In the world of healthcare revenue cycle management, there are numerous scenarios that can put a stranglehold on your revenue if you’re not prepared. With the COVID-19 pandemic causing varying degrees of change in inpatient volumes and visits, and telemedicine coming further into play, physicians and their practices are having to quickly navigate the nuances of their financial well-being. A practice may be buttoned up from the time the patient walks in the door, but what happens after the visit will determine when the practice will get paid. This element of the revenue cycle starts with coding. Here are five medical coding challenges that will ruin your bottom line.
1. Coding to the Highest Specificity
Missing data on a claim relative to the patient’s diagnosis and procedure can easily cause a rise in denials once received by the payers, resulting in potentially thousands of dollars in write-offs. Medical coders are responsible for coding patients’ claims to the highest level of specificity, ensuring the appropriate CPT, ICD-10-CM, and HCPCS codes are applied based on the patient’s chart from the day’s services.
COVID-19 and telemedicine are frequently bringing on new codes and code sets, all with different variations and modifiers to make the matter even more complex. Medical coders spend a lot of time researching and learning new codes, but every year – and throughout the year – changes and updates are made. Payers don’t only want to know the diagnosis and the treatment; they want to know the cause as well. The Coronavirus Aid, Relief, and Economic Security Act passed in March of 2020 allows for an additional payment from Medicare of 20 percent for claim billed for inpatient COVID-19 patients, however, it was later indicated that a positive COVID-19 test must be stored in the patient’s medical records in order to be eligible for this payment. Being able to stay on top of codes specific to the patient’s diagnosis at treatment is more difficult than ever before.
While code specificity is important, so too is ensuring the claims do not contain codes for exaggerated procedures, or even procedures that were never performed, resulting in reimbursement for these false procedures. This seems logical enough, but upcoding can easily occur as a result of human error, misinterpretation of a physician’s notes, or lack of understanding of how to appropriately assign the thousands of ICD-10-CM codes in existence. To add to the pressure, the Office of the Inspector General issued a plan with objectives to prevent fraud and scams, and remedy misspending of COVID-19 response and recovery funds.
Much like under-coding or not providing enough data on the patient’s visit can create issues, upcoding can be a major contributor to financial loss for a practice. Questionable claims can be denied and sent back for corrections and appeals, but upcoding can have more serious ramifications outside of paper-pushing between coders and payers.
Whether it’s making sure the codes are in accordance with the care provided, understanding the code sets that apply for each procedure, or comprehension of the medical record, refraining from upcoding will help ensure a sturdy and compliant revenue stream.
3. Missing or Incorrect Information
There’s a common theme to coding challenges, and that’s having the sufficient information necessary. This information typically is pulled from a patient’s chart or record of a visit, which is often completed by the attending physician. However, even when a claim is submitted, providing required information relative to the procedure to the payer is critical as well. Situations such as failure to report time-based treatments (such as anesthesia, pain management, or hydration treatments) or reporting a code without proper documentation can result in denials.
Furthermore, information in a patient’s electronic health record may also contain inaccurate information. Keystrokes and other human errors can cause these situations to flare up, and it takes a diligent, thoughtful coder to read between the lines and ensure claims have the appropriate information.
4. Timeliness of Coding
The Medical Group Management Association (MGMA) suggested in their 2018 Setting Practice Standards report that a Primary Care Physician should maintain a claim submission rate of 3.11 days after the date of service, but it is becoming increasingly difficult for practices to sustain anything close to this rate. Constant changes to code sets, an increased focus on submitting claims with sufficient and compliant information, and the requirement to code claims to the highest level of specificity, can easily delay the submission by days or weeks.
Nevertheless, delays in coding and submitting claims can cause major lags in payment and substantial loss in revenue. Insurance payers have statutes of limitations that require claims to be submitted anywhere from 120 to just 60 days after the date of service. Simply put – the more time spent coding the claim, the later it will be submitted, thus increasing the odds that the claim will be denied. Expert coders are aware of this and do everything in their power to get coded claims out the door.
