On January 13th we posted part one in this topic of Eligibility in healthcare, in that, we touched on deductibles, co-pay, and max out-of-pocket pay. Now in part two, we review the impact of price transparency in healthcare and its importance to the healthcare team decisions.
Consumers are the most important member of the healthcare team and are better collaborators in their care when they know all the variables and their required responsibilities in the process.
The individual consumer’s healthcare team includes, along with themselves, the physician and their staff, the pharmacist, an insurance adviser and possibly some gatekeepers as well. The communication of clear symptoms when a patient is diagnosed is the responsibility of that team along with building an understanding of the financial responsibility that goes with any medical solution. While providing answers, options and solutions is a provider responsibility, so is providing a cost for the provided care. Therefore, price transparency can be achieved when the cost for that care is presented in a clear and concise fashion so the patient can understand what they owe, why they owe it and when it is due.
Ensuring your staff is educated on discussing the financial responsibility with the patient from the first appointment and forward will strengthen the healthcare partnership and assist in the collection process. Understanding the steps that occur post the upfront estimate can be beneficial to the team. This discussion can be bolstered by ensuring bills are clearly marked with the statement, “this is a bill”, also clearly listing what the patient is being charged for when the bill is due and offering details on the methods of payment that are accepted. This clarifies what insurance will cover for the patient and their own out-of-pocket cost, prompting them to share any concerns and constraints with payments upfront.
Estimating patient responsibility is one part of the reimbursement process that is used for transparency for patient billing. The estimates can be provided using a spreadsheet of prior reimbursement and your most commonly billed CPT codes. If you would like an automated and more accurate option then look into a software tool like the Patient Responsibility Estimator by our solutions partner, TriZetto Provider Solutions (TPS). Giving this to the patient at the time of checking in will assure they have a rough idea of the costs and allow the office to collect upfront if needed.
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 Trial today!
[Contribution by Brenda Smelser with the DMC]
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 ]
One of our partners, Alpha II, is presenting a special webinar on COVID-19 billing changes on April 16, 2020, “COVID-19: Critical Coding and Regulatory Updates,” to provide the most up-to-date information on the coming changes to new procedures, diagnosis codes, telehealth updates, and changes to regulatory policies.
As guidelines for coding and billing of COVID-19 services are revised almost daily, rest assured Alpha II is working to implement these critical changes to regulations and coding guidance as quickly as possible by conducting near-daily promotions.
Here is a very brief summary of some of the updates we’ve implemented:
- Clarification of correct telehealth rendering POS and use of modifier -95
- Modification of diagnosis code edits for billing of COVID-19 symptoms from February 20 – March 31, 2020 and use of new diagnosis U07.1 for dates of service on or after April 1, 2020
- Addition of the new AMA CPT code 87635 effective March 13, 2020
- Addition of the new CMS CPT codes U0001 and U0002 retroactively effective February 4, 2020
- Modification for waiver of DME replacement requirements prior to March 1, 2020
- Modification for waiver of occurrence code 70 on SNF three-consecutive day stay validation prior to March 1, 2020
- Modification to LCD/NCD edits to relax rules related to respiratory-related devices and services
- Modification to Medicaid for temporary suspension to prior authorization rules in PHE areas effective March 1, 2020
You can get all the latest COVID-19 specific updates here: https://www.alphaii.com/landing/covid19
Alpha II is an EZclaim partner that provides “Claim Scrubbing” for our medical billing software system. View our website for more details on this: https://ezclaim.com/partners/
Medical billing managing collections during COVID-19 will be different than it was in the past. It has already changed a lot about how medical practices operate, and in a short amount of time. One thing that hasn’t changed, however, is that practices need to get paid in order to continue operating. This includes sending patients to collections when necessary.
Managing late or unpaid bills during economic uncertainty may require a different approach than you’re used to. Before you send patients to collections, make sure you take these steps first.
