PCC Client Lobby

Delaware Health officials this week recognized PCC for its role in linking a local practice's electronic health data to the state's immunization registry.

The Pediatric and Adolescent Center, in Milton, DE, a PCC EHR client since 2011, became the first pediatric practice in the state to electronically submit its immunization records to the Division of Public Health through the Delaware Health Information Network (DHIN).

PCC set up the interface through which the Delaware practice's immunization data will be automatically processed and submitted from PCC EHR to the local immunization registry. PCC submits immunization data using HL7 clinical messaging. HL7 is recognized under Meaningful Use as the standard messaging format for submitting EHR data to public health agencies.

Dr. Jan Lee, executive director of DHIN, says the automatic transmission of immunization records to the state will save practices the time and effort it takes to send the data manually.

"This is an important step in eliminating manual reporting and demonstrates that the systems can securely and efficiently share data," Dr. Lee said in a press release published Nov. 8. "We congratulate the P&A Center and the Physician's Computer Company for working with us in completing this important next step."

PCC has also established live interfaces with Oklahoma and New Mexico using HL7 messaging. Interfaces with Georgia, Tennessee, Texas and Vermont are currently in the works.

Click to read a PDF of the DHIN press release.

The morning after Hurricane Sandy slammed into New Jersey and lower Manhattan, leaving widespread flooding and power outages in its path, PCC began assessing the storm's effect on our practices in the area.

The situation was worrisome. PCC's Google map showing the real-time connectivity of our practices nationwide featured an ominous cluster of red markers covering the New York metropolitan area. Each of these 33 markers represented a practice whose power was cut by the storm.

One week later, all but four practices hit hardest by the damage are, thankfully, back online and slowly recovering from the devastation Sandy wrought.

And as we continue to help those offices still struggling, PCC reflects on Sandy as a storm for which we had to look outside our emergency response playbook for ways to offer support and technical services.

For some offices crippled by the hurricane, logistics made the standard procedure of mailing us the backup tape impossible. So PCC team leaders gathered to brainstorm solutions, such as setting up temporary hosting here at PCC, sending technical support staff to affected offices and soliciting the aid of neighboring practices.

The latter solution was employed in the case of a New Jersey practice located on an upper floor of a high rise building. With the power out, practice staff faced the prospect of lugging their 100-pound server down multiple flights of stairs to a working power source.

Fortunately, another PCC office about 10 miles away offered to run the affected practice's backup tape, from which the patient schedule could then be printed.

"In brainstorming and looking for new ways to anticipate need, we realized the resources we have in other practices who are willing and eager to help," said Jan Blanchard, PCC's Technical Solutions Team leader.

Next week, we'll bring you the story of how one New Jersey practice weathered the storm's aftermath.

PCC Support is always ready to help out when trouble strikes. But you can also save yourself from lost work time and stress by contacting us for important configuration work.

We especially encourage you to call or e-mail PCC Support during the following circumstances:

Adding a Clinician? Call PCC Support whenever you add a new provider so we can make sure your scheduling, EDI billing and Patient Notification Center configuration settings will all be ready for business.

Adding a Computer or Other Equipment? If you are adding a new computer, printer or any network device at your office, give PCC Support a call so we can help you get connected and avoid time-consuming conflicts with your existing equipment.

New Combination Immunizations? If you add a new immunization procedure to your procedure table, such as a combo-vaccination, contact PCC Support so we can help create entries for the many immunization features in Partner and PCC EHR.

New Procedure for Charting? PCC EHR can map procedures to items on the electronic encounter form. If your office uses PCC EHR's electronic encounter form, call PCC Support to learn how to make it work with newly added procedures.

Clinicians who want to authorize provider agents in PCC eRx no longer have to send PCC a form to do it.

Physicians who have been set up as administrators in PCC eRx can now add new provider agents or remove existing ones with just a few clicks. Here's how: 

•    First, visit the DrFirst options menu in either the patient's chart or the Rx Task queue.

•    Next, select "Manage My Agents" (The third option on the list). Here, you'll see a list of the practice's clinical staff with a "Y" and "N" marked by each name indicating whether they are users in PCC eRx.

•    Finally, select the names of the user or users you want to add or remove as a provider agent(s).

