GeBBS Healthcare 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), Revenue Cycle Solutions, RCM Solutions, Medical Billing BPO, Healthcare Revenue Billing, Insurance Billing Solutions, Best Practices

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), Revenue Cycle Solutions, RCM Solutions, Medical Billing BPO, Healthcare Revenue Billing, Insurance Billing Solutions

With the Start of ICD-10, It's Now About Reducing the Denial Rate

Posted on Fri, Oct 23, 2015 @ 07:00 AM

gebbs denial managementThe world did not come to an end on October 1, 2015. With the start of ICD-10, healthcare professionals anticipated an overall reduction in productivity of their billing staff. In a pre-October 1 survey, 94% of respondents indicated that they expected increased denials, but only 30% had done any work toward solving the problem. 

If you are one of these, you are suggested to begin immediately to improve your denial management processes and your ICD-10 coding. Most providers, payers, and even CMS expect there will be a noticeable increase in the coding denial ratios, which currently range between 15-20%, and may actually double. Though, by design, ICD-10 is expected to reduce the denial rates; in the short term there is bound to be reduced collections, higher denial ratios, and lower productivity.

If you have been less than diligent in your preparations, two things can help you rescue your revenue cycle from disaster:

EXPERT ICD-10 CODING

Medical coding is the lifeblood of your revenue cycle. Accurate and efficient ICD-10 coding is crucial to meet your financial and compliance goals. You need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient ICD-10 coding. This kind of coding support is available immediately from an experienced outsourcing provider.

When you partner with an outsourcing company for coding services, you add immediate value to your coding and revenue cycle operations. You will have immediate access to highly-trained ICD-10 coders who will improve your coding accuracy and production and eliminate staffing shortages and backlogs, while reducing your overall costs for coding.

DENIAL MANAGEMENT

The second thing you need is denial management support. A revenue cycle outsourcing company can provide access to a large pool of qualified denial management resources that can work in any practice management system or hospital financial environment and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  These analysts are adept at trending denials and looking for patterns of deficiency that will increase cash flow and reduce aging A/R.

Even prior to October, GeBBS has been dual and direct ICD-10 coding for several clients using iCode, a proprietary computer-assisted coding software. They have also helped clients with CDI projects to ensure charting and documentation will adequately support the greater specificity required for ICD-10 diagnoses.

If you feel the “hammer may still drop” on your revenue cycle, there is a solution: obtain outsourced coding assistance and denial management support. There is still time to rescue your revenue cycle.

Tags: ICD-10, Accounts Receivable (A/R), Best Practices, Insurance Billing Solutions

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

Bypassing the Insurance Companies

Posted on Mon, Aug 17, 2015 @ 08:00 AM

In an article entitled: “Boeing negotiates directly with more health systems” in this morning’s Modern Healthcare e-newsletter, it was reported that airplane manufacturer Boeing Co. will soon offer more employees the option of health benefits negotiated directly with local health systems. The employer, being skilled in the art of negotiations, is bypassing the big insurance companies and negotiating directly with providers. The company first used the strategy last year in Seattle to better control healthcare costs.

GeBBS Healthcare Solutions

Donn Sorensen, president of Mercy's operations in eastern Missouri said, “Boeing approached the health system looking to contract and successfully pushed for "very detailed" performance targets. If they can do one thing, they can procure. They are very data-driven.”

Some other large companies that include: Intel Corp. contract directly with Presbyterian Healthcare Services in New Mexico. Lowe's Corp. and Wal-Mart Stores have limited contracts for orthopedic and cardiac surgeries with select U.S. health systems.

Is this a harbinger of things to come?

Tags: Business Process Outsourcing (BPO), Insurance Billing Solutions

Top 10 Reasons Why You Should Outsource Your Revenue Cycle Activities

Posted on Thu, Mar 19, 2015 @ 12:12 PM

In today’s healthcare environment of shrinking reimbursements, due to governmental mandates and Medicare policy changes, the importance of maintaining a healthy revenue cycle is second only to providing the best patient care possible. Without an adequate margin there can be no medical mission.

