Lost laptop = $65,000 fine. Have you ever read such headlines and doubted whether a small billing company or independent physician practice would ever face such seemingly insurmountable penalties?
What happened? Most recently, an ambulance company out of Georgia paid $65,000 for a lost laptop that happened to be unencrypted. More often, small businesses and practices are taking work outside of the office, so this kind of violation is one that can occur to anyone.
The laptop contained 500 individual’s Protected Health Information. As a result of the investigation, the ambulance company will undergo a Technical Security Risk Assessment and is required to adopt a Corrective Action Plan. This is a great example of why it is important and mandatory to conduct a Technical and Objective Security Risk Assessment at least annually on all devices.
Following the investigation, it was uncovered that West Georgia Ambulance never provided a security awareness and training program for its employees! You and your workforce are your first line of defense. This reinforces the importance that both you, and your employees must understand what a breach is and the breach notification requirements! It was later revealed that West Georgia Ambulance failed to implement HIPAA Security Rule policies and procedures as well.
What can you do? As we have stressed before, it is important for you to understand that every complaint or potential breach must be investigated by HHS/OCR. If you, the Billing Company or independent physician practice, suspects a breach or complaint you must inform the covered entity (your client) and have a breach risk assessment completed to determine key factors and take action. Again, if you haven’t completed an accurate and thorough security risk assessment prior to that, you could also be penalized under ‘willful neglect’. This category alone is $50,000 per violation!
What we do is keep this from ever being a worry for you! In fact, we have a 100% audit pass rate since 2010! For example, Live Compliance has easy to understand HIPAA breach notification training. We perform your security risk assessment and manage all your requirements, including business associates, in a clean, organized cloud-based portal.
Don’t risk your company’s future, especially when we are offering a FREE Organization Assessment to help determine your company’s status.
If you are enjoyed this article about the lost laptop as well as 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 email@example.com.
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.
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
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!
Written by Dan Loch of EZClaim – As with most people at this time of the year, I like to reflect a short time on the year gone by before I make plans for the next year. Each year is filled with experiences that shape who we are and where we are going next.
This was a very exciting year for EZClaim and for me in my first year as the VP of Sales, Marketing, and BD. I used this year to truly understand who EZClaim was, is today, and help to guide EZClaim into the future. EZClaim, as many of you know, has been around for over 22 years. We are a firm that values our customers and the support we give them over everything else. We are a support firm that sells software as we like to say.
This year we decided to announce that support would be ending at the end of 2020 for one of our most popular products, EZClaim Advanced. This does not mean people have to stop using a product they love. We want to make sure we can continue to offer great products on the latest technology so it is time for us to move on.
This year we hosted our very first User Group Meeting in our home town of Rochester, Michigan. It was an excellent opportunity to meet face to face with the people we support on a regular basis while making some new friends that are considering our solution. During this meeting, we interviewed some current customers along with many of the EZClaim staff. Please take a couple of minutes and watch some excerpts that talk about EZClaim’s history, support focus, and family focus that forms who we are from our interview with the EZClaim Founder and President, Al Nagy.
We started a Blog this year and for the first time added a Facebook page to go along with our LinkedIn profile. Our plan is to communicate about industry topics on the blog and these social channels to assist our vast customer and prospect network. We have a lot of knowledge built up over the long history of EZClaim and it is time we share it. The blog will feature topics from our partners as well. Please be sure to watch for posts every few days in 2020 and beyond. Please let us know if there are any specific topics you want us to hit as well. We are always looking for feedback.
We added some new partners in 2019 that nicely complement our solution and have the same drive for customer support we do. Live Compliance for all your HIPAA compliance needs, Elation Health EMR for “The Quarterbacks of Healthcare” as they like to say, and Alpha II for claim scrubbing. All the vendors we work with are listed on our partners page.
As we go into 2020, EZClaim will focus on EZClaim Online, another Premier platform product due out in quarter four. This expansion of our Premier platform offers additional flexibility in how our clients interact with our billing and scheduling platform. In addition to Online, we will continue to enhance Premier by introducing new features such as Claim Status Inquiry (CSI) and more.
Thank you for being part of the EZClaim family and taking the time to reflect on 2019 with me and think about an exciting 2020. Please take a moment of your time and watch the message from Al Nagy.
