6 Telehealth Revenue Cycle Metrics to Track Right Now!

Revenue Cycle Metrics to TrackIn the wake of the COVID-19 pandemic, Telehealth adoption has exploded, and there are six revenue cycle metrics to track.

Many patients are prohibited or reluctant to venture out for on-site care. The combination of relaxed regulations and expanded payment parity for appointments has made virtual meetings easier and more attractive for providers, who are turning to these technologies to stay engaged with patients—and maintain cashflow. Dr. Robert McLean, a former president of the American College of Physicians, recently said, “this crisis has forced us to change how we deliver health care more in 20 days than we had in 20 years.”

A new industry report predicts that the number of Telehealth visits in the US will surpass one billion by the end of the year, and speculates that nearly half of those visits will be related to COVID-19. At Waystar, we have been closely monitoring claim trends and are seeing this growth firsthand. In fact, the volume of Telehealth claims on the Waystar platform has grown by more than 100 times since mid-March. On two particular days in late April, they accounted for more than 15% of our total daily claim volume. Before COVID-19, they would have accounted for less than one percent!

For many providers, this shift will require new revenue cycle strategies to meet growing patient demand without overwhelming clinicians and administrative teams—or already strained operating budgets. It’s important to remember this is still very much an evolving care delivery model with the opportunity for errors on the part of both payers, providers, and administrative staff. For this reason, revenue cycle professionals should diligently monitor claims to ensure proper adjudication, identify learning opportunities, and uncover areas for operational improvement.

Below, we’ve listed six core Telehealth-related metrics you should regularly track to ensure billing accuracy, maximize payer reimbursement and reduce claim rejections and denials. For more on how to best navigate the evolving telemedicine landscape, check out our resource hub here.

To report on Telehealth-related claims, you’ll first need to identify and isolate claims containing Telehealth procedure codes. See CMS’ Telehealth code list to identify the specific procedure codes and modifiers that apply to your organization.

Payer Analysis:
1. Payer Telehealth claim rejections by volume and/or billed amount
2. Payer Telehealth claim denials by volume and/or billed amount

If your Telehealth claims are being denied or rejected, do you know which specific payers are doing so at the highest rate? Drill down to discover the specific reason codes payers are attaching to rejections and denials so you can better understand payer-specific rules and avoid these oversights in the future. In some cases, you may identify trends that warrant a call to the payer to correct.

Provider Analysis:
3. Telehealth claim volume by provider

Review this claim volume by individual provider. If you notice providers within your organization generating a much lower volume of Telehealth claims than peers, perhaps they could benefit from additional training on Telehealth technology and use cases.

Ensuring Billing Accuracy:
4. Telehealth claim rejections by biller/team
5. Telehealth claim denials by biller/team

Are certain billing personnel or teams producing higher denial or rejection rates than others? Keep a close eye on these trends and remember most of this is new for everyone. If some team members are seeing more rejections or denials than they should, it could be a great opportunity to hold trainings and collaborate on strategies for success.

Maximizing Reimbursement:
6. Telehealth claim volume by procedure code

Which Telehealth codes are you using? Each code reimburses at a different rate, so choosing the wrong ones could leave money on the table. Be sure to read up on CMS’  requirements (check out their fact sheet and code list) to ensure you’re choosing the appropriate code(s) on each Telehealth claim.

 

Waystar Analytics
You have all the data you need to drive informed decision making and improve financial performance—you just need the right analytics tool in your corner. Our new Waystar Analytics solution offers a pre-built Telehealth dashboard that can help you easily interpret, share all the metrics above, and track these revenue cycle metrics. Click here to learn more about Waystar Analytics and how it can deliver the insights you need during this time of transition.

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[ By Waystar ]

Collecting Payments from Patients. Find Out How.

Collecting Payments from PatientsThe most important thing a medical practice can do for their financial health is collecting payments from patients. So, because patients are not usually savvy when it comes to the nuts and bolts of their contract, they become frustrated when you send them a bill and, beginning on January 1st, your office staff get inundated with the question, “Why do I have a balance?”

“Approximately 68% of patients with bills of $500 or less did not pay off the full balance during 2016—up from 53% in 2015 and 49% in 2014.” 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, let’s make sure your office is equipped and able for collecting payments from patients for the services you rendered, rather than them becoming a part of this scary statistic.

Let’s 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.

Maximum 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.

Now, keep in mind that 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, 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 to collect after the visit.

In addition to that, 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. Or, if you ready to get started right now, then download your FREE 30-day demo today!

[ Written by Stephanie Cremeans of EZClaim ]

Improve Your Billing Processes

Improve Your Billing ProcessesIf you are a member of the MEDICAL BILLING COMMUNITY, the norms of the day-to-day have changed. With the recent COVID-19 pandemic and the ‘stay-at-home’ order, you may find yourself with either more time on your hands and/or an increase of claims with new patients.  During this time, we want to offer you a couple of suggestions so that you can make the best use of the additional time you have, and also help you improve your billing processes.

