The recent release of the Stage 2 Meaningful User Measures clarifies the implications of the EHR deployment for physician practices and increases the urgency for your billing service to establish a role in the dramatic shift to EHR.

For physician practice clients, the reality of colleagues receiving their initial EHR incentive payments and the prospects of delay is having an impact.  If Eligible Providers do not qualify by the end of 2012, they lose $3,000 per provider in incentives.  Delaying until after 2013 will cost each provider an additional $15,000 in EHR payments.  A number of physicians are reassessing their initial ambivalence about the EHR incentives and taking a second look at what they need to do to qualify.  Failure to support the EHR initiatives can strategically impact your physician clients.

The proposed Stage 2 MU Measures expand the use of electronic transactions, require electronic imaging, and raise the bar on the percentages to qualify for incentives from the Stage 1 levels.  For example, Stage 2 requires use of computer order entry for lab and radiology orders as well as the electronic prescriptions in Stage 1.

The Stage 2 Measures could put providers hoping to avoid EHRs at a significant disadvantage.  For example:

Stage 2 includes electronic transfers of patient information on the transition of care from a primary care physician to a specialist.  Specialists who fail to support electronic transitions of care could be left out as referring physicians will find it easier to click on a button in their EHR to refer a patient rather than employing a referral coordinator to make the phone call.

Stage 2 includes secure messaging with patients over the Internet.  Physicians who fail to support such exchanges could be perceived as less convenient and responsive to patient needs.  Patients can look up their physician’s report on their lab results or their recent office note on the patient portal for practices using an EHR rather than leaving a message for the physician and playing phone tag.

Sitting out the EHR revolution as a billing service could also put you at a disadvantage.  EHR decisions and transitions have a tendency to overwhelm practices and may cause collateral damage to their billing and collection efforts.  Indeed, some practices focus on their EHR selection and fail to verify the capability of the PMS features or the effort to move to a different billing product.

During this demanding transition, your billing service can help your clients maintain cash flow as well as offer EHR options that work with your billing services and, as potentially important, may be supported by your organization.  The challenge is establishing a link between your billing service and your client’s EHR needs.

As a practical matter, your billing service is already a technology provider to your clients.  You should seriously consider extending your services to the EHR arena.  Consider the following issues:

• Staffing – Many billing services lack the expertise in EHR to support their clients.  However, there are many EHR aspects that require skills that you employ in your billing operations.  For example,

Technology – Your current expertise in communications, hardware and user support can be easily extended to the EHR arena.  EHRs are a more daunting challenge for many practices and require reliable and competent help.  Indeed, your physician clients will need computer access for every staff member that uses the patient chart as well as the resources to serve a larger set of EHR users.

Workflow Design – Billing services have designed effective processes to help the practice and billing service maintain optimal efficiency.  EHR implementation requires dramatic changes to clinical operations to take advantage of EHRs and benefit from their use.

Note that the Health Information Technology (HITECH) initiatives included training initiatives to develop 50,000 new HITECH professionals in educational institutions across the country.  Checking on the relevant program in your area or state may provide an attractive source of EHR trained staff to support your EHR services.

• Products – Consider choosing a few products that can interface with your billing service software.  For example, Kareo has several EHR partners.  By focusing on the key requirements of an EHR and providing effective support, you may be a preferred vendor that will ease the segue to EHR and preserve cash flow for your clients.  Additionally, your clients may be able to cut the timeline and expense of EHR by using your medical billing service.

The implementation of EHRs will become a necessity for many practices who want to maintain working and referral relationships with their colleagues and patients.  Your billing service can serve an important role for your physician clients as they realize what the EHR Incentives will do to their business model and industry.  This will lead your clients to the realization that they need an EHR strategy and solution.

Ron Sterling (800-967-3028, www.sterling-solutions.com) publishes the popular EHR Blog Avoid-EHR-Disasters.blogspot.com, and authored the HIMSS Book of the Year Award winning guide “Keys to EMR/EHR Success.”  He is an independent EHR consultant. Hear Ron speak in an archived webinar sponsored by Kareo: What You Need to Know About Selecting the Right EHR. Ron most recently wrote for Getting Paid on 4 EHR Technology Issues that Billing Services Can Help Clients With.