5. Staffing Shortages
However, finding experts well versed in coding claims quickly, accurately and in compliance with the False Claims Act is not always an easy task. As you can imagine, the increasing need for care within the senior population is causing a rise in claim volumes, and trying to find a team of coders who know the ins and outs of complex ICD-10-CM coding can easily cause a bottleneck in the revenue cycle. Health executives expressed their struggles to find talent back in 2015, and some forecasts expect a decline in commercial payments by 2024 to further hamper a C-suite’s ability to manage labor costs. The ramifications of incorrect coding are still a key topic of discussion to this day.
The time has come for practices to begin looking outside of their organization for coding support. How is your practice planning to tackle the coding conundrum? When choosing a partner for your medical coding needs, you need to pick an expert to help your practice stay on target. TriZetto Provider Solutions, a Cognizant Company, has available highly-trained, AAPC & AHIMA certified coders with the experience of getting the details right the first time and understand the importance of coding to the medical practice.
For more information about TriZetto Provider Solutions, a partner of EZClaim, visit their website, contact them, or give them a call at 800.969.3666.
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 them today at 877.650.0904.
[ Contribution of the TriZetto Provider Solutions Editorial Team ]
How to Modernize Your Medical Billing Payments Now
It is now very important to modernize medical billing payments capabilities since upwards of 80% of medical services that don’t get paid by insurance, never get paid!
Are you tired of providing medical services and not getting paid? Have you billed patients for their medical visit or co-pay just to find out that the bill showed up in collections? Are you looking for a better way to use modern technology to increase the number of medical claims being paid on time? If you own a medical practice or work in the medical billing industry, then chances are you have answered each question with a hearty “Yes!”
Last month, medical billing industry leaders came together to discuss how medical practices can streamline their paymentsystems and integrate credit card processing into their billing system. [ Participants: Dan Loch (VP of Sales & Marketing, EZClaim), Tony Peterson (VP of Business Development, BillFlash), and Michael Jones (Payment Services Analyst, FullSteam) all joined host Susan Martinez (Sales Consultant, EZClaim) ].
• CHANGING SYSTEMS AND PROCESSES: The practices that are winning in the payment collections game, and seeing the highest percentage of claims paid, are the offices that have updated their systems from the old school and traditional forms of payment collection to the modern, state-of-the-art systems with payment integration. Plain and simple, this means first educating the patient from the moment they walk in the door and streamlining your payments into one medical billing system to prevent human error. [ Click here to LEARN MORE ].
• STREAMLINING CREDIT CARD PROCESSING: Practices often have jumped headlong into credit card processing by using simple systems with variable fees like Square or Stripe. The problem with that is two-fold: First, understanding processing fees, and secondly, avoiding the errors that occur in the steps of processing those purchases over to the billing record. However, now EZClaim’s medical billing software has an integrated payment feature—which streamlines the billing and simplifies the fees. [ Click here to LEARN MORE ].
These are only a few of the very informational topics that were discussed during this podcast. If you are interested in learning how your practice can put these systems in place, increase patient payments, and simplify your billing process in your office, then click here to listen to the podcast and prepare to learn some new, up-to-the-minute ‘insights’ on modern medical billing systems.
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, visitEZClaim’s website,e-mail them, or call them today at 877.650.0904.
There are five primary medical practice fundamentals that, if focused on, will ensure your practice is working toward goals that will make the biggest difference. Practices are pulled in many directions each day, and it can be difficult to know what to prioritize, so the following are some recommendations.
1) Define Patient Engagement Goals Perhaps one of the most overused terms in today’s medical field is “patient engagement.” Much like the drawer filled with important yet miscellaneous items, if you can’t actually define it, you probably aren’t going to do something with it.
In 2021, it is imperative to define your office’s patient engagement goals in order to determine whether they are being met, and more importantly, if the value you’ve placed on engagement is benefitting your bottom line. This could include engaging via a more personal checkout process that explains how billing and payment will be done and asking patients if there are certain times of the year they wish to be notified for annual wellness checks.
2) Ask For Online Reviews Reviews remain one of the highest drivers of new customer acquisition. As a local business, you can create a Google Business account online that provides your address, phone number, and link to your website. Included is the ability to add reviews as well as phrases and keywords about your business within the Google Business dashboard, and it’s all free!
