The medical and healthcare fields are always evolving, adapting, and expanding as new technologies and standards are introduced, and it’s vital for hospital leaders and professional care providers to be aware of the latest changes and developments at all times.
One of the big recent developments came in March 2020, when the Centers for Medicare and Medicaid Services (CMS) set out their Interoperability and Patient Access Rule.
The idea behind this rule is to have hospitals and other healthcare institutions set up e-notifications with other providers throughout the care field, keeping everyone up to date on patient care events as and when they happen, with a view to improving efficiency for all when providing patient care and minimizing the risk of errors too.
The new compliance requirement will be put into effect on May 1 of 2021, and all hospitals and care providers wishing to maintain their CMS provider agreements and receive CMS reimbursements need to make sure they’ve got a compliance solution set up to send e-notifications for patient admissions, discharges, transfers, and other events.
Worryingly, a survey from PatientPing found that just 17% of hospitals were aware of and familiar with these new CMS requirements, with many worried that their institutions would not be ready by the time the deadline arrived. With this in mind, here are some key questions and answers about the e-notifications CoP compliance requirements.
What providers should receive the e-notifications?
Hospitals need to provide e-notifications to all care providers that have patient-care relationships in place and require up-to-date information on their patients for the purposes of providing accurate, efficient treatment and care. There are four main types of providers that need this information:
- Primary care practitioners
- Primary care practice groups
- Practice groups or practitioners identified by the patient as responsible for their own care
- Post-acute providers
What does the CMS mean by ‘real-time’ notifications?
The term ‘real-time’ has caused some confusion among care providers and hospital authorities, and many wonder if there is a set time-frame in place that qualifies as ‘real-time’. However, the term is quite accurate; the CMS requires that e-notifications be sent immediately at the time of a patient’s admission, discharge, or transfer.
There should be no delay whatsoever in creating these notifications, so you won’t be able to wait a while before sending them out or sending them in batches every hour, for example. They need to be provided straight away, on a patient by patient basis.
Do insurance providers need to be notified?
The CoP requirements set out by the CMS so far do not stipulate anything specific regarding e-notifications for insurance providers. These notifications only need to be sent out to primary care providers, practitioners, practice groups, or other entities. Insurance carriers are not including in the essential list of contacts.
However, there is no harm in providing these notifications to insurance providers too and the CMS has stated that its CoP requirements should be regarded as the minimum baseline for hospitals to follow, giving them the freedom to share notifications with other entities, if desired.
Is there a penalty for non-compliance?
Yes, and in the worst possible case scenario, your hospital’s certification will be terminated entirely should it fail to comply. CMS certification is of significant value to countless hospitals, playing a key part in determining whether or not they receive Medicare or Medicaid payments, and usually accounting for over half of their payer mix. In order to keep your certification, your hospital must meet the CoP requirements.
What are the options for my hospital?
Hospitals wishing to comply with the new requirements and maintain their Medicare and Medicaid privileges will need to set up e-notification systems. There are various ways this can be accomplished, and one of the simplest options is to make use of a leading care management solution with provisions for e-notifications.
My hospital already sends ADT feeds to Health Information Exchanges. Are we compliant with the new CoP?
This depends on various factors and will primarily be based on whether or not the Health Information Exchanges is able to fulfill the CMS requirements and send out e-notifications for all of the listed patient events like admissions and discharges, in real-time and to all of the listed care providers.
There has been some confusion regarding the new CoP requirements, but hopefully, this short FAQ section will have helped to bring some clarity to the situation, helping you make the right call and take action now to set up a smart e-notifications system you can rely on.