- Be upfront about payment expectations from the beginning
- You should already have a strategy in place regarding informing patients how much they owe for services. Stick to it. Many people are hoping for leeway on certain bills due to the economic impact of COVID-19, but gently remind your patients that for essential healthcare services to continue, practices need to keep revenue flowing, and that means billing will continue as usual.
- Set up payment plans
- If a patient is unable to pay a bill in full, help them set up a payment plan. BillFlash PlanPay lets you set up scheduled, automatic payments to be paid over a set period of time. This is the best option for both you and the patient because:
- The patient has a more manageable bill
- Your practice is more likely to be paid in full
- Setting up a payment plan shows your patients you’re willing to work with them. That’s usually all they need to be assured that you care.
- Send out multiple reminders
- Use whatever resources you have—email, phone, text, mail—to contact patients about balances they owe. Be courteous in your reminders, but firm. Most patients want to pay their medical bills. Often all they need is a simple reminder and an easy way to make the payment.
- BillFlash helps you manage all of this during the pre-collections phase to help ensure you are paid as quickly and completely as possible.
If none of these steps work, then it’s time to get collections involved.
What to Include in a Collections Letter
Include all the facts of the visit. This includes:
- Date of service
- Service provided
- Amount patient owes
- Payment options
Tone of the Letter
The right tone in your letter can do more to ensure payment and a continued relationship with the patient than anything else you include. You need to convey a sense of urgency, but without being overbearing and intimidating.
A few tips to keep in mind:
- Empathize with the patient. Simply saying “We understand you may be experiencing financial difficulties at this time” is more likely to get a response than a curt “final warning” threat.
- Explain why it is important for the patient to pay anyway. Example: Like any other business, our practice relies on revenue to thrive. In order to continue to provide these valuable healthcare services, patients need to pay their bills in full and on time.
- Offer a payment plan. Give patients one more opportunity to pay their bill in smaller chunks over a period of time to avoid having their account sent to collections.
We’re all experiencing difficulties during this global pandemic. The only way to get through it is to work together. Being upfront with patients about payment expectations and being willing to work with patients who have fallen on hard times will help all of us through this global health crisis.
BillFlash Collections Services can help you in managing collections during COVID-19, and simplify and streamline all your other collection processes for you, saving you the headache of exporting, importing, and working with a disconnected agency.
As an EZclaim ‘preferred’ partner, BillFlash is fully integrated with the EZclaim Premier billing application. For more details, view this informational video: https://www.rcm.billflash.com/ezclaim For more information about the EZclaim billing solution, view our website: https://ezclaim.com/
There WILL NOT be any changes to the MIPS Program in 2020, so all payers must be submitted and a minimum of 45 points must be earned to avoid the 9% penalty.
On March 23, 2020, CMS made it perfectly clear that MIPS Program is not going away in 2020. It also reiterated that the data requirements and thresholds in place for the 2020 program have not changed. Additionally, Promoting Interoperability and Improvement Activities must be done for the required durations or no points will be earned for those categories.
To put this in context, while the stakes have been raised every year, the final ruling for the 2020 reporting period is the most complex to-date, further increasing the stress, burden and financial risk for over 900,000 clinicians who bill Medicare Part B. Failure to comply or earn enough points for the 2020 reporting period will result in an automatic 9% penalty on every Medicare Part B claim paid for an entire year. This equates to a minimum of a $8,100 per provider hit to the bottom line.
Given the unprecedented time when everyone’s bottom line is at risk, now is the time to get a handle on what’s at risk with the MIPS program and proactively engage to ensure your bottom line is not further jeopardized by being assessed a 9% penalty. It can be challenging to know exactly what you need to do to earn points, optimize your score, and protect your Medicare reimbursements, as there are many commonly misunderstood aspects and nuances with the MIPS program.
So, with what is at stake and the inherent complexity in earning points, it is critical that you select the right methodology and partner who can help you maximize reimbursements and protect your bottom line. Not all reporting methodologies are the same.
