GeBBS Healthcare RCM Blog

AHA President and CEO Asks President-Elect Trump For "Steady as She Goes" Effort on Healthcare

Posted on Tue, Dec 20, 2016 @ 11:00 AM

By Nitin Thakor, GeBBS President & CEO

AHA President and CEO Rick Pollack recently sent a congratulatory letter to President-elect Donald Trump and asking him to go slowly on changes to our healthcare delivery system, particularly when it comes to the Affordable Care Act (ACA). This is good advice since healthcare represents a significant portion of the U.S. economy and essential public services. Pollack explained his case in terms that abrupt changes could lead to significant instability for patients, providers, insurers and others.

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However, he was not so cautious when it came to Stage 3 Meaningful Use and M&A mergers. Pollack urged the President-elect to cancel Stage 3 of Meaningful Use, standardize the M&A merger review process, and reform the RAC program.

Pollack's letter highlighted five areas of concern for hospitals: reducing the regulatory burden; enhancing affordability and value; continuing to promote quality and patient safety; ensuring access to care and coverage; and continuing to advance healthcare system transformation and innovation.

In my opinion, much of what Mr. Pollack asked for makes perfect sense. It is my sincere hope that President-elect Trump will understand the consequences of abrupt changes to any financial system. He has already softened his stance on cancelling ACA on Day One of his administration. There are many things wrong with the ACA and reform is needed. I am hopeful that thoughtful men and women of goodwill will come up with a new plan that includes more participation of the private sector and the ability to sell health insurance across state lines.

This will provide a replacement plan that continues to provide a mechanism for individuals to obtain affordable insurance coverage, with realistic deductible amounts. Everyone who works in healthcare knows that the regulatory burdens faced by hospitals and physicians are substantial and unsustainable.

I remain hopeful that thoughtful reform can be accomplished, and we look forward to working within this new healthcare delivery system.

Tags: Revenue Cycle Management (RCM), Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions, Medical Billing BPO, RCM Solutions, Revenue Cycle Solutions

Beware of Secondary Injury to Your Wallet after an ER Visit

Posted on Tue, Dec 13, 2016 @ 03:00 PM

A recent article in US News and World Reportexplained a little known fact of which most patients are completely unaware. A trip to the emergency room could cause a secondary injury to a patient’s wallet. Even if a patient goes to a hospital included in his or her health insurance network, if the emergency room physician who treats the patient is not part of the health insurance network, the patient will be responsible for a separate and unexpected bill.

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Is this a big problem?

Research conducted by Yale University found that roughly 2 of 10 in-network visits involved a doctor not in the patient's insurance network. Going to an in-network hospital does not mean all your charges will be covered.

There is some slight hope in these situations. If you are attended by an out-of-network doctor, it doesn't necessarily mean financial calamity. That can depend, in part, on the patient's insurance coverage. And, some states like New York have laws that offer some protection against surprise bills, although the extent of that protection varies.

There are limited options to rectify the unexpected charges. Patients can ask that the claim be processed again as in-network care since the patient had no way of knowing the doctor was out of network or they can try to negotiate a lower bill.

In recent years, especially since the creation of the Affordable Care Act's public insurance exchanges, insurers have formed networks of doctors and hospitals, in part, to gain some leverage for negotiating reimbursements.

When the medical treatment is an emergency situation, you don’t always have time to question the physician’s insurance network coverage. However, if you have time, it’s a good thing to make sure your attending physician is part of your health network.

Tags: Revenue Cycle Management (RCM), Healthcare Revenue Billing, Insurance Billing Solutions, Medical Billing BPO, RCM Solutions, Revenue Cycle Solutions

All is Not Well in the Small Hospital World When It Comes to the ICD-10 Transition

Posted on Fri, Nov 06, 2015 @ 07:00 AM

By Nitin Thakor, GeBBS President & CEO

So far small hospitals and small health systems are not faring as well as large hospitals and health systems during the ICD-10 transition. The press is full of reports about how well the transition is going for large hospitals, but that is not the case for smaller community hospitals.

Offshore Medical Coding ICD-10 Outsourcing

There are several reasons for this.  Many smaller hospitals were not as well prepared as the large hospitals. They just didn’t have the budget to conduct intensive preparation campaigns. Also, the lack of clinical documentation improvements (CDI) by their physicians seems to be an issue, and for some their greatest challenge.

