated data into their practice’s electronic health record (EHR) …


Medical Economics, January 2017

7 ways physicians can take control of uncompensated time

By Lisa A. Eramo

The workday for internist Jeffrey Kagan, MD, doesn’t end when he leaves his Newington, Connecticut, office. He still has two to three hours of unpaid work ahead of him reviewing lab reports, X-rays and MRIs, as well as returning phone calls.

Kagan says he spends 12 to 17 hours weekly on tasks for which he receives no compensation. This includes the work he performs each evening at home, plus unpaid tasks throughout the day, such as prior authorizations for insurance companies and research to identify the latest clinical treatments and closest centers of medical excellence that could potentially benefit his patients. 

“It’s not unusual for me to leave the office around 7 p.m. because I’ve had enough, come home and eat dinner with my wife, and by 8 p.m. I’m on the computer,” he says. “I’m there through the 11 o’clock news.”

Like many physicians, Kagan uses personal time to complete tasks necessary to keep his practice running efficiently. To some degree, physicians have always done this. However, anecdotal data suggests that physicians are spending even more of their time on uncompensated tasks than they ever had in the past …


For The Record Magazine, December 2016

Medicare Bundled Payments: Are AMI and CABG next?

By Lisa A. Eramo

Bundled payments have been growing in popularity over the past several years—particularly with the Centers for Medicare & Medicaid Services (CMS). In the beginning, these payment models were voluntary; forward-thinking organizations made the deliberate choice to participate. Now, the agency is taking additional steps to implement and grow mandatory bundled payments that continue to reward hospitals for working with physicians and other providers to avoid unnecessary complications, improve quality outcomes, prevent hospital readmissions, enhance the patient experience, and enable a faster recovery in the appropriate care setting …


Journal of AHIMA, November 2016

Standardizing interoperability is a team effort

By Lisa A. Eramo

AHIMA and other key stakeholders continue to drive national and global progress to achieve information systems interoperability in healthcare.

Like a complex puzzle, health information data and system interoperability takes time, effort, and collaboration to solve. And solving this puzzle is critical. Without immediate access to health information during a patient’s time of need, healthcare providers can’t offer effective—or perhaps even life-saving—treatment …


For The Record Magazine, September 2016

At a disadvantage?

Many providers feel under the thumb of Medicare Advantage plans

By Lisa A. Eramo

If you’re on a budget—and who isn’t these days?—you probably tighten your purse strings once in a while to ensure your bills are paid on time. Now imagine that you’re the Centers for Medicare & Medicaid Services (CMS). According to the latest data from paymentaccuracy.gov, the agency has made $14.1 billion in improper payments to its Medicare Advantage (Part C) supplemental plans, representing a 9.5% improper payment rate.

During a time when every penny counts, it’s not surprising that CMS has begun to take a closer look at its expenditures in this growing market.

Through its risk adjustment data validation audits of Medicare Advantage plans, CMS examines whether its risk-adjusted payments to these plans are appropriate based on actual provider documentation. Medicare Advantage plans are paid according to CMS’ hierarchical condition category (HCC) model that takes each beneficiary’s specific health risks and certain demographic characteristics into consideration. In essence, CMS pays Medicare Advantage plans a monthly capitated rate to cover expenses for patients with greater risk, meaning those who have multiple HCCs.

However, experts say that CMS’ scrutiny of Part C payments has led some Medicare Advantage plans to become particularly aggressive with providers in terms of denying payment …


Journal of AHIMA, September 2016

Five tips to develop and share your HIM ‘elevator speech’

By Lisa A. Eramo

As a health information management (HIM) professional, you know just how difficult it is to explain your profession to others. So many acronyms, so little time. How can you capture all of the nuances of HIM in a way that others will understand while also keeping their attention?

As an HIM freelance writer, I know the struggle. Friends and family members don’t quite get it. They know I write about healthcare, but they probably couldn’t articulate the types of topics I cover on a daily basis—medical coding, release of information, electronic health records, etc. Could your friends and family members describe the important work you perform within your organization? I’m guessing the answer is no.

In many ways, HIM seems to be the best kept secret in healthcare. That’s because very few professionals know how—and when—to educate others about HIM’s role within the healthcare ecosystem …


Medical Economics, September 2016

The next ICD-10 hurdle: Prepare for payer scrutiny

By Lisa A. Eramo

When the clock struck midnight on October 1, 2015, the healthcare industry shifted from the antiquated ICD-9 disease classification system to the more refined ICD-10. One milestone achieved. Can physicians assume it will be smooth sailing now that one major hurdle has been crossed?

