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Maximizing Revenue Cycle Efficiency

Maximizing Revenue Cycle Efficiency

By Ann Knutson, CPC-A

The healthcare revenue cycle includes all administrative and clinical functions that involve capturing, managing, and collecting the provider’s/facilities revenue. The cycle includes three distinct parts of the practice/facility that’s referred to as the front-end, middle, and back end. Unfortunately, most of the time there is little coordination between the three areas which can lead to more claim denials and lost revenue for the practice/facility. Therefore, adding a revenue integrity team to your practice/facility dramatically improves operational efficiency, compliance measures, and reimbursement rates. Members of the team must have extensive knowledge of and be familiar with the complete healthcare revenue cycle.

In order to foster collaboration between all three areas of a practice/facility that affect the revenue cycle, specific training needs to be implemented for staff, along with coding and documentation education for providers.

Specific staff training includes:

  1. Keeping up to date on billing requirements, such as coding guidelines, billing regulations, and insurance payer policies.
  1. Reimbursement updates, such as data showing rate of reimbursement vs. denials/rejections.
  1. Key performance indicators, such as data regarding common billing or coding errors leading to claim denials and rejections.
  1. Job expectations, such as all billing employees must know every aspect and function of their job in detail.

Provider education involves:

  1. Chart reviews to verify proper documentation.
  1. Quarterly meetings regarding coding guidelines, payer rules, and the importance of medical necessity.

Furthermore, creating templates and tip sheets for billers, coders, and providers improves operational efficiencies, clean claim submission, and proper provider documentation. It also decreases claim denials and puts everyone in the practice/facility on the same page.

In addition, the collaboration between coders and the accounts receivable team is crucial to improving reimbursement rates, the outcome of claim appeals, and compliance with regulations. It can also help to reduce the number of claim denials and rejections. Plus, medical coders are able to share their expertise regarding regulations and proper coding with the Accounts Receivable (AR) team members. This helps the AR team with reconciling claim rejections and denials along with properly submitting appeals. On the other hand, the AR team can inform coders of the current codes or coding combinations that are being rejected or denied by payers. With this vital information, coders can make the required coding and billing changes as they enter the charges and submit the claims. This can greatly improve the rate of clean claims submission. (AAPC, 2021)

Therefore, it’s in the best interest of a practice/facility to implement a revenue cycle management team that is familiar with the entire revenue cycle, fosters collaboration between all areas of the practice/facility and providers, and maintains open communication between all departments in order to maximize revenue cycle efficiency and reimbursement. For assistance with maximizing your revenue cycle efficiency, please contact us at MedCycle Solutions.

For more information about maximizing revenue cycle efficiency, please visit www.aapc.com.

Ann Knutson, CPC-A is an Accounts Receivable Specialist at MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit www.MedCycleSolutions.com.  

4 Ways Telehealth Has Changed the Landscape of Patient Care

4 Ways Telehealth Has Changed the Landscape of Patient Care

Have you increased the amount of Telehealth visits with your patients?
If not, you and your patients may be missing out.

Over the past two years, the COVID-19 pandemic has changed the landscape of patient care and increased the need for providers to utilize virtual healthcare services. Due to the Public Health Emergency (PHE) policy update, many healthcare practices had to shut down, pause or augment their services with telemedicine to provide flexibility in patient support.

Here are four ways Telehealthcare has been implemented to provide safe, necessary care for patients while augmenting revenue.

  1. Stop the Spread of Contagions
    With the need to quarantine, social distance, and reduce the risk for clinic staff and patients, many health practices adapted ways of providing non-emergency services. For patients with (possible) highly contagious diseases, such as COVID-19, many clinics ask patients to schedule virtual appointments to avoid possible infections and further outbreaks. This allows for keeping both the staff and patients as safe as possible while still receiving necessary treatment.
  2. Provide Essential Health Services
    For those patients that suffer from White Coat Syndrome going to the doctor’s office causes a great deal of stress and anxiety. By allowing patients to access care in the comfort of their own home for managing chronic health conditions, routine services, prescriptions, and referrals for testing and labs, this allows for greater patient access. Plus, it has the added benefit of reduced overhead costs associated with cleaning and turning exam rooms.
  3. Provide Physical and Occupational Therapy Healthcare
    Accidents happen. Whether motor vehicle accidents, workplace injuries, or trips and falls – PT and OT is imperative to keep patients mobile and progressing. Many providers offer hybrid services with virtual appointments for patients to keep them mobile while supervising and adapting exercises in their home environments.
  4. Provide Mental and Behavioral Healthcare
    Mental and behavioral healthcare is one of many patient-care needs. This is especially true for long-term residential care. Many nursing home facilities transitioned to telemedicine during the COVID-19 pandemic.


The U.S. Department of Health and Human Services, via the Centers for Medicare & Medicaid Services (CMS) heavily promoted the switch to Telehealth as infection prevention and control measures. They’ve made digital resources available that offer behavioral health and best practice guides for long-term nursing homes, a telemedicine tool kit, as well as other guidance.

If you think your practice and patients can benefit from implementing telehealth visits stay tuned for our next article on 5 Resources for Implementing Telehealth & Telemedicine.

