In the wake of the COVID-19 pandemic, Telehealth adoption has exploded, and there are six revenue cycle metrics to track.
Many patients are prohibited or reluctant to venture out for on-site care. The combination of relaxed regulations and expanded payment parity for appointments has made virtual meetings easier and more attractive for providers, who are turning to these technologies to stay engaged with patients—and maintain cashflow. Dr. Robert McLean, a former president of the American College of Physicians, recently said, “this crisis has forced us to change how we deliver health care more in 20 days than we had in 20 years.”
A new industry report predicts that the number of Telehealth visits in the US will surpass one billion by the end of the year, and speculates that nearly half of those visits will be related to COVID-19. At Waystar, we have been closely monitoring claim trends and are seeing this growth firsthand. In fact, the volume of Telehealth claims on the Waystar platform has grown by more than 100 times since mid-March. On two particular days in late April, they accounted for more than 15% of our total daily claim volume. Before COVID-19, they would have accounted for less than one percent!
For many providers, this shift will require new revenue cycle strategies to meet growing patient demand without overwhelming clinicians and administrative teams—or already strained operating budgets. It’s important to remember this is still very much an evolving care delivery model with the opportunity for errors on the part of both payers, providers, and administrative staff. For this reason, revenue cycle professionals should diligently monitor claims to ensure proper adjudication, identify learning opportunities, and uncover areas for operational improvement.
Below, we’ve listed six core Telehealth-related metrics you should regularly track to ensure billing accuracy, maximize payer reimbursement and reduce claim rejections and denials. For more on how to best navigate the evolving telemedicine landscape, check out our resource hub here.
To report on Telehealth-related claims, you’ll first need to identify and isolate claims containing Telehealth procedure codes. See CMS’ Telehealth code list to identify the specific procedure codes and modifiers that apply to your organization.
1. Payer Telehealth claim rejections by volume and/or billed amount
2. Payer Telehealth claim denials by volume and/or billed amount
If your Telehealth claims are being denied or rejected, do you know which specific payers are doing so at the highest rate? Drill down to discover the specific reason codes payers are attaching to rejections and denials so you can better understand payer-specific rules and avoid these oversights in the future. In some cases, you may identify trends that warrant a call to the payer to correct.
3. Telehealth claim volume by provider
Review this claim volume by individual provider. If you notice providers within your organization generating a much lower volume of Telehealth claims than peers, perhaps they could benefit from additional training on Telehealth technology and use cases.
Ensuring Billing Accuracy:
4. Telehealth claim rejections by biller/team
5. Telehealth claim denials by biller/team
Are certain billing personnel or teams producing higher denial or rejection rates than others? Keep a close eye on these trends and remember most of this is new for everyone. If some team members are seeing more rejections or denials than they should, it could be a great opportunity to hold trainings and collaborate on strategies for success.
6. Telehealth claim volume by procedure code
Which Telehealth codes are you using? Each code reimburses at a different rate, so choosing the wrong ones could leave money on the table. Be sure to read up on CMS’ requirements (check out their fact sheet and code list) to ensure you’re choosing the appropriate code(s) on each Telehealth claim.
You have all the data you need to drive informed decision making and improve financial performance—you just need the right analytics tool in your corner. Our new Waystar Analytics solution offers a pre-built Telehealth dashboard that can help you easily interpret, share all the metrics above, and track these revenue cycle metrics. Click here to learn more about Waystar Analytics and how it can deliver the insights you need during this time of transition.
[ By Waystar ]
A group of senators introduced the “Health Care PRICE Transparency Act” in a move to empower patients to lower their healthcare costs.
On a basic level, the Act will require all medical facilities to post payer-negotiated rates for all shoppable services, so the patient can find the most inexpensive way to take care of their medical needs. This legislation will give Americans the chance to see the actual costs of their healthcare visits, which in theory, will increase competition and lower healthcare costs for everyone.
The added transparency of the Act will bring more accountability and competition to the healthcare industry, and gives American’s more control over their healthcare costs. However, if you are a medical practice, a hospital, or a member of the medical billing community, you need to know how you can best respond.
• “What is this procedure going to cost?”: There is going to be mounting pressure on practitioners, medical billers, and hospitals to have answers for the cost of procedures. Jeff Leibach, a director with Guidehouse’s healthcare strategic solutions team, says that “regardless of the legal fate of the final rule, hospitals need to be prepared for more price transparency in the future.” So, to get in front of this—and help you compete against your competitors—you should be prepared with both what it will cost for individual services and procedures, as well as, a ‘value statement’ on why it will cost what you are charging.
