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MIPS Requirements for 2021

MIPS Requirements for 2021

2021 is coming to an end, but before the year is over, there are a few MIPS requirements that must be addressed. Please determine the correct course of action for your practice as soon as possible, as these requirements are time sensitive. As always, Criterions is happy to assist with guidance on these requirements, but only CMS can give definitive client specific clarifications.

By the end of the 2021 calendar year the following MIPS items MUST be completed:

Security Risk Analysis

A completed security risk analysis. The CMS issued tool can be found here.

Improvement Activities

Documenting and/or updating completed Improvement Activities. A full list can be found here.

Hardship Exemptions

Hardship Exemptions exist for practices under strain due to COVID, practice size, rural locations and other issues. The Hardship Exception Application must be completed by the deadline. More information about exceptions can be found here.


Top 5 Patient Engagement Tools from 2021

Top 5 Patient Engagement Tools from 2021

As the healthcare industry continues to evolve, the way providers communicate and engage with patients is changing too. Patients are becoming more interested in taking control of their health, which includes being able to access their health information from virtually anywhere. As a result, patients have become more interested in using technology in ways that can help increase accuracy of information while reducing the burden on practices. This is becoming a win-win scenario. Medical clinics can reduce cost and labor by adopting new technologies, which patients are naturally proficient at using. The COVID-19 pandemic has accelerated the adoption of these technologies to engage patients in new ways. This is resulting in some of the most reliable and up to date information the industry has ever seen.

Below are the top 5 patient engagement tools we have seen being used by our clients throughout 2021. While these tools will never replace in-person communication with medical professionals, we expect that they will continue to be used to increase patient engagement for years to come.

1. Telehealth

With a telehealth solution, practices will be able to offer virtual healthcare services to clients, like one-to-one and group video and messaging appointments, and securely share files and forms with patients. Practices can digitize the patient onboarding journey to boost acquisition from intake and informed consent, pre-appointment device testing, and automatic payment information.


2. Text Check-In

Providing the option to check-in via text message allows patients to check-in away from the front desk, reducing physical contact between patients and office staff. Text check-in messages and instructions can be customized by practice, providing flexibility in the process. By streamlining the intake process, practices can reduce patient wait times and increase time available for staff members to complete other administrative tasks.


3. Appointment Reminders and Follow Ups

Appointment Reminders can be sent via text message directly from EHR systems, allowing patients to confirm or decline appointments without a phone call. Because patients are very responsive to text messages, this helps reduce no-shows. Practices can also utilize Appointment Follow Ups to send information after the visit is complete. The automation of texting and email allows practices to engage patients both pre and post visit, providing a well-rounded experience.


4. Patient Portal

The Patient Portal allows patients to communicate securely with their doctor and provide important health and contact information. During the visit, doctors can upload resources to educate their patients by sending directly through the portal, leading to a more informed patient who can access information from virtually anywhere. In addition, the Patient Portal can display patient charges, allow payment via credit card, post money to practice account, and automatically update the patient’s ledger.


5. Questionnaires and Consent Forms

Consent forms can be assigned both manually and through the appointment schedule. Patients can then accept or decline the forms through their patient portal. Questionnaires are customizable and allow practices to collect information such as COVID-19 and depression screenings, satisfaction surveys, and more. Both forms and questionnaires can be sent prior to a patient’s visit to reduce input by nursing staff, allowing them to verify information provides rather than ask each question. This saves time for both patients and office staff while increasing efficiency at the practice.


These tools have been instrumental in engaging patients since the start of the pandemic and are here to stay. As technology continues to advance and patients continue to take a greater interest in their health, we can expect more patient engagement tools to emerge for years to come.


For more information on patient engagement tools available at Criterions, click here or complete the form below. ​

Top 5 Claim Rejections (and How to Avoid Them!)

Top 5 Claim Rejections (and How to Avoid Them!)

At Criterions, we want to help your practice optimize the claim lifecycle. That is why we have partnered with TriZetto Provider Solutions to help your practice improve your clean claim percentage and reduce processing delays. By analyzing claims submitted by Criterions clients, we have identified the top 5 reasons claims are rejected and ways to avoid them:

1. This provider is not approved to send electronic claims to this payer. Enrollment is pending.

When a rejection like this is received through any clearing house, this means that the client is not yet enrolled, or is not set up within the EHR. This can be avoided with a simple check from the enrollment team.


2. The COB information does not balance.

This type of rejection is common, but avoidable. When a provider sees this rejection, it typically means that the claim was submitted twice to the same payer after a payment was already issued. When this happens, it throws the balance off, causing the claim to reject.

In order to prevent a rejection like this, clients can check the patients claim ledger and review what claims are being sent.


3. Patient/Subscriber is not eligible. Please verify member ID/Insurance/Coverage.

This rejection states that the patient has either new insurance or that the ID is invalid.

To prevent this from happening, you must make sure that the patient has an active insurance, and that the member ID is valid. In order to verify this information, the patient must be contacted to confirm if any updates have been made to their insurance.


