At Orchard, we pride ourselves on researching and developing software tools that laboratory professionals can use to make their jobs easier and more productive, helping them maximize their value. We are also in tune with current healthcare and industry trends. These two factors have led to the development of our point-of-care testing (POCT) integration and management software, Orchard® Point-of-Care™. From a reimbursement perspective, Orchard Point-of-Care’s capability to automate POCT billing and help close care gaps using CPT II Codes makes the solution applicable for both fee-for-service (FFS) reimbursements and for value-based or performance-based contracts.
Orchard Point-of-Care Overview
Orchard Point-of-Care is designed for remote oversight of POCT, supporting centralized governance of a comprehensive POCT program across patient testing locations. Orchard Point-of-Care solves many of the problems associated with POCT management by enabling remote oversight to track patient testing, devices, operator certifications, and QC. Orchard Point-of-Care also integrates POCT into the EHR to allow immediate access to results and automate the billing process.
Automated Billing in FFS
Often many POC tests are not billed because the billing collection steps are too cumbersome. In a recent post-webinar survey, we found that up to 49% of respondents do not bill for POCT glucose. At a reimbursement between four and five dollars each, healthcare organizations (HCO) with a large volume of glucose testing that are not billing are leaving a significant amount of money on the table.
Orchard Point-of-Care can aid in capture of POCT orders from the EHR, send the completed results back to the EHR for rapid access, and simultaneously send a message to the billing system when testing is completed. With this process, billing is automated, eliminating the need for manual intervention. In a FFS scenario, Orchard Point-of-Care automates POCT billing using applicable Current Procedural Terminology (CPT) Codes and modifiers, ensuring that each POCT is appropriately billed.
A Contract-enhancing Tool for Value-based Care
For value-based or performance-based contracts, one way in which quality is being documented for payers is with the use of CPT Category II codes to demonstrate care gap closure. For this quality initiative model, Orchard Point-of-Care can support the addition of CPT II codes to close care gaps, thereby improving performance in value-based contracts.
CPT II codes are a new version of CPT codes that are used to assess Healthcare Effectiveness Data and Information Set (HEDIS) and Star rating scores. HEDIS is a set of standardized performance measures developed by the National Committee for Quality Assurance (NCQA) that is used to measure and compare quality across health insurance plans. The Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System is used to measure the quality of care for Medicare Advantage (MA) and Prescription Drug Plan (Part D) beneficiaries. Both HEDIS and Star ratings affect HCO reimbursements and bonuses and per-member/per month (PMPM) reimbursements can be improved by inclusion of follow-up CPT II Codes.
CPT II codes are used to “grade” performance by providing additional information to the insurance provider that demonstrates the level of quality. For example, in tracking Hgb A1c levels for diabetic patients, the CPT II codes correspond to the Hgb A1c result, showing the insurance company where the patient stands regarding their diabetes. Orchard Point-of-Care can automate population of CPT II Codes into the EHR so that the data can then be sent to the payers. Depending on facility size, a small improvement in HEDIS or Star-ratings can equate to a significant boost in reimbursements, while also demonstrating improved quality of care for patients.
Orchard Point-of-Care for Comprehensive POCT Oversight
In today’s HCOs, the complexity of POCT calls for a comprehensive management and integration software tool that integrates with the EHR, supports billing, and allows remote oversight of POCT activities. In particular, as healthcare reimbursements fall in both FFS and performance-based models, Orchard Point-of-Care can act as a tool to improve POCT reimbursements by automating capture of billing information. For more information about Orchard Point-of-Care, visit www.orchardsoft.com or call (800) 856-1948.
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