Many physicians have taken little or no advantage of ICD-10 training. This has led to a lack of knowledge on the documentation of procedures and diagnoses to meet the specificity requirements of ICD-10.

An even more common problem seems to be that many small hospitals, typically under 300 beds, have offered very little training to their physicians, either because of opposition by hospital physician staff, or ICD-10 transition teams did not understand the importance of upgraded documentation.

These small hospitals are working hard to catch up by adopting programs to help them meet the challenges of ICD-10.  In getting a late start to cope with ICD-10, many small hospitals are considering using an outsourcing medical coding and outsourcing medical billing partner, who has been diligently preparing for the ICD-10 transition for several years. An experienced outsourcing partner can provide immediate expertise to ensure small hospitals’ revenue risks are minimized. 

Working with a knowledgeable outsource partner can also reduce costs and overhead complexity. Expertise is available and there is no need to face the transition alone. Select an outsourcing partner on the basis of their coding and billing experience and knowledge. All of their coders will have undergone a stringent screening process to verify their skill level, education, experience, and level of professionalism. Most will be certified RHIT, RHIA, CCS, CCS-P, CPC or CPC-H.

An outsourcing partner can also provide targeted training programs to help physicians with CDI and to help hospitals retain their most experienced medical coders - those who will be the most valuable during the next year or so of the ICD-10 transition.

Finally, small hospitals need to take advantage of new technology that has dramatically changed the medical coding process within health information management.  Computer-assisted coding or CAC is a cutting edge technology that automatically derives medical codes within clinical documentation. CAC technology is an enterprise-wide coding solution that improves and enhances the overall coding process. It combines expert workflow technologies, rules-based automation, and certified coders to guarantee accuracy rates of over 95%.

Getting a late start does not mean you cannot win the ICD-10 race; it just means you have to work a little harder and smarter!

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Offshore Medical Coding

Survey Shows About 80 Percent of Hospital CFO's Consider Outsourcing RCM to be the Best Stop-Gap Measure

Posted on Mon, Oct 19, 2015 @ 08:00 AM

By Nitin Thakor, GeBBS President & CEO

offshore medical codingAccording to a recent survey reported in Healthcare Finance, 83 percent of hospitals now outsource some accounts receivable and collections, 58 percent of hospitals outsource some contract management, 55 percent of hospitals outsource some denials management and 68 percent of physician groups with more than 10 practitioners now outsource some combination of collections and claims management.

The expected impact of ICD-10 on the revenue cycle will prompt providers to outsource even more of their revenue cycle functions the article states. Larger health systems are even more bullish on the trend. The survey found 93 percent of larger hospitals (more than 200 beds) anticipate supplementing their existing revenue cycle software with outsourcing services in the first quarter of 2016 as fallout from ICD-10 likely affects cash flow and more value-based reimbursement opportunities are presented.

Outsourcing RCM: Onshore and Offshore Medical Coding and Billing

This trend is nothing new to GeBBS Healthcare Solutions. We have always promoted outsourcing as a means to cut through the complexity of revenue cycle management with proven expertise, operational excellence, and a sophisticated approach to business processes. Outsourcing providers have experienced, ready-to-deploy remote medical coding, denial management, and medical billing resources available immediately to ameliorate the effects of ICD-10.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, Offshore Revenue Cycle Management, Healthcare BPO Companies, Medical Coding Outsourcing, Remote Medical Coding

Outsourcing Chronic Care Management Is a Win-Win for All!

Posted on Thu, Sep 10, 2015 @ 08:00 AM

HIT-for-Chronic-Care-Management-1024x936The Centers for Medicare & Medicaid Services (CMS) has begun paying providers for delivering non-face-to-face care to their Medicare patients with two or more chronic conditions. This is a win-win for everyone involved in the process. Patients will experience improved outcomes and physicians have the opportunity to increase their revenue streams. CMS created the new CPT Code 99490 to reimburse providers for spending 20 minutes per month helping their patients manage multiple chronic conditions.

Medicare has traditionally only paid providers for care management services as part of face-to-face office visits. Now, eligible providers will be reimbursed at approximately $42 per qualified patient per month for these services. The Chronic Care Management (CCM) payment applies to both Medicare and Medicare Advantage patients.

