On this episode, we are joined by Matthew Oldham, VP Engineering at Graphium Health™. Matthew (called Matt throughout the episode) is a primary driving force behind the Graphium architecture and one of the greatest minds in the industry. We’ll be discussing another aspect of onboarding an anesthesia team: New Client Info. To see the screen schots referenced throughout, watch the video at the Time Out for Anesthesia YouTube channel or at the Graphium Health Blog.
The Client Info Section
The “client info” section is where we collect all of the information we need to set up an instance for Graphium and contains everything we need to know from you as a customer. We especially emphasize what we call the registry, which is one of the first things we send new clients to complete.
Organization & Facilities
Previously, when we spoke about the onboarding process, we discussed the anesthesia organization and facility names, and on the initial kick-off call, this is one of the first things we want to establish. What do you want to call your organization? If you’re looking at a chart, you’ll see an organization at the top level, and below it are your facilities, which is where the rubber meets the road. We’ll have you decide exactly what you want to title your organization in our software, and then we’ll need to know how many facilities are associated with this onboarding and what you want to call them. Examples of “facilities” are a hospital or a surgery center where your team practices anesthesia—identified in our software the way that your anesthesia providers recognize and refer to them. A typical onboarding consists of 3-4 facilities at a time, but we've done as many as 100.
Aside from the facility titles, we also need basic demographic information for each facility: the address, city, state, zip and phone. But we also include information about the tax ID number, which is most relevant when reporting your data for MACRA at the end of the year. Keep in mind: this is not necessarily the tax ID number for the facility. Rather, it is the tax ID number that the cases from that facility are billed under for your Medicare Part B claims.
In this section of the registry, we will ask for a list of your practicing anesthesiologists or CRNAs who are going to be documenting cases in Graphium. The key information we need to know is their first and last name, their NPI number, and what their provider type is: an MD anesthesiologist or a CRNA. We also need to know which of those providers practice at which locations so that we can then make them available to be selected in an anesthesia record for that facility.
To be clear, you can actually manually create providers in your own Graphium Health instance, albeit one-by-one. The reason we’re collecting this information all at once, though, is so that we can load them all for you at once up-front, making things a lot easier for you at the beginning. But also be aware that should a provider join your group later on, you can add them manually and simply.
The same is true of surgeon providers, which is actually a list that can usually be pulled out of your credentialing system—for instance, the facility's credentialing system or your billing software.
Again, specific to each facility, we need to know which surgeons practice here. In other words, Which surgeons do you serve as an anesthesia provider at that facility? Similar to anesthesia providers, we need three critical pieces of information: the first name, the last name, and the NPI. We also like to track the surgeons’ specialties. While that's not a critical part of the registry, it is very valuable because downstream, when you start looking at our analytics, you can actually start breaking down your productivity, your efficiency, and your quality by surgeon specialty instead of solely by surgeon names, which means you can start really doing some fun and helpful analysis based on the specialty.
This is an easy one. Also known as the “anesthetizing locations,” at each facility, we need to know the name, abbreviations, and description for each surgery location. For example, “OR-1” is Operating Room 1, while ENDO-1 is Endoscopy Suite 1. Most importantly, we need to know any and all anesthetizing locations - whether few or many. Do you perform anesthesia in an emergency department? A PACU? Do you perform “Out Of OR Procedures?” Try to list all locations here - not just ORs. Include Labor and Delivery, MRI rooms, or even your special room for dental procedures if applicable.
You’ll also be providing the Graphium onboarding team with a list of your surgical procedures. Typically, what we ask for are:
These pieces of information allow us to pre-populate lists in the Graphium software that enable the anesthesiologist, while documenting their anesthesia record at the point of care, to easily click on a list, search for either part of the description or even the CPT code if they know it. The provider can even use our app’s native speech-to-text feature to search. The end result is that the physician no longer needs to hand write the procedure or remember all the codes.
Another significant benefit downstream is that these procedures are already coded. That means that they can be imported into billing software, and claims can be generated much more easily than ever before. The billing company no longer needs to transcribe handwriting about the procedure—a more labor-intensive coding process for those claims.