Medical billing services are facing challenges that could enhance or disrupt your EHR timelines.  In addition to the move from 4010 to 5010, your EHR strategy cannot ignore the effect of ICD-10 codes starting in October 2013.

Although October 2013 seems far off, in the context of EHR implementation and use, the initiation of ICD-10 codes present a serious challenge for any EHR process.  Consider the following issues:

• As a practical matter, practices and medical billing services will need to focus on the ICD-10 coding transition in the summer of 2013.  Any distraction from EHR projects and other major changes will not be practical for most medical billing services and their clients.  Therefore, the bulk of any EHR implementation project has to be completed by the early summer of 2013 or started at the end of 2013 to free up resources to work on the ICD-10 transition.
• From the billing service view, whatever involvement you want to undertake should be established and proven before the focus switches to ICD-10.  Establishing the capability in time for ICD-10 will facilitate the sales of EHR products and capabilities to the many practices that will be struggling with ICD-10.
• Typically, it takes 4 to 6 months to start EHR implementation.  Depending on a wide range of issues including the size of the practice, locations, and depth of services, completion of the EHR rollout may consume 1 to 4 months more.  Even after EHR deployment, a practice could be facing a 4 to 8 month period of intensive transition for patient paper charts to the EHR.  Intensive changes or increased workloads could divert resources for the ICD-10 transition and imperil cash flow.
• Medical billing services that already offer EHRs will also be affected.  Indeed, many EHR vendors are expected to release an ICD-10 sensitive version as we approach the deadline.  For example, many EHR products use ICD-9 codes to classify patient visits and to trigger patient treatment plans.  However, ICD-10 codes have a level of specificity that will require grouping strategies to support EHR features.
• Many medical billing systems will be similarly affected.  For example, reports by diagnosis codes would require supplemental groupings for the same diagnosis for initial and follow-up visits (using different ICD-10 codes, but the same ICD-9 codes today.)

With the summer of 2013 as a blackout period for major EHR efforts, you need to work back to determine the best strategy and where your EHR offering should be as well as the practicality of implementing client EHRs before attention turns to ICD-10.  Consider the following:

• Where should the medical billing service’s EHR service development be? – In the run-up to ICD-10, any medical billing services that plan to have a role in EHR deployment should have established the capability and rolled out the offering.  Thereby, the medical billing service will be ready for clients that may want to quickly deploy an EHR solution after trying to manage ICD-10 manually.
• What EHR implementation stage should be completed by the summer of 2013? – EHRs are closely tied to ICD coding to maintain the referential integrity of the patient medical record, as well as support basic EHR functionality.  Therefore, dramatic changes to EHR use in the middle of the ICD-10 transition could generate too many changes that would be difficult to coordinate.  Indeed, dramatic changes to EHR use and ICD-10 coding could result in an unstable environment.  Therefore, all EHR projects should allow sufficient time and efforts to adjust to ICD-10s.  For example, an EHR implementation project may replace the patient charge, use the system for workflow, and even charting, but delay order entry and billing until the ICD-10 transition has been completed.
• What should a billing service do about clients who are not implementing an EHR by the summer of 2013? – A number of authorities believe that EHRs will be essential to meeting the ICD-10 coding challenge.  However, a wide array of physician practices will not be implementing EHRs in time for ICD-10.  Any practices that are not implemented in time may require additional training and coding support from the medical billing service organizations as well as a plan to implement an EHR, where appropriate.

ICD-10 transitions represent a significant amount or work and a serious risk to medical billing services and their clients.  Recognizing the level of effort needed to transition to ICD-10 codes, medical billing services need to establish EHR strategies and implementation plans that will not interfere with the transition to ICD-10 and avoid disruptions to cash flow and billing processes.

Ron Sterling (800-967-3028, www.sterling-solutions.com) publishes the popular EHR Blog Avoid-EHR-Disasters.blogspot.com, and authored the HIMSS Book of the Year Award winning guide “Keys to EMR/EHR Success.”  He is an independent EHR consultant. Hear Ron speak in an archived webinar sponsored by Kareo: What You Need to Know About Selecting the Right EHR. Ron most recently wrote for Getting Paid on 4 Steps to Get the Most from Your EHR Effort.