Who is eligible for the new CCM payments? Providers eligible to bill Medicare for chronic care management include:

  • Physicians (regardless of specialty)
  • Advanced practice registered nurses
  • Physician assistants
  • Clinical nurse specialists
  • Certified nurse midwives (or the provider to which such individual has reassigned his/her billing rights)

The challenge for many physicians is that this follow-up care management and care coordination is very time intensive, and they simply do not have the professional staff bandwidth to provide this ongoing chronic care management.

The solution: outsource this function to a healthcare organization that is staffed with healthcare professionals who have extensive expertise in the care management of chronic health conditions.

Here’s how it works. The physician creates a specific healthcare plan for his patients and turns that plan over to the outsource organization who is responsible for the daily or weekly contact with the patient to monitor his or her progress, provide health coaching according to the physician’s care plan, ensure the patient is being compliant with the plan and report this progress to the physician.

This allows the physician to extend his chronic care management of patients by giving him the added professional staff bandwidth he needs.

Physicians have been providing care management for years; however, Medicare is now offering physicians the opportunity to bill for these services, providing a new revenue stream. By outsourcing the daily care management activities physicians can combine technology, clinical services and analytics that yield improved patient interactions between actual office visits, with almost no impact on their current professional staff. Outsourcing will allow the physician to increase and maximize patient enrollment in the program, increase patient compliance and provide CCM documentation requirements, while minimizing additional workload.

Outsourcing care management provides an end-to-end solution that will improve outcomes and provide increased revenue for the physician.

Physicians and patients working together to improve their health conditions is not a new trend in healthcare. Part of the CCM requirement includes the patient’s consent to encourage “program buy-in” with shared decision-making around the care management activities. Patients, who are compliant with their physician’s care plan, tend to be healthier and achieve better outcomes.

The communication between the outsourced organization’s professional staff and the patient is an extension of the physician’s practice. Additionally, ongoing interactions through personalized messaging motivates and supports patient’s to reach predetermined health goals set for them by their physician.

As a result, engaged patients are more likely to participate, adopt healthier behaviors and follow their physician’s care plan. The end result is higher quality of patient engagement, increased compliance, better outcomes, lower costs – and increased revenue for the physician.

Tags: Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions

New CMS Initiative Can Generate Revenue for Physicians

Posted on Wed, Sep 02, 2015 @ 05:30 AM

 

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The 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT Code 99490 -- Chronic Care Management (CCM), reimbursing practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients. 

CMS has recognized that in the U.S. seven of the top ten causes of death are from chronic illnesses, with 85 percent of healthcare costs going to treat those diseases and two-thirds of Medicare dollars being spent on patients with five or more of these chronic conditions. 

In 2010, Medicare spending totaled over $300 billion and increased significantly as the rate of chronic conditions increased. In that year, beneficiaries with two or more chronic conditions accounted for 98 percent of all Medicare hospital readmissions. As staggering as the readmissions number is, more daunting is the fact that CMS estimates that $17 billion of the $26 billion spent on readmissions were potentially avoidable. 

The most common chronic conditions among Medicare beneficiaries in 2010 were high blood pressure, high cholesterol, heart disease, arthritis and diabetes. 

Chronic diseases such as diabetes, cancer and asthma are the most common, costly and deadly of all health problems – yet also the most preventable, according to the Centers for Disease Control and Prevention (CDC). 

CMS has started paying monthly reimbursements for Chronic Care Management services to providers who deliver 20 plus minutes of non-face-to-face chronic care coordination to eligible Medicare beneficiaries with two or more chronic conditions. 

These services can be fulfilled by the provider or performed by a subcontractor. This is a critical element of the CMS initiative. 

Traditionally, physicians have not had the staff bandwidth to support intensive Chronic Care Management; however, this initiative allows doctors to outsource much of the hands-on daily care coordination to healthcare organizations who are staffed with experienced care management professionals. The billing physicians are responsible for creating their critically-ill patients’ care plans and directing the efforts of their professional outsourced staff. 

Medicare has traditionally only paid providers for care management services as part of face-to-face office visits. The new CCM payment applies to both Medicare and Medicare Advantage patients. 

Patients are still responsible for a 20 percent copayment, and documentation of the CCM services is required. However, costs should not be an issue because research shows that only one in ten beneficiaries rely solely on Medicare for their healthcare coverage. The rest have some form of supplemental coverage for medical expenses, so up to 90 percent of patients may not have to pay any out of pocket for their CCM. 

