CMS Centers for Medicare & Medicaid Services – Patients Over Paperwork

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Medicare and Medicaid services have changed significantly over the past few years, and the organizations that operate them are adapting to meet patient needs and thrive in the modern era. One of the main policies that the Centers for Medicare & Medicaid Services (CMS) has debuted is a “patients over paperwork,” campaign, which services to reduce unnecessary burdens on patients, increase the efficiency of the organization, and improve the beneficiary experience.

Over the past few years, the CMS has reaped the benefits of this new program and continues to find new uses for it. Read on to see how experienced healthcare administrators are taking steps to improve their patients’ lives and change national systems that millions of people use.

A view of a doctor’s tools.

Image via Flickr by andrewmalone

What Is Patients Over Paperwork?

The Centers for Medicare & Medicaid Services publishes an average of 10,750 pages of regulations each year, placing an undue burden on healthcare providers who need to navigate these rules and make sure their offices, staff, and patients are compliant. On average, for every hour doctors spend seeing patients, they spend two hours doing paperwork.

That statistic has secondary ripple effects on patients. First, patients have a harder time scheduling appointments, as doctors have fewer hours that they can spend working with people. A patient might have to wait several months to see a specialist. Next, patients have less time with doctors, as healthcare teams try to rush people through and fit more patients in for visits so they can reduce wait times. Doctors might miss something, or patients might not be able to ask all of the questions they have about their treatment.

The “patients over paperwork,” campaign was started in December, 2017 to reduce regulatory burdens on healthcare providers and make it easy for patients to get the treatment they need. Almost anyone who works within the healthcare field and treats patients on Medicare or Medicaid are likely to interact with this campaign and will hopefully benefit from it.

How Did the CMS Develop the Patients Over Paperwork Plan? 

In 2017, the CMS took its first steps to reduce bureaucratic burdens from healthcare providers and patients. The organization started with data collection. It sent out nine Requests for Information (RFIs) or surveys to people who use Medicare and Medicaid resources and systems.

It highlighted the term “burden,” in these surveys, and realized the term was used more than 2,600 times in the RFIs. According to the April 2018 CMS newsletter, the data came from a variety of “institutional providers, clinicians, beneficiaries, health plans, small/rural entities, and more.”

Once the information was collected, it was then sorted. This provided the CMS with a clear picture of what burdened its users the most and what needed to be prioritized. Of the 14 categories that the CMS hopes to improve, a few of the segments include:

  • Auditing and Claims Denials: the auditing appeals process, including better information on why a claim is denied.
  • Documentation: the documentation process, including beneficiary notes and requirements.
  • Health Information Technology (IT): software requirements and policies to protect patients’ information online.
  • Payment Policy and Coverage Determinations: such as billing, coding, and the Merit-based Incentive Payment System (MIPS).
  • Quality Measures and Reporting: including cost reporting, data transparency, and information sharing across channels.

A significant number of the complaints had to do with online care, information sharing, and treatment. As more patients enter the digital era and doctors start using telehealth, both parties need to be aware of the regulatory requirements without getting overwhelmed by the sheet amount of information.

Below are a few examples of the Patients Over Paperwork campaign in action, proving how minor regulatory changes can have a major impact on the public health field.

Nurses Are Allowed to Initial Patient Prescriptions

Once you understand the goal of Patients Over Paperwork, you can start to understand some of the changes the CMS made to make the process easier. For example, one of the first courses of action the CMS made was clarifying signature requirements by healthcare providers.

Before the “Patients Over Paperwork,” improvements, the CMS denied any claims that featured a nurse’s initials on a medication administration log instead of a full signature. Nurses often initial documents to save time and space on forms. What a nurse might have done out of habit, or even in a moment of carelessness could bog down the patient and the hospital with denied claims.

