Basics of Claim Form 1500

CMS 1500 forms are the universal claim forms used by medical providers to submit claims for their services to the insurance carriers. They are pre-printed red and white forms designed by the Centers for Medicare and Medicaid Services. They were formally known as HCFA 1500 forms but they were redesigned to allow for the reporting of the NPI, or National Provider Identifier.

The CMS form is sold by the United States government printer or any of your local printers in many different configurations such as single, multi-part or continuous feed. The original forms are used for making claim. You can get a copy from an online source but unfortunately, this cannot be used in making claims. This is because the form will be processed with the help of a scanner which require that the form be of certain color and quality, failure to which the contents of the form will not be read well.

It is very important that the CMS 1500 forms are completed properly to ensure that correct payment is made. If the form is not completed properly, the claim may be denied by the insurance carrier. Many providers have practice management software that completes the forms for them, but the information must still be loaded into the practice management software program properly in order for it to be printed out in the right format.

Many of the insurance carriers have different requirements for what information goes in each box on the claim form 1500. For example, if you are billing an insurance carrier that requires authorization for the services being billed and they assign an authorization number, they may require that the authorization number be in box 23. Other carriers do not require that anything be in box 23. It is important to know the different requirements for each of the insurance carriers that you bill to.

ONC Certified EMR

An ONC certified EMR is the one that which is certified by an ONC ATCB. ONC stands for (The Office of the National Coordinator). The certification guidelines and criteria are handled by ONC. Currently there are 6 organizations recognized by ONC as ATCB (authorized testing and certification body) namely Drummond Group, InfoGard Laboratories, Inc., SLI Global Solutions, ICSA Labs, and Surescripts LLC.

According to the ONC, aims, among other things, to improve the quality of health care while reducing costs; improve the coordination of care and information among hospitals, labs, physicians and other health care organizations; ensure that personal health records (PHR) remain secure, and promote the early detection, prevention and management of chronic illness. An ONC certified EMR could play a significant role in achieving above goals.

For the ONC to do its work, significant upgrades to health IT systems across the country will be necessary. To that end, and in response to provisions of the HITECH Act, the ONC drafted an interim final rule for an initial set of standards, implementation specifications and certification criteria for electronic health record (EHR) systems. 

The Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of ARRA passed in 2009, created "new incentive payment programs to help health providers as they transition from paper-based medical records to EHRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions." (Aug. 30, 2010)

The HHS further explains that "to qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of ONC certified EMR systems. Certifying bodies such as the ONC-ATCB ensure EHR users that their software will support the specific tasks of M

What Do You Understand By Certified EMR

A certified EMR is the one that which is certified by a certifying body. The certification guidelines and criteria are handled by ONC (The Office of the National Coordinator). Currently there are 6 organizations recognized by ONC as ATCB (authorized testing and certification body) namely Drummond Group, InfoGard Laboratories, Inc., SLI Global Solutions, ICSA Labs, and Surescripts LLC.

The ONC’s mission involves many aspects of health information technology (HIT), including policy coordination, strategic planning for the adoption of health IT and health information exchanges (HIE), establishing governance for the Nationwide Health Information Network and, above all, promoting a national health IT infrastructure.

This last mission, according to the ONC, aims, among other things, to improve the quality of health care while reducing costs; improve the coordination of care and information among hospitals, labs, physicians and other health care organizations; ensure that personal health records (PHR) remain secure, and promote the early detection, prevention and management of chronic illness.

For the ONC to do its work, significant upgrades to health IT systems across the country will be necessary. To that end, and in response to provisions of the HITECH Act, the ONC drafted an interim final rule for an initial set of standards, implementation specifications and certification criteria for electronic health record (EHR) systems.

The Health Information Technology for Economic and Clinical Health (HITECH) Act, a part of ARRA passed in 2009, created "new incentive payment programs to help health providers as they transition from paper-based medical records to EMRs.  Incentive payments totaling as much as $27 billion may be made under the program.  Individual physicians and other eligible professionals can receive up to $44,000 through Medicare and almost $64,000 through Medicaid.  Hospitals can receive millions." (Aug. 30, 2010)

The HHS further explains that "to qualify for the incentive payments, providers must not only adopt, but also demonstrate meaningful use of certified EMR systems. Certifying bodies such as the ONC-ATCB ensure EMR users that their (EMR certified) software will support the specific tasks of Meaningful Use.

Tips for Choosing Best Online EMR

Making the right EMR purchase the first time can be a positive experience! Keep in mind successful electronic medical record implementation will enhance your practice and improve patient care. Even if you have shortlisted the list between desktop and online EMR, selecting a best online EMR for the practice or hospital is not an easy task.

Software selection tips that can help to choose a best online EMR for the practice (or hospital):

1. Have your current and near future practice needs been defined?

    * Does the EMR interface with your billing or practice management systems?

    * Is your practice's record management methodology supported?