Health eFilings‘ CEHRT is the best choice for a reporting partner. Their cloud-based ONC certified software fully automates the process and does all the work without any IT resources, administrative support and workflow changes from the practice. Health eFilings service is an end-to-end electronic solution that will save significant time, be a turn-key submission process, and maximize the financial upside for providers.
As more than 25% of the 2020 reporting period is behind us, now is the time to act while there is still plenty of time to positively impact your results and points earned.
Health eFiling provides the nation’s only fully automated solution for MIPS compliance and is integrated with EZclaim’s billing solution. Click on the following link for more details: https://healthefilings.com/ezclaim
[Contribution by Sarah Reiter with the Senior VP of Strategic Partnerships]
During these unprecedented times, EZclaim is monitoring Coronavirus (COVID-19) developments, and are working to maintain the safety of our customers and employees. We are doing this by following the guidelines set forth by our state and local governments, and the recommendations from the CDC.
To enhance the safety of our employees, families, and communities, EZClaim is transitioning to a remote workforce to continue to serve our clients during this difficult period. We will remain available, and anticipate no disruption to our service or support.
Feel free to e-mail us or visit the contact page on our website to issue any question or concern.
Thank you for your patience, and please be safe!
Whether you are a person new to medical billing or someone who’s been in the business for years, launching a new medical billing practice can be hard. Understanding the market, connecting with new clients and knowing how to master your processes are challenges that you often learn as you go. Despite these challenges, it is rewarding to be out on your own growing a new company. Before you jump, let us help you understand some essential keys that you can research upfront and prepare yourself to get one step closer to being successful.
1. ONE BILLING PLATFORM VERSUS MULTIPLE PLATFORMS: First and foremost you must make a conscious decision to either focus on being an expert on an individual medical billing platform, like EZClaim, or tackling multiple platforms. There are pros and cons of both: being an expert can make you extremely efficient in your use of the software’s billing and, scheduling features, however, it can also limit your client base to only one set of software users. Whereas having a basic understanding of multiple platforms can allow you a larger base of medical offices while limiting your ability to truly understand how best to serve each individual client’s needs.
Pro tip: Start and master one trusted billing program, and grow your options as your billing business grows.
2. GET CLEAR ON THE CLEARINGHOUSE: A new billing company owner does not want to be held to just one clearinghouse as options are key here. Having the ability to work with any or many would be an essential piece to your billing services, however, you still want to know the best clearinghouses in the business. Understanding which clearinghouses provide the best products and services and being able to recommend those services to your client upfront will make your life easier and their business run smoother. For this very reason, EZClaim has built its software around partnerships and integrations with the best clearinghouses to make working with the one you need easy.
3. COMPLY OR DIE (HIPAA Compliance): The third key to any start-up is first understanding the importance of HIPAA Compliance. Medical billing firms literally can come crashing down with any missteps, mistakes, or misunderstandings of this essential piece of the puzzle. It goes without saying that if you are going to choose a billing software be sure that they have partnerships built around making sure you are protected. You are also responsible to make sure the data is protected so your customer and their patient’s data is safe.
HIPAA Hint: Check out Live Compliance for further details on the topic.
There are many options available out there for your new medical billing practice, and we recommend doing your research. Within that research, you will find that EZClaim ranks very high in performance and comes in at a great price.
To learn about EZClaim go to our about page, sign up for a demo and/or download a trial for free today!
An independent physician gastroenterology practice in Utah had to report a breach related to a dispute with a Business Associate to the Office for Civil Rights department of HHS.
After the investigation into the breach, it was determined that the practice of Steven A. Porter, MD “had failed to complete an accurate and thorough risk analysis, and failed to implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level” and therefore, has agreed to pay a $100,000 fine.
In addition to the monetary penalty, the practice is required to implement a Corrective Action Plan (CAP). According to the investigation resolution agreement, the practice agreed to conduct a thorough Risk Analysis, the Practice must develop a complete inventory of all its categories of electronic equipment, data systems, and applications that contain or store ePHI, which will then be incorporated into its Risk Analysis, and must complete a Risk Management plan. They must also revise and implement actionable policies and procedures, all of which should have been in place prior to the breach incident.
Have you ever read such headlines and doubted whether a small Billing Company or independent physician practice actually ever face penalties?
According to the Resolution Agreement, the practice must also completely reinvent their Business Associate process, and implement a strict protocol to ensure it’s Business Associates are HIPAA Compliant. In addition to ensuring their Business Associate relationships are accurate, the entire staff must undergo security and privacy training that stresses the use of Business Associate services and applications, disclosures to Business Associates that require a Business Associates agreement or other reasonable assurances in place to ensure that the Business Associate will and can safeguard the PHI and/or the ePHI. This puts immense pressure on the Business Associates, such as Billing Companies, to ensure that they are HIPAA Compliant, but also independent physician practices to ensure their Business Associates, “down the chain” are also compliant. This is also known as gaining Satisfactory Assurance of vendor HIPAA compliance.
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, a billing company, or other vendor, suspects a breach you must inform the covered entity (your client) and have a breach risk assessment completed to determine key factors and take action. Keep in mind, a business associate is a ‘person’ or ‘entity’. This means there is no Billing Company too small or too large to comply with the Federal HIPAA regulations. 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! 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. It’s easy, call us at (980) 999-1585, email me jim@LiveCompliance.com or visit LiveCompliance.com
[ Contributed by Jim Johnson, President of Live Compliance ].
There are many commonly misunderstood aspects and nuances with the MIPS program, particularly in how points are earned. For a healthcare practice it can be challenging to know exactly what to do to earn points, optimize the score, and protect their Medicare reimbursements. But, at the same time, the stakes have been raised every year and the final ruling of the program is even more complex than it has been in the past, further increasing the stress, burden and financial risk for a healthcare practice.
The approach a practice takes to report for MIPS will greatly impact the results. Many do not understand, or have awareness of, the different reporting methods available to them. Many Providers erroneously still 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 covers their reporting obligation or that an EHR’s reports satisfy the MIPS requirements. These misperception and erroneous assumptions are detrimental to the financial interests of any practice.
There is a third reporting methodology that has been established and authorized by CMS, called CEHRT, or Certified EHR Technology (software). The CEHRT methodology assists CMS with their need for more valid data submitted through technology and to refocus Providers from merely using technology towards Providers leveraging technology to improve outcomes. Reporting via a CEHRT using software that has been certified by the ONC is a superior approach because it optimizes the points that could be earned and therefore, maximizes Medicare reimbursements for the practice.
Recently an RCM company CEO approached us at Health eFilings with the decision to use six of her clients to conduct a side-by-side comparison of the registry and Health eFilings (CEHRT) methodologies for reporting. In this manner, she intended to validate for herself whether a CEHRT or registry would generate the greatest ROI for her clients. The results of using Health eFilings’ MIPS Accelerator service, on average earned almost triple the points versus a registry for the same year for the same clients.
“Due to limited understanding and guidance, we weren’t aware of the differences of the reporting methodologies available for my clients. We believed there was greater opportunity, but the current registry methodology we had chosen didn’t demonstrate that for our clients.”
Katy, RCM Company CEO
This side-by-side comparison highlights not only that a CEHRT is the superior method of reporting as Health eFilings was able to leverage technology to facilitate the ease, accuracy and completeness of tracking and reporting, but it also maximize a Provider’s MIPS score. Additionally, given the levels of Medicare reimbursements for these practices, the higher score resulted in their earning a positive payment adjustment, which significantly improved their bottom line. And, take note that if the Registry were to perform the reporting for the 2019 reporting period, these practices would not earn enough points to avoid the penalty of negative 7%.
Health eFilings with its proprietary ONC certified software has many advantages over any type of registry:
- Automatically extracts data from any EHR or billing system
- No staff or IT time required to comply
- Benchmarks performance versus peers based on CMS standards
- Proprietary algorithm evaluates 9 million combinations to select best quality measures to optimize score
- Earn 10% in bonus points for the Quality category
- eCQM deciles earn more points than registry deciles
- Almost all eCQM’s have a CMS benchmark versus less than 25% of registry measures
- Electronically submits the data to CMS
And, important to note that it’s NOT too late to comply for the 2019 reporting period as Health eFilings is able to support new clients, but time is of the essence. Reach out NOW if you or your client hasn’t reported for 2019—there is NO REASON to accept the 7% revenue hit.
