Ongoing efforts to improve the quality of care, enhance the efficiency, and reduce the costs of healthcare provision nationally have led to a focus on digital solutions like electronic health records (EHRs) and e-prescribing. Other changes coming to the practice of medicine include the growth of RAC audits and the implementation of ICD-10. Neurologists face some crucial deadlines. Those who fall behind leave money on the table and eventually risk financial penalties. Ahead, we'll look at some critical areas of focus. Look for ongoing coverage and helpful advice in future editions

E-Prescribing and Meaningful Use

Much ink has been spilled over EHRs, which are intended to streamline care, reduce errors, and cut costs. Practices will soon be compelled to use EHRs that qualify for meaningful use requirements. Those who do so now have the chance to earn incentives. Incentives are now in place for e-prescribing.

In order to comply with meaningful use standards, 40 percent of all prescriptions, as opposed to just those through Medicare, must be done with e-prescribing, Mark D. Kaufmann, MD, a dermatologist specializing in EHR issues, has pointed out. Simply e-prescribing for all Medicare patients may not be sufficient; if you are e-prescribing for 100 percent of your Medicare patients and none of your other patients, you may not reach the 40 percent for total prescriptions written.

Only those that are e-prescribed are included in the total percentage of e-prescriptions required (40 percent) to qualify for incentives, Dr. Kaufmann notes. Even though faxing a prescription to the pharmacy involves electronic communication, it will not be included in that bottom line number of e-prescriptions.

For many current EHR systems, e-prescribing is possible, although systems have limitations. For example, some will not generate an e-prescription and a physical record, which some patients desire. Several years from now, when more computer and EHR systems are likely to be linked among pharmacies, practices, and hospitals, meeting the e-prescribing standard may be much easier, Dr. Kaufmann, says.

Practices that have not already purchased an EHR system should make sure that the vendor they select offers software that will keep track of total number and percentages of e-prescriptions. If you already have an EHR but are uncertain as to whether it tallies these percentages, it may be wise to contact the vendor and request a software update, Dr. Kaufmann notes.

For more details on Meaningful Use Requirements for EHRs, see the sidebar.

ICD-10 is Coming

ICD-10 or 5010 reporting will be required for all covered entities beginning October 1, 2013, and is now available for trial use. ICD-10 replaces 4010 for all covered entities.

Unfortunately, neurologists may deal with non-covered entities, who may stick with ICD-9, at least for some time. That means practices must be prepared for a potential period of overlap. A non-covered entity might include Driver's Insurance.

EHRs will need to be updated to accommodate ICD- 10 and, hopefully, will accommodate both ICD-9 and 10. This should be a rather simple process, but it is something to consider and investigate before signing on with an EHR provider. Be sure to ascertain the costs of upgrade and any special requirements.

RAC Audits: 30-Day Deadline

Do you realize that practices have 30 days, from the date of issue, to respond to a RAC (Recovery Audit Contracts) audit request for records? In order to meet that very tight deadline clinicians must have speedy access to their patient files.

Failure to submit records within 30 days is the number one reason for RAC judgments against physicians. To ensure timely processing, be sure that any RAC requests for documentation are sent to the proper address. Auditors may send letters to off-site billing contractors or to the attention of someone in the office who is unfamiliar with the process, leading to costly delays. Practices have a right to indicate where RAC requests are to be sent.

Be proactive in investigating protocols for acquiring records from any hospital where you consult or with vendors who may house your patient records, so that you can be assured timely access.

Aside from failure to respond, the most frequent error uncovered by RAC auditors is improper use of new versus established patient codes, observes, Marc Nuwer, MD, PhD of the AAN's Medical Economics and Management Committee. Improper use of moderator 25 is another common problem, so brush up on these issues.

If you find errors in a filed claim, correct it and resubmit it, Dr. Nuwer says. Don't wait for a RAC audit to catch the error.

One major difference between RAC audits and Medicare carrier audits is that, because RAC auditors are paid a percentage of what they collect, this could cause more aggressive audits. In Medicare audits, there is no financial incentive for auditors. All providers should be aware that an appeal process for RAC audits exists.