2. Before you purchase your EMR...

    * Compare a number of EMR systems

    * Focus on EMR systems that best fit your needs

3. Which EMR technology do you need?

    * A client-server EMR software or a web based EMR software solution

    * Does the EMR allow and support for practice growth

4. Can you get an EMR software demo?

    * Is it specialty specific

    * Is it as easy to use on complex patient cases

5. How complicated is the EMR to use?

    * Are the EMR document templates customizable?

    * Will the electronic medical record solution save your office staff time?

6. How easy is office implementation?

    * Easy and shared access among providers and staff

    * How disruptive implementation will be to your practice

7. What electronic medical record features are supported?

    * Charge capture for billing?

    * Voice recognition

    * etc, etc, etc.

8. Is the EMR solution technologically stable, compatible and flexible?

    * Is the electronic medical record solution 'certification focused'?

    * Is it stay within HIPAA compliance for privacy standards and confidentiality?

9. What is the actual cost of electronic medical record ownership?

    * Cost for EMR hardware/software license, installation, training, upgrades and maintenance

    * Is there an EMR software efficiency cost savings from successful office implementation?

10. After you purchase your software system, what then?

    * Is there reliable continuing EMR software vendor support and training?

    * Are EMR customizations easily available?

Taking into consideration the above mentioned selection tips would help to make a right decision as regards best EMR / best online EMR for the practice.

Advantages of HIPAA Compliant Solutions

 The pressure on the healthcare industry across the world including US is on the rise as regards delivery of better quality of patient care and to bring about reduction in costs. Medical IT solutions like claims processing system, practice management software, EMR (electronic medical records), EHR (electronic health records), etc. are proving to be handy in achieving the above goal. The technology is helping to make life easier for doctors, hospitals as well as patients. However, the problem being there are a large no. of vendors offering a wide range of medical IT solutions. A particular system may be suitable for the practice and other may not. In absence of some sort of standardization and guidelines the optimal results can not be expected. Here, comes the role of HIPAA compliant solutions that are developed as per the HIPAA guidelines and set of rules.

HIPAA stands for “Health Insurance Portability and Accountability Act”, the act was enacted in 1996. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Basically HIPAA is a regulatory body that provides guidelines as one of its functions as regards the development of healthcare IT systems ultimately known as HIPAA compliant solutions.

HIPAA compliant solutions provide a no. of safeguards as against a non-HIPAA compliant / un-standardized healthcare IT system:

1) Administrative Safeguards - policies and procedures designed to clearly show how the entity will comply with the act.

2) Physical Safeguards – controlling physical access to protect against inappropriate access to protected data.

3) Technical Safeguards – controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.

Information systems housing PHI must be protected from intrusion. When information flows over open networks, some form of encryption must be utilized. If closed systems/networks are utilized, existing access controls are considered sufficient and encryption is optional. And many other guidelines that ensure safety and security of data, standardization of system by introducing functional features and so on.

If we sum up, HIPAA compliant solutions ensure better safety and security of data, standardization, functional features and inclusion of other privacy policy / procedures that can be helpful in achieving the optimum utilization of the system.

How to Choose a Right EMR Solution

The importance of EMR solutions in today’s hi-tech environment can not be denied. It is believed by industry experts that he who denies the adoption of newer technology has to pay for it in terms of excessive time consumption, poor productivity and unreasonable ROI. It is also believed that if a right EMR solution is chosen and implemented, it will not only benefit doctors but to the patients as well to a great extent.

The process of choosing a right EMR solution starts with documenting the current office work flow that supports the patient encounter. This is a tedious, iterative and time consuming process that is critical to the success of any electronic medical records implementation. Document exactly what happens when a patients sees a doctor. What forms do they fill out? What happens to those forms? Are they sent to other departments? What systems is data entered into? Who are the people involved and what do they do to move the process forward? Every detail, process, form, system, technology and person involved in the process has to be properly documented to fully understand the work flow of a patient encounter. This process involves many iterations and every person that is involved in the process before a complete understanding is gained.

Once the work flow is documented, a list of vendors needs to be prepared who provide with the certified EMR solutions. On preparing the list, the requirements of the practice must be compared with the features of the respective electronic medical records solution. The factors also need to be considered such as reviews about shortlisted vendors, pricing, long term support and so on.

Desktop vs. Web Based EMR

Based on HIMSS reports for the last few years, there has been rapid pace in the adoption of EMR technology. However, a question that often disturbs is a choice between desktop and web based EMR.

Practically over a period of time everything has gone “wired”, no field is an exception to the rule. EMR’s came into existence with the desktop versions, however, looking into the widespread advantages of internet, web based EMR’s have come into existence. The biggest advantage a web based EMR would provide over a desktop version is that the data is stored centrally and the information can be accessed from any where and at any point of time. 

Another major difference between desktop applications and web based EMR software can be seen in the cost. Web-based applications are simply less expensive when compared to desktop applications. Web based applications can be used on subscription basis, which keeps out of pocket expenses low. Using web based EMR software will help you keep your startup costs to the minimum. Added to that, web based EMR software requires no investment in upgraded hardware. Thus, your IT maintenance costs will come down drastically with web based EMR software.