Patient Portal: The thread that connects patient and provider to enable deeper mutual engagement for managing healthcare

2017 Alliance feature article provided courtesy of TriMed Technologies

What do patient engagement, Electronic Health Records, appointment scheduling, bill payment and reconciliation, prescription refill requests, retail experience, Value Based Payments, HIPAA, and physician office best practices all have in common?

While they seems to be a varied cornucopia placed in a single basket, they all can be connected with technology called Patient Portal.

Like three major highways merging together into a single expressway, and moving at higher and higher speeds, healthcare is experiencing the convergence of government mandates, disruptive payor models, and the general population’s changing expectations and seeming culture shift to consumer driven, retail experiences.

Healthcare providers, from hospital systems to primary and specialty care providers, are increasingly connecting with their patients through their respective Patient Portals. At least they are attempting to do so. In a report published by the American Hospital Association in July 20161 between 2013 and 2015 online medical views more than doubled, download of medical records nearly tripled, and requests to change medical records more than doubled in that period. While this news sounds promising, the reality is that on a broad scale, patients/consumers reported very low use of the tools that patient portals primarily provide.

A survey in 2015 prepared by Nielsen’s Strategic Health Perspectives2 and presented by The Council of Accountable Physician Practices points to the gap between government mandates and payor and provider desires over against the unmet needs of consumers when it comes to not only basic online access, but to deeper interaction with their healthcare provider. This is broken down to HAVE vs. WANT in the following chart:

trimed-patient-portal-table1

Moreover low-income consumers, those with a combined household annual income of less than $35,000 and Medicaid consumers said that they WANTED Text Appointment Reminders at a rate of 22% and 32%, respectively. That’s nearly one in three Medicaid recipients, for just one potential online engagement service. When it comes to Text Reminders about taking medications or other health reminders, nearly one in four respondents receiving Medicaid benefits said that they WANTED this engagement.

But there are additional health care related tasks that are available to consumers that the Patient Portal can provide. According to general population benchmark data published by ACI Worldwide and Aite Group in January 20173, more than 56% of bills are paid online by way of a biller, bank or third party web site. Of note for the revenue cycle management side of physician practices, nearly three out of four of online bill payments are made on the biller’s (ie, practice) websites. Healthcare providers who fail to implement this ‘low hanging fruit’ of patient engagement do so at the cost of efficiency and best practice workflow.

Portals provide the ability for patients to schedule, cancel and reschedule appointments online. This technology is analogously utilized by the airline industry across carriers and has been in use for some time – whereby a consumer can prepay their flight and choose a seat at the same time. The healthcare industry, such as it is, lags behind in the implementation of this kind of service to it’s own consumers, due to either practice financial or cultural barriers – maybe both.

Other value drivers of a Portal include the ability for patients and guarantors to request prescription refills, view and respond to lab results, and view and print immunization schedules for parents and guardians. Online demographic registration and the completing of online forms, including consent forms, are additional workflow efficiencies that effective practices are beginning to utilize to minimize cost and enhance the patient experience.

One dictionary has the definition of a portal as: a door, gate, or entrance, especially one of imposing appearance, as to a palace. And technically, that’s what an online Patient Portal should provide – a doorway that connects a patient or family to his or her healthcare provider – a doorway that opens both ways. The foundation of the Portal, if all of these good things are derived, is the Electronic Health Record. The EHR provides the infrastructure that connects the patient and provider and allows them to intelligently manage health care efficiently and securely.

Aside from the fact that government mandates require the use of a Portal (among many other things) in order to maximize reimbursement and avoid future penalties under new MACRA value payments, a Portal – or doorway- between patient and provider only makes sense. Of course any technology that provides online access to the patient must meet the stringent demands of HIPAA privacy and security. This requires both technological and practical standards within a practice in order to comply.

In summary, the big picture is that the Patient Portal connects a lot of dots in the constellation of patient-provider healthcare. It opens the door of opportunity to engage more deeply with their healthcare provider and it balances the power between provider and patient whereby the patient has online access to their Protected Health Information 24/7. But not all patients are engaged, and a significant percentage of the population wants to engage in more ways than physicians, due to either financial or cultural reasons, are able and willing to provide. Over time however, it seems inevitable that physicians and patients will come closer together in the management of individual care. It’s just a question of how much time that will take.

