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Meaningful Use: Commercial Insurance Companies Adopt Criteria

Health Insurance Companies Process 1 in 5 Claims Wrong

If Doctors Want to Get Paid They May Have to Buy an EHR

meaningful use criteria stress doctorI was reading a blog post from John at “EMR and HIPAA” entitled “Commercial Insurance Implementing Meaningful Use” that stated on August 5, 2010, four insurance companies would now include Meaningful Use criteria in their pay for performance (P4P) programs.

Meaningful Use is being able to demonstrate the use of an Electronic Health Record (EHR) based on the criteria set by the government. Even if you have an EHR and are using it, but do not meet the standards, it will not count. Don’t have an EHR? Well that really does not count.

The meeting took place at the Health Industry Forum held in Washington DC by the United States Health & Human Services Department (HHS). The insurance companies and the government met to discuss their collaboration to support providers in the adoption of certified health records which includes Meaningful Use.

The four carriers that met were Aetna, United Healthcare, Wellpoint and Highmark Blue Cross Blue Shield.

Not sure at this point what the insurance companies will require of physicians. It is too early to tell.  If this requirement happens, medical practices may have a hard time implementing Meaningful Use.  Smaller medical practices may lack the expertise and resources to install an EHR and prove Meaningful Use.  But if medical practices don’t meet the criteria, will that mean even lower reimbursements for physicians?

These 4 insurance carriers may just be the start.  Now that the federal government has made “clear” the criteria and how to achieve Stage one of Meaningful Use (yes, there are 3 stages), how many more insurance payers will jump on the bandwagon?

One thing is for sure, healthcare is getting more and more complicated.  It is going to be tough for small to mid-sized medical practices, and even large ones, to keep up. Ongoing training for office staff, buying new computer equipment and software, or outsourcing medical billing and EHRs are going to be the only alternatives to continue to get paid for the work the physicians perform.

Do nothing and some practices may go out of business.

is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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