Predictive Analytics Identify High Risk Hepatitis C Patients

Researchers from the University of Michigan have developed a predictive analytics algorithm that uses basic EHR data to flag patients at high risk of developing complications from the hepatitis C virus (HCV), according to a study published in the most recent issue of Hepatology.  As payers seek to control the costs of extremely expensive but highly effective new HCV treatments like Sovaldi, the use of clinical analytics to pinpoint the most meaningful course of treatment for patients may help to avoid unnecessary spending.

The predictive analytics model was developed using a dataset derived from the Hepatitis C Antiviral Long-term Treatment Against Cirrhosis (HALT-C) trial conducted by the National Institutes of Health.  The team used machine learning techniques to process clinical information such as lab results, age, body mass index, and details of the virus type to create a risk score for patients.  The score is more accurate than previous attempts because the algorithm uses more lab values than other models and analyzes how the values change over time…(Read More Here)

Billing & Reimbursement

A modifier is necessary for reimbursement when running a Lipid Panel and a Direct LDL on the same day. The correct modifier to establish that the Direct LDL is distinct or independent from the Lipid Panel performed on the same day is the –59 modifier. Although a calculation cannot be individually billed, this would establish that this is a Direct LDL rather than a calculation that is considered to be included in a Lipid Panel.

Preparing for a Laboratory Inspection

Laboratory testing is regulated to determine compliance and improve patient care

In the United States, the Centers for Medicare and Medicaid Services (CMS) regulates all human laboratory testing (except research and Department of Defense laboratories) to determine compliance and improve patient care. The agency’s Clinical Laboratory Improvement Amendments (CLIA) covers about 251,000 laboratory entities. In addition, the Department of Defense laboratories (in military facilities and Veterans Affairs hospitals) accept and adhere to the CLIA requirements…


Compliance history often dictates the occurrence of subsequent inspections. Laboratories demonstrating CLIA compliance (based on type and number of deficiencies cited previously, proficiency testing performance, and number and types of complaints lodged) may be invited to submit a self-survey document. The option to fill out an Alternative Quality Assessment Survey (AQAS) is available every other survey cycle (a two-year period). The basis for good quality patient care serves as a foundation for performing well on inspections. In other words, laboratories that pay particular attention to doing what needs to be done and documenting accordingly will be handily prepared for an inspection…(Read More Here)

Updated Clinical Quality Measures Revealed by CMS

Eligible hospitals and healthcare professionals looking to meet meaningful use requirements and obtain financial incentives from the Medicare and Medicaid EHR Incentive Programs will need to keep track of electronic clinical quality measures (eCQMs), which are part of clinical quality reporting programs such as the Physician Quality Reporting System (PQRS).

Today the Centers for Medicare & Medicaid Services (CMS) announced the annual update for the 2014 electronic clinical quality measures. Healthcare providers will need to utilize these updated measures to report 2016 quality data electronically for CMS quality reporting programs. These programs include PQRS, the EHR Incentive Programs, and the Inpatient Quality Reporting Program (IQR).

The reason CMS updates quality measures on an annual basis is to keep the specifications in agreement with modern clinical guidelines along with code systems. These measures need to stay pertinent and actionable within…(Read More Here)

Edition 7: ICD-10 Implementation

The HIPAA act of 1996 required the department of Health and Human Services (HHS) to adopt national standards for health care transactions. Further additions under the Affordable Care Act of 2010 (ACA) included requirements to adopt the use of ICD-10 standards for diagnostic coding. As many of you are aware the date for implementation to switch to ICD-10 coding is set for October 1, 2015. This was after a delay by congress in 2014. The repeal of the SGR payment formula signed into law on April 16, 2014 made no reference to a delay of ICD-10 implementation for 2015. At this time it appears that the date of transition to ICD-10 coding remains October 1, 2015…(Read More Here)