• Prepare to Comply or Cover the Costs: As it stands now, the legislation is moving towards technology assisting with the billing transparency. This will aid the patients to better understand the cost of services. This is a ‘clarion call’ for you to begin preparing for this reality or you will struggle with being fined and potentially publicly shamed in publications for being offenders. We recommend starting to comply NOW before the deadline ‘sneaks up’ on you.
• Use It To Improve: Currently, healthcare practices are, in many cases, already working at capacity. The added effort of defining cost and selling procedures are enough to make some healthcare facilities put this off until it is too late. Yet, while many may be considering accepting the fines and fees associated with non-compliance, we advise using this as an opportunity to improve—to better establish your medical practice’s services, and promote your ability to be proactive to change. Getting ahead of the coming ‘wave’ of consumer expectations of healthcare will be a benefit.
• Seek Out Vendors That Can Assist: The changes that are coming for individual practices and healthcare providers can be overwhelming, and potentially it might just be more than what an IT team or private practice can handle. Forward-thinking billing departments should be investing in software vendors that can help fill that gap. EZClaim is a medical billing software company that partners with Trizetto to provide a tool called, Patient Responsibility Estimation (PRE). This tool assists in clarifying costs to consumers by providing a cheap and fast way for them to pay for out-of-pocket costs. [ Click here to learn more about how EZClaim can help you ].
It is clear that the expectations of consumers are changing, and the wave of medical transparency is on its way. Accepting it, preparing for it, and using vendor software to help overcome it, can be the difference of your practice avoiding fines and fees. For those forward-thinking and proactive practices who want to learn about how EZClaim can help, e-mail one of their sales representatives, go to their website for more details, or download a FREE 30-day trial today!
So, it looks that there will be a lot new for E/M coding (Evaluation and Management) in 2021, and practices should start to get ready for it.
Well, it seems the only constant in the world of medical billing is change, and 2020 would only compliment that cliché. While the chaos of COVID-19 forced many unexpected changes—how you see your patients and bill for services—a bigger change is in the works for 2021. This change will complement the “Patients Over Paperwork” initiative from CMS and the AMA, which has been developed to eliminate “Note Bloat.” So, since the new year will roll out changes to E/M visits, now is the time to make sure that all parties are prepared for this long overdue and welcome change to medical billing.
Evaluation and management services have been long overdue for an overhaul. The 1995/1997 guidelines were in place well before electronic medical records, and with the growth of EMR’s, the process to document for a specific level required a lot of tedious, unnecessary documentation. (A cursory a look at some of the proposed updates for E/M CPT coding and documentation requirements will verify that!)
• History and Examination: While the elements of history and examination that are pertinent to a specific visit shall be recorded, they will no longer be used to ‘score’ the level billed
• Code Selection: It will be based on MDM or time
• Medical Decision Making: It will still utilize the CMS Table of Risk. However, the wording and explanations are being updated to provide more concise language. For instance, definitions will now be included to clearly identify subjective wording like “self-limited and stable chronic illness.” The clinical example will likely be removed, and terms are more clearly defined. We will see this same type of clarification in the MDM table. For example, the 2021 guidelines will specify that the amount and/or complexity of data to be reviewed must also include analysis.
• Time-based Code Selection: It will also be easier. The guidelines will give specific amounts of time rather than the generic estimate that we currently see attached to E/M codes. Another major advantage to the codes selected based on time, it will now include non face-to-face services. There will also be additional add on codes—in 15-minute increments—if the time has been exceeded for the 99205 or 99215.
While changes are daunting, this change will be rewarding from a documentation standpoint. So, if you need help with training your team on these new updates, there are FREE videos available on the AMA website, or you can enlist the help of an independent consultant like RCM Insight.
One way of keeping up with these changes is to use EZClaim’s medical billing software, which is continually updated. For more details, visit their website, ezclaim.com, contact them, or just give them a call at 877.650.0904.
[ Written by Stephanie Cremeans of EZClaim ]
There are five things to consider as you reopen your medical office: Reevaluate your budget; Get your staff’s buy-in; How to actively bring patients back into the office; Continuing to use Telemedicine and other online tools; and be flexible.
As the curve flattens and restrictions around the country loosen up, medical practices are slowly reopening their doors for non-essential services. But reopening doesn’t mean business will resume as usual. Every industry is making changes as we navigate a “new normal.”
Many of those changes center on social distancing guidelines, but there are other matters to consider as well. Here are some details about the strategies to keep in mind as you reopen.
Reevaluate Your Budget
Government restrictions may be lifting, but medical practices are not going to bounce back immediately. Any financial goals you had in place for 2020 likely won’t be met this year.
Some budgetary adjustments will be necessary. Here are just a few ideas:
- Check in with vendors, landlords, and creditors to discuss any accommodations they may have for cash-flow disruptions
- Consider delaying payment of bonuses and other discretionary payments
- Seek aid from government economic relief packages and loans for small businesses and front-line workers. Stay informed on what your options are, as changes are ongoing.
This goes without saying, but make sure you’re up to date on patient billing and payments, too, including telemedicine visits. If you have patients who need extra time to pay their bills, EZClaim customers can set up a payment plan for them using BillFlash PlanPay.
Get Your Staff’s Buy-In
Before you start bringing patients back in, your entire medical staff needs to understand your new policies and be on board with enforcing them. They need to be reassured that their safety is a top priority, as well.
It’s been a difficult few months for front-line healthcare workers, and will continue to be stressful in the months going forward. Do what you can to acknowledge their hard work and dedication.
Actively Bring Patients Back to the Office
Some people are eager to get out of their homes and into public spaces again, while others plan to shelter in place a while longer. Either way, your patients aren’t going to return in droves. Many are less comfortable going back to a doctor’s office, so be proactive about making your patients feel safe enough to return.
Americans have become experts on how viruses spread over the past few months, so anything you’re doing to clean and sanitize your office should be visible. Affixing physical distancing floor markers, procuring enough PPE for your staff, and installing hand sanitizer stations is a good start. Show your patients what you’re doing to protect them; simply telling them what you’re doing when they aren’t around won’t be enough.
As you communicate your new policies to patients, be aware that they may be feeling overwhelmed. Be transparent and connect with them on a personal level. Don’t be afraid to show your human side; otherwise, your office will be just another place with a long list of rules to follow.
Keep Using Telemedicine and Other Online Tools
The technology that got you through stay-at-home orders can continue to support you long term. Telehealth isn’t going away. Plus, patients will still want contactless payment options.
Evaluate what has worked over the last few months and incorporate them as part of your new normal.
For example, you may want to have a plan in place regarding which patients get priority with Telehealth. At-risk individuals will still need to stay home as much as possible, so make sure Telehealth will still be an option for them.
Another tool that has been valuable during the pandemic is contactless payments. COVID-19 has changed the way people are paying—for the good. They want the option to pay their bills online, or directly from their mobile devices. Some patients will even consider switching providers if another practice offers them online payment options their current provider doesn’t have.
EZClaim easily accommodates a variety of payment preferences with its BillFlash integration, from online SelfPay to sending pre-visit charges for telemedicine visits (LinkPay). Sign up for a demo here. You can try BillFlash, at no cost, for 30 days.
Local outbreaks may still happen. Many households have lost income. Patients have different preferences and needs regarding where an encounter happens and how they pay.
Things are still changing by the week. As much as we all want a new, consistent normal, we need to be prepared to continue to make adjustments as needed. Ultimately, it is your patients and your practice’s financial health that will benefit from your ability to adjust with the times.
BillFlash, a fully integrated component and trusted partner of EZClaim, offers a variety of revenue cycle management services that have served EZClaim customers well for many years, as well as through the COVID-19 pandemic. For more information or to see a demo, contact BillFlash at 435-940-9123, email them at GetPaid@BillFlash.com, or visit their website at BillFlash.com.
For detailed product features or general information about EZClaim, you can either schedule a one-on-one consultation with our sales team, view a recorded demo, or download a FREE 30-day trial right now.
For general information about EZClaim, visit our website at ezclaim.com/
A recent medical billing webinar on Telehealth that EZclaim hosted is now available to review.
On April 30th, EZClaim hosted a Telehealth Updates Webinar for our clients with guest speaker Sandy Giangreco Brown – Director of Coding and Revenue Integrity Health Care at CliftonLarsonAllen, LLP
We had one of the largest viewing audiences 101 active attendees in the session. Sandy shared informative billing codes and direct links to update hands-on information for billers actively coding Telehealth sessions. For those of you who missed it, we have provided on our website the recorded session ezclaim.com/webinars and can provide the presentation slides too! Just send a request to: firstname.lastname@example.org
We continue to get views of this presentation and look forward to hosting more hot topics with the CLA Team.
With the onset of COVID-19 came a great opportunity for clinics and hospitals to offer Telehealth and Communication Technology Based (CTSB) services. The Centers of Medicare and Medicaid Services, or CMS, have provided many updates to the available services that can be provided and billed to the patients to help practices not only stay afloat financially but also and most importantly, to keep their staff safe and provide excellent care to their patients!
There were new guidelines released even after this webinar on 4/30/2020 (which can be found here – https://www.cms.gov/files/document/se20016.pdf, and now includes audio only Telehealth for services such as psychotherapy, tobacco cessation and medical nutrition counseling as well as diabetes self-management training. CMS is also increasing the payments for the Audio Only services from $14-$41 nationally to $46-$110.
As of April 30, 2020, in order to bill Telehealth, RHCs are now required to bill the G2025–CG–95 from January 27, 2020 to June 30, 2020. Then on July 1, 2020 to the end of the PHE, they will be billing the G2025 with an optional 95 modifier, per CMS SE20016 Medicare Learning Network Transmittal.
FQHCs will need to report three (3) codes for their Telehealth Services:
- G0467 (or other appropriate FQHC specific payment code)
- 99214–95 (or other FQHC PPS Qualifying Payment Code)
CLA is on the frontlines and closely monitoring and analyzing activities related to Telehealth and other virtual health regulations
CMS Telehealth fact sheet, Frequently Ask Questions:
As your practice adjusts to Telehealth going forward, EZclaim’s medical billing solution can help you simplify patient billing and help you get paid for Telehealth visits. (Our recent medical billing webinar on Telehealth may just help you better understand the current situation).
So, to help you investigate how EZclaim’s medical billing solution may work for you, either schedule a one-on-one consultation with our sales team, or download a FREE TRIAL to check it out the software yourself. For additional information right now, contact EZclaim’s sales team at 877.650.0904 or send an e-mail to email@example.com.
[Contributed by Sandy Giangreco Brown – Director of Coding and Revenue Integrity Health Care, CliftonLarsenAllen LLP]
Patient Payments – Written by Stephanie Cremeans of EZClaim
Why do I have a balance? The golden question regarding patient payments every physician’s office staff member dreads beginning January 1st. Unfortunately, your patients are not usually savvy when it comes to the nuts and bolts of their contract, and they are frustrated. They thought their plan was good, but now they have a bill.
68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. This number is expected to climb to 95% by 2020
Source: Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017
So here we are, in 2020. Let’s make sure your office is equipped and able to collect patient payments for services rendered rather than becoming a part of this scary statistic.
Begin with the basics. Make sure that your staff understands these key terms and is comfortable explaining them to your patients.
Deductible – The deductible is the amount the patient has to pay for covered services before the insurance plan pays. Some insurance plans will apply an office visit to the deductible, others will not. Family plans typically have an individual and family deductible.
Copay & Coinsurance – These are both the portion the patient will be responsible for after their deductible has been met. Copays are a set, flat fee. Coinsurance is a set percentage that the patient will pay.
Max Out of Pocket – This is the limit of what a patient will pay for covered services within a plan year. Again, on family plans, there may be an individual max and family max.
Keep in mind your staff will not know the details of your patients’ plans, nor should they be expected to! In the ever-changing world of health insurance, our patients need to become better consumers. So just being able to explain these key terms and why they create a patient balance will help them become better insurance plan shoppers!
Use your tools. Look into using Integrated Eligibility (available through your billing software and your clearinghouse). This will allow your staff to check remaining deductible balances, copay and coinsurance amounts with the click of a button. These results allow practices to confidently collect at the time of service rather than spending time and money on sending statements and working collections after the visit.
Create a plan and stick to it. Use this time to review the efficiency of your patient collections plan. Are you using an outdated plan or policy? Have you considered offering payment plans to patients with an HSA card kept on file? Make sure that your employees understand how important patient collections are to the practice, educate them on the plan and support them when they hold patients accountable to the patient collections policy.
For more information on how EZClaim can help you with this journey, schedule time with our sales team. Ready to get started? Download your free 30-day demo today!