ONC-ACB Certification ID: | Certification Date: Nov 11, 2019
2020 To Do List

2020 To Do List

As the final quarter of 2020 approaches, practices should take action on time-sensitive programs that will impact reimbursement in the future. Below is our “2020 To Do List” with details outlining the steps you need to take to achieve each item.

Check Your MIPS Numbers

October marks the last quarter that practices can begin to achieve compliance for certain MIPS categories in 2020:
Confirm submission method – If you submitted via registry in the past, and plan to submit via eCQMS, or are considering submitting through a registry for 2020, make sure you understand the allowed measures, costs, and outcomes.
• Practices should run their Promoting Interoperability and MU3 – Clinical Quality Measures reports every month to ensure practice is meeting requirements.
• Complete your Security Risk Analysis.
• Document progress on Improvement Activities.

For more information, read the MIPS 2020 and Criterions blog post.

Register for PAMA

The Centers for Medicare and Medicaid (CMS) currently requires all providers to use a Clinical Decision Support Mechanism (“CDSM”) to electronically validate advanced imaging orders using approved online guidelines. On January 1, 2021, imaging centers will not be reimbursed for orders that do not include this information so it is vital that ordering physicians be able to perform the validation without impacting their workflow.

Learn how to meet the AUC validation requirements under PAMA here. 

Purchase NYC and NY State Immunization Interface

With changes to MIPS, practices are now required to have live bidirectional interfaces with NYCIR and NYSIIS.

Why practices need it:
• These interfaces send immunizations for Adults and Children to the respective registry electronically in the new MIPS format.
• The old interface is no longer valid with new rules.
• Practices without the electronic interface cannot attest on MIPS for submitting to a public registry. This will affect MIPS compliance.
• Practices not in NYC must purchase a NYSIIS interface for immunizations for Adults and Children.
• Practices in NYC must purchase a NYC CIR interface for immunizations for Adults and Children.
• This MIPS interface sends the immunizations administered, as well as retrieves the patients current immunizations already administered by other physicians from the registry.

Contact support@criterions.com to purchase.

If you have any questions about the 2020 To Do List, fill out the form below and a member of our team will be in touch:

Appropriate Use Criteria (AUC) for Advanced Imaging

Appropriate Use Criteria (AUC) for Advanced Imaging

LogicNets and Criterions have joined forces to provide a solution for you to meet the AUC validation requirements under PAMA. The LogicNets AUC Solution is a cloud service that lets you easily confirm that an advanced imaging order for Medicare/Medicaid patients is appropriate based on your patient scenario. When done, it generates the new reimbursement codes CMS now requires with your imaging orders.

Why is AUC a Requirement?

The Centers for Medicare and Medicaid (CMS) currently require all providers to use a Clinical Decision Support Mechanism (“CDSM”) to electronically validate advanced imaging orders using approved online guidelines. On January 1, 2021 imaging centers will not be reimbursed for orders that do not include this information and so it is vital that ordering physicians be able to perform the validation without impacting their workflow.

About the LogicNets AUC Solution

The LogicNets AUC Solution is an affordable and secure online service for rapidly evaluating a patient scenario and either validating that an order is appropriate or recommending appropriate alternatives. The solution draws on CMS-qualified guidelines developed by Intermountain Healthcare. It can run in the background when integrated with an EHR and automatically switches to an interactive visual mode to collect clinical information from you to complete the validation. The solution provides a unique visual diagnostic pathways view of the guidance, making it easy for you to indicate key factors and be aware of and evaluate alternative approaches if necessary.

How to Get the Service

In order to get the AUC Solution, simply go to LogicNets.com/AUC. You can read more about the solution there and you can gain access to the service by clicking on the “Sign Up” button. Be sure to enter “Criterions” in the space for additional information to indicate that you will be using the service in conjunction with Criterions software. Once you have filled in your basic information, LogicNets will create an account for you and contact you with instructions on how to access.

Questions about the AUC solution for advanced imaging? Fill out the form below:

Video: Documentation Through Criterions

If you are…

• still using paper for patient-related documentation

• struggling with managing the flow of your office’s documentation

• piling up paper in storage cabinets

• constantly entering redundant information onto documents

• overwhelmed with forms and compliance issues

… then, you are familiar with the challenges in managing the internal flow and storage of these important records.

You are likely to be in search of a cleaner and less complicated process. The Documents features included in Criterions is the paperless solution you may be looking for. Watch the video below to learn more!


If you are interested in a free, custom demo of the Criterions EHR software, complete the form here.

Decoding the Hidden Costs of Credentialing

Decoding the Hidden Costs of Credentialing

*This post was written by our partners at TriZetto Provider Solutions.

It’s safe to say that healthcare practitioners are well aware of the importance of credentialing. Beyond the legalities required of practicing physicians, credentials are needed for a practice’s revenue cycle to function properly. If providers aren’t enrolled with payers, they can’t receive payment for submitted claims. It’s as simple as that.