4. Claim Rejected as a duplicate.

Coming across a rejection like this means that the claim was sent twice.

The easiest way to make sure this does not happen again is to ensure you are not sending claims that have been sent within 24hrs, or else the claim will reject as a duplicate.


5. The Payer ID Number is required and must be valid.

A rejection that stated the Payer ID is invalid means that the insurance carrier you are billing has a Payer ID which is not valid with the clearing house, as each clearing house has their own payer IDs.

To avoid this, make sure all Payer IDs are up to date within the EHR. To check if they are correct, you can contact the clearing house directly by phone or see if the clearing house has a link on their website that will help you identify the correct Payer ID.


By keeping an eye out for common claim rejection reasons, your practice will be able to avoid them and lower your claims rejection rate. This means that you will be able to reduce delay and increase coding compliancy.


For more information on TriZetto Provider Services, click here or complete the form below. ​

What is Health Information Exchange (HIE)?

What is Health Information Exchange (HIE)?

There is an increasing demand for interoperability amongst healthcare providers and patients for access to and sharing of a patient’s medical records electronically. Providers want to participate in the exchange of data to improve patient care and outcomes. Health information exchanges (HIEs) facilitate the exchange of patient medical information electronically – securely and efficiently. In 2019, the utilization of local, state, and regional health information exchanges by hospitals increased to over 50-percent [1].

Types of Health Information Exchange Data:

There are three types of HIE that each offer unique access to health information [2].

1. Consumer Mediated Exchange - In this type of exchange, patients have more control over their records and their use among healthcare providers.
2. Query Based Exchange - In this type of exchange, a healthcare provider can request and search patient medical information across multiple different healthcare providers.
3. Directed Exchange - In this type of exchange, coordinated care is facilitated by a bi-directional transfer of patient medical information between healthcare providers.

Why Practices Need Health Information Exchanges?

HIE helps healthcare providers provide high quality care to patients by improving the speed and cost of patient outcomes. According to Qsource [3], the transfer of health information helps practices to:

1. Avoid errors – interoperability is only successful when there is a reduction of errors, which leads to cost effectiveness. In addition, avoiding readmissions can also be cost effective.
2. Improve diagnoses – when healthcare providers have increased access to tests and information about a patient, patient care is more effective and efficient.
3. Reduce testing – unnecessary testing improves patient satisfaction, promotes quality of care, and reduces costs.

As the demand for HIE increases, medical providers should work with their EHR software provider to implement a solution that meets the needs of their patients.

For more information on how Criterions can support your practice with HIE, complete the form below:

[1] Jason, C. (2021, March 26). Stages of Health Information Exchange Implementation. EHRIntelligence. https://ehrintelligence.com/features/stages-of-health-information-exchange-implementation.
[2] CapMinds. (2020, November 16) “The Essential Guide To Health Information Exchange.” CapMinds Blog The Essential Guide To Health Information Exchange. CapMinds. www.capminds.com/blog/the-essential-guide-to-health-information-exchange/#.
[3] Qsource. (2019, November 6). QPP: What is Health Information Exchange and How to Make it Work for Your Practice. Qsource. https://www.qsource.org/qpp-what-is-health-information-exchange-and-how-to-make-it-work-for-your-practice/.

How Does FHIR Improve Patient Care?

How Does FHIR Improve Patient Care?

Fast Healthcare Interoperability Resources, or FHIR, is an interoperability rule that will enable on-demand information exchange of clinical records among providers and data systems. FHIR was created by the Health Level Seven International healthcare standards organization (HL7) specifically for healthcare organizations. The goal of FHIR is to assist practices in delivering more value to patients between appointments, so that they can focus on providing the best possible care to patients in the office. This will, in turn, result in more coordinated, cost-efficient care.

Too often, health systems are distracted by the technical or administrative processes that facilitate interoperability in healthcare. This causes providers to lose sight of their top goal: improving patient care by sharing the best information available at the point of care. By adopting the new healthcare data exchange standard, providers can more efficiently share patient data, payers can drive down costs and improve outcomes, and patients can take greater control of their health.

FHIR builds on previous data format standards like HL7, but it is easier to implement because it uses a modern web-based suite of API technology. FHIR makes it easy to provide healthcare information to healthcare providers and individuals on a wide variety of devices including computers, tablets, and cell phones. It also allows third-party application developers to provide medical applications which can be easily integrated into existing systems. FHIR helps Healthcare IT software providers rapidly create new innovative solutions to improve patient care. Because FHIR is a modern architecture solution and scales well, the next generation of applications can utilize FHIR to bring their solutions to market faster, and with greater impact.

Criterions partners with EMR Direct to help your practice improve patient care. EMR Direct can enable data from Criterions EHR at FHIR endpoints, for access to these resources by users you authorize, leveraging patient portal credentials already in place.

For more information on how to set up FHIR, complete the form below:

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