ARCpoint Health has unveiled a new software tool to enable primary care physicians to garner greater reimbursements and better manage labs. Developed by ErgoSum Health, the software platform is a web portal that offers pinpoint wellness exam guidance, triggers lab options and reminders, and coalesces all the reports in one web-based portal or meshes with the practice's electronic medical records (EMR).
The software tool is aimed at supporting the physician's ability to keep up with some of the everchanging requirements of Medicare, the Affordable Care Act (ACA), and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). "This is designed by health care attorneys, some of whom worked on ACA legislation," says Terry Pouncey, president of ARCpoint Labs of Birmingham at Greystone. "So it's optimized to handle all the idiosyncrasies and legalities of that legislation, and also designed to be compatible with MACRA and Meaningful Use."
ARCpoint Health helps physicians not only meet those requirements, but potentially generate additional revenue. "A lot of reimbursements are now based on outcomes, so this platform increases reimbursements through compliance with the regulations," Pouncey says. "And all the diagnostic tools are at your fingerprints."
For instance, Medicare pays $110 reimbursement for the annual wellness visit. "Statistics say only 10 percent of patients who are eligible actually get this exam each year," Pouncey says. "Physicians may even be doing an annual exam but not following the regimen required by Medicare or incorrectly coding to qualify for the reimbursement. This platform helps solves that."
ARCpoint Health walks the physician through the required questions for compliance and alerts the physician to additional assessments and lab tests covered under that exam that could enhance the diagnosis, such as the neurocognitive assessment. "Not a lot of neurocognitive tests give you a quantitative report off an assessment, but ARCpoint Health does," Pouncey says, adding that the ancillary exams can lead to separate reimbursements.
The software platform offers over thirty Behavioral Mental Health (BMHE) assessments, including for alcohol and substance abuse. "MACRA has specific guidelines for behavioral and mental health exams," Pouncey says. "And these are MACRA-ready." ACA also allows for yearly screening with several BMHE assessments.
Some are self-assessments, allowing the patient to perform them on a tablet at the physician's office. "The results are instant so the physician can have them prior to meeting with the patient," Pouncey says.
At the end of the wellness visit, ARCpoint Health also generates a seven-page patient care plan document required to be compliant. "Physicians may not be doing that, but they're supposed to, and this software platform will give you the patient care plan that they can walk out the door with," Pouncey says.
Through the ARCpoint Health's web portal, physicians can access all the results at any time. Or they can utilize the EMR interface. "If they want the results also stored with their EMR and potentially order labs and view results through their EMR, they can do that," Pouncey says.
The aggregating of lab testing forms the other component of the software, including blood, genetic, blood allergy, pharmacogenetic, and toxicity for up to 30 different drugs at once. "The software has a prequalification engine that matches the patient's diagnosis and medical conditions with medical criteria of that patient's insurance to ensure proper diagnostic lab utilizations," Pouncey says. It also matches the patient's personal and family history and medications with the medical criteria of the patient's insurance for genetic testing.
Pouncey says ARCpoint Health takes the work out of finding labs for different testing. "They may have been using Lab A for basic blood tests, Lab B for genetics, and Lab C for allergy testing. But this allows you from a single platform to order all these tests, and the results come back into their EMR," he says. "It's a single point of order for all their lab work, and the labs themselves are in-network, all vetted out and approved for the platform."
Physicians choose the labs they want to use from the menu of options when they set up the platform. It also simplifies access to and ordering tests that may only occasionally be needed, like genetics. "This is targeted at primary care physicians who may do some cancer screening and allergy testing, but not do it every day, all day long," Pouncey says. "This gives them access to some panels that are predefined, like ordering off a menu."
Pouncey says practices do not buy ARCpoint Health. There is a per exam charge if any exams are used, but the lab platform service is free. "It's no different than ordering a lab test now, you're just using this platform to do it," he says.
Besides the ease of handling lab testing, Pouncey says the value in using ARCpoint Health comes from the underutilization of these Medicare exams. "This platform enables that option for physicians in a precise and compliant manner, so you don't have to worry so much about claims rejections. You're not having to chase reimbursements anymore."