Please have a safe and joyful holiday with your friends and family.
Need help getting your To-Do list done? We have you covered!
With 2019 nearing its close, now is a great time to evaluate your revenue cycle management
and look for areas of improvement in the coming new year. Make 2020 the year you put the
focus back on your patients by automating your revenue cycle and improving your bottom line.
The best place to start is by ensuring you get your To-Do list done early!
Making the list is just like a New Year’s resolution: Easy to do but hard to complete without a
partner there to support you. The right solutions should be at the root of your strategy. EZClaim
and TriZetto Provider Solutions (TPS), a Cognizant Company, have the tools and support to
make a difference in your practice and can help you get through the list:
Go digital – Check!
Improve denials management – Check!
Get paid faster – Check!
If these challenges are at the top of your 2020 To-Do list, get in touch with our revenue
cycle experts now to find out how we can help you check them off your list and make sure you
are ready to recoup all that you are owed in the coming new year.
In the meantime, download our infographic with the details of the financial and operational
benefits of getting your To-Do list done early this year.
Don’t run off, Electronic Data Interchange or EDI is quite simply a standardized method for businesses to transfer documents electronically. Some typical business uses for EDI are purchase orders, invoices, shipping notices – types of transactions where the pertinent data can be separated from the regular communication related to negotiations, business deals, vendor contracts, etc. Why are we talking about it here? Easy. A set of standards for the healthcare industry has been adopted and make your life easier.
EDI creates efficiency and helps to automate data entry that is often performed manually. Before HIPAA, there were more than 400 different process forms in paper format. Thanks to the research of the Workgroup for Electronic Data Interchange (WEDI) to explore ways to control skyrocketing healthcare costs and patient privacy protections and the subsequent enactment of HIPAA, EDI is available for use in the healthcare landscape.
Just like EDI used in business, Healthcare EDI functions by exchanging information via transaction sets created as standards by organizations like the American National Standards Institute (ANSI). When HIPAA-covered healthcare providers electronically exchange any of the information covered in the list below, the transaction requires the use of adopted standards.
Claims and encounters information
Payment and remittance advice
Enrollment and disenrollment
Referrals and authorizations
Coordination of benefits
Why is this important? – Efficiencies created in the entry and transference of data reduce errors, saves time and, in turn, saves money. These efficiencies have been adopted for the healthcare industry as they apply so readily to patient and claims data, eligibility, and security.
The EDI Benefits
Standardization: The elimination of proprietary formats creates consistency, reduces errors and the need for translation.
Efficiency: Data does not require manual entry. This reduces errors and speeds up the process as it becomes more automated.
Accuracy: Automated data entry means a reduction of errors, which translates to a savings of both time and money.
Cost savings: Digital transactions reduce paper usage, storage solutions and time used for manually completing paperwork.
Greater security: Since only authorized parties can access the data, patient data is better protected and the risks of HIPAA violations are significantly decreased.
HIPAA Compliance – Healthcare EDI transactions are more secure than paper methods of transmitting information. Only authorized users have access to transactions, which is in keeping with healthcare data management practices. That being the case, EDI helps to enable secure data transmissions that comply as HIPAA mandates.
So, why isn’t everybody using EDI? – The use of EDI for data entry and transfer requires both parties to be technologically equipped to handle the transaction. For many smaller businesses, these initial costs can be prohibitive. In many instances, the standards to use between provider and payers are not defined or agreed upon; this results in paper documents being used a fallback.
Looking forward – In addition to the advancements in mobile and smartphones, we now have many types of wearable tech that can be used to track all types of health data. The advancements of mobile EDI can empower patients and practitioners alike to not only ease the portability of patient data, but also mobilize patient health information, track health trends, diagnose potential or emerging health issues, and simplify billing. While technology marches ahead, we will all need to keep in mind the methods for enabling data transfer and keeping compliant for security, safety, and privacy.
EZClaim Premier can generate, parse and display ANSI Healthcare EDI transaction sets as well as clearinghouse formats. This means you are ready to start processing claims using HIPAA-compliant EDI methodology right away with the end-to-end simplicity, compliance, and the peace of mind that comes with ease of data entry, assurance of data free from errors to produce clean claims and, with that, fewer rejections. We continually update our software to keep pace with any changes that may occur in the EDI space.
