Concerned about the claims process during COVID-19? Well, Alpha II remains on the forefront of the coding and billing changes during the COVID-19 public health emergency (PHE). They understand this is a confusing time for providers, practices, and hospitals.
Now more than ever, practitioners are relying on the revenue brought in by accurate claim submission. So, if you would like more up-to-date details, join us for our Bring Revenue Integrity to the Claims Process During COVID-19 webinar on June 16th at 1 p.m. ET, and learn how to recover revenue based on the waivers allowed under the PHE. Click here to register for the webinar.
We have also compiled a comprehensive COVID-19 billing and coding FAQ document of questions received during our highly-attended webinar series. Click here to download the resource.
As guidelines for coding and billing of COVID-19 services are revised regularly, Alpha II is implementing these critical changes to regulations and coding guidance—almost immediately.
Alpha II empowers precision across the revenue cycle process so you can experience reduced cost, improved cash flow, and increased revenue. Through its software-as-a-service (SaaS) solutions, Alpha II supports coding, compliance, claims editing, value-based quality reporting and revenue analysis.
For more details about how Alpha II’s solutions can keep your coding, billing, and editing current, view our website or fill out our contact form to ask us a specific question.
Alpha II is a preferred partner of EZClaim, and their software is integrated into our medical billing software. For detailed product features or general information about EZClaim, visit our website at ezclaim.com/
Because of COVID-19, some practices are doing triage from the car before they will allow a patient into their offices. Practices should also take a ‘cue’ from this by instituting protective measures for their finances.
I went to the doctor for a regular visit last week, which seemed anything but regular. I sat in the car and called to let them know I had arrived. They verified my demographics and insurance information over the phone; me in the parking lot, them in the office. The MA came out with her PPE and took my temperature, found me to be fever free so I could enter the building.
My nurse practitioner came in for our visit. We went about our appointment as usual except this time she took my superbill up front herself and handed it to the check-out staff member. We scheduled a Telehealth visit instead of a traditional office visit. At the checkout desk I said “I’m pretty sure I have a balance from the last visit, can I take care of that today?”. I loved where their heart is at, but I was sad to hear her say “You do, but we aren’t worried about that today. Just pay when you get the next statement.”
With so many things in chaos right now, so much thrown at you and out of your control – let us not forget about the protective measures you can put in place for your practice. This is the time to get some vitals and triage from the car, before blindly allowing the chaos into your business. So, what should you be tracking?
Start with basics – look at the aging balances. More than likely, you have money on the table! In EZClaim, you have the option to run a full aging, but the more efficient option is running the Insurance Follow Up report and the Patient Follow Up report. Just running these reports will let you know where there is money that needs to be collected. In addition – it just may show you that it is time to reevaluate policies and procedures in your office related to patient balances and insurance follow up. Here is a peek at what these two reports can do for you.
Patient Follow Up Report: This report will show you balances that are outstanding with your patients. While this may not be the easiest time to ask patients to pay their balances, there are steps you want to consider:
- Consider what you will do with lingering patient balances. The Patient Follow Up report will show how many statements have been sent since the last patient payment. If you have sent several statements is it worth continued efforts?
- Contact your patients to see if they can pay with an HSA or FSA account
- Offer to set up a payment plan
- Write off the balance as a bad debt or a one time professional courtesy
- Consider sending the account to collections
- Use technology to your advantage. Take this time to consider enabling online payment options.
- Create or revise patient payment policies and train your staff on these policies
Insurance Follow Up Report: This report will show your balances that are outstanding with insurance companies. Some of the useful features of this report include:
- Ability to see the aged balances by payer. This lets you get the biggest bang for your buck. Look for payers that have a large percentage of balances in the oldest buckets and work those first.
- All the information you need for calling the insurance is right there on the report. You will have easy access to date of birth, member ID number and claim totals on the report.
- During your research you will find common themes. Use these themes to update your office procedures and train your staff to eliminate errors so that claims get paid quicker.
EZclaim billing software can help you manage your office’s finances. Visit our website to find out more about our solutions: https://ezclaim.com/
[ Contribution by Stephanie Cremeans with EZClaim ]
As Patient Payment Responsibility continues to increase, sending patients to collections efficiently & effectively is more critical to the financial health of your practice than ever before. Here are some helpful tips to optimize your patient collections process.