According to the CMS, under the new rule, “Claims won’t be denied if a support care provider, such as a nurse documenting chemotherapy, doesn’t sign part of the record.”  While a primary-care provider still needs to sign off on all treatment, secondary providers can track their treatment with initials and other forms of personal confirmation.

This signature over initials rule also created more work for the CMS. The number of claims is expected to decrease as fewer claims denial requests are sent, fewer people need to submit claims, and fewer claims are audited for arbitrary reasons. Patients will be treated faster and staff paperwork will decrease. This is one small common-sense step to reduce bureaucracy that improves the entire process.

Rehabilitation Therapy Programs are no Longer Based on Time

While regulations of nurse signatures certainly affect patients when claims are denied and paperwork needs to be filed again; however, there are other changes that the CMS is making that can directly affect the type of care that patients receive.

Previously, inpatient rehabilitation facility (IRF) claims were denied even if a patient could benefit from patient care because the CMS set guidelines based on the amount of time that a patient would need treatment. According to the CMS, under the new regulations, doctors, “use clinical review judgment… based on the individual facts and circumstances of the case, and not based on any threshold of therapy time.”

This small change in wording can have a dramatic impact on the lives of patients. American Addiction Centers reports that as many as 90 percent of people who need drug addiction treatment do not receive it. They cite studies that 12-step programs and other therapy-based treatments aren’t nearly as effective in most cases an inpatient care, which allows addicts to complete the detox process and complete a full program that gives them the tools to succeed.

Did You Know?

Most therapy-based organizations are happy with a 30 percent success rate and admit that 70-80 percent drop out before the six-month mark.

While therapy-based addiction is a lifesaver for some, it is ineffective for others. By changing the rules so that healthcare providers can focus on the patient, not just the timeframe, more people are likely to get the inpatient care they need. If this rule change can increase completion rates and prevent relapses, then the Patients Over Paperwork plan will save lives and help drug addicts across the country.

Billing for Immunosuppressive Drugs is Improved

Initially, the goal of the majority of these regulations was to prevent fraud. Medicare and Medicaid administrators wanted to prevent fraud schemes to collect additional benefits. By making sure everything had to be in order, there is no way a doctor or patient could lie about the treatment plan they completed. However, many believe these regulations have gone too far. What was meant to prevent fraud and loss to the Medicare and Medicaid offices has turned into an unwieldy burden that makes people not want to sign up for the programs in the first place.

Common sense is one of the main reasons why many of these Patients over Paperwork strategies are approved. Each change is reviewed to learn how it has negatively impacted the healthcare industry and what risks are involved when these changes are adjusted.

For example, if a healthcare provider mailed an immunosuppressive drug before the end of treatment, and set the service date as the mailing date, the claim was rejected. Technically, the patient did not receive or take the drug on that day, because they were still in inpatient care. This rule was changed so the healthcare provider can use the patient’s date of discharge, even if they mail the medication a day or two before the patient actually leaves hospital care.

The risks involved in this rule change are minimal. Doctors are able to enter information about the patient’s treatment digitally without confusing the system, and both the provider and CMS can easily review the dates for accuracy when needed. This is more of a clarification than an exact change, but the impact on audits and paperwork will be significant.

Patients Over Paperwork is a key example of the power of healthcare administration. While you might not think changing one regulation (out of 11,000 pages) will have a major impact, it can improve patient care across the country and reduce the burden on providers, doctors, and staff.

Tomorrow’s healthcare leaders need critical thinking and strategic planning to succeed. That’s why the Executive Master of Health Administration Online degree that trains these leaders emphasize IT development, leadership to address regulatory issues and more. Tomorrow’s leaders can work to provide quality feedback to the CMS and efficiently adopt the new Patients Over Paperwork rules to run more efficient organizations. Both the staff and the patients benefit from these changes and will appreciate their leaders who usher them into the new era of managing healthcare policies and patient care.

Sources:

Centers for Medicare & Medicaid Services

Centers for Medicare & Medicaid Services

American Addiction Centers