The cloud is still a mystery to many and when it comes to cloud security regarding Health Insurance Portability and Accountability (HIPAA) compliance and your patients’ protected health information (PHI), the unanswered questions you may have can lead to a lot of stress. We’re here to help make your life easier, so we’ll put this in plain and simple terms. Here are the necessities that make for HIPAA compliant secure hosting and cloud storage solutions. Making sure your hosting and/or cloud storage provider ticks these boxes ensures adherence to the security standards that are required to keep your patients’ PHI, your practice and your reputation safe.
Business Associate Agreement (BAA)
Private hosting environment
SSAE 18 Certification
Cloud computing is an impossible-to-ignore convenience and EZClaim Cloud provides the best of both worlds – the ability to work wherever you want and the peace of mind that comes with knowing your practice and patient data are protected on secure servers with nightly backups. EZClaim Cloud uses Netgain, the industry standard for secure and scalable HIPAA compliant for hosting and secure cloud storage. Rest assured EZClaim Cloud has the security of you and your patients’ PHI covered in every respect.
Not to mention EZClaim Cloud gives you these additional benefits:
Data Permissions Control
Less onsite technical support
Works on all Operating Systems
If you would like to dig deeper to get extensive information regarding HIPAA compliance and the cloud computing environment, visit the U.S. Department of Health and Human Services (HHS) for their Guidance on HIPAA and Cloud Computing.
If you like the sound of the outstanding benefits that EZClaim Cloud provides backed by Netgain, a leader in secure cloud-based hosting and storage, we invite you to learn more or upgrade your account today.
We hope you enjoyed the “Security – Keep Your Head In The Clouds” blog article. Click here to see our full blog page to see all of our most recent posts!
We often find that the reason behind declining medical practice revenues doesn’t have to be uncovered – it’s right there in plain sight in your payer contracts.
Practices that don’t track their payer contract rates are reimbursed on average 4 percent less. (1)
Payers make inaccurate payments on one out of every 14 healthcare claims. (7.1%) (2)
A recent study showed that physicians billed $5.15 below their contracted fee schedule per code. (3)
While working with healthcare groups across the country, we have seen payers reduce their fee schedules by 5 to 12%.
Fortunately, longstanding patterns of poor attention to contracts can be broken by analyzing and monitoring your payer contracts. You’ll be more informed and in a much better position to compete and thrive.
Updating Your Charge Fee Schedule
Making yearly updates to your charge fee schedule is one of the most important things a provider can do to ensure the collection of an appropriate amount for services.
Rates change over the years due to Amendments, Proprietary Market Fee Schedules or CY Medicare-Based Fee Schedules.
Payer Reimbursement Pitfalls
Most contracts contain an evergreen clause, which is a fancy way of saying that the contract goes on and on until something triggers renegotiation and/or termination. The contract is automatically renewed unless one or both of the parties modify or terminate it.
% of Billed Charges (BC)
Contracts that are primarily based on a percentage of billed charges (BC) will be devastating if, for example, your charges are at 150% of CY Medicare and the Agreement pays 50% of billed charges – you are getting paid 75% of CY Medicare.
Oftentimes an agreement will state that the payer has the right to amend the contract without prior written notice. Reject any language which gives the payer unilateral amendment rights.
If the agreement requires the payer to provide notice of the amendment, remember, usually; “Following (30) days written notice. Failure to object constitutes agreement.”
“Lesser of” Language
All too often, practices have certain codes that fall below contract rates and almost all contracts have a “lesser of billed charges (BC) or contract rate” provision. Meaning, if your contract rate is $100 and your charge is $50 – you just lost $50 and cannot get it back!
The primary mission of CodeToolz is to help medical providers increase their revenue. It’s as simple as that.
Texas Medical Association, 2019
American Medical Association’s National Health Insurer Report Card, June 2019
Medscape Physician Compensation Report 2019
We hope you enjoyed this article about the Payer Reimbursement Pitfalls. Click here to visit our main blog page to read more interesting and useful articles from EZClaim!
Is Electronic Visit Verification (EVV) a buzz word or is there really something that must be followed? It is not just a buzz word in the market so if you have not already dug into 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 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 6 elements of the service:
Type of Service
Individual receiving service
Date(s) of Service
Place of Service
Who Rendered the Service
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.