Optimize your MIPS Score and Protect your Reimbursements

Optimize your MIPS Score and Protect your Reimbursements

MIPS is a point-based program and understanding how to earn MIPS points is critical to avoid a 9% penalty. The MIPS program continues to change and evolve each year as it meets the goals laid out in the MACRA law and carried out by CMS.  Since the program was implemented in 2017 the points threshold to avoid a penalty has grown from 3 to 60 out of a possible 100 MIPS points; the penalty has increased from 3% to 9% of annual Medicare reimbursements; and, the number of patients required to be reported on has increased from 20 patients to all patients for all payors.  With the rules changing every year, the strategy you previously used to score MIPS points and report may no longer be optimal.  If you want to avoid the 9% penalty in 2021 and beyond, you must think differently and evolve your strategy for MIPS.

With all the complexities and nuances of the program, it’s challenging to know what you can do to impact your MIPS score.  Here are three critical considerations that provide guidance on ensuring you have the right MIPS strategy to optimize your ability to earn MIPS points for the 2021 reporting period.

The Quality Category, worth the most points, is the category to focus most of your effort.  Because the Quality category is worth anywhere from 40 to 85 MIPS points, focusing on this category throughout the year is critical. You need to submit a full year’s worth of data so now is the time to ensure that you are capturing all relevant data in your EHR and or billing system so that it can be properly extracted and reported on for your submission.

40% of the MIPS points require you meet stringent timeframe requirements.  Two of the  MIPS categories, Promoting Interoperability and Improvement Activities, have timeframe requirements where you must perform and document activities for a minimum of 90 continuous days.  These are not easy categories in which to be successful and so if you wait too long you will find it impossible to put the right actions in place to complete the activities necessary to earn any of the MIPS points in these categories.

The reporting methodology you choose impacts the points you can earn.  Not all reporting methodologies are the same and the reporting methodology you select has a significant impact on the MIPS points you could earn.  Unless you select a reporting partner that will help you earn the most points available by leveraging technology to facilitate the ease, accuracy, and completeness of tracking and reporting to maximize your score, you risk leaving MIPS points on the table and significantly sub-optimizing your score.  Reporting via a CEHRT, like Health eFilings, is the best approach because it optimizes the MIPS points that could be earned and therefore, maximizes Medicare reimbursements.

Health eFilings’, a CEHRT, is the national leader in automated MIPS reporting and our cloud-based ONC certified software fully automates the MIPS reporting process.  And because Health eFilings’ service is an end-to-end electronic solution that doesn’t require any IT resources, administrative support, or workflow changes, you will save significant time while maximizing your financial upside.

Contact Sarah Reiter, sreiter@healthefilings.com, or 608.841.1866 to find out how to maximize your 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.

[ Contribution from the marketing team at Health eFilings’ ]

Integrating an EHR and PM – RCM Insight

Integrating an EHR and PM – RCM Insight

Have you ever been a bit overwhelmed when shopping around for all your medical practice needs?  Of course!  There are so many pieces required to meet all the HIPAA and reporting requirements, but it’s also about efficiency and ease of sharing information between clinicians to administrators.  This can make the all-in-one Electronic Health Record (EHR) and Practice Management (PM) systems very tempting.  Keep in mind, you will pay a hefty price for an all-in-one, which makes this a very simple decision for some practices.  The good news:  You have alternatives that still provide the same ease of sharing data through integration.  I recently interviewed Dan Loch, President of EZClaim Software, LLC.  EZClaim offers a stand-alone billing platform that offers several options for integration with clearinghouses and EHR’s.  I asked Dan what he felt the biggest advantages were to using stand-along programs.

    1. Your practice will get the best of both worlds! Often practices will find a great EHR, but the billing side is not the best, or vice-versa.  Using stand-alone programs that can talk to each other allows a practice to choose an EHR solution that is best for their clinicians AND a PM solution that is best for the billers and administrators.
    2. Typically, stand-alone systems are more ‘nimble’ in responding to industry and regulatory changes.
    3. Integrating multiple ‘best-in-class’ software packages creates an offering with much more in-depth capability.

If you are currently using separate EHR and PM solutions but the programs are not integrated – consider looking into this feature.  This will relieve the burden of entering data twice.  Start by verifying if the programs have an existing integration.

    • If so, the hard part is done! Just ask what the process is to get set up and if there are any fees associated.
    • If not, consider contacting your PM software vendor to inquire what formats they accept for EHR integrations. Once they provide the specs, work with your EHR to determine if you can export in the required format.