The first thing to consider is to review your Accounts Receivable (AR)—to collect payments due you to INCREASE YOUR INCOME.  According to the American Medical Association (AMA), claim denial rates range between 0.5% and up to 3% or more, and that 90% of claim denials are preventable. Some of the most common claim denial reasons can be rectified by correcting claim management workflows, including claim submission and patient registration procedures. The following are a few of the most common oversights for claim denial.

  1. Use EZClaim software to check automatically for missing information, including absent or incorrect patient demographic information and technical errors
  2. Make sure you do not have duplicate claim submissions
  3. Check that claims do not have services previously adjudicated
  4. Review for claims with services not covered by the payer
  5. Make sure the time limit for claim submission has not expired

Secondly, revisit and resubmit open claims.  Surprisingly, 31% of providers still use a manual process to resubmit. Our partner, TriZetto Provider Solutions (TPS), has an Advanced Reimbursement Manager Pro (ARM) that has two great tools that can improve your ability to tackle collecting and repaying underpaid and overpaid accounts. Below are some key features that can be automated by their software, and will help to improve your billing processes:

  • Identify common errors and payer trends
  • Analyze contract performance
  • Customize and assign work into queues
  • Quickly access information from interactive dashboards
  • Automate the appeal process

Thirdly, know that EZClaim and our partner TPS have worked together to bring you the most powerful medical billing software tools to solve claim denials. Our partnership not only simplifies the billing process but also helps resolve denied claims in an efficient way. In addition to that, our customer support team is available to help you learn best practices with these tools, and support you however you need it.

Finally, if you are frustrated with your current medical billing solution, investigate how EZclaim’s medical billing solution may work for you.  You can either schedule a one-on-one consultation with our sales team or download a FREE TRIAL to check it out the software yourself. For additional information right now, contact EZclaim’s sales team at 877.650.0904 or send an e-mail to sales@ezclaim.com.

Watch Medical Billing Webinar on Telehealth

Medical Billing Webinar on TelehealthA recent medical billing webinar on Telehealth that EZclaim hosted is now available to review.

On April 30th, EZClaim hosted a Telehealth Updates Webinar for our clients with guest speaker Sandy Giangreco Brown – Director of Coding and Revenue Integrity Health Care at CliftonLarsonAllen, LLP

We had one of the largest viewing audiences 101 active attendees in the session. Sandy shared informative billing codes and direct links to update hands-on information for billers actively coding Telehealth sessions. For those of you who missed it, we have provided on our website the recorded session ezclaim.com/webinars and can provide the presentation slides too! Just send a request to: sales@ezclaim.com

We continue to get views of this presentation and look forward to hosting more hot topics with the CLA Team.

With the onset of COVID-19 came a great opportunity for clinics and hospitals to offer Telehealth and Communication Technology Based (CTSB) services. The Centers of Medicare and Medicaid Services, or CMS, have provided many updates to the available services that can be provided and billed to the patients to help practices not only stay afloat financially but also and most importantly, to keep their staff safe and provide excellent care to their patients!

There were new guidelines released even after this webinar on 4/30/2020 (which can be found here – https://www.cms.gov/files/document/se20016.pdf, and now includes audio only Telehealth for services such as psychotherapy, tobacco cessation and medical nutrition counseling as well as diabetes self-management training. CMS is also increasing the payments for the Audio Only services from $14-$41 nationally to $46-$110.

As of April 30, 2020, in order to bill Telehealth, RHCs are now required to bill the G2025–CG–95 from January 27, 2020 to June 30, 2020. Then on July 1, 2020 to the end of the PHE, they will be billing the G2025 with an optional 95 modifier, per CMS SE20016 Medicare Learning Network Transmittal.

FQHCs will need to report three (3) codes for their Telehealth Services:

  1. G0467 (or other appropriate FQHC specific payment code)
  2. 99214–95 (or other FQHC PPS Qualifying Payment Code)
  3. G2025–95

CLA is on the frontlines and closely monitoring and analyzing activities related to Telehealth and other virtual health regulations

CMS Telehealth fact sheet, Frequently Ask Questions:

As your practice adjusts to Telehealth going forward, EZclaim’s medical billing solution can help you simplify patient billing and help you get paid for Telehealth visits. (Our recent medical billing webinar on Telehealth may just help you better understand the current situation).

So, to help you investigate how EZclaim’s medical billing solution may work for you, either schedule a one-on-one consultation with our sales team, or download a FREE TRIAL to check it out the software yourself. For additional information right now, contact EZclaim’s sales team at 877.650.0904 or send an e-mail to sales@ezclaim.com.

[Contributed by Sandy Giangreco Brown – Director of Coding and Revenue Integrity Health Care, CliftonLarsenAllen LLP]

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