Until now, administrators in PCC eRx had to request provider agents via a paper form.

For today's segment on preparing for PCC EHR, our UC PCC EHR panelists will share how their offices set up visit templates (protocols) in advance of go-live. Once again, here is today's tip, compliments of Dr. Joseph Segapeli, of El Paso Pediatric Associates, Mary Anne Anderson, a nurse at East Bay Pediatrics, Dr. Michael Granum, of Michael Granum, M.D., and Judy Rapoza, office manager at Pediatric Associates of Fall River.

Question:

How Did Your Office Set Up Templates in Preparation for Go-Live?

Mary Anne - The practice's EHR champion, Dr. Vo, built the initial well and sick protocols that are still a "work-in-progress." For instance, clinicians have found that the sick protocol doesn't usually work with head injuries, so a protocol has been created specifically for head trauma. This and other protocols, such as one for abdominal pain, have been added on as needed. Having been online nearly a year, the practice would now like to train another clinician to help write protocols, as it is a time-consuming task.

Dr. Segapeli - Originally, the practice wanted protocols for everything but eventually settled on one sick and one well visit using Bright Futures guidelines. The practice has since added visits for ADHD, prenatal and circumcision. Dr. Segapelli advises that clinicians don't have to check everything off on a protocol just because it's there. If it's a simple visit, just check off what applies and leave the rest blank.

Dr. Granum - The practice uses Bright Futures guidelines for well visits and a few tweaks have been made along the way. Multiple sick protocols that were developed but never used have since been pared down into one robust sick protocol. For new patient visits, SOAP notes are used and dictated using Dragon.

Judy - Like Dr. Granum's office, Pediatric Associated of Fall River started off wanting lots of sick protocols but are now down to age-specific wells, one sick visit and a recheck.

Protocol-Building Takeaways

• Pick one clinician to write protocols in advance of go-live. Too many cooks in the kitchen will likely complicate and slow the process.

• When building protocols, it's recommended to start with age-specific well visits.
  Nothing is written in stone. Protocols developed before go-live can always be revamped or tweaked later.

• Write protocols and encourage colleagues to train with them well in advance of go-live.

On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.

Here is a starter list of resources. The list will be updated as new information and resources become available.

● FREE Code converter: The ICD-10 code online translator tool allows you to compare ICD-9 to ICD-10 codes. ICD-9 is being expanded from 17,000 to approximately 141,000 ICD-10 codes, and this online tool can help you map that expansion.      

http://www.aapc.com/ICD-10/codes/index.aspx

● FREE World Health Organization Learning Tool: The WHO Electronic ICD-10-training tool is designed for self-learning,and classroom use. The modular structure of this ICD-10 training permits user groups specific tailoring of courses on individual paths, if desired. Detailed information is given in the introduction of the tool, and in the user guide.     

http://apps.who.int/classifications/apps/icd/icd10training/

● ICD-10 Implementation Guide for Small and Medium Practices: Centers for Medicare and Medicaid Services (CMS)

Implementation Guide

● ICD-10 Transition: An Introduction: CMS

ICD-10 Transition

● FREE training videos at codapedia.com: You'll need to become a member, but it's free. Once you log in, you'll have access to free ICD-10 training sessions by coding instructor Nancy Maguire

http://codapedia.com/login.cfm

Carrie Gillander: Sponge Bob Square Pants

Jan Blanchard: Cowgirl

Douglas Beagley: Doctor Who

Lynne Happe: Open Source Software

Simonne Gratton: Geisha

Jen Loiselle: Raggedy Ann/Andy

Deb Bergeron: "Very Happy" Clown

Zach Zilius: Homemade Chicken Costume/Folding Chair

Chip Hart: Executioner

Kristen Ryan: Pirate

Jill Fahy: Lederhosen

Romni Palmer: Roman Gladiator

Erica Greenwood: Pink Panther/Gypsy

Phil Greenwood: Never Dressed Up

Are you and your office staff prepared to properly implement the new immunization administration codes?

On Jan. 1, 2011, new CPT codes 90460 and 90461 will replace codes 90465-90468.