There is no single solution that works for every practice.  If you’d like to learn more, check out this article from EZClaim ‘All-in-One’ or ‘Specialized’ Medical Billing Software?  Which is Best?  I hope that this information will help you weigh your options and find the right fit for your specific situation.  If you have questions or would like some help determining what would be best, RCM Insight is here to help!  Visit us at www.rcminsight.com and submit a request to chat on the Contact Us page.

 

Are You a MIPS Expert?

Are You a MIPS Expert?

If you are not a MIPS expert (Merit-based Incentive System), your Medicare reimbursements may be decreased by 9% in the next year. However, it’s not too late to avoid the penalty for the 2020 reporting period, but you need to act now!

One of EZClaim’s partners, Health eFilings’ has ONC-certified software that completely automates the MIPS compliance process for you. The software will automatically extract the required data directly from EZClaim (and/or your EHR), and then proprietary algorithms will process the 9,000,000 possible combinations of quality measures for each clinician to identify which measures should be submitted to CMS (Centers for Medicare and Medicaid Services) to earn you the most points.

Need a MIPS expert? Well, Health eFilings is one of the best, and CMS has accepted 100% of their submissions on behalf of their clients. If you have completed your 2020 reporting, reach out to them, and learn how you can earn even more points in 2021.

For more information about EZClaim’s medical billing softwaree-mail, visit their website, or contact them at 877.650.0904.

[ Article contributed by Sarah Reiter, SVP Strategic Partnerships, Health eFilings]

Life Cycle of a Medical Bill (Revenue Cycle 101)

Life Cycle of a Medical Bill (Revenue Cycle 101)

Life Cycle of a Medical BillThere are five ‘phases’ in the life cycle of a medical bill: Pre-appointment; Point of care; Claim submission; Insurance payment or denial; and Patient payment. This post will overview each of these phases, and could even be considered to be a “101-level” course on Revenue Cycle Management.

With high deductible health plans on the rise, the recent explosion of telehealth appointments due to COVID-19, and many other factors in play, it’s more important than ever for everyone to understand the life cycle of a medical bill, and how the process works. The healthcare revenue cycle is relevant not only to those who work in healthcare, but to the patient, too.

The revenue cycle is the series of processes around healthcare payments—from the time a patient makes an appointment to the time a provider is paid—and everything in between. One way to think of it is in terms of the life cycle of a medical bill. Although there are many ways this process can play out, this post will lay out a common example below:

1. Pre-appointment
For most general care, the first stage of the revenue cycle begins when a patient contacts a provider to set up their appointment. Generally this is when relevant patient information will begin to be collected for the eventual bill, referred to on the financial side of healthcare as a claim.

At this point a provider will determine whether the appointment and procedure will need prior authorization from an insurance company (referred to as the payer). Also, the electronic health record (EHR) used to help generate the claim is created, and will begin to accumulate further detail as the provider sends an eligibility inquiry to check into the patient’s insurance coverage.

2. Point of care
The next step in the process begins when the patient arrives for their appointment. This could include when a patient arrives for an initial consultation, an outpatient procedure, or for a follow-up exam. This could also include a Telehealth appointment.

At any of these events, the provider may charge an up-front cost. One example of this is a co-pay, which is the set amount patients pay after their deductible (if they are insured), however, there are other kinds of payments that fall into this category, too.

3. Claim submission
After the point of care, the provider completes and submits a claim with the appropriate codes to the payer. In order to accomplish that, billing staff must collect all necessary documentation and attach it to the claim. After submitting the claim to the payer, the provider’s team will monitor whether a claim has been been accepted, rejected, or denied.

[ Note: Medical coding refers to the clerical process of translating steps in the patient experience with reference numbers. The codes are normally based on medical documentation, such as a doctor’s notes or laboratory results. These explain to a payer how a patient was diagnosed and treated, and why. This information helps the payer decide how much of an encounter is covered under any given insurance plan, and therefore how much the payer will pay. ]

4. Insurance payment or denial
Once the payer receives the claim, they ensure it contains complete information and agrees with provider and patient records. If there is an error, the claim will be rejected outright and the provider will have to submit a corrected claim.

The payer then begins the review process, referred to as adjudication. Payers evaluate claims for accurate coding and documentation, medical necessity, appropriate authorization, and more. Through this process, the payer decides their financial obligation. Any factor could cause the payer to deny the claim.

If the claim is approved, the payer submits payment to the provider with information explaining details of their decision. If the claim is denied, the provider will need to determine if the original needs to be corrected, or if it makes more sense to appeal the payer’s decision.

Following adjudication, the payer will send an explanation of benefits (EOB) to the patient. This EOB will provide a breakdown of how the patient’s coverage matched up to the charges attached to their care. It is not a billing statement, but it does show what the provider charged the payer, what portion insurance covers, and how much the patient is responsible for.

5. Patient payment
The next phase occurs when the provider sends the patient a statement for their portion of financial responsibility. This stage occurs once the provider and payer have agreed on the details of the claim, what has been paid, and what is still owed.

The last step occurs when a patient pays the balance that they owe the provider for their care. Depending on the amount, the patient may be able pay it all at once, or they might need to work with the provider on a payment plan.

 

The above example represents one way the lie cycle of a medical bill can play out. Some of the ‘phases’ are often repeated. Because of the complexity of healthcare payments and the parties involved, there is not always a ‘straight line’ from patient care to complete payment. That’s why we call it the revenue cycle, and there are companies that provide systems for its management.

One of EZClaim’s partners, Waystar, aims to simplify and unify healthcare payments. Their technology automates many parts of the billing process laid out above, so it takes less time and energy for providers and their teams, and is more transparent for patients (Click here to learn more about how Waystar automates manual tasks and streamlines workflows.) When the revenue cycle is operating at its most efficient, providers can focus their resources on improving patient care—and that’s a better way forward for everyone!

For more information of how Waystar works together with EZClaim, click here.

[ Article and image provided by Waystar ]

———————————-

ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support, and can help improve medical billing revenues. To learn more, visit their website, e-mail them at sales@ezclaim.com, or call a representative today at 877.650.0904.

New HIPAA Compliance Requirements Coming!

New HIPAA Compliance Requirements Coming!

New HIPAA compliance requirements are coming!

In an effort to make the HIPAA Privacy Rule as easy to understand as possible, the Office for Civil Rights (OCR) has come up with a list of rules that clearly explain what Business Associates are now “directly liable” for. As OCR Director Roger Severino explains, “We want to make it as easy as possible for regulated entities to understand, and comply with, their obligations under the law.”  The list consists of ten rules that, if failed to follow, can result in penalties and monetary fines.
[ Note: Check out our previous post to access this list ].

 

Immediate Requirements:
As we enter the fourth quarter of the year, you may be wondering what immediate requirements should a Business Associate complete before the end of the year?

One of the most important rules also includes information about Business Associates, and their need for proof of satisfactory assurance when the covered entity requests this of them. Satisfactory assurance is crucial, because it ensures the Business Associate is HIPAA compliant, and therefore, must also be in the form of a contract.

The Satisfactory Assurance contract is oftentimes outlined in the form of a questionnaire, and requires the Business Associate to disclose the date of completion for various compliance requirements.

These include distribution and completion of workforce HIPAA training, implementation and distribution of policies and procedures, Business Associate documentation, and completion of an annual HIPAA Security Risk Assessment.

 

Are You Prepared?:
If a Covered Entity requests this proof from your organization, would you be able to successfully complete it without outdated completion?

If you are uncertain that your organization would be able to easily and efficiently provide that documentation, you may be facing thousands of dollars in fines for each vulnerability!

 

HIPAA Compliance Myths: 

False: The security risk analysis is optional for small providers: All providers who are “Covered Entities” under HIPAA are required to perform a risk analysis. In addition, all providers who want to receive MU, and MIPS incentive payments must conduct a risk analysis.

False: Our office uses the Cloud, so we don’t need a risk assessment: Even if you have a fully HIPAA compliant cloud vendor, your patient data (ePHI and PII) still must go through all your systems to get to the cloud. So, you are still required to perform technical, administrative, and physical security risk analyses.

False: Our EHR makes us compliant, so we’re fine: While your EHR may provide excellent privacy and security features, it definitely doesn’t exempt you from the HIPAA security requirements.

 

Live Compliance helps their clients meet the ever changing and complex HIPAA State and Federal regulations. They protect the information they are entrusted with, and ensure their clients pass any Health and Human Services audits. If you are unsure or need assistance, call Jim Johnson with Live Compliance at (980) 999-1585.

Live Compliance is a partner of EZClaim, a medical billing software company. For more details about their solutions, visit their website at ezclaim.com.