New and existing providers are required to maintain credentials and it’s not an easy process, even for the most well-oiled office. In order to take on the most patients and collect optimal revenue, practices also need to accept a wide array of payers. In fact, there has been a 5 percent uptick in providers enrolled with 10-20 payers, according to VerityStream’s 2018 Provider Enrollment Survey. Gaining enrollment with these payers involves verifying qualifications in order to accept patients, submit claims and ensure a steady stream of cash. Administrators need to collect the educational history of providers, fill out forms and submit the applications. It sounds easy enough, right?

Think again. There are hours of administrative work needed and a high risk for human error, with any hiccup in the process likely causing delays. It’s been said that up to 85% of credentialing applications are incomplete, which could cause delayed billing, lost revenue or even audits.

When it comes to credentialing, time is money. A 2016 survey by Merritt Hawkins found that a non-credentialed doctor was losing approximately $6,600 a day. Multiply that by the total amount of physicians in a given practice, and the potential losses are staggering.

“Up to 85% of credentialing applications are incomplete, which could cause delayed billing, lost revenue or even audits.”

Credentialing is a necessary evil, so do you handle in house or outsource? That’s the million dollar question. Utilizing current staff resources sounds like the easy solution, but does your organization have a dedicated employee to focus on your credentialing needs? Probably not. Chances are, this employee is pulled in many directions and isn’t able to dedicate time solely to credentialing. And if you do plan to handle the process with current staff, are your employees well-versed in all payers and their processes? Factor in learning curves or potential staff turnover and the time associated with training new employees and the not-so obvious financial costs quickly add up.

So how does the average practice streamline the process and ensure that credentials are gained as painlessly as possible? The old adage “you get what you pay for” could easily apply to this scenario. Hiring an outside resource means you are essentially paying for expertise and efficiency, which will save time and money in the long run. Why wouldn’t you want to utilize expert resources with in-depth knowledge of payer and state nuances? However, before making a  decision, you need to know how much your practice could save by using a third party. Knowledge is power and having an accurate picture of your potential revenue is the first step to determining the best option for your organization.

Access the credentialing ROI calculator from TriZetto Provider Solutions, a Cognizant Company, to receive an estimate of potential revenue savings. Discover the hidden costs associated with the credentialing process and see just how much revenue your practice could gain in 2020. You’ll gain enrollments quickly and accurately, keep employee satisfaction levels high (since they won’t be burdened by the process) and ultimately, increase revenue.

Don’t allow the complicated payer credentialing and enrollment process to be a burden on your practice. The credentialing experts at TriZetto Provider Solutions have experience working with various payers and providers of all backgrounds. TriZetto will collect and submit information in a timely manner and perform all necessary follow-up tasks. Together, Criterions and TriZetto will lighten your load so you can focus on patient care and growing your practice.

Have any questions about credentialing? Contact us using the form below:

6 Benefits of Automated Appointment Reminders

6 Benefits of Automated Appointment Reminders

If you have had a doctor’s appointment recently, it is likely that you received an appointment reminder prior to your visit. It is even more likely that the appointment reminder was automatically sent to you without office staff monitoring the process.

Automated appointment reminders via texts, emails, or phone calls provide many benefits to both practice administrators and patients. Here are just a few:

1. Reduced “No-Shows”

Patients have schedules too, and sometimes doctor’s appointments may be forgotten. It is all too common for patients to forget to cancel their appointment, resulting in a “no-show.” Automated appointment reminders can be sent until a patient confirms or cancels their appointment. This means that it is virtually impossible for patients to forget.

2. Increased Patient Satisfaction

Appointment reminders can be sent via phone call, but many people prefer a quick and easy text or email message. Upon receiving an appointment reminder via text or email, patients are able to confirm or cancel their upcoming appointment with the click of a button. By reaching patients in a way that is most convenient for them and taking the hassle out of rescheduling appointments, patient satisfaction will increase.

3. Time Saved for Administrative Staff

Without automated appointment reminders, administrative staff is tasked with calling patients to confirm appointments and rescheduling if necessary. This process can be very time consuming for staff. Utilizing a system with automated reminders provides office staff with status indicators for the appointment reminders, making the process more efficient.

4. Maximized Revenues

By reducing “no-shows,” there is more time in the schedule for doctors to see patients who are available for an appointment. With more time available to staff, they are able to focus on projects that will drive more revenues to the practice. Costs of staff will also decrease if the appointment reminder workflow is automated.

5. Minimal Maintenance Required

After the initial setup of automated messages, sending reminders on existing appointments requires minimal maintenance from office staff. Messages can be customized for a variety of appointments including, but not limited to, recalls, vaccine notifications, lab results, and patient satisfaction surveys. Notes are automatically added to patient records to indicate all actions taken on an appointment including appointment history, confirmations, and cancellations.

6. Improved Patient Health

Automated appointment reminders keep health top of mind for patients. Missing doctor’s visits can cause issues to go undiagnosed or untreated. If patients are regularly seen, sickness and long-term illnesses can be prevented.

With the use of automated appointment reminders, work is reduced for administrative staff and practices can earn more money. Automated reminders also benefit patients by providing a convenient way to confirm or cancel appointments and reschedule to stay consistent with their health.


If you are interested in learning more about the benefits of automated appointment reminders, feel free to contact our team using the form below:

Request a Demo!