The new coding guidelines say that administration coding should reflect the number of diseases immunized against as well as the number of shots. The work and the responsibility of administering a vaccine is now measured by both the antigens and the supplies, personnel, and other expenses inherent to the task.

To prepare Partner and train your staff, we've put together a comprehensive document that covers all aspects of the new codes, including an overview of administration codes and the changes; billing and posting; Partner configuration changes and new features; and possible pitfalls involving insurance companies.

Read the documentation now at learn.pcc.com/immsadmin2011

Download our Support Form to request help updating your Partner system.

If Marion Hayes could offer one piece of advice to fellow office
managers about PCC's Autopost Insurance Payments program, it would be, “give it a try.”

Pediatric and Adolescent Care of Silver Spring, where Hayes works, was one of the first PCC practices to sign up for the program that takes incoming payments and adjustments, posts all the simple ones, then creates a separate report for claim responses that need manual attention.

A year later, the billing process at PACSS has become a lot easier and more accurate, according to Hayes.

Before autopip, it would take staff all day to post a Blue Cross and Blue Shield voucher of 34 pages. Now, the same process can be completed in two hours, sometimes less, said Hayes.

Hayes said anyone using autopip should run it in conjunction with Partner's allowedit program, which monitors each payer's contracted fee. If a CPT code is not paid according to the practice's contractual fees, it won't post.

“We have already caught one insurance company changing our fees without notice, and anothernot living up to the contract they signed,” Hayes said. “Would this have caught if we did not have autopip? Perhaps, but we caught it immediately with autopip. It helps us keep an eye on the insurance company and keeps them honest.”

Since its launch in October 2009, 56 practices have signed up for autopip. Current users include large practices that employ several billers; smaller offices,where the office manager might play multiple roles; and practices in between.

“Autopip frees your time up by removing the most mundane aspects of posting insurance payments,” said Justin Ballou, project manager for PCC's Electronic Data Interchange team. “Anything with the slightest discrepancy goes to manual posting.”

When a biller runs autopip, he or she can be sure that only those payments and adjustments that match outgoing claims will be cued up on the autopost list, said Ballou.

Anything else – a claim that was denied; a CPT code or charge amount doesn't match a charge history; a claim total is negative; a payment or adjustment is not attributed to a specific charge – will appear on the manual report.

At PACSS, the number of checks that automatically post versus those that need manual attention is about 50/50, said Hayes.

Ballou said the average practice using autopip will see anywhere from 50- to 75 percent of its ERAs autoposted.

As more practices sign on to the program, Ballou added, PCC's exposure to the nuances of different payers will help developers improve the speed and accuracy of the system.

At PACSS, the use of autopip has freed up billers to spend more time reviewing unpaid claims. Autopip has also decreased the types of billing errors that were common with manual posting, said Hayes.

When processing ERAs, Autopip takes into account the payer fee schedules that are posted in Allow Edit. Prior to Autopip, Hayes said, it was easier for a biller to mistakenly post an EOB that included the wrong fee for service.

While using allowedit to maintain up-to-date fee schedules for every insurance company is not necessary for Autopip to run, it is well worth the effort, said Hayes.

“Keeping fee schedules up-to-date is a little time consuming, but you're also making sure you're getting paid correctly,” Hayes said. “I love Autopip. I think it's a great tool, and I wouldn't do without it.”

Hayes encourages any practice that is manually posting to consider Autopip.

“I would say take time to see how the system works,” said Hayes. “Once you do that and see that it's posting correctly, your confidence in autoposting will build.”

In 2007, PCC's Practice Vitals Dashboard web-based reporting tool offered the basics. In a nutshell, clients could log-in to see and compare their practices' revenue and sick-to-well visit ratio with that of other pediatric practices.

Three years later, the Dashboard's menu of reports on pediatric benchmarks has grown from basics to bells-and-whistles. In the past year, 60 percent of PCC's clients have logged in, at least once, to view an expanded offering of clinical measurements, including well-visits and asthma reporting.

The Dashboard's newest quality measurement, called the Childhood Immunization Status, reports on the percentage of patients who have had the CDC-recommended immunizations by their second birthday. The measurement was highlighted at this month's AAP National Conference and Exhibition in San Francisco.

Read more about the Childhood Immunization Status Report