Home Forums Discussions Meaningful Use Urgent Information For All Using MU Wizard

Yes, my title is in caps because I am screaming.

Posted today by ZAHN:
"Assuming you finished all the codified dx/clinical support etc and ready to sign-off, YOU NEED TO COMPLETE THE BILLING PART WITH CPT CODE AND DX, then click sign off. Run meaningful wizard report and the related #s will appear.

AC assume everyone is using the billing portion of the program automatically, therfore, CPT and proper Dx are used there to link to the encounters. Ac tech staff (didn't know?) and it was never mentioned so as the instruction in the wizard."

Why would AC assume we were using the billing since it is not a real PM program as yet? I have never added CPT codes since I am not using AC for billing. I have just tested Zahn's theory, and YES, it appears that the reason that my CQMs all stayed at zero was because of no CPT code. So, to get credit for my last month's work, I will have to go back and manually add the superbills with CPT even though they are of no other use to me.

WHY WOULDN'T AC HAVE INCLUDED THIS INSTRUCTION FOR THE MU WIZARD?
AND, WHY WOULDN'T TECH SUPPORT KNOW?

THANK YOU!!!

I met with a consultant recently to review our M.U. readiness, and was reviewing the MU Report I prepared (we have been using the MU features in a live environment for the past 3 weeks to identify workflow issues w/ recording the data).

It seemed odd that I was seeing zeros for so much of the reporting data, especially things I know for a fact we are entering correctly (BP, BMI, etc). The consultant advised me to consult w/ AC and ask how it is compiling that data. I'm glad you identified this issue and reported it here. THANK YOU SO MUCH!!!!

In one sense, I agree it's not appropriate to assume everyone is using the PM module ( I don't, b/c it's terrible and we have an excellent PM program used independently). Therefore it should not be linking the data through the billing component of AC.

However I started playing with it this morning since reading your post. And started wondering about the "bad data," and how the option of signing the note without using the PM module could allow me to discard the bad data, while signing the note and selecting the CPT code would allow me to selectively incorporate the "good data."

I realize this is against the spirit of M.U., and probably illegal. So I'm no advocating for using the AC glitch to selectively incorporate "good data" and exclude the "bad." What I'm proposing is for other people to think about it from this perspective and share their thoughts on the matter.

I have a question about manually adding the CPT codes for previous office visits. We began our 90 day MU period on 9/1/11. When I manually add a CPT code for a previous visit I cannot add anything to the four ICD-9 blocks to associate with that visit. We did include the ICD-9 codes in the encounter before we signed off. Will this make a difference when the MU wizard is creating a report?

I am a little lost here. There are 3 types of MU requirements:
1. Core (must satisfy all 15, though one is actually the CQM's below)
2. Menu set (must do 5 of 10)
3 CQM (must do 6; 3 required and 3 alternate)

Donna, are you saying that you need a CPT JUST for the CQM counting? That is a significant finding, though one that I can understand. Do you think it affects counting for Menu items?

Adam, you seem to be saying that you need the billing codes for the core items (like vital signs). That is harder to fathom. I do not use AC for coding either and yet when I check the "meaningful use checkpoint" I see that vitals and other core items do register in the counting for that core item. Can you clarify how you see cpt coding affecting the core items?

Jon,
Yes, to be more precise, the core and menu items were counting without a CPT code on the encounter. The CQMs require the CPT code to be present in order to populate the numerator and denominator.

Ted,
Just add your CPT code to the visit superbill, your previously recorded ICD-9 will be there, and you will get credit in the MU wizard for your CQM. All my CPT codes have a $0 charge (since I am not really using them in AC). Just adding the CPT does the trick.

These are the results of my experimentation with it today.

Ted, I do not know about "manually add a CPT code for a previous visit," so can't really comment on this. I am adding a CPT code at the point of care on the same date of service for the note I am creating.

The main point that you probably already understand is this: know what data needs to be recorded and what doesn't.

For example I have a reminder at my work stations, which lists very simply 6 things: 3 core and 3 alternate core measures that I have selected to measure. What the scoring criteria are, and what triggers will produce a good result.