Footnotes

  1. Data from the 2015 AHA Annual Survey Information Technology Supplement
  2. Prepared by Nielsen’s Strategic Health Perspectives for CAPP & Bipartisan Policy Center 2015
  3. © Copyright ACI Worldwide, Inc. 2017

Palmetto GBA E-mail Update: Tuesday, September 12, 2017

October 2017 Release ‘Dark Days’ for the Common Working File (CWF) Hosts
In anticipation of the October 2017 Release, the CWF Hosts will not process claims beginning Friday, September 29, 2017 through Sunday, October 1, 2017. During this period, which is commonly referred to as ‘dark days,’ the CWF Hosts will install the October 2017 Release, complete weekly/monthly/quarterly processing activities, and perform scheduled data center maintenance. This means Medicare Administrative Contractors (MACs) will not have access to the Health Insurance Master Record (HIMR) and Beneficiary Data Streamlining (BDS) transactions. Eligibility information in HIQA and HIQH will also not be available to providers.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Influenza And Pneumococcal Vaccines And Administration Reimbursement
These immunizations are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • JM Part B//Drugs/Biologicals
  • JM Part B//Physician
  • JM Part B//Primary Care

Palmetto GBA E-mail Update: Monday, September 11, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

Provider Contact Center (PCC) To Close For Training On September 15
The Provider Contact Center (PCC) will be closed for training on September 15, 2017, from 8 a.m. to 12 p.m. ET. The PCC will reopen at 12 p.m. ET.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update
CR10262 provides the 2018 annual update of HCPCS Codes for SNF Consolidated Billing (SNF CB) and explains how the updates affect edits in Medicare claims processing systems. By the first week in December 2017, new code files will be posted at http://www.cms.gov/SNFConsolidatedBilling/. Make sure your staff is aware.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Medicare Secondary Payer Inquiry Form
As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

A/B MACs Team Up with DME MACs for External Breast Prostheses and Related Mastectomy Supplies Webinar: October 18
Local A/B MACs and the DME MACs are excited to announce two collaboration webinars coming October 18, 2017. The event will be offered twice in the same day to accommodate national attendees. This webinar will focus on Medicare’s coverage of External Breast Prostheses and related supplies following surgical intervention. The educational representatives hosting the webinar will also spend time reviewing documentation requirements (such as detailed written orders and medical records). There will be plenty of time for questions after the presentation portion of the webinar. Please plan to attend.

Applies to:

  • JM Part A//General
  • JM Part B//General

MACtoberfest Workshop Conference: Innovation Today for Success Tomorrow
Palmetto GBA, the JM A/B MAC, is presenting an informative workshop in Columbia, South Carolina that will provide information related to the most common errors identified through a variety of data analysis and tips to avoid them. This workshop is intended to keep providers apprised of Medicare guidelines as well as using technology for better results. The recommended participants are administrators, billers, nurses and other healthcare professionals that submit claims to Medicare. Topics include: Electronic Data Interchange (EDI), Medicare Updates, Appeals, Medical Affairs, Medical Review, eServices portal, and Provider Enrollment and Revalidations. This is a free event! Please plan to attend.

Applies to:

  • JM Part B//General

September 2017 Medicare Part B Updates, Changes and Reminders: September 20
Palmetto GBA will host the Medicare Administrative Contract Part B September 2017 Quarterly Updates, Changes and Reminders Webcast on September 20, 2017, at 10 am. ET. These updates, changes and reminders include any new billing regulations, hot topics that impact provider billing, and a Q & A segment for questions on covered material. Note: An NPI and PTAN are required to register. You should only enter ‘n/a’ if you do not have an NPI or PTAN. Please share with your staff, and register today.

Applies to:

  • JM Part B//General

Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices?
Did you know you can view your latest electronic Comparative Billing Report (eCBR) in eServices? Be sure to check them out today!

Applies to:

  • JM Part B//General
  • JM Part B//Chiropractic
  • JM Part B//Physician
  • JM Part B//Primary Care

eServices makes it easy to monitor the use of your NPI!
eUtilization reports provide rendering providers and ordering and referring providers access to their personal data. Check them out today.

Applies to:

  • JM Part B//General
  • JM Part B//Physician
  • JM Part B//Primary Care

MLN Connects: Thursday, September 7, 2017

News & Announcements

  • Hospice Provider Preview Reports Available through September 28
  • IRF and LTCH Provider Preview Reports: Review by September 30
  • IRF and LTCH Compare Quarterly Refresh
  • Mapping Medicare Disparities Tool: 2017 Enhancements Released
  • 2015 Inpatient and Outpatient Hospital Utilization and Payment Data Available
  • Healthy Aging® Month: Discuss Preventive Services with your Patients

