Nov 11, 2021 | Health eFilings, Partner
MIPS Strategic Guide – How to Choose the Right Reporting Partner
Given the way the MIPS program has evolved, all healthcare practices regardless of size or specialty must evolve their approach to MIPS reporting to assure their success with the program. However, most clinicians do not understand or don’t have awareness of, the different reporting methods available to them and the impact the reporting method can have on their success with MIPS. With what is at stake financially, it is critical that you understand and select the right methodology and partner to maximize your MIPS points and protect your bottom line.
Many clinicians erroneously think that a registry is the only reporting option available to them or that they are required to use a registry. Or, they think that their EHR handles reporting for them. These misperceptions and general lack of awareness of the other reporting methodology will be detrimental to your ability to be successful with MIPS. And, given that 50% of all clinicians will be penalized annually by next year, the legacy reporting methods (registry or EHR) will not be able to fulfill enough of the reporting criteria to earn the minimum MIPS points needed to avoid the 9% reduction in Medicare reimbursements.
To help you determine if you are choosing the right reporting method and partner, we’ve identified the five most important factors to consider in order to increase your probability of avoiding the 9% penalty.
- Reporting Classification – is the reporting partner a CEHRT?
- Service Approach — Does the reporting partner use ONC certified software to do all the work with no IT resources, administrative support, or workflow changes?
- Quality Measures — Is the reporting partner certified by CMS to calculate all eCQMs, which earn significantly more points than registry measures?
- Benchmarking — Are proprietary algorithms used to assess the 9 million possible combinations of Quality measures to maximize earning MIPS points?
- Submission Method — Does the reporting partner submit a comprehensive electronic file directly to CMS to comply with reporting for all MIPS categories?
If you answer “no” to any of these questions, then the reporting partner you are working with will not be able to maximize the MIPS points you can earn. Given every MIPS point matters, because MIPS points determine your reimbursements and impact your bottom line, it’s time to consider a new strategy with a new reporting partner.
Health eFilings, a CEHRT, is the national leader in automated MIPS reporting. They utilize ONC-certified software to handle 100% of the tracking and reporting of the required data to CMS. And because their service is classified as an end-to-end electronic solution, you’ll also earn additional bonus points toward your MIPS score even though they are doing all the work. Health eFilings as your partner is the more effective and efficient reporting method so you will earn more points and, ultimately, receive higher reimbursements.
Learn more about how Health eFilings can help your practice here: https://healthefilings.com/ezclaim. Contact Sarah Reiter, sreiter@healthefilings.com, or 608.841.1866 to find out how to maximize your Medicare reimbursements and protect your bottom line.
About Health eFilings:
Health eFilings, a CEHRT, is the national leader in automated MIPS compliance and quality data analytics. Its services drive improved patient outcomes, optimized quality measures, and stronger financial results for healthcare practices. Their proprietary cloud-based ONC certified software is significantly more efficient and effective than any registry as it does all the work to extract, calculate, benchmark, format, and electronically submit MIPS data to CMS so clients avoid significant penalties and earn maximum reimbursements. And, you can have peace of mind knowing you are working with the best partner because CMS has accepted 100% of Health eFilings’ submissions. Learn more here: https://healthefilings.com/ezclaim
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Oct 14, 2021 | Partner, TriZetto Provider Solutions
New No Surprise Act Tackles Unexpected Medical Bills
Two-thirds of bankruptcies filed in the United States are a result of medical expenses. It’s an alarming statistic, but probably not surprising. It’s no secret that many people have trouble paying out-of-pocket medical costs, so much so that a recent survey from The Commonwealth Fund found that 72 million Americans have some sort of trouble with medical debt.
It’s a common problem, but why? Let’s say a person visits a hospital, perhaps an emergency room, and receives a myriad of services. Maybe they arrived via ambulance or required treatment from an anesthesiologist. Although they may inquire about an estimate at the time of service or have an idea of their coverage, the exact financial responsibility is often a mystery. But what’s a person to do? They need medical assistance, and they need it at that moment. Then a surprise arrives in the mail in the form of an outrageously high medical bill. It’s something many of us have likely experienced.
What’s the cause of such an expense? Often the charge stems from using an out-of-network provider. Basically, this means that the hospital may have been in-network, but the physicians were not. Additionally, patients are often confused about medical coverage. Even with a good understanding of their benefits, situations may arise that are out of their control, and there may be unintended outcomes. Patients may (falsely) believe that all services rendered will be considered in-network when they go to an in-network facility. However, this isn’t always the case. In some instances, even though their physician is in-network, patients referred to specialists (such as a pathologist or radiologist) may discover the ancillary services were out of network. It is only after the patient receives a bill that they discover the issue. In the case of an emergency visit, patients don’t have the luxury of researching for in-network hospitals and typically go to the nearest hospitals. Patients may also be taken to out-of-network hospitals by ambulance. Researchers estimate that 1 in 6 emergency room visits and inpatient stays involve care from at least one out-of-network provider. The cost of out-of-network visits can have devastating financial consequences for the patient.
A 2019 study by the Government Accountability Office (GAO) found that the cost for air ambulance services clocked in at approximately $40,000. A large portion of this cost (over 70 percent) often fell out-of-network, meaning that the balance usually was placed on the consumer. When such a service is needed, it’s understandable to not have the option to “shop around” for a cheaper, in-network alternative.
Thankfully, help is on the way. Leaders and policymakers at the federal level have taken steps to tackle the issue. On July 1, 2021, the Biden Administration announced a new rule aimed at protecting consumers from surprise medical bills. In conjunction with the Department of Health and Human Services (HHS), together with the Departments of Labor and Treasury and the Office of Personnel Management, debuted “Requirements Related to Surprise Billing; Part I.”
This announcement, the first in a series, will go into effect on January 1, 2022, and protect patients from those all-too-common surprise medical bills. It’s an important step forward in protecting patients.
“No patient should forgo care for fear of surprise billing,” stated HHS Secretary Xavier Becerra. “With this rule, Americans will get the assurance of no surprises.”
Let’s dive into the new regulation. Among other provisions, the rule:
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- Protects patients from surprise billing in emergency services. These provisions will safeguard patients in emergency care situations from unknowingly accepting out-of-network care and incurring unexpected expenses.
- Limits out-of-network cost-sharing. Patient cost-sharing for emergency and non-emergency services, such as a deductible, cannot be higher than if provided by an in-network provider. Simply put, co-insurance or deductibles must be based on in-network rates.
- Bans out-of-network charges for ancillary care. Previously, out-of-network providers like anesthesiologists could have been assigned, even though the facility or physician was in-network.
- Requires that providers and facilities provide patients with accurate cost information and advance notice of any out-of-network charges for non-emergency services. A consumer notice must explain that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.
- Allows providers and insurers access to a dispute resolution process should reimbursement issues arise around reimbursement.
With the increase in high deductible health plans and increased out-of-pocket costs, finances are top of mind. From the consumer’s standpoint, gaining healthcare services will be less stressful. On the simplest level, this ruling will hopefully eliminate those hefty surprise bills, which can only be seen as a positive. Moving forward, patients can rest assured that they will be more aware of expenses and will avoid out-of-network charges for emergency care.
So can consumers finally say goodbye to surprise medical bills? Hopefully, they become a thing of the past. And how will this bill affect the future of the industry? Advocates are hoping these regulations and newfound transparency will eventually lower costs, for one. More importantly, it shines a light on the need to improve the overall patient experience. It’s a step in the right direction and has the potential to improve healthcare policies going forward for years to come.
For more information on solutions that equip you to have informed conversations about financial responsibility and eligibility, contact a TriZetto Provider Solutions representative today.
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Sep 29, 2021 | Partner, TriZetto Provider Solutions
With healthcare costs on the rise and an increasing segment of uninsured consumers, the patient payment landscape is changing rapidly. How can medical offices evolve and optimize collections while keeping patient satisfaction high? Thankfully advancing technologies are making it easy to simplify collection processes to increase revenue.
1) Communicate responsibility
How many times have you purchased a good or service without knowing the cost beforehand? Probably not many. Healthcare should not be any different. By providing cost expectations, care providers can give patients the opportunity to not only understand their fiscal responsibility but to also take a proactive, involved approach. Communication allows patients to determine if the value of the service they are receiving is worth the cost. When finances and choices are transparent, patient satisfaction rises.
2) Collect upfront
It’s said that medical providers collect only 25 percent, on average, of available co-pays and deductibles at the time of service. If the patient departs after the initial visit without making a payment, the likelihood of receiving the co-pay drops significantly. Consumers are used to paying for a product at service at the time of use, so why should medical care be different? Capitalize on patients that are willing to pay at the time of service by collecting upfront. Processing payment during the appointment is a step toward helping the patient to be invested in their care, which increases the chance of gaining future payments.
3) Empower patients
We know that patients are taking a more active role in their care and like to be in control of costs. Knowledge is power, and giving patients the information and tools needed is critical to empowering patients to pay. An effective strategy engages the patient early to learn their payment and communication preferences, then proving the proper options.
4) Build awareness
When adding payment options or considering changes to your payment workflow, increasing awareness is key. Be sure to engage your staff and provide the most accurate information on your website and within advertising tools (such as posters in the waiting room). If time and budget allow, conduct a survey to gain patient feedback. A small sampling of users will give insight into the likelihood that patients will adopt new tools and practices. It’s critical to explain the value in an informative, yet simple to understand the way that will resonate with your audience.
Thinking your practice may not have the staff or means to optimize payment processes? Consider tools from TriZetto Provider Solutions that can enable patients to conveniently pay by utilizing a variety of methods, including easy-to-understand statements. Learn how our partnership can help you streamline your workflow, improve efficiencies, and get paid faster.
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Sep 23, 2021 | BillFlash, Partner
We see it all the time, a patient visits their doctor’s office to seek treatment and then receives a bill in the mail for their portion of the medical expenses. When a patient receives the bill, they are often alarmed at the amount that is due and may not have the funding to pay the balance in full. In a recent study conducted by UCLA, it is estimated that there is $140 billion in medical debt that has been reported on credit reports (VeryWellHealth, 2021). In fact, this research study found that one in every five consumers was already in collections prior to the COVID-19 pandemic.
As cases of COVID-19 increased in 2020, many consumers feared visiting their doctor’s office that they avoided their routine office visits, and/or lost their employment further impacting a patient’s ability to pay for any medical expenses. As providers continued to keep their offices open, many providers witnessed a decrease in patient volume while also seeing a reduction in revenue. According to a recent article published in Medical Economics (2021), 55% of practices were impacted by a decrease in revenue while 60% were impacted by a decrease in overall patient volume. Combined with the number of patients that were already in medical debt and/or collections, many practices faced a financial crisis as a result of the COVID-19 pandemic.
As the COVID-19 pandemic seemed to become more stable in early 2021, many patients felt comfortable returning to visit their doctor and/or were able to secure employment, providing patients with employer-sponsored insurance coverage. With the current rise of COVID-19 cases increasing again, practices are left with the ongoing challenges of attempting to maximize revenue collection with the risk of history repeating itself and the patient’s inability to pay their medical bills or avoiding their office visits.