Thus for example when I am seeing a patient for diabetes that is also obese, I look at the reminder which says "CQM's: Weight--age >18, if BMI yellow or red: document ICD code V65.3" This tell me to tell the patient about their weight issue, briefly remind them to eat less and exercise more, and record v65.3 in the diagnosis list. I carry on with the visit, etc. Then I sign the note, include a fake CPT code for 99213 or 99214 since I'm NOT using the PM software for billing the charges entered are $0.

When I run the meaningful use wizard under "Reports," it has successfully logged a +1 numerator and a +1 denominator under the measure NQF0421 (Adult Weight Screening and followup."

I have tested this out all day today on patient after patient and the numerator and denominators go up. This is the trigger to record CQM data: entering a CPT code at the end of the visit.

JBS, up until today I was never entering a CPT code ever, not once in my life did I use that. I could not understand why the numerator and denominator under the REQUIRED CORE CQM's were all registered a zero. However I had been using MU live in the office for three weeks, and records hundreds of office visits. yet not one numerator or denominator registered in these fields.

Then Donna posted as above. It fixed my problem.

Since today, I am entering CPT codes and I have several entries in the numerator and denominator fields of the CORE CQM's. That was the fix.

TO CLARIFY: Prior to using CPT codes, I was getting registries in the CQM Alternates (not the Alternate Core CQM's , but the CQM Alternates). These were unaffected by using CPT entries.

for added clarification, I am specifically referencing the HTN, Preventive Care/Tobacco, and Weight screening measures of the Required Core CQM. These were all registered as zero. But now these are recording entries and everything on the report seems good.

does this make sense?

Aggggghhhhhhhh. (Painful scream from SE Missouri).
Please say it isn't so!
I guess it's not negotiable.
One of the amazing parts about AC is our ability to
customize it for our own use. I wish that was possible
for this very important step.

I am so thoroughly confused now, I'm not even sure what everyone is talking about. I can look at the past 90 days of core measures while in the patients chart....see what I've done for that particular patient and run a report of all patients over the past 90 days. That report shows that I have met the criteria for each of the core measures and have done 4 out of 5 of the menu sets I selected.

Then I go to the report section and try to generate a report and there is nothing there. I'm very confused about this coding issue. We do our diagnosis ICD coding and cpt coding when signing the note but we don't bill through AC. I don't understand how that matters. I also don't understand the mention of the PM module when no PM module exists. Isn't that the V7 many of us are waiting for?

I guess our consultant is going to need to come back and do some more consulting. I can run reports on my own and get a denominator and numerator. EG. I can find all patient with 250 in their diagnosis and then run a report about 250 with hgac documented in tracked data. I get a numerator and denominator and that works fine so I am very confused about this wizard and what he does.

I started using V6 1 month ago with no CPT codes at the time of signing the encounter. I am having a lovely evening going back and adding CPT for all of my visits, so I can get my data from the MU wizard. Here is the procedure if you need to do this:

Open Account Information tab of patient file
Choose visit from date of service drop down
Click Add CPT below rows
Code search opens, type your CPT code
Highlight the line and click Add to Bill
Click Save Changes
Update Superbill Info, say Yes

If we print claim forms from amazing charts at the end of every day, how is it that this information is not there already??? I do not understand.

I am not doing this because IL Medicaid is not up to speed but....

If you are doing superbills (printing claim forms qualifies) you SHOULD be entering in the info needed.

To go back and put in the coding is not a big deal, but a bit time consuming. I DO NOT KNOW WHAT CODES NEED TO BE ENTERED BUT...

On the main screen, go to billing and the second item (or Control and D)
Pick the date (or dates) you want to edit. This will bring up a list of names.

If you click on one of the names, the billing section of the chart for that person will open.

You then click on Add CPT (lower middle third) and add the necessary CPT.

You pick a code (99213) and probably add a dx (htn, IDDM, ect)
Click "Save Changes" (lower R corner) and then close the chart.

It may ask you for pricing, I'm not sure. Doesn't matter because once a price is in, it will not ask again.

AGAIN, I AM NOT SURE WHAT CODES YOU NEED TO ADD. We use AC for billing out to MTBC so we use this.

You can add codes fairly quickly. A couple of hours you should be able to do a lot of charts, it's really quick once you get the hang of it.