The biggest change for this new initiative is the focus placed on patient collaboration and care coordination that takes place outside of office visits. Non-face-to-face service includes any time the provider spends on the patient’s care plan – anything from communicating with other health providers (outsourced care management staff) on behalf of the patient’s care management. 

CMS allows physicians who bill for Code 99490 to delegate this non-face-to-face time, and provide only general supervision on the CCM work they do. This critical change allows physicians with smaller professional staffs to extend the care management of chronic diseases to their patients who need it the most, and at the same time create a new revenue stream.

Tags: Healthcare Revenue Billing, Best Practices, Insurance Billing Solutions

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Healthcare Revenue Billing, Accounts Receivable (A/R), Accountable Care Organizations (ACOs), Affordable Care Act

How Can You Define Success with Your BPO Provider?

Posted on Tue, Jul 02, 2013 @ 11:56 AM

The first step in determining your success with a BPO provider is to define a clear set of objectives that you expect them to meet. If you can’t define what you expect them to do, you can’t measure it. When setting your expected objectives for your BPO engagement, make sure they map to your business objectives, and don’t be too explicit. Make sure your objectives are broad enough to drive business process improvements across your entire enterprise.
The next step is to ascertain your facility’s present level of performance. You must know where you are starting from if you are to measure the success at the end of your BPO journey. As part of your internal due diligence process, healthcare organizations should accurately measure their current performance to provide a verifiable base from which to develop fair and objective service level requirements for the BPO provider. Therefore, you can establish both the quantitative and qualitative standards of performance that will be required of your BPO provider.
Here are attributes of a BPO engagement to help you define your success:
  • Customer satisfaction -- The most important factor to consider in a BPO engagement is, are you satisfied with your results. If you aren’t satisfied with the engagement, then no matter how many objectives were met, it is not considered successful.     
  • Financial savings -- BPO in many cases provides a financially compelling alternative to providing the services in-house. Most engagements identify this as a key objective. If the BPO services are not improving your bottom line, they are not successful.
  • Service delivery and quality – Service delivery and quality aren't usually used in the same sentence, but they should be. Your objectives for the BPO engagement should be as specific as possible when documenting your expectations on delivery and quality. To make this a truly deliberate requirement, add a metric that tracks the number of requests you have to make for a specific service to be addressed and then document how your request was handled. This adds the quality aspect to delivery.
  • Scalability to meet your needs -- Your BPO partner needs to be positioned to meet your growth requirements. An important measure of their success was how quickly they were able to ramp up their staff and skill sets to meet your changing needs.
  • Stability and variability – Your BPO provider needs to provide a stable operational environment even in situations that are variable. Some of the most successful BPO ventures are with components of IT or applications that are sometimes very stable, but often provide variability that must be dealt with “on the fly.” Was your BPO vendor able to handle these situations?
  • Predictability – You should expect predictability in your BPO services. Establish metrics around what you define to be “predictable” and measure your BPO provider against them.
  • Competency and staffing -- Competency and staffing are strategic BPO business issues. Did your BPO partner provide competent staffing and the appropriate skill sets to meet your specific needs?
  • Ability to react to changing requirements -- BPO is sometimes associated with an increase in formality, which manifests itself in the form of “red tape.” When your business requirements changed, was your BPO partner able to respond to these changes in a timely manner?
If you measure your BPO engagement against the foregoing attributes, you should be able to define your particular level of success.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing

Trends in Healthcare Billing: Healthcare Revenue Cycle Management and Global Offshore Medical Billing

Posted on Wed, May 29, 2013 @ 01:02 PM

Today’s healthcare delivery system is at the center of many political and social debates. The ongoing focus of these debates is often how the healthcare financial process is handled, and it is one of the many problems frustrating professionals in the billing department of hospitals and medical facilities.

Each year, $350 million is spent to submit and process claims in the healthcare industry, according to Dell, and that number is only expected to climb. Equally disheartening, HMFA stated in a late 2011 report that trends in A/R reserved for write-off and collectible A/R indicate that “the net revenues billed by hospitals are getting harder to collect.”

Healthcare facilities are facing a host of issues that complicate billing, including changes in healthcare records keeping, increasing out-of-pocket costs for patients, changing healthcare laws, changing Medicare and Medicaid policies, and the looming possibility of the Affordable Healthcare Act. Because of increasing operating costs in the medical industries, healthcare facilities cannot afford to let their A/R go unchecked.

