Electronic Visit Verification (EVV)

Electronic Visit Verification (EVV)

Dec 10, 2019 | Electronic Visit Verification (EVV)

Electronic Visit Verification (EVV)

Electronic Visit Verification (EVV) is not just a buzzword in the market, so if you don’t already understand it, we suggest you do so soon. It is a rule that goes into effect in less than a month. If you provide personal care services, you need to understand what to do so that you do not have a disruption in your revenue stream.

Section 12006(a) of the 21st Century Cures Act (Cures Act) mandates that states implement Electronic Visit Verification (EVV) for Medicaid personal care services (PCS) and home healthcare services (HHCS) that require an in-home visit by a provider. States must require EVV use for all Medicaid-funded PCS by January 1, 2020, and HHCS by January 1, 2023. State Medicaid programs providing PCS and HHCS will be required to submit data that will electronically verify the following elements of the service:

  1. Type of Service
  2. Individual receiving service
  3. Date(s) of Service
  4. Place of Service
  5. Who Rendered the Service
  6. Time Service began and time service ended

Electronic visit verification was created to help cut down on fraud and ensure that people receive the documented care they need and was designed to help verify that services billed are for actual visits made. Any state that fails to comply with the Cures Act EVV requirements will be subjected to up to a 1% reduction in payments. Each individual state can choose how they implement an EVV system. The Centers for Medicare and Medicaid Services (CMS) do not endorse any one type of system and states may choose to implement more than one EVV system. States can choose to either build and manage their own EVV system or they can select an external vendor, each at their own cost. Some states are allowing providers to choose a state-sponsored vendor or one of their own choice. Providers will need to contact their state to see what model they will be implementing.

Some states are using a model that allows providers to submit EVV information on electronic data interchange (EDI) 837p claims. If your state has selected this option, EZClaim Premier along with its partners can accommodate the EVV requirements and you will be able to send your information on your electronic claims. Please contact your state for what your EVV reporting requirements are and how they will be implemented. For additional information and resources, visit the EVV Guidance page at Medicaid.gov.

If you are ready to take advantage of the flexibility and simplicity of filing claims, consider EZClaim Premier. Download your free 30-day trial today!

[ Written by EZClaim ]

 

Clearinghouses – Simply a Pass-Through Portal?

Clearinghouses – Simply a Pass-Through Portal?

Dec 10, 2019 | AMBA 2019 National Conference Session Recap

AMBA 2019 National Conference Session Recap

Written by Stephanie Cremeans of EZClaim – AMBA 2019 National Conference Session Recap

I recently attended a breakout session of a seminar with a slide titled: “Clearinghouses are not Simply a ‘Pass-Through’ Portal.” With my role as a software support specialist, I immediately tensed up and thought about how inaccurate this statement is – I hear from clients that think that the software or the clearinghouse has changed their data, but that simply isn’t how it works. Well, kind of not how it works. You know that nothing in medical billing is as simple as it seems! Depending on how your practice management system works and depending on your understanding of how electronic claims are filed this may or may not be a valid statement. While I’ve always described a clearinghouse as simply a “pass-through” for your claims this seminar got me thinking about how much more a clearinghouse is! Let’s explore a little, starting from entering your claim into your PM system and clicking send.

The first piece of the puzzle is understanding what your PM system is (or isn’t) doing with the data. You’ve entered the claim data and you are ready to send your claims to the clearinghouse, but how is that data transferred?  There are 2 typical formats – Print Image or ANSI 837. All claims being sent to payers must be in the ANSI 837 format, following specific guidelines for submissions. Although some clearinghouses are no longer accepting Print Image files, some do. In this instance, the PM system creates a snapshot of a claim form which requires the clearinghouse to move data into the correct fields for claim submission to the payer via the ANSI 837. Preferably, your PM system can create the ANSI 837 file for submission to the clearinghouse. The biggest advantage here is that you can typically view the file and the clearinghouse will not be changing anything before submission to your payer. If your PM system cannot create an ANSI 837 file I would consider upgrading or find a new solution.

So that’s it, right? If you have a system that creates a Print Image the clearinghouse is more than a pass-through and they “change” your data. If you send an ANSI 837 file, it simply passes your file along. Well … while this may be true, it’s really only part of the story, and you are potentially missing out on some pretty amazing resources that are at your fingertips! In addition to submitting the claims to your payers, they can scrub claims for common errors, confirm batch receipt and acceptance, provide claim level updates of accepted/rejected claims, and provide electronic remittance advice for auto-posting insurance payments. In addition, many offer additional services (for an additional fee) that can integrate with many practice management systems like integrated eligibility, determine deductibles and co-pays, patient cost estimators, claim status inquiry, patient statement processing, and printing services for your paper claims.

I’m working hard to remove the phrase “just a pass-through” from my definition of a clearinghouse. Once you have submitted an 837 file, they are still doing so much more than simply passing along the file.

EZClaim partners with TriZetto Provider Solutions but is designed in such a way that it will work with any clearinghouse a customer would like to use. The white-glove support team is even there to help set up the connection if needed.

We hope you enjoyed this AMBA 2019 National Conference Session Recap by EZClaim. Click here to view our blog page for more interesting and useful articles. 

New Medicare ID Cards

New Medicare ID Cards

Dec 10, 2019 | New Medicare ID Cards

New Medicare ID Cards

New Medicare ID Cards – Written by Stephanie Cremeans of EZClaim

Medicare updated their cards with a new Medicare Beneficiary ID (MBI) and has finished a mass mailing effort to send new cards to every beneficiary (including Medicare RR members). 

Medicare updated cards to help protect patient information by not printing social security numbers on the new cards.  Effective January 1, 2020, Medicare will be denying claims submitted with the old ID numbers. Here are some tips to help you avoid Medicare denials:​

  • ​​Ask your Medicare patients for their new card at the next visit and update your billing system
  • Use the MBI lookup tool online to look up the new MBI number using their social security number (available through your local MAC)
  • Check remittance advice for new MBI number on payments through December 31, 2019.  Medicare will be returning the MBI on every remit, even when claims are submitted with the old number – this means you can access this information within EZClaim Premier through our customizable grids.  
  • You can also contact EZClaim to create a validation rule to keep claims from being submitted after January 1, 2020, with the old number. 

Capturing the correct insurance information at the registration or check-in plays a vital role in the revenue cycle.  If you need to review your processes RCM Insight offers workflow assessments to help you fine-tune the processes and can help you ensure your processes are working efficiently from registration to payment in full.

We hope you enjoyed this blog article about the New Medicare ID Cards! Click here to Follow Us on Facebook to stay up to date with our most recent happenings at EZClaim or view our additional blog posts on our blog page to read our large collection of interesting and useful articles!

Compliance Plan Breakout

Compliance Plan Breakout

Dec 10, 2019 | AMBA National Conference, Live Compliance

Compliance Plan Breakout

AMBA 2019 National Conference Session Recap

Compliance Plan Breakout – Written by Stephanie Cremeans of EZClaim

Any provider that is treating Medicare or Medicaid patients is required to have a compliance plan for their practice. This is mandated under the Patient Protection and Affordable Care Act of 2010.

The Office of Inspector General (OIG) has established an outline of seven components to help the small or individual provider offices get started. They also understand that small practices don’t typically have extensive resources creating and establishing a plan, and encourage practices to start with one item, making the compliance plan a working document that is updated and added to as necessary. The seven components are as follows:

  • Conduct internal monitoring and auditing
  • Implement compliance and practice standards
  • Designate a compliance officer or contact
  • Conduct appropriate training and education
  • Respond appropriately to detected offenses and develop corrective action
  • Develop open lines of communication with employees
  • Enforce disciplinary standards through well-publicized guidelines

Let’s dig in a bit to the first component, conducting internal monitoring and auditing. Starting with this step will help a practice lay the groundwork of its compliance plan and shed light on areas that need additional work. There is no set number of records that are required to be audited, rather a suggestion of 5 (or more) per provider annually for a small or solo practice. You can start your compliance plan by simply documenting that no less than 5 charts per provider will be audited annually. Keep track of the results and use them to start implementing other components. For instance, you have the audit results, but what is considered passing? What are you going to do if a provider isn’t compliant? Document the answers and you are building your plan. Did the audit show specific areas for improvement? Find applicable training or host training for those that need it, document it in your plan. Did you find overpayments? Document how these are to be handled, resolve them quickly, and put policies in place to prevent a bigger problem.

By taking steps to create a compliance plan and show a good-faith effort to improve on risk areas your practice will reap the benefits of clean claims with a reduction in denials, fewer billing errors, and the assurance that your records are ready for an audit. This will also reduce your risk exposure to fines.

For help getting started with that first audit, setting benchmarks and improvement plans or for education on problem areas contact RCM Insight. For additional assistance with building your HIPAA compliance plans contact Live Compliance.

If you are enjoying the informative content we’re providing and have a specific topic you would like to see covered, we would love to hear from you! Please feel free to send along your ideas via email to sales@ezclaim.com.

MMBA Michigan Chapter Meeting – Northeast

MMBA Michigan Chapter Meeting – Northeast

Dec 10, 2019 | MMBA Chapter Meetings

Northeast MMBA Chapter Meeting

Kick-off the new year with valuable insights at the Northeast MMBA Chapter Meeting.

Cybersecurity – Cybercriminals are developing more advanced attacks and they are no longer purely technical. In today’s internet-connected world we all have a role to play in securing the environment we live in. Senior Security Analyst JJ Strieff will lead a discussion regarding the technology we use every day and the part we must play in keeping it secure.

2020 CPT Updates – The 2020 CPT updates bring many exciting changes and opportunities for more accurate reporting of the services provided by healthcare professionals. Speaker Robin Hicks has over 25 years of health care experience and has been teaching Medical Assisting, Billing, and Coding for over 15 years at Macomb Community College. Please join Robin as she takes an in-depth look at the new codes.

Please note that the CMU Health College of Medicine building now has a required keypad pin code to enter the building. After registering for the event, you will receive a pin code for entry two days prior to the meeting.

This program has the prior approval of AAPC for 3.5 continuing education hours. Granting of prior approval in no way constitutes an endorsement by AAPC of the program content or the program sponsor.

Northeast Chapter Meeting | January 8, 2020 | 8:00-11:45 AM

CMU College of Medicine | 1632 Stone Street | Saginaw, MI 48602

Register today at the MMBA website

Can’t make it to one or more of the MMBA Chapter Meetings? Get an EZClaim demo at any time. We have pre-recorded demos or you can schedule a one-on-one demo to meet your needs.