Feb 9, 2021 | Medical Billing Software Blog, Partner, Trizetto Partner Solutions
The COVID-19 pandemic has put a spotlight on the need for mental health resources as illness, job losses, and isolation continues to create unprecedented stress levels. According to recent surveys conducted by the Larry A. Green Center, more than half of clinicians reported declining health among patients due to closed facilities and delayed care, and more than one-third noted that patients with chronic conditions were in noticeably worse health as a result. Even more striking, over 85 percent reported a decline in inpatient mental health with 31 percent seeing a rise in addiction.
With mental health access at the forefront of our minds, there is no doubt a demand for qualified professionals that can handle these complex patient needs. While the sense of urgency for these services exists, especially as more and more healthcare consumers are resuming in-person appointments, unfortunately, there are processes in place that can create unnecessary roadblocks for practitioners.
Complying with the Council for Affordable Quality Healthcare’s (CAQH) behavioral health credentialing requirements are especially challenging. Unlike traditional medicine, treatments and therapies for conditions such as addiction are not as well understood by payers. This makes it more difficult to gain or maintain the credentials necessary to submit claims for therapy services.
Ninety percent of the time counselors and therapists apply for network status are denied! That’s a striking statistic, even for seasoned professionals, and everyone can agree that appealing denials and requesting payers review credentials in greater depth are a time consuming and expensive burden. On average, the time required for behavioral health credentialing of professionals is up to five times greater than for medical professionals because of nuances specific to the industry. The turnaround for completed enrollments is slower too, on average 180 days versus 120 days. In addition, some payers will only allow certain therapies for providers without advanced degrees. Because denials for behavioral health are common, therapists must understand which therapies a network will accept and focus on therapy-specific credentialing. In the current environment, practitioners should also ensure that Telehealth or virtual appointments will be covered for the safety of all.
So how can mental health providers stay ahead of enrollments and avoid credentialing-related denials? Outside assistance from experts like those at TriZetto Provider Solutions offers an end-to-end credentialing service that ensures continuous payer follow up and insight into enrollment status. Our credentialing professionals are devoted to helping providers gain and maintain their credentials. We understand the nuances associated with behavioral health credentialing and have direct relationships with all major payers. TPS allows you to do what you do best – manage patient care – by alleviating the burden of credentialing and making sure you never miss quarterly re-attestation deadlines.
If your mental health services are being denied, we are here to help. Learn how solutions from TriZetto Provider Solutions can help your practice simplify credentialing.
TriZetto Provider Solutions is a partner of EZClaim and can assist you with all your coding needs. For more details about EZClaim’s medical billing software, visit their website, e-mail their support team, or call them at 877.650.0904.
[ Contribution: The TriZetto Provider Solutions editorial team ]
Feb 9, 2021 | Claims, Electronic Billing, Features, Medical Billing Customer Service, Medical Billing Software Blog
Are you working in the medical billing industry as a biller or an owner of a billing company? If so, the KEY medical billing insights and best practices that came out of our interview with Maura Jansen (VP of Operations) and Jennifer Withington (Director of Revenue) at Missing Piece Billing & Consulting Solutions will be VERY VALUABLE for you to consider.
Jennifer, an expert in understanding the problem-solving techniques and the investigative nature of medical billing, offers insights that both educate and inspire. Maura, an executive member of the billing community, also added an important perspective about EZClaim’s medical billing software. The following are some highlights from our interview.
EZCLAIM: When did you get into the industry?
JENNIFER: “I worked in group homes for the waiver side of group aid and then I went to Missing Piece. Missing Piece primarily deals with ABA providers and provides early intervention rendered to children. For me, the move from waivers with adults to professional billing, indirectly assisting children, was attractive and I took to the billing side of things.”
EZCLAIM: What does that mean when you say you took to the billing side of things?
JENNIFER: “Insurance doesn’t make a lot of sense when you first start. So, I took to the investigative side of making sense of medical billing claims. Figuring out what the payer’s rules are, reading their manuals, and figuring out the technical jargon with the purpose of preventing claim denials was attractive. I liked the puzzle of it.”
EZCLAIM: Are there things that you value in your work that offer meaning to what you do?
JENNIFER: “It’s really when I know that if I do not intercede with the insurance company and get this paid the patient is going to be responsible for the balance. So, to help, I have taken things to the department of insurance, or I have gone ahead and filed that third letter of appeal and really taken the time to research it. Because I don’t want a parent who is already struggling with having a child with more needs than maybe the other children would have, I don’t want them struggling with a $25,000 bill. ABA is extremely expensive because it works. And so, if insurance doesn’t pay it then the only other funder is the parent. And my goal is that parents should not have to pay any more than they absolutely have to.”
EZCLAIM: What are some of the strengths that make you good at what you do?
JENNIFER: “I am a good problem solver. I am good at taking a large problem and breaking it into smaller problems and knocking each one down until I solve the bigger issue. At the end of the day, that’s really what accounts receivable is.”
EZCLAIM: What would be an example of your problem solving on a day-to-day basis?
JENNIFER: “So you always start with the denial and then you have to work back to the billing. For example, if I have a claim denied for services rendered from an out-of-network service provider, but we know we are in-network then my first problem is, are we actually in-network? Then, you go onto the next link which is did the payer recognize you as in-network? It becomes like a decision tree, if you get a ‘yes’ then you are probably done, and you get the claim processed. If it is ‘no’, then you have to start digging with the payers contacting reps, make calls, and supply them with documents to get down to why they don’t have your provider listed within the network. Once you solve that problem, then the claim should be able to be processed. It is either going to pay or deny. Then depending on which one it is, you apply the same technique.”
EZCLAIM: What would you offer someone who is considering entering the field?
JENNIFER: “You should be good at processing and reading information because to get a claim paid you to have to know the rules of engagement. You need to be familiar with how to read a contract, how to read technical information about billing, and have to have a glossary of information about what you are billing. Those are the building blocks to get to know what you are doing.”
EZCLAIM: You work with EZClaim’s medical billing software platform, what role does their software providers and how does that impact your work?
JENNIFER: “EZClaim really serves to eliminate these denials before they happen, which is the ultimate goal of any accounts receivable or billing. EZClaim has edits that we use. It alerts us if the system thinks the claim is a duplicate, for example. It also helps in the set-up of the claim. We load all the fee schedules in EZClaim’s procedure code library and that lets us monitor the charge rate, make sure all the points of billing are on the claim (i.e. correct code, modifier, and charge). They also make sure that the authorization is appended to the claim. And then after we have actually done the work of getting a claim in the system, we use EZClaim reports to audit our own billing. So, we use the EZClaim service report. It makes it easier for us and our providers to see what has been billed and make sure that the billing is correct.”
EZCLAIM: If you were going to share something with your colleagues in the field, what would you share about the software that makes your life easier?
JENNIFER: “Number one, it is not the software itself, it’s the EZClaim staff. Their customer service is far beyond what a normal billing software company provides. If I have a problem, or if I have a report, or if I have a data point that isn’t in any report, they are available and they are there for me. And if they don’t have a solution for the problem, they will provide me with a workaround. So, that is very valuable. That is why Missing Piece works so well with EZClaim because customer service is number one for us, too. They don’t just want to answer your question, they want to help you understand your question.”
“The other thing that I find valuable is that their reporting modules are just a lot more robust than the other billing software companies that I have dealt with.”
EZCLAIM: Maura, do you have any thoughts from an administrative level that you can offer on EZClaim?
MAURA: “Well, when we hire a new person we know that, even if this person has very little experience in the healthcare field, it’s going to be a quick and easy process for them to learn EZClaim… EZClaim has also made it kind of a joy to work with. We really value them as a partner. We love the service they provide, and we value them as a platform.”
ABOUT EZCLAIM:
EZClaim can also help you with medical billing insights since it is a medical billing and scheduling software company. It provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.
Jan 11, 2021 | Electronic Billing, Health eFilings, Medical Billing Software Blog, Partner
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 software, e-mail, visit their website, or contact them at 877.650.0904.
[ Article contributed by Sarah Reiter, SVP Strategic Partnerships, Health eFilings]
Jan 11, 2021 | Electronic Billing, Medical Billing Software Blog, Partner, Trizetto Partner Solutions
With a new year comes new medical coding changes.
After the examinations, x-rays, and surgeries, lives another major part of a physician’s day that happens behind the scenes. All the hard work needs to be processed through a successful claim submission, meaning that ultimately earning payment all boils down to one thing – coding. Evaluation and management codes, or E/M codes, are codes a physician uses to report a patient visit. This administrative task – a necessity for any physician – is often cumbersome and prone to errors. Most importantly, it uses up valuable time that could be better spent.
How many of us have experienced the “hurry up and wait” scenario? The type of appointment where you wait in a waiting room, then wait a little more in the exam room, then eventually get 10 minutes with your doctor…only to be rushed out so the next patient can be shuttled in. Unfortunately, it’s all too common. It’s safe to say that many patients could benefit from more face-to-face interaction with their providers.