Not quite. There is yet another hurdle to cross in the coming months—navigating the conclusion of the ICD-10 grace period—a year-long moratorium on retrospective denials of unspecified claims …


Go Practice blog (Kareo), August 2016

Can an EHR help save time? Yes … with these 7 savvy tips

By Lisa A. Eramo

There are few things more frustrating than wasted time—especially in the workplace. Most of us want to be productive—to feel as though we’ve accomplished something or made a difference. We certainly don’t want to be slowed down by technology. Neither do physicians, many of whom are afraid to make the transition to an electronic health record (EHR) system for this very reason.

Anticipated loss of productivity continues to concern physicians considering a transition to an EHR system. In fact, 59% of office-based physicians who haven’t yet adopted an EHR say loss of productivity is one of the biggest barriers, according to a 2014 report published by the Office of the National Coordinator (ONC) …


Journal of AHIMA, August 2016

Stopping thieves in their tracks: What HIM professionals can do to mitigate medical identity theft

By Lisa A. Eramo

The clues are subtle but critical: Perhaps you get a bill for urgent care services you never received. Or upon reviewing your medical record through a patient portal, you see a diagnosis of back pain and multiple prescriptions for narcotic pain relievers.

Though not definitive, chances are probable that you’ve been an unfortunate victim of medical identity theft due to a breach of your healthcare data. In the last two years, nearly 90 percent of HIPAA-covered healthcare entities have had a data breach, according to the Ponemon Institute’s “Sixth Annual Benchmark Study on Privacy and Security of Healthcare Data,” published in May 2016.1 Forty-five percent of healthcare entities had more than five data breaches during the same time period.

Although not every breach leads to medical identity theft, many of them do. Medical identity fraud has nearly doubled since 2010, according to the Medical Identity Fraud Alliance (MIFA). Thirty-eight percent of covered entities said they’ve experienced at least one case of medical identity theft that affected patients or customers during the past 24 months, according to the 2016 Ponemon study …


MedCityNews, July 2016

5 tips to prepare for CMS’ new cardiac bundled payment model

By Lisa A. Eramo

High-quality care at a low cost is the goal of the Centers for Medicare and Medicaid Services’ newly proposed bundled payment model targeting cardiac care. If finalized, this mandatory model would take effect July 1, 2017 and affect hospitals in 98 randomly selected metropolitan statistical areas.

Why should hospital leaders care about this new bundle? …


Go Practice blog (Kareo), July 2016

A frugal EHR implementation: Is there such a thing?

By Lisa A. Eramo

The average up-front cost for an in-office EHR is $33,000, according to HealthIT.gov. Up-front costs for a web-based EHR are reported as slightly less at $26,000. However, these estimates don’t indicate what is included, and there can be a wide variation in expenses related to training, implementation, staffing, and patient load. Even with reduced patient load and some added staff costs, there are some EHR vendors that provide solutions at a far lower cost.

Still, there are both upfront and ongoing expenses when implementing an EHR. And many physicians are concerned about that impact and whether or not there is enough return to warrant the investment.

The good news is that with a little strategizing, physicians can make frugal decisions that won’t make or break their EHR implementation …


MedCityNews, July 2016

4 questions every healthcare provider should ask about fitness wearables

By Lisa A. Eramo

By 2018, 81.7 million users will own a wearable fitness device, according to eMarketer. And while consumers dabble in the cool features and sleek user interface of their wearables, healthcare providers continue to ask one important question: Does this tsunami of patient-generated data ultimately belong in the medical record?

The answer will be largely dictated by patients themselves, many of whom have already begun to express a strong desire to share wearable data with their healthcare providers …


Medical Economics, July 2016

How to utilize care coordination to boost practice income

By Lisa A. Eramo

With the proliferation of  accountable care organizations and other alternative payment models, the trend toward value-based reimbursement is already well underway. Primary care physicians who weather this storm of payment reform successfully will be those who prioritize care coordination to keep patients healthy. Unfortunately, this often requires three of the most limited commodities in today’s practices: time, operational resources and money.

The good news is that in 2013, the Centers for Medicare & Medicaid Services (CMS) began paying for transitional care management (TCM). TCM includes services rendered for certain patients during their transition from an inpatient hospital setting to a community setting, such as their home. In 2015, CMS continued to recognize the importance of care coordination by starting to pay for chronic care management (CCM). CCM includes non-face-to-face services provided to Medicare beneficiaries who have two or more significant chronic conditions.   

But many physicians feel that the financial payoff isn’t worth the extra effort required to fulfill documentation and other requirements …


 

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