Apr 13, 2020 | Alpha II, Medical Billing Software Blog, Partner
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:
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- 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 the 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/
Mar 10, 2020 | Live Compliance, Medical Billing Customer Service
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!
Mar 10, 2020 | BillFlash, Partner
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 get 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 benefits 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 an 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 sales@billflash.com
Dec 10, 2019 | Alpha II, Claims, Partner, Revenue
Getting Claims Right the First Time
Getting Claims Right the First Time. Contributed by Timothy Mills, Chief Growth Officer, Alpha II, LLC
The numbers are staggering. Industry averages report that nearly 20% of all claims are denied, rejected, or underpaid. And considering the cost to rework claims — not to mention even higher appeal costs — as many as 60% of returned claims are never resubmitted.
With figures like these, it’s no wonder medical practices continue to face intense financial pressure. As negotiated reimbursements stagnate and operating expenses like rent and salaries continue to increase, the struggle to maintain steady revenue becomes even more crucial. For many practices, conducting reviews of their revenue cycle workflow would show gaps in their claims process. The good news is – these gaps can be bridged with the help of emerging technology.
With a saturated market of coding, billing, and compliance solutions, how do you begin to find the right technology for your practice? When trying to improve revenue integrity, it is important to understand exactly what vendors offer. For example, consider the term “first-pass claims rate,” which is still used by some healthcare IT vendors to represent the number of claims initially accepted by payers. But what is often overlooked is the number of those initially accepted claims that will be denied or underpaid. A better question would be – what percentage of claims are getting paid the first time they are submitted?
The fact is, practices that do not employ the latest clinical coding and editing tools within their revenue cycle are leaving money on the table. This is revenue that is rightfully theirs but is being pursued at high, incremental costs. It’s time to rethink traditional denials management practices, move beyond the “first pass claims rate,” and embrace the future of denial prevention.
It’s your money. Go after it.
Still not convinced that investing in emerging clinical coding and editing software can save your practice money? Let’s see what relying on traditional denials management methods might really be costing you.
Each rejected, denied or underpaid claim represents earned revenue your practice is missing out on. Based on industry reports, the average cost to rework a claim has been pegged at more than $25, and appeal costs can skyrocket to over $100. It’s estimated that as many as two-thirds of all denied claims are recoverable. But practices often weigh the reimbursement amount of a claim against the cost to rework or appeal that claim. For smaller claims, many decide it just isn’t worth the effort, which is why getting claims right the first time should be the ultimate goal.
So how much are practices losing by simply correcting and resubmitting denied claims using traditional denial management methods? Let’s look at an example using figures from an actual mid-sized specialty practice. This practice submits 1,900 claims a month and the average claim is $150. They have a better-than-average denial/rejection rate of 10 percent. Even with that lowered rate, this practice is losing roughly $28,500 a month to unresolved denied claims. If two-thirds of those denied claims are recoverable, they stand to recoup $19,095 in reimbursements after the claims are corrected and resubmitted. Factor in the cost associated with reworking denied claims using the industry average of $25 per claim, and this practice is spending $4,750 in administrative charges alone to recover their own revenue. This brings their actual recovered revenue down to $14,155 per month or almost $170,000 annually. Investing in a comprehensive clinical coding and editing solution is still cheaper than what the practice spends per month when reworking denied claims.
The Alpha II Solution
Are you ready to submit precise claims the first time? Contact Alpha II, a leader in revenue cycle solutions. Our comprehensive clinical claim editing solution, ClaimStaker, covers the entire continuum of care, verifying claim data from the payer’s perspective and allowing for corrections prior to filing.
Check out our Denial Impact Assessment Calculator to see what your denials really cost your practice or contact us today for a free personalized Claims Assessment. See why ClaimStaker does more than clear claims. It gets claims paid.
We work hard to update our blog to keep you up-to-date on what’s happening in the field of medical billing software. If you have a topic you would like to see discussed, please contact us.
Dec 10, 2019 | BillFlash, NexTrust, Partner, Revenue
9 Signs It’s Time to Outsource Your Medical Billing and Coding.
Contributed by James Easley, VP, Marketing of NexTrust, Inc
Should a practice outsource their billing and coding or manage it in-house? This is one of the most important business decisions for practices to get right. Which is the better option for your practice? Here are nine signs that it may be more financially beneficial to outsource medical billing.