Provider Compliance

  • Lumbar Spinal Fusion CMS Provider Minute Video — Reminder

Claims, Pricers & Codes

  • October 2017 Average Sales Price Files Available

Upcoming Events

  • Overview of MIPS for Small, Rural, and Underserved Practices Webinar — September 8
  • New Medicare Card Project: Clearinghouses and Vendors Special Open Door Forum — September 12
  • Qualified Medicare Beneficiary Program Billing Requirements Call — September 19
  • Reporting Hospice Quality Data: Tips for Compliance Call — September 20
  • PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call — September 26
  • Physician Compare Call — September 28

Medicare Learning Network Publications & Multimedia

  • Medicare Diabetes Prevention Program: Audio Recording and Transcript — New

MLN Connects: Thursday, August 31, 2017

News & Announcements

  • New PEPPER Available for Short-term Acute Care Hospitals
  • Hospice Compare Update Document Available
  • Participate in Quality Payment Program Website Testing
  • Departmental Appeals Board: Submit Feedback
  • Correction to QRDA III Implementation Guide for Eligible Clinicians and Eligible Professionals

Provider Compliance

  • Billing For Stem Cell Transplants

Upcoming Events

  • IMPACT Act: Medicare Spending Per Beneficiary Measures Call – September 6
  • Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call – September 7
  • Qualified Medicare Beneficiary Program Billing Requirements Call – September 19
  • Reporting Hospice Quality Data: Tips for Compliance Call – September 20
  • PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call – September 26
  • Physician Compare Call – September 28

Medicare Learning Network Publications & Multimedia

  • IMPACT Act Call: Audio Recording and Transcript – New
  • A Physician’s Guide to Medicare Part D Medication Therapy Management Programs MLN Matters Article – Revised
  • Preventive Services Poster Educational Tool – Revised
  • Medicare Costs at a Glance: 2017 Educational Tool – Reminder
  • Suite of Products & Resources for Rural Health Providers Educational Tool – Reminder
  • Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet – Reminder
  • Physician Fee Schedule Fact Sheet – Reminder
  • Telehealth Services Fact Sheet – Reminder
  • Transitional Care Management Services Fact Sheet – Reminder
  • Federally Qualified Health Center Fact Sheet – Reminder
  • Rural Health Clinic Fact Sheet – Reminder
  • Medicare Home Health Benefit Booklet – Reminder
  • Critical Access Hospital Booklet – Reminder

Palmetto GBA E-mail Update: Friday, August 25, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

September 2017 Medicare Advisory
The September 2017 Medicare Advisory is now available. Please review this issue for Medicare policy and coverage updates as well as announcements for upcoming provider education opportunities. Please remember to share this information with your staff.

Applies to:

  • JM Part B//General

When using the Clock Draw test (CDT) to assess the patient’s cognitive function as part of the Annual Wellness Visit, do we need to scan the actual paper CDT into the patient’s medical record?
The provider may scan the patient’s Clock Draw test (CDT) but it is not required. At a minimum the interpretation and scoring of the drawing must be documented. Please share with appropriate staff.

Applies to:

  • JM Part B//General

A Physician’s Guide to Medicare Part D Medication Therapy Management (MTM) Programs
Medication Therapy Management providers work with physicians to deliver the best medication therapy to patients and to coordinate their medication therapy across multiple practitioners. The latest clinical information is used by MTM providers when reviewing patients’ medication therapy, such as updates to the Beers criteria for high-risk medications and revised monographs for old and new medications. MTM providers also listen to patients’ concerns about their medications and may offer recommendations to physicians and patients to help achieve their goals of therapy. As always, physicians make the final decisions about changes in drug therapy.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Palmetto GBA E-mail Update : Thursday, August 24, 2017

Email and Faxed Inquiries
CMS requires all providers to utilize the Provider Contact Center (PCC) (855-696-0705) as their point of contact with their Medicare Administrative Contractors. If you submit an unsolicited fax or email inquiry directly to a specific department or individual your inquiry will be routed to the written correspondence area within the PCC for proper logging, tracking, research and response. An escalation process is used for complex issues. Submitting inquires directly to the PCC will assure CMS compliance and allow for the most timely response.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

CMS Launches Jimmo Settlement Agreement Webpage
The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Medicare Secondary Payer Inquiry Form
As a reminder, A Medicare Secondary Payer Inquiry Form is available in the Medicare Secondary Payer forms section of our website. To ensure timely processing of your request, this form should be used for any Medicare Secondary Payer (MSP) request pertaining to Primary or Secondary payment of claims. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Prohibition on Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program
Medicare providers may not bill QMB individuals for Medicare cost-sharing, regardless of whether the State reimburses providers for the full Medicare cost-sharing amounts. Further, all original Medicare and MA providers–not only those that accept Medicaid–must refrain from charging QMB individuals for Medicare cost-sharing. Providers who inappropriately bill QMB individuals are subject to sanctions.

Applies to:

  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare