4 Signs Your Aging EMR Disrupts Your Compliance Standards

Have you experienced compliance issues that need to be corrected? Given the significant penalties that can be handed down for a HIPAA violation, and the time spent on correcting and worrying about them, it’s easy to end up with compliance troubles. An aging EMR system could be the culprit. As technology improves and the landscape changes, your therapy practice’s EMR system may no longer be up to current standards. Worse, it’s possible for your provider to go out of business, leaving you with unsupported software that is no longer being updated or tested. There are four signs that you may need to replace your EMR to avoid compliance issues.

It’s Not In The Cloud

Cybersecurity is a growing concern for healthcare organizations. Ransomware, in particular, is a huge problem. Criminals often target healthcare providers due to the high value of the deeply personal data they hold. Despite this, in 2020, only 44% of healthcare organizations adhered to basic NIST cybersecurity standards. High profile data breaches happen to healthcare providers of all sizes several times a year, and 2020 only made things worse with an overall increase in incidents across all industries. Add in the increase in remote work and telemedicine over the last year, some of which is likely to remain in place as patients and providers alike realize the value of telehealth, especially in rural areas, and it simply no longer makes sense to self-host your EMR system. A HIPAA-compliant cloud system allows you to reduce the amount of time and energy you spend worrying about cybersecurity, while ensuring that your providers have access to the EMR system wherever they are and across multiple devices. This saves time as well as reducing security and compliance risks.

It Doesn’t Update Common Payer Rules

Common payer rules change frequently. As a bare minimum, your therapy EMR vendor needs to be updating the system annually to reflect changes to ICD-10 diagnosis codes and NCCI Edit Rules, the addition of new CPT codes, and any changes to quality payment programs such as a Merit-Based Incentive Payment System. Not updating these rules and staying in line with them can greatly increase the number of claims that are denied, leading to lost reimbursement and wasted time resubmitting payment requests. A good EMR system will enable you to configure your own payer-specific rules to help protect your practice and maximize reimbursement. This is particularly useful if you are dealing with state and local rules that may be different from the standards coded into the default system. It will automatically update payer rules as they change and ensure that you are not, for example, using obsolete ICD-10 or CPT codes, and that you are properly coding documents to get all the reimbursements.

It Doesn’t Track Incomplete Notes

All practice owners struggle with getting clinical notes completed on time. It’s human nature to forget about something you did partially and meant to come back to later; often your brain will insist that the task was, in fact, completed. The notes then wait until another provider, the patient, or an auditor notice their absence or incomplete nature and flags it. At that point, it could be challenging to go back and fix the problem, resulting in holes, insurers not reimbursing, and an issue that multiple people then have to sit down and try to resolve. This can also reduce patient trust. With good modern therapy EMR software, the system will track incomplete notes and send alerts to providers and staff to make sure they are aware of outstanding work. It will flag which patients need Progress Notes, Re-Certifications, Plans of Care, and Discharge Summaries. The system will then continue to remind clinicians until they actually do the work, ensuring that it is not forgotten and is completed in a timely manner. This is helpful to patients and caregivers, as well as ensuring that records are compliant and up-to-date. It also makes sure that when multiple providers are involved in a patient’s care plan, they are properly communicating with each other and have the notes they need to move forward.

It Doesn’t Provide Billing Guidance at Point of Documentation

When your therapists select charges, they could make mistakes. Remembering which codes go with which payers and which treatments is literally impossible (there are thousands of CPT codes in use at any given time). It is also something that providers should not be taxing themselves with. The best way to make sure that everything is entered properly is to provide billing guidance right when the therapist is making that initial selection. This reduces time spent correcting things later and ensures that an incorrect charge does not slip through the cracks. A modern therapy EMR will be set up to show your provider which codes are allowed for the current payer, preventing them from selecting CPT codes that could result in denials or rejections. This ensures that data is entered correctly at the start, meaning that you spend less time changing them later. Also, it saves time at the point of care by allowing the therapist to pull up the codes quickly during the patient’s visit. It is also good for patients, as a minor CPT error can result in them being sent a bill they should not receive, which you then have to help them correct. Other things to consider about your EMR software are its reliability. Is the vendor’s tech support always available and responsive? Is it being updated regularly? If you don’t like the answers to some of these questions, then it may be time to start shopping for a new therapy EMR vendor. Make sure that your new vendor is HIPAA-compliant, provides quality cloud services, and performs regular updates and backups (including the ability to obtain your backups, just in case). Replacing your therapy EMR may be necessary to avoid compliance issues, and it may also be a good idea if you are experiencing reduced reliability. A new, modern therapy EMR will save you a lot of time handling compliance and denied claims and can protect your practice from high HIPAA compliance penalties.