- Communicate your collection policy upfront
- Integrate your collections process with your billing
- Consider offering discounts for self-pay patients
- Accept multiple forms of payment
- Offer multiple payment options
- Require patients to make “good faith” payments
Practices that employ the following practices can help prevent sending patients to collections or make the collections process much more efficient and effective.
1.Communicate your collection policy upfront
Prior to patient appointments, clearly communicate your collection policy. This helps the patient plan ahead to pay in full in the specified time period. This is especially important for patients that must meet a deductible or coinsurance amounts towards the out of pocket expenses. When patients are aware in advance, they are more likely to make some of their payment upfront. In addition to pre-visit communications, specify your collections with signs in your office, intake forms, information documents and on your website.
2. Integrate your collections process with your billing
The current process to send patients to collections is tedious, time-consuming and prone to error and miscommunications. That’s because staff must constantly and manually pull lists of patients eligible for collections and send all the necessary patient information to the agency. Plus, all the complex back and forth communications, followed by posting accounting for the payments.
Leveraging an automated patient billing system like BillFlash, you can create rules based on aging and minimums that queue up patients eligible for collections and send all the necessary information to begin the collections process. Practices can manage the entire collections process right in the patient billing system including setting rules, approving accounts for collections, and reports. To learn more, call NexTrust BillFlash at 435-940-9123 or visit collections.billflash.com
3. Consider offering discounts for self-pay patients
While insured patients receive discounts through their insurance provider, self-pay patients are responsible for their full payment. As an incentive to pay bills in a timely manner, offering self-pay patients a discount to pay in a timely fashion could reduce accounts sent to collections, improve the patient payment experience, and help improve your cash flow.
4. Accept Multiple Forms of Payment
Limitations in accepted payment methods and payment options can be a liability for your practice in getting paid quickly, and sometimes, getting paid at all. You can remove these barriers by incorporating payment systems that make it easy to accept all card types as well as payment plans. The BillFlash Billing and Payment system lets you offer these payment options to your patients simply. Patient billing and payments can then be synced with EZClaim because of the existing integration with BillFlash.
5. Offer Multiple Payment Options
Patients may find themselves in collections because out of pocket expenses are often much higher than they expected and can sometimes be thousands of dollars. Offering various payment methods and payment plans improves the patient experience and overall satisfaction.
Limitations in accepted payment methods and payment options can be a liability for your practice in getting paid quickly, and sometimes, getting paid at all. You can remove these barriers by incorporating payment systems that make it easy to accept all card types as well as payment plans. The BillFlash Billing and Payment system lets you offer these payment options to your patients simply. Patient billing and payments can then be streamlined because of the existing integration with BillFlash.
6. Require patients to make ‘good faith’ payments
If a patient is not paying their balance in full, requiring them to pay a portion of the payment is a helpful first step in keeping their commitment to fully meeting their financial responsibility. These small steps not only make the debt more manageable for patients but creates payment momentum for future payments so that at 90 or 120 days they owe much less and are less likely to be candidates for collections.
With increasingly more patient payment responsibility, the risk for patients being sent collections can rise as well. So, helping your patients avoid collections and optimizing your collections process when collections become necessary, can bring big financial returns
Call NexTrust today 435-940-9123 or email at firstname.lastname@example.org or go to collections.billflash.com to learn how collections are now integrated with automated patient billing and payments to improve the financial health of your practice.
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Denials are a concern for every provider and institution. Denials stress every aspect of revenue cycle management as they eat away at the bottom line, stress cash flow, and subsequent operations, and drain and entangle administrative, clinical, and financial resources during appeals. IMO has the tools you need to aid in reducing denials.
Some estimates suggest that as much as 9% of claims are denied annually and with ~$3.6 Trillion in spending in 2018, ~$324 billion in claims were denied, initially. Fortunately, 63% of claims that were denied were recovered, but not without a cost.¹,²
A closer look at the causes for denials, suggests that missing or invalid claim data and medical coding accounted for 20% of denials.¹ Without a doubt, these mid-cycle and back end processes are critical components to efficient revenue cycle management.