Now EZClaim and Health eFilings want to ensure you can partner with the only complete, end-to-end MIPS compliance solution that saves you significant time and money. To learn more, click the following link: https://healthefilings.com/ezclaim
[ Article written by Sarah Reiter, Vice President of Strategic Partnerships with Health eFilings ].
This article about new patient billing methods was written by Angie Carter with NexTrust.
Communication is easier than it’s ever been, but a lot of practices aren’t taking full advantage of two of today’s most effective mediums of communication: email and texting. Patients, like all other consumers, spend a lot of time on their phones; it’s where they keep in touch with friends and family, as well as businesses they work with regularly.
Most practices rely heavily on phone calls to contact their patients about appointment reminders, insurance issues, etc. But many adults now prefer to communicate via email or text. Often a quick phone call will do the trick, but email and texting gets your foot in the door a lot more often. Furthermore, people are far more likely to respond to a text or email than a voicemail.
Here are a few ways to build your contact list at your practice to improve communication with patients, ensuring greater patient satisfaction and better cash flow.
- Collect cellphone numbers & email addresses during new patient registration.
Consider making these required fields. Allow the option to fill out more than one email address or mobile number as well, since most households have several. It would also be helpful to quickly explain why you need this information. BillFlash allows you to send out regular statements and eBills through email and text, and you can also quickly update your patients on any last-minute changes happening at your practice.
If you have a newsletter or regularly send out practice updates, make sure patients know about these as well. This is another opportunity to ensure you have the information you need to better communicate with your patients.
- Ask for an email address & cellphone number any time you confirm an appointment.
Even if your current patients have already given you this information, use appointment confirmations as an opportunity to verify the information you have on file is current. Email addresses change all the time, so it’s crucial to ensure they’re up to date so you know your messages are being received. And for patients who haven’t yet provided this information, this is a good time to tout the benefits of being digitally connected.
- Encourage mail-only patients to go paperless.
A huge barrier to patients paying their bills on time—or at all—is that it’s often not as simple to pay a medical bill as it is to pay, say, a utility bill. BillFlash simplifies this process tremendously, both for the patients and your practice. By providing an email address and cellphone number, patients can more easily stay current on their medical bills and procedures.
- Ask patients to provide feedback on your website.
Give your patients a space to express their thoughts at their convenience. Include a form on your website for patients to fill out—which would include their email address and phone number—and add the info they provide to your database. You could also post signs throughout your office encouraging patients to visit your website to provide feedback about the care they received that day.
- Add cellphone number/email to check-in sheet.
Most practices require patients to sign in whenever they come in for an appointment. Consider adding a column or two that asks for their email and cellphone number. At the top of the column you could include a note that says something like “Want to receive appointment reminders via text or email?” to reiterate the benefit patients will receive by providing this information.
- Offer patients an incentive to provide their email address & cellphone number.
People love free stuff—that’s a given. Try running a fishbowl incentive every few months. All patients would need to do is drop their email address and/or cellphone number into a bowl and they’ll be entered into a drawing to win a prize. And why reward just the patients? Incentivize your office staff to collect this information as well.
Everyone has a cellphone number and email address, but it does take some effort to collect them. But it’s effort that rewards you many times over, as this makes it easier to keep patients in the loop and ensure you get paid. BillFlash makes it easy to automate patient billing and payments—including sending reminders via email or text—to improve the financial health of your practice.
BillFlash is integrated into the EZclaim billing application. Click here to view a video that discusses the details.
For more information about new patient billing methods and sending electronic bill notifications through text and email, contact EZclaim or their statement and payment services partner, BillFlash, at 435-940-9123 or firstname.lastname@example.org