Upcoming Event: Blueprint for OASIS Accuracy

This December, the Texas Association for Home Care & Hospice is continuing its ongoing series of educational events. Cradle Solution, Inc. will be showcasing the CradleMRx software at the upcoming “Blueprint for OASIS Accuracy” event on December 8-9, at the Omni Dallas Hotel at Park West. As our clients already know, Cradle Solution, Inc. understands that Medicare providers are required to make constant changes to their processes and operations, in order to comply with evolving CMS requirements. Our company upholds its promise to integrate the best technology available, while adhering to all new Medicare billing, coding, and reporting requirements. We would like our clients to attend this two-day workshop focusing on new data collection rules for OASIS-C reporting. This event will also cover how to accurately encode your OASIS data for payment under the Prospective Payment System. Additionally, our clients will have the chance to learn about new and upcoming features of the CradleMRx software. Prospective clients will have an opportunity to view a full demonstration of the solutions offered by our newest application. We believe the “Blueprint for OASIS Accuracy” conference will provide your agency with necessary information that will be beneficial to your overall business. For more information, and to register,visit the TAHCH website. For further reading on the CradleMRx product details, please visit www.cradlemrx.com.

Making Use of Certified EHR Technology

Electronic Health Records

As a professional provider, you are accustomed to making constant changes and updates to your operations in order to comply with Medicare rules and guidelines. However, you may not know that since 2009, the federal government has been moving to completely overhaul the way the medical industry handles electronic patient information. Over the next five years, Medicare providers will be encouraged to transition their current health records systems to those that are certified by the Office of the National Coordinator for Health Information Technology (ONC). After this period of conversion, providers will face penalties via a percentage reduction in payments for failure to employ a certified EHR system.

Cradle Solution, Inc. is dedicated to providing you with the most current technology available and fully intends to receive its own ONC certification so that our CradleMRx software can continue to provide outstanding solutions in the years to come. Our company is also committed to keeping our clients informed about changes in statutory compliance. Electronic health records will be a cornerstone of the healthcare industry going forward, and we feel it is vital for you, as a healthcare provider, to be informed of the benefits and penalties related to implementing certified software technology.

Medicare has announced a new incentive program for eligible providers that implement certified EHR technology between 2011 and 2014. Certified EHR technology means software that has been approved for use by an ONC Authorized Testing and Certification Body (ATCB). As an eligible professional, you must be a licensed Medicare doctor that is not hospital-based. Registration for the program will begin in spring 2011.

Under the program, you may qualify for incentive payments beginning in 2011 or 2012 and will continue receiving payments for five years. If you meet the requirements for incentive payments in 2011, you will receive your first payment that year. Each payment thereafter will be reduced and paid annually until 2015. If you are eligible to receive your first payment in 2012, or any year after, you will continue receiving phased-out payments until 2016. Medicare incentives are reduced for providers that meet electronic health record criteria between 2013 and 2014, while no incentive is granted for qualification in 2015. The payment will be equal to 75% of the providers Medicare allowable charges for Part B services rendered with a maximum permitted payment of $15,000 the first year and reducing annually to a maximum permitted payment of $2,000 the fifth year.

Beginning in 2016, providers that do not exhibit “meaningful use” of a certified EHR system will receive reduced claim payments for failure to adopt the new technology. Penalties will begin in 2015 with a 1% reduction in the Medicare fee schedule for the billed service, increase to a 2% reduction in 2016, and settle out at a 3% reduction for services rendered in 2017 and thereafter. Substantial loss in reimbursement is a potential consequence of not transitioning within the next five years.

The CradleMRx home health blog will keep you updated on when registration has opened for this incentive program and any changes that may be made to it. We encourage you to research this topic further and will be happy to answer any questions you may have about how this changeover affects the CradleMRx software and your business.