Contrary to belief, consumers actually want to pay their medical bills and are seeking more payment options. According to the 2020 Trends in Healthcare Annual Report, providers and consumers must adapt to a new payment experience in order to enhance how they interact with one another. In addition, more than half of consumers would consider changing their provider for a better payment experience. One may ask, what constitutes a better payment experience? Consumers are showing a higher demand for contactless payments and the ability to work with their providers to create a payment plan or auto-payment options. Unfortunately, many providers have not adapted to their consumer’s needs and continue to operate with traditional methods creating dissatisfaction amongst their consumers
How can providers change their operations to facilitate a more consumer-friendly experience for their patients? Front-office staff play a pivotal role when interacting with patients and should be collecting up-to-date contact information to ensure patients are communicated with effectively, have the most recent insurance data to avoid any processing delays, and should collect a patient’s consent ahead of time for new features such as eBills, texting, and payment preferences. EZ Claim customers can streamline their revenue collection opportunities by partnering with BillFlash for innovative billing opportunities and various payment collection features that consumers highly desire. While nobody can predict if this recent wave of COVID-19 cases will lead to another quarantine phase or not, it is important for providers and consumers to enhance how they interact with one another to create solutions for healthcare needs.
For more information about automated patient statements and patient payment options, contact EZClaim, NexTrust BillFlash, GetPaid@BillFlash.com, or call BillFlash at 435.940.9123 (Option 3). For more details about EZClaim’s medical billing software, visit their website, e-mail their support team, or call them at 877.650.0904.
Resources
Hui, K. (2021). Americans owe $140 billion in medical debt. Here’s how to avoid it. Very Well Health. Retrieved from https://www.verywellhealth.com/medical-debt-medicaid-study-5194846
InstaMed (2021). The Trends in Healthcare Payments (11th Annual Report) 2020. Retrieved from https://www.instamed.com/white-papers/trends-in-healthcare-payments-annual-report/
Luz, M. (2021). How an effective revenue cycle management strategy can help reduce burnout. Medical Economics. Retrieved from https://www.medicaleconomics.com/view/how-an-effective-revenue-cycle-management-strategy-can-help-reduce-burnout
Sep 21, 2021 | Live Compliance, Partner
Per the HIPAA Privacy Rule and HIPAA Security Rule, both Covered Entities and Business Associates, must require HIPAA training for all workforce members that access protected health information (PHI) or electronically protected health information (e-PHI) in any of its forms and should be provided “as necessary and appropriate for the members of the workforce to carry out their functions within the [organization].”
According to the Rule, training must be provided “to each new member of the workforce within a reasonable period of time after the person joins the covered entity’s workforce.” Along with all other annual compliance requirements, HIPAA training is arguably the most important. Your workforce members are your first line of defense in the event of a Breach and must be able to identify your organization’s designated HIPAA Security Officer, and have a firm understanding of the HIPAA Privacy and Security Rule. Training should also highlight the organization’s Technical, Administrative, and Physical Safeguard objective security requirements. It is best practice to provide ongoing security awareness training and, in addition to the mandatory annual training, the Privacy Rule also highlights what’s known as “periodic” training. The goal is to ensure workforce member’s knowledge of HIPAA compliance is not forgotten.
The HIPAA Privacy Rule states that “An [organization] must document that the training as described [in the HIPAA Text] has been provided.” Failing to do so will be seen as “willful neglect” and will result in HIPAA violations including monetary penalties as high as $1.5 million dollars. A minor violation may only result in a corrective action plan requirement, whereas a significant data breach attributable to a lack of training will be viewed more seriously.
At Live Compliance, we make checking off your compliance requirements extremely simple.
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- Completely online, our role-based courses make training easy for remote or in-office employees.
- Short informative video trainings to meet periodic training requirements
- Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location. Conducting an accurate and thorough Security Risk Assessment is not only required but is a useful tool to expose potential vulnerabilities, including those such as Password Protection.
- Policies and Procedures are curated to fit your organization ensuring employees are updated on all Workstation Use and Security Safeguards in the office, or out. Update in real-time.
- Electronic, prepared document sending and signing to employees and business associates.
Call us at (980) 999-1585 or visit www.LiveCompliance.com.
