The federal No Surprises Act was signed into law on December 27, 2020 but it will be another year before it takes effect.
The American Medical Association (AMA) has created a 6-page guide for physicians to summarize the new law. The law concerns patients receiving an unexpected bill for medical care that they believed would be covered by their health insurance.
You can find a copy of the AMA guide here: https://www.ama-assn.org/system/files/2021-02/surprise-billing-provisions-guide.pdf
Earlier versions of the bill were opposed by AMA for favoring health plans and disadvantaging physician practices. The final version better reflects that AMA response to patients receiving an unanticipated medical bill.
The new law offers protections to patients when they receive a surprise medical bill due to:
• Unanticipated care from out-of-network physician or other professional
• Emergency care at out-of-network facility
• Emergency care from out-of-network physician or other health professional at in-network facility
The AMA guide provides information about independent dispute resolution (IDR) including the setup process, how it is initiated and what details can be reviewed by IDR.
The guide also details the requirements of various stakeholders, for example physicians and health care facilities, so the infrastructure is ready when the law takes effect in January 2022.
Our GlaceEMR software is constantly evolving and improving to best suit the needs of our users. Industry trends emphasize the use of electronic and virtual applications wherever possible, due to ease-of-use as well as increased accuracy and efficiency. Providers and patients alike benefit from an integrated system with real-time responses from pharmacies, clearinghouses, group care providers, etc.
Glace aims to offer features that make it easier to provide value-based care to patients. Our newest features continue this trend. A simplified workflow with real-time responses ensures patients receive medications sooner. Charge code calculators and same-day submission ensures providers get reimbursed faster.
Glenwood is in the process of getting certified by SureScripts for two new capabilities. These features are expected to be available in GlaceEMR next quarter.
Electronic Prior Authorization for Prescription
Glace will soon offer an integrated Electronic Prior Authorization module through SureScripts. This will enable prescribers to quickly and easily obtain electronic versions of prior authorizations so patients can begin taking their medications sooner.
Real-Time Prescription Benefit
By adding the Real-Time Prescription Benefit to the Electronic Prior Authorizations, providers can complete the entire prescribing process without leaving their workflow. They will be able to see which drugs require prior authorization at a glance, then automatically launch the prior authorization process upon prescribing. Together, these solutions allow the provider to:
• Review patient-specific drug prices before prescribing
• Evaluate clinically relevant and preferred therapeutic alternatives based on the patient’s benefits
• Compare drug pricing across channel options such as mail order and retail
• Complete prior authorizations only when necessary and streamline the workflows for centralized teams or staff at the point of care
Billing Updates: Dialysis Billing
The system now provides an easy way to track dialysis patients.
Providers can capture dialysis charges more quickly and efficiently through GlaceEMR and submit all dialysis charges on the same day as the patient encounter.
The system utilizes a charge calculation engine to calculate the dialysis code based on the patient’s visits and keeps it ready for the provider to approve the charge with the click of a button.
Learning to coexist in a world with COVID-19 has been one of the biggest challenges for individuals and businesses alike. Many businesses are having to adopt new methods of customer communication and engagement, and the healthcare industry in particular is facing serious issues of access and equity among patients. We are now seeing an emphasis on promoting virtual engagement options and patient access, while also focusing on how providers can maximize reimbursement for COVID-related treatment.
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CMS will begin enforcing a new rule to drive interoperability and patient access to health information starting in July 2021. The main goal will be to offer a more complete overview of the patient’s medical care with focus on CMS-regulated payers.
Glenwood Systems will be closed on Monday May 31st in
observance of Memorial Day