reality check billing and reimbursement

The American Recovery and Reinvestment Act of 2009 (ARRA) authorized $1.5 billion for construction, renovation, and equipment for the improvement of health information technology. In order to meet ARRA requirements, providers’ must meet meaningful use in three specific stages to achieve the goal of improved patient care outcomes, i.e. “meaningful EHR users”. Physicians are offered financial incentives by Medicare which is described as a Meaningful Use EHR − stages 1-3 must be met by 2016 or facilities will have to pay Medicare a fee for not meeting meaningful use. Physicians who demonstrate that certified EHR technology is used for the purpose of electronic prescribing and electronic health exchange of health information in accordance with law and health information (HIT) standards are eligible for meaningful use. Meaningful use are objectives and measures that achieve goals of improved patient care outcomes and delivery through data capture and sharing. Electronic Health Records (EHR) movement and integration into the United States’ healthcare system is a daunting undertaking, but in order to avoid paying penalties, practices must meet Meaningful Use by 2016.

You are the revenue cycle manager of a small physician practice with 20 providers who see about 155,000 patients a year. When meeting with the CFO and CEO of the practice, you discuss Meaningful Use and the stage your practice is at with Meaningful Use. You report:

• The practice is currently capturing health information in a standardized format.
• The practice is currently communicating captured information for patient care coordination processes.
• The practice uses captured information to track key clinical conditions and engage patients in the delivery of care.
• The practice is transmitting patient care electronically across multiple settings.

According to the list that the revenue cycle manager shared, what stage of meaningful use is the practice currently fulfilling?

1. Stage One
   1. Capture Electronic health information in a standardized format
   2. Communicate captured information for patient care coordination processes
   3. Initiate the reporting of clinical quality measures and public health information
   4. Use captured information to track key clinical conditions and engage patients in the delivery of care

1. Stage Two
   1. Electronically transmit patient care summaries across multiple settings
   2. Establish more patient controlled data
   3. Increase requirements for e-prescribing and incorporating lab results
   4. Provide more rigorous health information exchange (HIE) among multiple settings

1. Stage Three
   1. Facilitate patient access to self-management tools
   2. Implement decision support for national high-priority conditions
   3. Improve population health
   4. Improve quality, safety, and efficiency leading to improved health care outcomes
   5. Provide access to comprehensive patient data through patient-centered HIEs

What stage do you think they are closer to? Explain why or why not.

How would you handle criticism from the CEO and CFO for not being further along in the process?

Explain your response in detail. Please save your two to three paragraphs in a word document and submit to the appropriate dropbox.

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