The value here is apparent. Less work for the providers up front, a quicker and easier workflow for the billing company, and, ultimately, faster and more accurate billing and collections for the anesthesia group.
“Comorbidities” is a very similar list. These items are also going to be selectable on your anesthesia record in Graphium. We’ll need your most common comorbidities that you want the anesthesia providers to be able to select on a case. While a comorbidity is not always required, providers understand that if you code a case as a ASA-3 or above, you are required to provide a comorbidity in order to generate a claim and have that claim be approved and reimbursed. And again, this is just the most common ICD-10 codes for the comorbidities that you wanna see on your form.
CPT Code Reconciliation
The next piece of client information we’ll need is CPT Code Reconciliation. This section applies mostly to clients who use Graphium’s MACRA compliance tools. For any case to be eligible for any given MACRA measure, it has to have a qualifying CPT code—primarily the ASA CPT codes—which actually make a case eligible for reporting. Sometimes we need the surgical CPTs as well, because some MACRA measures require that they have a denominator that specifies a list of ASA CPTs or specific surgical CPTs. This happens when the measure is specific to a certain type of procedure that makes the case then eligible for MACRA. While we can get these CPTs at any point in the year, it's best if we can get them throughout the year, because then you can use our analytics tools to monitor your projected compliance. This enables your anesthesia group to consider the actual procedure that was performed and know that you're not looking at projected compliance for a bunch of procedures that won't even qualify for the measure, which is impossible without the CPT code.
If you come up with a plan up front, and you know what is required to get those CPT codes from your billing team back into Graphium, you’ll solve that problem sooner rather than later. And having a plan in place is going to make life really easy, and in many cases, we can even automate it through an interface.
This one is simple. If you plan on using Graphium’s barcode-scanning feature to effortlessly pull up your surgical patients, then we’ll need you to send us a sample patient barcode. Specifically, the barcode should represent the encounter number, which is the number that will allow us to match the correct patient information from your integration’s ADT feed. Every once in a while, facilities will have specialized barcodes that append additional numbers to the barcode, and we prefer to know that earlier so that we can make necessary changes to the way our system handles the code and ensure that everything matches up perfectly.
Business Associate Agreements (BAA) & Qualified Clinical Data Registry (QCDR) Agreements
This is just paperwork, but it is essential paperwork from a HIPAA perspective. We need a BAA in place. We won’t delve too deeply into defining a BAA in this space, but, basically, we send you a BAA and, if needed you send us your BAA, and both parties sign what is needed.
For MACRA reporting customers, we’ll also send our QCDR agreement. This agreement with our partner company (the QCDR) allows us to send them MACRA data through the end of the year.
The Graphium Health™ Status Page
The Graphium Health Status Page is exactly what it sounds like: a web page that shows you the status of our platform at any given time. In the event that we have an outage, whether it's planned or unplanned, or if we have to do maintenance, or AWS has an outage that affects us in some way upstream and causes one of our services to be unavailable, we report that here. Then you or anyone in your organization (users, providers, IT staff, administrators, etc.) can be made aware of any time we have a problem with one of our services, we have an outage or disruption, or we have a degradation performance, or whatever the case may be, we report that here through our status page.
You can also subscribe to those updates so that you will receive notifications via email or text, or Twitter, or RSS.
Facility Vendor Requirements
If our team needs to be on-site, we’ll need to make sure that we’ve satisfied your facilities’ requirements, such as:
Many facilities use a credentialing system called Reptrax or SEC3URE, but different facilities go about security and credentialing in different ways. Naturally, we need to comply with the facility requirements if we’re going to be on site, so we'll talk about this a little bit later in training to ensure that we’ve met all requirements beforehand.
The Future of Graphium Onboarding
We have very ambitious goals of making onboarding a completely self-service feature on our platform. A large part of that work will be uploading your registry information as outlined above. We’ll be excited to share developments along our roadmap as they come to life!