This fits with what Donna explained above: you don't need CPT for the core measures or menu items to work.

This part is confusing; can you explain what you mean by "try to generate a report and there is nothing there"? You are correct: it doesn't matter if you bill through AC, so long as you enter the cpt for each encounter.

Adam is using the term "PM" a little differently. It is simply the portion of AC (in V4,5, or 6) that allows you to code cpt's and diagnoses, and then generate a superbill.

Thank you Wendell!!!!

Hi Donna,

What version of AC are you using? V6.09 or V6.10? I am using V6.09. I enter CPT codes for all visits, yet I still get zeros for the two core CQMs - smoking & BMI (but with a check for both of them), I do get #'s and a check for Hypertension. For the alt. CQMs, I fail on each of them, I know I followed the AC recommdations on some of them. I am fine on the Core and Menu.

Please help me here!

Thanks,

Cindy, IM

Yes, indeed, thank you Wendell.
I used my paper superbills to go back though my days, but your method is a quicker way of getting to each day's encounters. You end up at the same superbill page as my instructions above to add the CPT.

Cindy,
The wizard apparently does not work correctly in V6.0.09.
You have to upgrade to 6.0.10.

Appreciate your help!

Cindy

Okay.....so is it true that the Wizard doesn't work for V 6.0.09?? We have not upgraded to 6.0.10 because it is still beta and we have been too busy to deal with the upgrade process and what it does to our IT guy and all the computers. Our IT guy also does our billing so we were going to wait for the bugs to be gone and things to slow down. I'm pretty sure that I meet all of the criteria already but I just can not figure out how to generate the reports and I've been coding the ICD and CPT # for each encounter. Does this mean that my next step will have to be upgrading to Version 6.0.10??? Or am I doing something wrong elsewhere in V6.09??

There is a youtube video on the amazing charts channel of somebody attesting to MU in about 7 minutes....not good audio or visual though and it looks like it is all done at the CMS link and I'm assuming I need my reports to go there.

So do I in fact need to upgrade to V.6.10 to get the Wizard to work for the reports???

Thanks for the help
Nancy

6.0.9 has a time out issue on CQMs and you need to upgrade - attesting does indeed take less than 10 min if you have the report in front of you with the numbers.

When I am in the patient's chart and generate a report including all patient for the past 90 days...I get a really good report. All but one green light and the one that isn't at goal will be there very soon.

Then I go to the reports section for amazing charts on its opening page up at the top and I try to make reports and it is just alot of zeros and red XXX's. Disappointing!

One is not able to print the report that is generated within the chart. At least there is no print button and I can't figure out how to do it. I could take a picture of it with my iphone but that doesn't seen like the proper way to attest that I've done something???

You can print by using Print screen and pasting into paint, but you need to find out what is red in AC report - some require attestation to turn green, some are CQMs, you really need to read carefully, determine what you need to get it going and try again - just do all you can today and run 1 day report - see if it is catching information you are doing and if one category is not working, read the full information under that item and see if you missing something (like V65.3 and V65.41 for dietary counseling and excercise counseling).

The only thing I have that isn't green for the past 90 days is CCD with transition of care and I believe that that is because I don't write my letter at the same time that I sign my note. Notes are signed every day but I send a message about consult and it is set up by someone else and I write the letter and CCD report generated at letter writing time....so it has been done, it just isn't being picked up so I'm changing my work flow a bit to pick it up.

So what is not green on the main AC report - you said lots of red xxxxs and zeroes.

6.0.10 is no longer beta, it is the official release.

According to post by Jon B, it is the last release before V7.

When I go to the report area from the main page of AC and click on the Wizard in the report section of AC, there is little if any green. I have not gone there often only every few weeks...nothing much has changed...maybe a couple of things

When I go into the Wizard while I am inside a patient's chart and run the report for the past 90 day while I am inside the patients chart, everything is green. I can watch things go from red to green when I am working on that chart. Then I can see that I have completed sections on charts other than that single patient's chart when I do the 90 day report. For example....not many patient's have asked for an electronic copy of their health records. I have given 100% of those who asked a copy. In fact, I did it several ways in order to get the # to register and that criteria to turn green. When I run a report I always get 100% for that core measure. I also get 100% for several other core measures....far beyond the benchmark.