Many people claim that payment for evaluation and management services is undervalued, specifically when it comes to ambulatory services. Additionally, it’s been argued that the fee schedule itself is not well-designed to support primary care, which requires ongoing care coordination for patients. Pressure existed to increase payment rates for ambulatory E/M services while reducing payment rates for other services. Thankfully, The Centers for Medicare and Medicaid Services (CMS) took notice. With the goal of increasing efficiencies to reduce unnecessary burdens, the “Patients over Paperwork” initiative was established. Per CMS, E/M codes make up 20% of total spending under the physician fee schedule. Part of this initiative aims to reduce the coding and documentation requirements for E/M codes, in turn giving physicians more time to spend with patients. In partnership with The American Medical Society (AMA), CMS worked to revise the rules for evaluation and management coding requirements. These changes were finalized in the 2020 Physician Fee Schedule (PFS) with an effective date of January 1, 2021.
So what exactly was revised? The E/M updates affect codes 99201 through 99215 and include the deletion of code 99201 along with revisions to the code selection for 99202 – 99215. Below is a summary of the revisions to E/M codes:
- Elimination of code 99201
- Decrease the burden of coding requirements
- Decreases the burden of documentation
- Decreases the need for audits
- Revises the definitions for Medical Decision Making (MDM)
- Revises the definition of time spent with the patient to total time including non-face-to-face for E/M services by a physician and other QHP
- Requires a history and/or examination when medically< necessary
- Offers a clear time ranges for each code for time spent with the patient
- Addition of a new 15-minute prolonged service code
- Clinicians will choose a code based on MDM or total time
These changes apply to office visits and other outpatient services. It’s noteworthy that these changes represent the first changes to the E/M codes in over 25 years! More importantly, the changes streamline the coding process, reduce clinician burden, and will allow physicians to put the focus back on patient care.
Billing and coding should always be top of mind, but it can be hard to keep up. This is why it’s critical for physicians, clinicians, coders, and billers to completely understand these changes. To help comprehension, the AMA released a checklist identifying ten steps to help the practices prepare for the upcoming changes that can be accessed here. To learn more about the medical coding changes and the summary of revisions, visit the AMA website.
TriZetto Provider Solutions is a partner of EZClaim, and can assist you with all your coding needs. For more details about the EZClaim medical billing solution, visit their website, e-mail their support team, or call them at 877.650.0904.
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Note: This article is not a comprehensive overview and is NOT intended to provide coding advice, rather it is intended to highlight the new changes in effect and the need for physicians to ensure they have received the proper training for the upcoming changes.
[ Contributed by TriZetto Provider Solutions Editorial Team ]
Dec 14, 2020 | Live Compliance, Medical Billing Software Blog, Partner, Support and Training
There are a few HIPAA items to focus on RIGHT NOW—before the end of 2020!
The U.S. Department of Health and Human Services (HHS) has designated the “Health Insurance Portability and Accountability Act” (HIPAA) as the national standard for protecting the privacy and security of health information (in 1996). This led to the Health Information Technology for Economic and Clinical Health Act (HITECH), which has a provision in it for audits, and the HHS Office for Civil Rights is responsible for carrying out HIPAA audits, and responding to complaints and breaches. Ignoring them is not an option!
A Risk Assessment IS NOT Enough
A risk assessment is only one element of the compliance process. You must also “implement security updates as necessary and correct identified security deficiencies.” In other words, you must act via a Corrective Action Plan (CAP) and follow the required risk assessment process.
Dark Web
It is no secret that the “Dark Web” is a scary place to lose your information. So, what if it did happen and affected your entire company? Identity thieves get anywhere from $1-$1,000 for medical records, for each instance! So, how can you protect yourself and/or your organization?
Well, data breaches are becoming more common—sometimes which are out of your control—so carefully monitoring where you store and enter your passwords can be extremely beneficial to help minimize the risk of a hack and keeping personal or patient information protected.
One solution for this is the automatic Dark Web monitoring built into the portal of one of EZClaim’s partners, Live Compliance. Their solution helps keep an ‘eye’ on employees whose information was involved in a breach, and suggests next steps to take where the breach was found. Then, it allows your to conduct an accurate and thorough Security Risk Assessment. This is not only required, but is a useful tool to expose potential vulnerabilities, including those that involve password protection.
So, what can I do to ensure this doesn’t happen to me or my organization? Well, Live Compliance makes checking off your compliance requirements extremely simple by providing:
● Reliable and effective compliance
● Completely online, our role-based courses make training easy for remote or in-office employees
● Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location.
● Policies and procedures are curated to fit your organization, ensuring employees are updated on all workstation use and security safeguards in the office, or out. It is updated in real time.
● An electronic document is sent to employees and business associates
So, don’t risk your company’s future, especially when Live Compliance offers a FREE Organization Assessment to help determine your company’s status.
For additional details, call them at 980.999.1585, e-mail them, or visit their website at LiveCompliance.com
[ Article provided by Jim Johnson of Live Compliance ].
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call a representative today at 877.650.0904.