1. Do You Lack Visibility into Billing and Payment Metrics?
Do you know your key financial metrics and how to improve them? Many practices are not aware of their actual revenue metrics which are the “vitals” for the financial health of their practice. For example, only about 35% of practices appeal denied claims, which means most are losing out on thousands of dollars every month.
Without the ability to measure these financial vitals, it’s difficult to know how to improve. Does your practice have a financial analyst as well as the staff with the skills to identify problems and make improvements? If not, practices should consider looking at external experts to provide these metrics and are able to make the necessary billing improvements.
2. Is Your Revenue Decreasing?
For practices that are aware of their billing and payment metrics, are you seeing your collections decrease? Is the time it takes to collect increasing? Unfortunately, this is more and more common among practices due to the ever-changing complexity of the insurance billing processes. Outsourcing is not the only solution, however fixing this problem internally can often be costlier and time-consuming than outsourcing.
You need a solid income stream to keep your clinic operating effectively. If billing mistakes, coding complexities, and reduced reimbursements or denials have negatively affected your collections, then you need to consider outsourcing your billings and collections to keep your company from falling victim to a bad revenue stream.
Not only does this keep your business running optimally, but it also allows your personnel to focus on other responsibilities and ensure quality customer service.
3. Are Billing Errors and Rejected Claims Costing You Money?
The American Academy of Family Physicians reports that a 5-10% denial rate is the industry average. To be financially sound, practices should do what’s necessary to keep this rate below 5%. Because high claim denial rates require additional costs and staff time to correct and resubmit, many practices have found the outsourcing resolves this issue and provides higher net income overall.
4. Are You at Risk of Staff Absence or Turnover?
While every industry faces the challenges of staff turnover, the effects are often felt acutely among medical practices when billers leave. Since claim processing is integral to the lifeblood of a practice, replacements or new additions to your billing department unavoidably result in a slowdown in claims processing. Practices can remove this variability and risk through outsourcing their billing and pushing the staffing burden to the third-party. Practices then rely on a team that can ensure the work of claim processing continues without interruption.
5. Are Staff Billing and Coding Skills and Training Insufficient?
Many practices take on the responsibility of hiring, managing and training Internal billing and coding staff. This works well in many practices. However, if billing and coding staff is under-experienced or not current on compliance and regulatory issues, practices must cost-effectively provide regular training to get and keep them current. Practices that prefer not to take on these burdens can find a simple solution in outsourcing.
6. Has In-house Billing Become Too Expensive?
Considering the costs of hiring, salary, benefits and administrative costs of in-house medical billers, practices may find it costs less overall to outsource their billing.
In addition to employee costs, practices must purchase equipment, software, and more. In-house billing costs can quickly add up. Practices should compare internal costs to outsourcing to determine both the best operational and cost-effective methods for billing and coding management.
7. Do You Have New Providers or a New Practice?
Newer practices may find it difficult to navigate the complexities of medical billing and coding. These new practices or practices with new providers need to ensure they are focused on growing their business and providing a high level of care.
Delegating important responsibilities to a trusted third-party allows new practices and providers to do just that. Outsourcing your medical billing during this time can relieve the burdens of hiring, training or managing a team of new billing employees.
8. Is Your Clinic Growing?
A growing practice can have similar challenges as a new clinic. Reputation is critical when growing your business and ensuring high-quality patient attention and care can become more difficult.
As your staff will likely be tasked with more responsibilities and duties during this growth period, why not ensure they can still provide meaningful services by taking some of those administrative duties off their hands. Your personnel will thank you for this by continuing to provide quality care to patients, which in turn will help you to continue growing.
9. Is Your Attention Divided Between Patients and Running a Business?
Overseeing internal billing and coding requires a substantial amount of effort, time, and expertise. Without dedicated staff to handle this, the responsibility can fall on the shoulders of clinic owners, physicians, or other administrative staff.
This can mean less time focusing on patients or other relationships and practice management responsibilities. When practices outsource the billing process, physicians and administrators are free to focus on providing quality healthcare services to patients.
If you found yourself nodding your head to one or more of these questions, it’s worth taking some time to learn if outsourcing would be better for your practice. NexTrust offers both patient and insurance billing services that not only improve revenue but allow providers and staff to focus on providing the highest level of care.
Free $25 gift card with RCM demo
Call NexTrust today 435-940-9123 or email us at rcm@billflash.com to learn how our Patient Billing and Insurance Billing services can improve the financial health of your practice.
Stay tuned to our blog for the latest information related to the medical billing field from EZClaim and our esteemed partners.
