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Is there a way to exclude an encounter from Meaningful Use calculations? Here's why I'm asking.

Some patients are referred to my office for procedure only (EMG/NCV). While we perform a focused examination, if the patient is there only for the procedure, we don't take full histories or even document/review medications and such. A procedure report is generated, imported to the chart, and returned to the requesting provider.

A couple years ago we discovered that if we documented these appointments as encounters, they were being included in meaningful use and bringing our percentages down. So we started simply documenting a brief summary as an addendum/procedure, and importing the full report into imported items.

The problem with this is if that patient is referred for testing again in a year or two, which is not uncommon, there is no "previous appointment" that shows up in AC and my staff thing the patient has never been here before.

So I need a way to document an appointment without it being included in meaningful use calculations. Any ideas?

Anytime an encounter note is signed off on, it records on the Meaningful Use Wizard for the provider that finalized the note. There is no way to exclude encounters from the Meaningful Use Wizard unfortunately, however, since this does sound like it is happening often there are still ways you can ensure that you get credit for the proper measures in MU. For example, measures such as ePrescribing only increase when you are prescribing. The same goes for Medication, Lab, and Radiology orders as they only increase in both numerator and denominator when you perform the necessary functions. If you don't do these during the procedure appointment, they are not positively or negatively increasing at all.

Specifically, the measures that would be affected by signing an encounter (meaning the denominator will increase) deal with the patient portal. My suggestion for this is to create a portal account for the patient if they do not have one in the system already and then send their Full Patient Record to the portal as well as a secure message to indicate what was done in the procedure so they also have that in their portal (both done from the Summary Sheet of a patient chart). This way you are still getting credit for these on the Meaningful Use Wizard regardless of what the appointment was for.

Separately, the only other measure that the denominator increases with a signed encounter is the Patient Educational Resources. I imagine that not every procedure visit has Patient Education materials to go with it but if it does then simply check the box above the Plan to indicate "Patient Education Given". This measure has a 10% threshold so even if you can't complete it all the time it shouldn't be detrimental to your numbers.

In the past when Meaningful Use had more measures to worry about that were affected by encounter sign off and this would have been a bit more difficult to work around but it is certainly achievable now that the portal is the main concern when it comes to encounters being calculated.

The only other suggestion would be the addendum option, which doesn't seem to be the best for what you are trying to do.

I hope this information is helpful for you, please let me know if you have further questions or concerns.

Stefan,
Thanks for that explanation. The way that the MU Wizard does those calculations has always been a mystery. If those are the only measures still effected by an encounter sign-off, then working around the issue is easier than it use to be, especially with that information.

Neurodawg,
Another option that might work is to set-up a sham provider. Call them "Dr Procedure" and create a schedule. Any procedures could be documented as an encounter the way that you have been doing, but signed off by that doctor. The old visits will show up in the patient history. Dr Procedure will not qualify for MU, but he won't hurt your numbers!

That is a good work around, but wont AC want to charge another license fee for the provider. We found that out when we went into version 9+ that anyone labeled a provider needed a license.

Neurodawg,
We also do several in office tests that other physicians refer here for and stopped creating encounters but just dictate the test results as an addendum. However, in order to know if a patient has ever been here we have to open the patient chart and go to the past encounters tab to see if there are any reports. It is a couple extra clicks but seemed the best way for meaningful use for those test patients to not count against us.

Neurodawg,
We should check with AC about this. In the past, AC was willing to let us set up as many "sham" providers as we wanted; I do not know if that policy has changed. If they do, it really does resolve this problem nicely.

When we changed to 9.2 we had more doctors in the computer than we had a license for and got warning from the program at first...we had to get rid of my partners names in the computer We have 2 offices and we cross-cover, so 1 doc may need access to another database 1x in 8 weeks...

This is exactly what we've been doing. I was just hoping there was a better way.