A/R must be carefully managed, and the most effective way to do that is with improved healthcare revenue cycle management (RCM). Many healthcare facilities are looking to streamline and reduce costs by outsourcing, offshore, critical parts of their billing cycle, principally to India, a country with proven expertise in all facets of U.S. RCM.

Healthcare Revenue Cycle Management

What is revenue cycle management?

True revenue cycle management begins before the patient even visits the facility. It begins with eligibility and benefits verification including pre-authorization and enrollment. This allows healthcare providers to verify coverage in advance for every patient and also give the patient his or her out-of-pocket costs before the procedure. The second phase of revenue cycle management is implemented in the coding process. Coders can have as little as eight months of training (no high school degree necessary) to be certified. In order to increased efficiency, coders should be prescreened and required to be proficient in all the following code sets and usage guidelines: CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS. The next phase of revenue cycle management is in the billing phase; more specifically, in charge capture and payment posting. The more efficiently billing is done, the first time, the more likely payments are to be collected. Fourthly, payments must be posted correctly and quickly to the right patient, for the right services. The final phase in revenue cycle management is receivables follow-up, a step that often gets neglected if procedures are not in place to ensure it.  In this stage, claims must be continually worked, resubmitted and processed until payment is received.

Global Offshore Medical Billing

When billing is outsourced as part of a healthcare revenue cycle management transition, compliance and cost savings both are possible. Again, coders have minimal requirements to start in the medical field. However, a diligent RCM provider can source talented and certified coders from India to produce the most accurate coding and billing support team. This will increase the accuracy and speed of processing, create costs reductions of up to 40 percent in some cases and increase compliance.

Both of the aforementioned initiatives, healthcare revenue cycle management and offshore medical billing, provide not only cost savings but increased compliance, so essential in the current regulatory environment. Audits are intensive in the healthcare industry, HIPAA compliance is non-negotiable and ADRs are on the rise. Healthcare providers cannot afford to maintain inaccurate or outdated records, billing or coding systems any longer. Healthcare revenue cycle management may be the present trend of the decade, but it has longevity because it is a solution that works and is critical to a healthcare provider’s financial well-being.

 

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Healthcare Revenue Billing, Medical Coding, Knowledge Process Outsourcing (KPO)

GeBBS Healthcare Solutions to Showcase Coding Workflow & Automation Platform at RBMA 2013 Radiology Summit

Posted on Mon, May 06, 2013 @ 01:55 PM

ENGLEWOOD CLIFFS, NJ, May 08, 2013 -- GeBBS Healthcare Solutions, Inc., an industry leader in healthcare revenue cycle management outsourcing solutions, will be demonstrating its state-of-the-art coding platform, iCode, at the Radiology Business Management Association (RBMA) 2013 Radiology Summit, May 19-22 in Colorado Springs, Colorado.

iCode, a SaaS-based coding platform, combines GeBBS’ expert coding capabilities with workflow technology, rules-based automation and certified coders to guarantee over 97 percent accuracy rates. It includes documentation and audit tools including ICD-10-focused documentation analysis and the ability to perform data analytics and reporting.

With demonstrated success in radiology, iCode works across all medical specialties with all input formats including HL7, PDF, TIF, scanned paper reports and more. The solution was designed by an expert panel of coders with a combined experience base of over 100 years, thereby delivering best of breed workflow management to drive significant efficiency and quality. iCode’s reporting engine is customizable and provides insightful and actionable intelligence to physicians and practices. In addition, its exception management module enables coding managers to track and ensure all charges are billed out in a timely manner while facilitating physician education.

“As a multispecialty coding platform, iCode acts as a universal tool for all specialties including radiology, pathology, emergency and anesthesia,” remarked Nitin Thakor, President and Chief Executive Officer at GeBBS. “Our strong track record of providing technology and service solutions which enable our clients to improve their financial and clinical performance is the driving force behind GeBBS' rapid market acceptance. iCode has already been implemented at three large customer sites, which is evidence that our unique solutions are addressing the market's needs.”

Visit GeBBS Healthcare Solutions at booth #226 at RBMA, or go to www.gebbs.com to learn more about iCode and the company’s other solutions and services.

 

 

Tags: ICD-10, Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), GeBBS Healthcare Solutions, Healthcare Revenue Billing, Insurance Billing Solutions