Mariellen Mezzacappa has a variety of experience in the medical field. She has worked for doctors, hospitals, pharmacies, and insurance companies. Her experience includes bill review and coding with a wide range from EAPG 3M, DRG, Workers Compensation to Appeals and coder Affidavits for Litigation. She provides verification of code selection for operation reports, documentation review, and credentialing. Additionally, she has worked on operation policies, compliance training, and project management.

MedCycle Solutions provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit www.MedCycleSolutions.com.

5 Resources for Implementing Telehealth & Telemedicine

5 Resources for Implementing Telehealth & Telemedicine

Although Telemedicine has been around for years, it was really the COVID-19 pandemic that expedited the need for implementing these services rapidly and on a larger scale.

According to Medicaid.gov “telemedicine seeks to improve a patient’s health by permitting two-way, real time interactive communication between the patient, and physician or practitioner at the distant site.” This can be accomplished via telephone, video calls, or through web-based applications utilizing a microphone and video camera.

In our previous article, 4 Ways Telehealth Has Changed the Landscape of Patient Care, we discussed ways practitioners can provide safe, necessary patient care while providing a cost-effective alternative to augment revenue.

To assist in navigating telemedicine/telehealth, we’ve provided five telehealth links for providing healthcare.


1. Telehealth for Providers: What You Need to Know

CMS Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) provides a 17-page document with electronic links for telehealth and telemedicine. This resource is for providers who wish to establish permanent programs. It includes links to vendors, patient monitoring, documentation tools, etc.


2. CMS List of Telehealth Services

CMS Centers for Medicare & Medicaid Services

The CMS have made available resources for medical billing and coding. This resource link contains the 2022 medical coding schedule for allowed services for Medicare telehealth services.


3. How to Get or Provide Remote Health Care

The Health Resources & Services Administration (HRSA) provides information for both patients and providers on telehealth services. Providers can get information on remote care, find recent COVID-19 reimbursement, billing, and policy changes.


4. Introduction to Telehealth for Behavioral Health

The HRSA provides information on getting started with providing Behavioral Telehealth. This may also be referred to as telebehavioral health, telemental health, telepsychiatry, or telepsychology. There are resources for developing a Telehealth strategy, billing, and preparing patients along with many other resources.


5. Is Telehealth Viable for Mental Health Needs Post-Pandemic?

The American Association of Post-Acute Care Nursing (AAPACN) provides an in-depth article meant to help nursing home facilities walk thru providing mental and behavioral healthcare in its facilities. Prior to COVID-19, long-term care facilities didn’t see the need for technology. COVID-19 proved that by utilizing smaller technology, such as iPads, residents are able to get safe, immediate mental and behavioral health care.

MedCycle Solutions provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit www.MedCycleSolutions.com.

After Pandemic Impact on Outsourcing RCM

After Pandemic Impact on Outsourcing RCM

After Pandemic Impact and Outsourcing Revenue Cycle Management

The impact of the COVID-19 pandemic will be felt in every industry for many months to come. For medical providers, they are facing some of the most challenging financial times they will or have known. Therefore, we understand that it is crucial for providers to re-access their business and look for ways to cut costs with minimal impact on their practice or their patients.

To compound the issues providers are facing, there has been a wave of changes in recent years with new coding and telemedicine requirements that are making it difficult for provider offices to remain independent. Add on the constant rise in the cost of living and expenses while insurance reimbursements continue to decrease, and the issues get worse and worse.

Many have decided that outsourcing to a complete revenue cycle management company could help alleviate some of the undue burdens, cut costs, and keep providers compliant with their coding and billing. Ultimately this allows providers to continue to focus on patient care, which is their goal. As providers, you understand that revenue cycle management is a crucial part of your physician’s office. If not managed properly, it could result in an office leaving thousands of dollars on the table in unclaimed revenue. Over the years, our free audit services have allowed providers to have a free, transparent, and unbiased assessment of how their accounts receivable department functions. We are always amazed at how many providers do their billing in-house, and sometimes even when they outsource,  are not aware of how much money they have sitting in their accounts receivables.  Getting this knowledge is the first step to increasing revenue and efficiency.

In-house medical billers and third-party outsourced revenue cycle management companies should be giving provider offices monthly aging reports to assess their financial forecast. Each accounts receivable bucket over 60 days should hover at approximately 1 0% or less of the entire revenue balance. If account receivable buckets are higher than 10%, providers may be leaving money on the table, and the account may not be getting worked as providers think they are. In efforts to avoid unpaid claims and a spike in accounts receivable, outsourcing your revenue cycle management to a third-party medical billing company, such as BC Medical Billing, could help providers in countless ways. Many practices recognize that keeping their revenue cycle management optimized is key in delivering regular practice operations; however, they are not always sure how to achieve that. Outsourcing may be the solution!

Outsourcing alleviates the practice from managing a new medical billing employee, paying a salary and benefits, completing training and onboarding protocols, and managing the lost time from a learning curve. Many providers feel that it is not a wise use of the back office executive personnel’s time to worry about finding coders in-house and then wondering if the charges are captured and billed correctly. Instead, the business office should be focusing on how to grow the providers and the physician practice.

Our free audits will help you determine if you have found the right solution for you. If not, we are always there to assist and always increase the provider’s revenue.


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 BC Medical Billing ]

5 Medical Coding Challenges That Hurt Revenues

5 Medical Coding Challenges That Hurt Revenues

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.

2. Upcoding
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 ]