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Aug 26, 2021 | Partner, Waystar
Waystar’s newest guide investigates the state of denials and appeals in today’s healthcare landscape and explores how today’s most successful providers are redefining the core components of their denial and appeal process to grow revenue, streamline workflows and revitalize their approach to the process.
Denial and appeal management today
Like many administrative tasks further burdened by the impacts of the COVID-19 pandemic, denial and appeal management workflows dependent on manual processes are experiencing new strains on accuracy and productivity.
Last year a survey investigated how billing and administrative tasks were impacted by COVID-19, with 37% of surveyed providers reporting an increase in workloads due to issues with coding and requirements. An assessment of the general industry outlook found claim denial rates are at an all-time high, with 33% of surveyed hospital execs reporting concerns they are entering a “denials danger zone,” where rates grow to 10% or more.
Estimates put the cost of reworking denials as high as 20% of rev cycle expenses because on average they cost 4x as much to process than the initial claim. With so much strain already present on providers’ resources, many are turning to automation to ease the burden.
How automation elevates the process
Once a provider has been notified of a denied claim, steps are taken to identify whether or not it can be appealed. Many of the errors that cause denials come down to administrative issues that took place at the start of the claim lifecycle.
A recent analysis found 86% of the denials processed between July 2019 and June 2020 were avoidable. Analysis indicated that many of those issues stemmed from front-end errors related to benefit information, coverage detail, and shortcoming related to missing or invalid claim data.
While there’s a wide mix of problems that could cause a denial, with different providers experiencing a diversity of challenges depending on their location and patient population, they all face a common hurdle: the burden of manual denial management and appeal procedures put on administrative staff.
Like many other administrative processes, providers for the most part rely on a mix of manual and electronic procedures to handle denial and appeal management. But the industry’s continued reliance on manual procedures is beginning to have a negative effect.
How providers are transforming their approach to denial + appeal management
Studies have found that it costs about $118 in reworking fees to appeal a denied claim. These costs are exacerbated by the industry’s overall reliance on manual processes—a systemic issue many recognize yet fail to capitalize on. Indeed, while many providers see the promise automation can deliver on, they still face a number of considerations before pushing forward with implementing an automated solution.
And automation is a hot topic for providers for a very good reason—studies have demonstrated the US healthcare system could save as much as $16.3B by automating old or outdated processes. When it comes to denial and appeal management, the benefits are far-reaching, from improvements to productivity and a reduced strain on resources to huge boosts to claim accuracy and revenue recovery.
What to look for in a denial + appeal management solution
Leading-class solutions offer a wide selection of tools to provide a comprehensive approach to denial and appeal management, using customized, exception-based workflows to streamline the entire process and overturn a sizable increase in denials.
The appeal toolset a solution offers should make it easier to coordinate and use the info and data necessary to automatically process appeals and recover cash that would otherwise create productivity issues or unnecessary fees.
The solution’s ability to prioritize appeals based on cash value automatically lets staff concentrate on tasks that actually demand their attention, supporting them with additional tools like automatically generated payer-specific appeal forms and robust analytics capabilities that allow you to track and measure progress and problem areas.
Keeping disruptions at a minimum is key when considering your solution as well, so consider its ability to work efficiently with your existing systems and look for a partner that can demonstrate a strong history of seamless integrations.
Wrapping it up: why denial + appeal management solutions matters
A recent Waystar survey found 76% of providers categorized denials as their biggest RCM challenge. And the wider picture of healthcare reflects an industry struggling to solve a long-standing problem with manual processes and few answers.
Implementing an automated denial and appeal management solution is quickly becoming the optimal path forward for most providers, even if many have apprehensions about committing to the switch. But as new innovations cut down on the resources and time needed to implement the tech, the time is quickly approaching where the switch will be easier, and more vital, than ever before.
Click here to find out how Waystar can help fully automate the process and help you recover more revenue while reducing the burden on staff.
Heading to AMBA in October? Visit Waystar and EZClaim while you’re there! Stay tuned for more event details.
ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
[ Contribution from the marketing team at Waystar ]