To encourage your patients to leave reviews, create cards with step-by-step instructions for posting online reviews via Google. Be picky. Make sure you ask your best patients to participate, who will be honored that you asked. Don’t forget to monitor to see how your business listing looks to potential new patients.
3) Offer Friendly Medical Bills Of course, we’re not suggesting you add flowers or poignant sayings. Rather, explain a statement to your patients at checkout or within their financial package; this helps the process flow more naturally. BillFlash patient statements have five different messaging rows you can customize for communication. Plus, you can also send electronic patient statements through text and email.
In 2021, communication with patients—even on billing statements—should be natural, friendly, and simple. Getting paid is a segment of the medical practice workflow and should be as easy and frictionless as possible.
4) Ask About Payment Preferences People are driven by routine and behavior. In today’s world, when paying for an item, the buyer is offered numerous options including cash, debit and credit, no-interest, pay-over-time plans, payment apps, or even Near Field Communication (NFC) like Apple and Google Pay. Granted, the last two have had very low adoption rates, but keeping an eye on payment trends costs little more than time and may add something unexpected to your bottom line.
In 2021, identifying the preferred patient payment options could be the difference between getting paid quickly and not getting paid at all. Don’t overlook the enormous value people place on how they give and take money.
5) Use RCM Services An RCM vendor helps you get the most out of your practice revenue. They help you collect more from difficult balances, empower patients to pay in full, and improve your claims processing—without adding extra work for your office staff. Working with the right RCM services provider ensures you are paid more for the work you do. They also help identify reasons for claims denials, which have a positive impact on your practice revenue, as well.
EZClaim Launches EZClaimPay, a new feature in its medical billing software that makes credit card processing painless!
EZClaim, a company with the mission of elevating its clients to stay in front of the ever-changing landscape of medical billing, announced today the launch of its credit card processing feature and service called, EZClaimPay.
EZClaim released the product in August 2020 as a solution to the ever-changing landscape of payment reconciliation. It was cited by customers as a timely response to a ‘pain point’—credit card payment processing—another example of EZClaim’s devotion to their mission.
Dan Loch, VP of Marketing commented that “EZClaim’s goal continues to be making life easier for medical billers at practices and billing firms. EZClaimPay is just one more feature within our mission of living up to that goal.” This feature will help companies get in front of the changes in medical transparency that are coming soon.
EZClaimPay provides for consolidated reconciliation (Payment reports; Chargeback management; and Reconciliation reports) and a single point of contact for support (Hardware; Software; and Payments).
EZClaim has developed a robust payments platform—tightly integrated with their software and support—to make accepting credit cards for payment PAINLESS! EZClaimPay makes software and payments better together.
ABOUT EZCLAIM: EZClaim is a medical billing and scheduling software company that provides best-in-class customer service and support. To learn more, e-mail them at firstname.lastname@example.org or call a representative today at 877.650.0904.
Concerned about the claims process during COVID-19? Well, Alpha II remains on the forefront of the coding and billing changes during the COVID-19 public health emergency (PHE). They understand this is a confusing time for providers, practices, and hospitals.
Now more than ever, practitioners are relying on the revenue brought in by accurate claim submission. So, if you would like more up-to-date details, join us for our Bring Revenue Integrity to the Claims Process During COVID-19webinar on June 16th at 1 p.m. ET, and learn how to recover revenuebased on the waivers allowed under the PHE. Click here to register for the webinar.
We have also compiled a comprehensive COVID-19 billing and coding FAQ document of questions received during our highly-attended webinar series. Click here to download the resource.
As guidelines for coding and billing of COVID-19 services are revised regularly, Alpha II is implementing these critical changes to regulations and coding guidance—almost immediately.
Alpha II empowers precision across the revenue cycle process so you can experience reduced cost, improved cash flow, and increased revenue. Through its software-as-a-service (SaaS) solutions, Alpha II supports coding, compliance, claims editing, value-based quality reporting, and revenue analysis.
For more details about how Alpha II’s solutions can keep your coding, billing, and editing current, view our website or fill out our contact form to ask us a specific question.
Alpha II is a preferred partner of EZClaim, and their software is integrated into our medical billing software. For detailed product features or general information about EZClaim, visit our website atezclaim.com/
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