We understand how important it is for practice managers to align clinical descriptions documented at the point of care to the correct ICD-10CM codes to ensure accurate coding and appropriate reimbursement.
IMO knows how challenging it can be to translate diagnoses documented in a provider’s clinical language to the appropriate ICD-10CM codes, especially when code sets change.
Furthermore, we understand the risk to the bottom-line if diagnoses are not accurately captured when they are transferred between systems.
To help our customers tackle coding challenges, simplify their workflow, and manage risk, we developed IMO Core, our industry-leading clinical interface terminology.
IMO Core can help billing and coding professionals streamline the process of transferring diagnoses and codes from the billing summary or EHR into the practice management system. Additionally, IMO Core helps maintain the clinical, diagnostic, and coding integrity of claims that originate from a different EHR system to help billing and coding professionals easily navigate through interoperability challenges.
With IMO Core you can:
Document more credibly
- Maximize reimbursement by easily capturing secondary conditions
- Reduce denied claims with accurate, specific diagnosis terminology
- Increase Medicare Advantage reimbursement by identifying all HCC diagnoses and codes
Operate more efficiently
- Quickly and accurately find and document diagnoses that are mapped to appropriate codes
- Save time with diagnoses and codes that are automatically updated by IMO subject matter experts (SMEs)
- Ensure accurate billing and coding with maintenance-free terminology that is always current
About Intelligent Medical Objects
At IMO, we are dedicated to powering care as you intended, through a platform that is intelligent, intuitive, and intentional. Used by more than 4,500 hospitals and 500,000 physicians daily, IMO’s clinical interface terminology (CIT) forms the foundation for healthcare enterprise needs including effective management of EHR problem lists, accurate documentation, and the mapping of over 2.4 million clinician-friendly terms across 24 different code systems.
We offer a portfolio of products that includes terminologies and value sets that are clinically vetted, always current, and maintenance-free. This aligns with provider organizations’ missions, EHR platforms’ inherent power, and the evolving vision of the healthcare industry while ensuring accurate care documentation and administrative codes. So, clinicians can get back to being clinicians, health systems can get reimbursed, and patients can more easily engage in their own care. As intended.
To learn more please contact Will Caldwell or visit: https://www.imohealth.com/schedule-a-demo/
If you enjoyed this piece about reducing denials, be sure to read more informative articles from EZClaim and our partners.
Join Health eFilings, the national leader in automated MIPS compliance for a free educational webinar on what you need to know about MIPS and what you can do now to optimize your score with minimal resources or time on your part.
Session Title: MIPS Compliance: What to do now to avoid penalties and maximize revenue
Overview: With the end of the 2019 MIPS Reporting Period and the start of the 2020 Reporting Period, it’s clear that the stakes have been raised yet again making it even harder to avoid significant penalties. The MIPS program is even more complex than it has been in the past, further increasing the stress, burden and financial risk to providers like you.
Even though the 2019 Reporting Period is over, there is still an opportunity to avoid an automatic 7% penalty for non-compliance. And its never too early to learn more about MIPS and what you can do in 2020 to maximize your Medicare reimbursements.
By attending the webinar, you will learn:
- How to avoid the automatic penalty for the 2019 Reporting Period
- The elements of each of the four MIPS components and how they apply to you
- The complexities of each category and how to navigate them to optimize your MIPS score
- The importance of starting to capture the required data now to earn MIPS points for 2020
- The fundamental and critical differences between reporting methodologies
Day & Time: Thursday, January 30, 2020, from 1:00 – 2:00 pm EST
Presenter: Sarah Reiter, Vice President Strategic Partnerships of Health eFilings
Presenter Bio: Sarah Reiter is the Vice President of Strategic Partnerships with Health eFilings. Health eFilings is a national leader in automated MIPS compliance and data management. Health eFilings’ proprietary, cloud-based, ONC certified software is the most effective and efficient reporting methodology as it automatically extracts, formats, benchmarks and electronically submits quality measure data to CMS so providers avoid significant penalties and earn maximum reimbursements.
Register today for this free informative webinar to learn more about MIPS Compliance. Be sure to follow us on Facebook and/or LinkedIn to keep up with all the latest from EZClaim.
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!