Sorry if this has been asked before as I seem to remember something similar but can't find it.

When I put all the info into the patient and click on the top right I can see how I am doing with continued progression towards my goal. However, if I use the official wizard, the denomenator and numerator are zero.

Was it something about cpt codes... do I use this for all my charts, just some...extra clicks for a non billing person....

Thanks

I don't use the billing system in AC either Neil.
You are correct in that not all MU data is collecting unless you select a CPT and sign the note. Most the data is collected upon signing the note however.

Some of the CQM and all of the Alternate CQM data is not recorded correctly unless you add ICD-9 diagnosis codes and select a CPT billing code prior to signing the note.

You don't have to enter ICD-9 and CPT codes for all patients however, rather just do it for the ones that have measures you want to report on. Again I'm talking about the Alternate CQM. Core and Menu items don't fully depend upon the ICD9/CPT codes being entered.

For example, under the Alternate CQM's you track diagnostic imaging in the setting of low back pain. You would enter the dx of Lumbago 724.2, select CPT 99213 or whatever, then sign the note. But don't use the AC pre-formatted order for xray. You will therefore run the MU Report and find the numerator and denominator have both increased by one unit.

I'm not aware of any Core or Menu items that are negatively impacted by NOT using ICD9/CPT codes. Can you think of any specific examples where you are finding the issue?

So, looked again....edging towards the goals for core and menu.....still nothing on the numerator and denominator, both say 0.

Okay, let's try to be super specific and work through this. There should not be reports of zero unless AC is not understanding how you are inputting the data.

Can you please tell me exactly which goals are giving you the zeros?
If these are CQM's or Alternate CQM's or Menu items? List the ones specifically on which you have selected to report data, please.

Many of the CQMS do require that an office visit CPT Code be used on the superbill. If you have not been adding CPT codes, you can go back and add them onto a patients chart by going to the account information tab in the chart and pulling the superbill. From here, you can just click on “add CPT” and type in an office visit code you would like to use and attach it to the superbill. (If the pt meets all the other criteria that goes into a specific CQM then this CPT code will make your numbers in the wizard go up)


Speaking of the criteria….many of the CQMS are VERY specific and require a number of criteria to be met before you will get credited for the CQM. My recommendation would be to check the exact criteria that the CQM is requiring. You can do this by opening the Wizard, clicking on the CQM tab and then double clicking on a CQM you are looking to meet. If you scroll down to the bottom, you will notice that we offer this information under “How to do this in AC”.

Here are some criteria that are generally the missing link or links to getting your CQM numbers to budge; a specific ICD-9 code that needs to be used during an encounter, 2 signed off encounters during the reporting period, documentation with decision support, the pt needs to be within a certain age range, vitals need to be taken. These criteria differ from each CQM but are often times over looked.


Some other CQM tips I have found along the way -

-If a CQM requires a decision support rule to be completed, you MUST type in a result in the results box. The program will allow you to leave the results box blank, but for MU be sure to add a comment then hit save.

- Sticking with decision support; if the CQM requires a decision support rule to be used it must be done from the most recent encounter, prior to signing off. It will not count toward MU if you document under the Summary Sheet because it doesn’t show that it was done during the visit.

- If you are getting all zeros in your CQMS and you do not have a mid-level provider, try to check the box at the top of the wizard that says “don’t include mid-level” you may see your numbers appear with this change.


I hope this information helps! I realize how confusing the process can be and I will be happy to assist anyone with their Meaningful Use incentive.

Many Thanks
Katie Vacca
Product Support Specialist

Katie: I am wondering if you saw my suggestions under the Wish List forum about having all the CQM data on one page in an easy format? Right now, it is very complex to remember all the necessary steps, on multiple CQMs, when you are in a patient visit, who incidentally (!) has multiple medical problems that actually need to be addressed. Any way we can make this simpler will help meet goals; please see my post on the wish list forum.

Boondoc- I just read your Wish List post and I agree with your great idea. It seems like that would be something that could make the CQMS more manageable and less confusing. I will be more than happy to pass this idea along to our development staff and see if this is something that can work.

Katie Vacca
Product Support Specialist

THANK YOU KATIE...FOR THE LOVE OF GOD THANK YOU!!!!

(somewhat) hijacking this thread:

What about for those of us who are doing manual superbills?

The doctor is doing the diabetic foot exam 'Additional CQM'.

We saved to the clinical decision support screen, but would it still 'count' toward the measure if the patient had the ICD codes for the diabetic foot exam (2028F and the G codes) + the office visit charge on a MANUALLY CREATED superbill?

I think i just found my own answer. In 'how to do this in AC' for the diabetic foot exam, it says nothing about the additional billing codes. so apparently we dont have to do it!

Brock,
For the cqm's you must input a cpt code into AC or the encounter will not be counted. You can put whatever you like on your manually created superbill, but you MUST enter a cpt when you sign off your note in AC.
As to the ICD codes, I can't specifically speak to that cqm, but if you think about it, how would the AC wizard know to count the patient as a diabetic unless you had entered the diabetes ICD code? I think you need the ICD code for that cqm as well.

The CPT code is whats a bit bothersome. This would create two bills for the patient that day, it looks like.

I suppose I get your point but I certainly don't see it that way. If you are not using AC for billing, the superbill that is generated in AC is not used; it is just a recording device. I certainly don't see it as being an ethical or legal issue if that is your concern.

Jon,

Might be incriminating myself here, but we have engineered a transfer of bills daily between AC and our billing company.

The bills are grouped by patient, so if you have 2 encounters both with a 99213 in it, the billing company will see 2x 99213's for patient john doe for that day.

At least thats what I think would happen. I'll have to test it out with some fake patients.

Nothing incriminating...in fact, I am intrigued. Would you mind describing your process in more detail?
If you are using a "manual superbill" then the billing company is using that (and NOT the AC super) to do the billing. On the other hand if you are sending them the AC super, don't you want that to have the appropriate CPT (and ICD9) on it? If it does, then that will count for your cqm's.