ICD-10 Implementation Strategies

Cradle Solution, Inc. believes it is imperative that all providers stay informed of requirements that must be implemented for the October 1st, 2013 changeover to ICD-10-CM and ICD-10-PCS. The operational modifications required to prepare for this transition may be extensive, and our clients need to be aware of the steps they should be taking now, in order to prepare for the upcoming deadlines. While the Centers for Medicare and Medicaid services initiated a freeze on coding updates, standard changes will still be made in 2011, though updates for 2012 and 2013 will be limited, to allow providers time to prepare for ICD-10 adoption.

Your organization”s budget will be your primary tool in readying your company for this switch. Most importantly, you need to consider factors such as hardware requirements, software upgrades, and training costs. The addition, or conversion, of ICD-10 compliant software may demand that workstations, servers, and other hardware be replaced or improved. Ideally, your business should consider these expenses as part of your 2011 budget. Costs associated with integrating a new application or upgrading to a compliant one will likely be incurred during the 2012 period. It is for this reason that you should plan to make any hardware improvements within the next year.

ICD-10-CM and ICD-10-PCS training will be major factor in your budget as well. Admissions, coding, billing, and collections staff will need to be educated about the ICD-10 switch long before the October 1st 2013 target date. HIPAA 5010 adoption is required by January 1st, 2012 in anticipation of, and as a prerequisite to, the implementation of ICD-10, so your employees must be familiar with new features and statutes well in advance. We suggest developing departmental training plans to organize and implement new policies and procedures.

It is expected that most payers will be fully prepared for this transition and begin using the new coding system immediately, as fines for non-compliance are steep. However, new methodologies may result in delayed processing of claims. It may take your organization some time after the effective date to reconcile all outstanding ICD-9 claims due to new coding and reimbursement issues and guidelines. It is anticipated that there will also be a reduction in productivity immediately following the changeover, as providers begin to use the new coding system. Your business may want to consider setting aside an emergency or reserve fund to supplement your budget, in the event that you have difficulty billing and receiving reimbursement for services rendered.

While the preparation may seem intimidating, you will receive several benefits by preparing and adhering to the new ICD-10 structure. Claims payment accuracy will be improved, coding will be more organized and specific, and your company will have a competitive advantage.

Cradle Solution, Inc. will continue to provide information and news regarding the upcoming changes to ICD-10 as the compliance date approaches.


Protecting patient privacy is the most crucial facet of any health care operation. Recent federal legislation has resulted in several major changes to the Health Insurance Portability and Accountability Act (HIPAA) that you, as a health care entity, need to be aware of. These amendments may impact your organization’s operations and obligations.

The federal stimulus bill passed in 2009 addressed some of the outstanding issues that HIPAA did not foresee. The HITECH (Health Information Technology for Economic and Clinical Health) Act regulations consist of three major changes relating to how patient information is exchanged.

Review current and implement new contracts with your business associates.

The HITECH Act”s changes to the definition of business associate effectively make them covered entities. Restrictions on how protected health information is gathered, exchanged, and marketed will take effect in 2011. We recommend that you have a designated privacy compliance officer review all contracts with your business associates to ensure that you are not vulnerable to penalties. New contracts establishing how protected information is exchanged may be necessary for entities that were not previously considered business associates.

Be aware of your continuing obligations.

In addition to the requirements set forth by HIPAA and HITECH, you should also stay informed about changes to privacy laws within your state, as you are subject to these as well. HITECH has not only increased the security of information, but also requires additional disclosures in your privacy practices and implements new breach notification requirements.

Know which entities may access protected health information.

Rules regarding accounting of health information disclosure are scheduled to change in January 2011. These changes will no longer exempt you from keeping a record when protected health information is used for treatment, payment, or healthcare operations. You will now be required to maintain detailed documentation of the release of all protected information and must be able to provide that documentation upon request. Additionally, individuals will have the right to request that their information not be released to specific entities in certain circumstances.

For example, if a health plan requests protected health information for the purposes of making payment and the patient has paid for the service in full and disclosure is not required by law,the provider must honor the individual”s request.

To find out more about what you can do to prepare for upcoming changes to privacy laws,see the following links: