March 23, 2023

How To Complain, Revisited

Today, CMS reminds us that we can use their ASETT HIPAA Compliance site (Administrative Simplification Enforcement and Testing Tool) if you think a trading partner is forcing you to accept (or send) non-standard administrative transactions, such as ASC X12N 837 Claims or 835 Remittance Advice. The tool also validates against 60-plus clinical and non-clinical code sets, including ICD 10 diagnosis and procedure codes. Best of all, you can file a complaint directly with the CMS National Standards Group (NSG), whose job it is to police HIPAA Transaction and Code Sets violations.

CMS is not trumpeting this capability, but it looks like they also have an option to test your own EDI files (or perhaps ones you've received) without necessarily filing a complaint.

Back in the day, word on the street was that the ASETT tool's foundational architecture was based on the Edifecs validation engine technology. I can't confirm or deny that, but if you are using a different translation/validation technology, it might be a good idea to see if your streams are clean, as it were.

A Word from Our Sponsor: CarePrecise offers the sharpest healthcare provider tools in the shed. At CarePrecise, we are all about data integrity and validation. 

CCN and PAC ID to NPI: Crosswalk between the NPI Registry and Hospital and Group Records

The federal Centers for Medicare and Medicaid Services (CMS) publishes a wide range of information on U.S. hospitals, which all carry the unique identifier, the CCN number (CMS Certification Number)*. On the other hand (which often seems to not know what its counterpart is doing), CMS also publishes the frequently updated NPPES database (National Plan and Provider Enumeration System), commonly known as the NPI Registry, which uses the NPI number (National Provider Identifier) as its unique identifier. While hospitals and other medical organizations will have only one CCN Number, they are required to have at least one NPI number, and they're permitted to have as many as they like (and they do seem to like quite a few). 

And, between these two ID systems, the CCN and the NPI, ne'er the twain shall meet.

CarePrecise has developed a sophisticated system to "roll up" an organization's NPI-numbered records with its CCN number (and with the PAC ID for practice groups, which stands for "PECOS Associate Control ID"). This mighty trick produces some eye-opening data, such as contact names and titles, license information, specializations, market data added by CarePrecise to NPI records, and the ability to crossmatch groups to their members and hospital affiliations, directly from their NPI numbers. It also permits integration across the complete line of CarePrecise provider data packages, and all of the information that CarePrecise collects or creates and then merges to the NPI records.

Currently, these CarePrecise rollups (or "crosswalks" if you prefer) are the only available such thing in a relatively comprehensive dataset. The full rollup of all medical facility NPI numbers is available for hospitals, and a single "priority" NPI number is currently available for practice groups, with a full rollup of all PAC ID-to-NPI linkages in development with a tentative release date in May 2023.

The hospital CCN-to-NPI crosswalk is part of the Authoritative Hospital Database (APD), and the Group PAC ID-to-NPI link is part of the Authoritative Physician Database (APD) and CarePrecise Platinum.

The "rolling up" is made possible by several CarePrecise innovations, starting with the CoLoCode (co-location code) affixed to almost every provider in the 7 million+ record CarePrecise master reference database. To fill in additional linkages, the Placekey is used. Placekey is a unique "point of interest" identifier, also attached to essentially every one of the 7 million+ CarePrecise provider records, which can readily be used to link data between data suppliers for a variety of purposes.

* The CMS Certification Number has replaced the term Medicare Provider Number, Medicare Identification Number or OSCAR Number. The CCN is used to verify Medicare/Medicaid providers for survey and certification, assessment-related activities and communications. Note that CarePrecise includes the old OSCAR Number in its CarePrecise Complete and CarePrecise Advanced/Platinum datasets, if reported by the provider in their NPI record(s) or available through third-parties, but this is a small fraction of records, and the OSCAR numbers have changed, hence the need for a CCN-to-NPI crosswalk.

Press Release: Unlock Hidden Pharmacy Fax Numbers with ScriptFax

CarePrecise has set a release date of 3/28/2023 for the following press notice:

ScriptFax™, a comprehensive database of pharmacy fax numbers and related information, is now available to make it easier for healthcare professionals to send prescriptions and refill requests to chain and independent pharmacies. Built using advanced data mining across millions of records, ScriptFax reveals hard-to-find fax numbers for chain pharmacy locations, as well as more than 47,000 independent pharmacies. Fax is still used widely, even in this age of ePrescription systems, often behind the scenes, to assure delivery of prescriptions.

"We are excited to finally offer healthcare professionals a way to access often-hidden pharmacy fax numbers," said Michael Christopher, Chief Data Analyst at CarePrecise LLC, the technology company behind the ScriptFax Enhanced Pharmacy Fax Database. "With this constantly-updated resource, users can instantly identify and connect with the appropriate location."

Public healthcare provider records contain fax numbers for many U.S. pharmacies, but the large chain pharmacies tend to obscure this information by deliberately reporting non-working fax numbers, or reporting no fax numbers at all, although accuracy is required by U.S. federal law in pharmacies’ provider registry records. The CarePrecise technology sees around this kind of obfuscation to uncover hidden fax numbers linked to specific pharmacies. Monthly releases of ScriptFax represent a fully-updated resource, containing not only listings of tested transmissible fax numbers, but also those numbers tagged as having failed testing, including deliberately obfuscated numbers. These "bad" fax numbers are provided to help companies clean in-house fax data, and to purge bad numbers acquired by other means.

Users can search by pharmacy name and location, ZIP code®, and other data. ScriptFax includes contact information for each location. The dataset can serve as the basis for online pharmacy search applications, and can be paired with another CarePrecise data module, SelectGeo, to perform "near me" (or near any U.S. location) searches. The SelectGeo module includes the latitude and longitude of all HIPAA-covered U.S. healthcare providers, including pharmacies, pharmacists, and prescribers, linking geocodes to NPI numbers.

Once a user has identified the store location, they can choose the correct fax number based on ScriptFax's grading and prioritization tags. More than one fax number may have been found for a given pharmacy location, and ScriptFax includes prioritization to take much of the guesswork out of this vital healthcare communication channel. ScriptFax is already powering national and regional prescription delivery technologies serving 2.75 million drug and treatment prescribers in the United States.

The product is ready for immediate download. Visit the ScriptFax product page for details.

March 22, 2023

New Clinical Doc Software "Listens" to the Patient Visit

Microsoft's Nuance Communications has recently rolled out a new version of its clinical transcribing software, DAX Express, powered by OpenAI's GPT-4 technology. According to Microsoft, this will be the most advanced medical transcription software available in the market today. It will use natural language processing (NLP) to understand and accurately transcribe spoken words into textual information.

The GPT-4 technology is a conversational and ambient AI, which means it can understand the context of conversations and accurately transcribe verbal exchanges. This is intended to help medical professionals save time in the transcription process and make the tasks more efficient. The GPT-4 technology also allows for real-time analysis of conversations, which will help with improved accuracy in the transcription.


Nuance's ambient AI technology is designed to "listen" in during physician-patient visits and take notes. Incorporating GPT-4, DAX Express can swiftly generate draft clinical notes as soon as the patient visit concludes for expedited review from the physician or assistant. The software works fluidly with many popular electronic medical records software products, simplifying integration into existing systems.


Your next doctor's appointment may be documented by artificial intelligence, which suggests that patients should pay attention to the physician's notes section on their patient portal, to review for errors. This write has discovered inaccuracies in his own visit notes, even before the introduction of AI (or was it before AI, as there is no way to tell?).

New Study: Online Physician Ratings May Be Misleading

When considering patient satisfaction scores found on third-party review sites, it is important to keep in mind that the scores may not be accurate. Ratings may be erroneously influenced by a variety of factors. This misrepresentation could have serious repercussions as individuals increasingly use these ratings to select a physician. Studies demonstrate that people generally trust the ratings as their only source of information when picking an expert in this field.

A study investigating patient satisfaction ratings published in the Journal of Medical Internet Research, Timothy J. Daskivich, MD, MSHPM, lead author and assistant professor at the Department of Surgery in Cedars-Sinai, emphasizes how important it is to interpret ratings correctly as patients place a great deal of trust in them. The researchers examined ratings of 212,933 providers from October 2014 to March 2017 on Healthgrades, a consumer rating website that ranks medical professionals from 1-5 stars. This data was linked to the U.S Centers for Medicare & Medicaid Services' Physician Compare tool and ordered by specialty type. After conducting a statistical analysis to examine each provider's average satisfaction score distribution, it became apparent that ratings systems are in need of improvement throughout all specialties within the field.


Results from the research indicate that patient satisfaction ratings most often had a positive outlook and stayed within limited ranges. This means scores that seem high may be average or even low when compared to other physicians, misleading patients into believing they are selecting the best doctor. For example, if 90% of doctors in a specialty receive more than four stars on their reviews, it may suggest less-than-meaningful data.


As the public becomes more interested in online reviews and comments concerning healthcare services, this study arrives at an opportune moment. People are increasingly visiting third-party websites to get a better understanding of what physicians have to offer. Although there has been a proliferation of these third-party sites, including Healthgrades, Zocdoc, and Yelp, they often present information based on a small number of reviews and incomplete or unverified information. As a result, many health systems – such as Stanford, Cleveland Clinic, and the University of Utah – have begun posting more complete ratings and comments from their own outpatient satisfaction surveys. The tools do not measure healthcare quality, but communicate only submitted "patient satisfaction ratings," either directly from the patient or indirectly through the provider who collected patient feedback. Rather than relying only on a ratings metric, examining patient comments, where available, may be more helpful.


The study's authors suggest that third-party online review sites should be more transparent and post median star ratings for medical providers, in addition to noting their rank among peers within their specialization. For greater ease of access, they have created an interactive tool, Compare My Doc, that allows users to compare any given provider's specialty and rating with those of other specialists.

March 8, 2023

CMS Pushes Connectivity Supports for Better Health

Citing research that associates internet connectivity with better health outcomes, the Centers for Medicare and Medicaid Services (CMS) is asking people who know elders with no or limited internet connectivity to share the news about a new benefit.

"If you or someone you know needs help paying for internet service, you may qualify for a monthly discount on a new or existing internet service plan through a government program called the Affordable Connectivity Program (ACP).

"You may also qualify for a one-time device discount of up to $100, to buy a laptop, desktop computer, or tablet from participating providers."

The program supports the whole household, so if you have a qualifying individual in your home, you should be able to obtain services on their behalf.

Benefits include:

  • Up to a $30/month discount on your internet service
  • Up to a $75/month discount if your household is on qualifying Tribal lands
  • A one-time discount of up to $100 for a laptop, tablet, or desktop computer (with a co-payment of more than $10 but less than $50)
  • A low cost service plan that may be fully covered through the ACP


People can apply by pulling up AffordableConnectivity.gov or calling 1-877-384-2575. On the site, you can download a PDF application form that lists the various criteria, though we recommend using the online application process once you've reviewed it.

Notably, even if you are already enrolled in the FCC's Lifeline program, you may still be able to qualify and receive the ACP supplements. 

Rather than requiring a new, complex set of qualification criteria, your enrollment in one or more other federal programs (SNAP. WIC, SSI, Medicaid, and numerous others, including VA benefits) provides the necessary hoop-jumping by proxy. It's great to see the government offering new benefits without inventing a whole new system of red tape to support it. 

DISCLAIMER: CarePrecise uses data provided by CMS develop and refine its products.

March 6, 2023

Is Physician Wellness a Cult?

My eyes popped open this morning when I read this shocking but insightful piece that suggests that physician wellness programs are not only ineffective, but may actually help drive doctors over the edge.

"Health care could accomplish physician retention by reversing the structural issues that continue to burn doctors out: the moral injury, the unsafe working conditions, the throughput-driven and profit-motivated provision of health care, and more.

"But that's hard. Instead, it's easier to keep physicians captive — and that's what the system has chosen. Consciously or otherwise, it employs a tactic used to great effect by other high-control groups such as cults." 

How physician wellness programs keep doctors captive

By Mark G. Shrime

March 4, 2023

Tools for Marketing to Healthcare Providers

These days, healthcare providers are inundated with marketing messages from all sorts of vendors—from EMR companies, to medical device manufacturers, to basic medical supplies, to physician enablement platforms and health plans seeking to expand their provider networks. With so much competition vying for their attention, getting a message heard is becoming increasingly difficult. But by understanding the nuances of targeting healthcare professionals and leveraging specific strategies designed to appeal to different specialties across the board, you can successfully navigate even the choppiest of marketing waters. In an earlier post, we discussed best practices for reaching this holy grail audience and arming yourself with a strategy that will help cut through digital clutter — all while respecting the tightening time constraints in the ever-evolving space occupied by doctors, allied health professionals, and administrators. There's some good marketing moxie in that post.

A Plug for Platinum

We'll focus here on CarePrecise Platinum, the most popular healthcare marketing database package from CarePrecise, and, arguably the most powerful and affordable available anywhere. It offers more than 7.4 million up-to-date records of U.S. healthcare professionals and organizations, including contact details, searchable specialty location information, used by hundreds of companies to establish tightly-defined target segments within the provider universe, plus software for easily compiling highly specific target lists. Building these lists is one of the earliest steps in organizing a successful campaign. With Platinum's sophisticated but simple search capabilities, users can easily identify the likeliest prospects among any number of specialties, anywhere in the U.S., using Zip Codes or the powerful geographic radius search tool. From there, users create custom audiences segmented them according to their specific criteria, and then export lists for every segment in formats compatible with every external software, from sophisticated CRM platforms, to the most basic mailing and telemarketing services. Platinum even offers the ability to automatically proper-case names and addresses for the most professional presentation; SharpMail is our exclusive tool for intelligent generation of correct salutations and full names with credentials, specific to the healthcare field.


Video: Introduction to CP ListMaker, the targeting software inCP ListMaker, CarePrecise Platinum CarePrecise Platinum


Because email addresses are costly to obtain, it makes sense to trim the target list to a cost-effective number. CarePrecise can match email addresses to prospects' NPI numbers; Platinum has the ability to export a target file for sending to CarePrecise for email matching. More on that in a moment.


A healthcare marketing strategy needs to be tailored for specific targets' attributes — not just a one-size-fits-all approach that may have worked in other industries. There are 869 different descriptions of healthcare providers in the industry's standard Provider Taxonomy Codes. Among these are 228 distinct specialties for physicians. It's important to keep in mind that there are 58 specialties for physician assistants — advanced practice clinicians who are providing more and more patient contact, prescriptions, and orders for treatment, and becoming decision-makers and excellent contacts for many kinds of marketing campaigns. All of these specialties are linked to their practitioners in CarePrecise Platinum, as are other criteria, including geographic location by state, county, city, and Zip Code.


Platinum's data is sourced from millions of Medicare claims every month, the PECOS database, and other huge data stores maintained and updated regularly by the federal Centers for Medicare and Medicaid Services (CMS). CarePrecise is among the most respected distributors of healthcare provider data used in marketing, and CarePrecise Platinum is the most powerful, user-friendly, and affordable software and data available for creating campaign segmentation in U.S. healthcare. As of this writing, Platinum and its 7.4 million healthcare provider records and targeting software — the most used U.S. healthcare provider data tool — is priced $874 for a single download, fully functional, with no expiration date. It isn't a "trial edition," it's the real thing, despite its surprisingly low cost.


Fresh Data

CarePrecise Platinum's underlying provider data is updated every month. With a subscription to the updates, users receive a download link either quarterly or monthly with a simple drop-in data update to the most recently added new records, retired records, and changes to contact information, licenses, and all the rest of the included data.


Healthcare Provider Email Addresses

Email marketing is one of the most effective channels, especially when accompanied by good business intelligence on the contacts. As mentioned earlier, CarePrecise Platinum can help to focus email campaigns on precisely the email addresses needed for the campaign, without buying emails for thousands or hundreds of thousands of clinicians that just don't match the the target profile. After identifying prospects using Platinum's criteria options, one button click creates a file that the user can send to CarePrecise for a count and quote on the available email addresses. CP Preferred Email™ is a closely curated universe of millions of healthcare providers' direct email addresses. The quote returned to the user includes details on multiple pricing options, and a link to place the order. Email addresses can be pulled right into Platinum, where the user can create precisely the file that fits the campaign, choosing which columns to include from the vast number of data points in CarePrecise Platinum.


CarePrecise offers a 95% email deliverability guarantee — the best in the industry. This means that for any invalid email addresses over 5% of the purchase, CarePrecise will refund in cash, or give credit towards a future email purchase at double the number.


As an example of physician email coverage, the CarePrecise can match verified CP Preferred Email addresses to an average of 75% of physicians. These doctors' email addresses are sourced from medical journals, societies, and conferences, among other high-quality resources, and all are permissioned for use. Also available are dentist email addresses, physician assistant email, nurse practitioner and RN email, pharmacist email, and many more healthcare email categories. CarePrecise audits email addresses every few weeks, and offers only those that pass verification testing. CP Preferred Email is the result of an exclusive auditing methodology that involves more than just ping testing. It includes ingestion of bounce reports from selected clients' campaigns, as well as the email campaigns of our customers who submit their reports for guaranteed refund or credit. This email quality control is the most rigorous in the healthcare space, and the only one of its kind.


A well-executed physician email marketing campaign can be an incredibly effective tool for engaging customers and driving conversions. The CarePrecise Platinum platform, coupled with CP Preferred Email, can build the kind of relationship with physicians and allied healthcare professionals that yield profitable results over the long term. To take these relationships a step further, Platinum includes primary and alternative phone numbers, as well as primary and secondary practice locations. For rounding out contact information even further, CarePrecise offers ScribeFax — the most complete and reliable fax number database for prescribing clinicians. An earlier post describes how ScribeFax is used.


More on CarePrecise healthcare provider marketing tools...

March 1, 2023

"Physician Enablement Companies" Allow Small and Independent Physicians to Compete

Back in the day, a bunch of us expended a lot of effort, creativity, and collaboration to streamline and standardize the electronic claim transaction(s) for healthcare. The idea was to have such a rigorous data specification, it could meet the needs of every US payer for every US physician, lab, hospital, clinic, or facility. It got us past the days when health plans could use their own numbering systems for practitioners and organizations, or insist on using their own "local codes" for certain procedures or charges.

Pretty cool, huh? We saved billions of dollars and billions of trees by moving the lion's share of healthcare administrative transactions to electronic formats. In fact, for claims, remittances, eligibility, and enrollments, the HIPAA standards were the ONLY legal way to transmit. Health plans had to accept ANY valid claim, from any size healthcare provider.

Everything was hunky dory for about a minute.

Then came value-based care. Or, more to the point, value-based reimbursement. All of a sudden, providers were "invited" to take on some of the risk traditionally borne by private insurers and public health plans like Medicare and Medicaid. If they could prove they saved money (I mean "improved outcomes regardless of cost"), they got a piece of it. Every month seemed to bring a new pilot program, each with its own, relatively unregulated reporting requirements. Negotiating a worthwhile contract or administering a profitable approach required new sets of skills, from technical to clinical to actuarial.

In other words, small providers, hospitals, and clinics took a hard shot to the bottom line.

Into this black hole rode a new breed of white horse. The Physician Enablement Company. Our friends at Fierce Healthcare tell a story of one such company, Privia Health

"The company's strategy is to partner with providers by setting up a single tax ID entity that facilitates payer negotiations and clinical alignment while maintaining a provider’s legacy ownership structure. It also organizes ACOs for risk-bearing value-based contracts and provides its tech and services platform."

The article also mentions other companies in the space, including Aledade, Vytalize Health
and Pearl Health.

"The movement of value-based care is long overdue and primary care providers and community providers are on the forefront of that movement," [Parth Mehrotra, Privia Health President and CFO] told Fierce Healthcare recently. "I am generally surprised that a lot of consolidation hasn't happened and people haven't caught up to UnitedHealth and what they've done with Optum. I think you're seeing a lot of that catch-up happening now from a strategy perspective," he said.

If your organization has a need to identify and contact US physicians, you might consider our Authoritative Physician Database™. We start with data we extract monthly from the CMS NPPES system, the "single source of truth" for practicing physicians, hospitals, and other healthcare providers. We then aggregate or derive further data and metadata, resulting in 1 million+ U.S. Physicians with specialties, practice group & hospital affiliations, graduation year, payments, phone, fax and more.

We also recommend letting Lowell and the Feat play you out.