But I go back and try to print the report in the report section....everything(almost) is red. If this is a bug...okay but if there is a way to get reports without upgrading to version 6.10....I was planning on not doing another upgrade until V7.

The upgrade is pretty time consuming and I'm a small practice and I guess I have a dozen reasons why I am just sick of all this meaningless meaningful use. I've been sucked in to this massively timeconsuming meaningless venture. For what??? Is it really worth the time/life I'm wasting???

I was using a computer in my practice in a meaningful way long before the government came up with this crap. I'm really frustrated...don't want to leave $$$ on the table.

That's funny, usually when there is a new version, you are notified that you are not using the most up to date version and I have not received that notice yet when I log in.

There is a problem with the update notification.
See here: http://amazingcharts.com/ub/ubbthreads.php/topics/35294#Post35294

As I posted on another thread back on 9/12, I found some helpful info from the AMA on the CQM process:
http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-clinical-quality-measures.pdf

"Although CMS requires all EPs to report core measures, there is no requirement to satisfy a minimum value for any of the numerator, denominator or exclusion fields for clinical quality measures. The value for any or all of those fields, as reported to CMS or the States, may be zero.
? If an EP reports zero values for their three additional clinical quality measures, then for the remaining clinical quality measures in Table 6 (other than the core and alternate core measures), the EP will have to attest that all of the other clinical quality measures calculated by the certified EHR technology have a value of zero in the denominator. If this is done, the EP is exempt from reporting any of the additional clinical quality measures (other than the core and alternate core measures) in Table 6."

As I read this info, all we need is a num/denom/exclusion figure to report. These numbers may be "0". Am I incorrect about this? Or is this an example of murky/meaningless use?

Having to enter CPTs into a system that we don't use is not a good use of time. It is extra work for those of use who have to enter the codes into another billing system.
If AC PM was 100% functional and had kinks worked out, we might use it. Our experience with the PM side was 3 years ago and was not helpful. Maybe it has gotten better with time.

I wish AC would not get into the pm business and just continue to hone the amazing clinical side they already have in place.

My confusion is do you enter a CPT code when you finish a visit - I put mine on a superbill as I leave room. If you know the CPT code you are going to use it really is no big deal to enter it - you don't have to click the boxes for each shot, EKG, PFT, etc - since you are not using it for PM. Just put the office code and hit save.

Now if you do not use ICD-9 codes and have never got into looking them up it could be a bit more work but you just have to get into the habit - it will also fulfill the criteria for a problem list as you need ICD 9 codes for the summary sheet to have diagnoses, etc.

An obscured line buried way down deep in the instructions on the meaningfull use wizard under the CQM Required tab:

"For many CQMs, in order for a pateint encounter to be included in Meaninful Use, CPT codes (and sometimes relevant ICD9 codes) must be used."

(this was a cut and past, I usually use a different spelling for patient...)

You would think this would at least deserve a bold face font or something seeing how important it is!

My staff teases me and calls me "Rainman" because I am so good at coding. At least on our system right now, our 6.09 is running slowly. It isn't inviting to add more time in the room waiting for AC to pull up and change screens.

How did those of you with V6.10 get it?? I have had V6.09 since before ACUC in June and keep getting notified that I have the latest version. I had to email the tech staff to request 6.09, trying to get it before ACUC but then of course it was made available to everyone there. But I cannot seem to find anywhere on the website currently to update to 6.10--or did you get it as your original download of AC?

Try this for the download:
http://www.amazingcharts.net/6010.zip

Steve,
You are right.
That instruction is there, as you say, buried.
I read the MU wizard instructions multiple times without this registering. Ugh!

After 4 hours, and 3 days,my staff finally got the attestation in Thursday.

I received a notice from the central Florida REC that the first check to go out to a physician for MU took 7 1/2 weeks after attestation.

Will the federal government still be funding and be funded for this program in November?

Frank,
Congrats! Did you have trouble with the CQM's as has been discussed in this thread? Any other advice for those of us who are just starting the 90day process?

I downloaded V 6.0.10 and I'm still not getting numerators. Again there are green checks but no numerators. There is one denominator and that's it.

My office manager did it with Claire's(AC) help.