One way to ensure your revenue cycle remains as healthy as possible is to enlist the help of a healthcare BPO company to assist with -- or handle completely -- your revenue cyclegebbs outsourcing medical billing activities. These organizations are expert at keeping your revenue cycle fine-tuned and optimized to its maximum performance level, much like a highly-trained
mechanic can do for your automobile. There are literally dozens of advantages that third party revenue cycle companies can provide, such as onshore and offshore medical coding and offshore medical billing. Here, in my opinion, are the top 10 reasons why healthcare financial professionals should consider outsourcing.

  1. You will see an increase in your reimbursements and collections.

  2. Your labor costs for revenue cycle maintenance will be reduced.

  3. Requires no capital investment.

  4. You get immediate access to highly-skilled and expert personnel that will mitigate risks from frequently changing governmental regulations.

  5. Staff members will be freed up to work on other critical financial issues.

  6. You will receive daily, detailed financial reports upon which you can take immediate action.

  7. Your revenue cycle will be easier to track and manage.

  8. It’s an uncomplicated solution that works from day 1 of implementation.

  9. No additional staff, training or office spaces are required.

  10. You get immediate peace of mind that you are doing everything you can to maximize your revenue cycle.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Medical Coding, Affordable Care Act, Insurance Billing Solutions, Offshore Medical Billing, Offshore Medical Coding, Medical Billing BPO, Offshore Revenue Cycle Management, Remote Medical Coding, Medical Coding BPO

ERAs Are a Win-Win over Paper EOBs

Posted on Thu, Feb 12, 2015 @ 08:52 AM

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Affordable Care Act (ACA) mandated that all healthcare plans adopt and support ERA operating rules before January 1, 2014. 

Here are just a few reasons why you should adopt ERAs:

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Significantly Reduce Processing Time: The major benefit of implementing ERAs is that they significantly bring down the medical claims billing processing time. When payment postings are done electronically, cash flow is accelerated. Also, since everything is electronic, the length of time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.

Reduce Manual Workflows: By adopting ERAs, providers and healthcare billing companies can reduce manual workflows significantly. Also, the number of employees can be reduced who have been assigned to post payments, or these employees can be reassigned to other medical claims billing functions.

Electronic Posting Efficiency: ERAs allow the use of electronic auto posting features, which enable posting of payments on to the system automatically. The error rate of the automated posting method is much less than that of manual postings, and the time spent correcting manual errors is also lessened.

Cost-Effective: Healthcare providers and medical billing companies can save significant dollars by implementing ERAs. The cost involved in recruiting new employees and training current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be realized. Electronic payment posting is not only time efficient, but also cost-effective.

It’s “Green”: The adoption of ERAs has encouraged several healthcare billing companies and providers to “Go Green.” Approximately, 2.5 billion pieces of paper can be saved by using eco-friendly electronic payment processing.

If you want to immediately achieve these benefits, your practice, hospital or billing company can implement a full-service outsourced payment posting solution that will allow you to instantly convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:

 

Contact GeBBS Now

 

Tags: Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Accounts Receivable (A/R), Insurance Billing Solutions, Data Analytics

Patient Access Management: The New Vanguard in Healthcare

Posted on Thu, Nov 20, 2014 @ 03:37 PM

With all of the changes in healthcare reimbursement policies and the influx of high-deductible patients, healthcare providers need to shift their patient access management strategies to meet these new challengesNo longer can the registration process be looked upon as a simplistic completing of forms patient_billingand getting the patient into a bed. Today's patient access professional must be capable of highly skilled worksuch as reviewing referrals, obtaining authorizations, verifying eligibility, determining the patients’ willingness and ability to pay, requesting payment at time of service and arranging sophisticated payment schedules to ensure collection of revenue for services rendered.

Today’s patient access representatives have much broader responsibilities than did traditional registrars in the past. Hospital information systems use insurance plan codes to identify the various products offered by each insurance carrier. Patient representatives are expected to quickly decipher which plan the patient belongs to from the patient's ID card. The patient representative's choice affects the manner in which the claim is sent to the carrier, and an incorrect choice can delay claim submissions and often result in rejected claims and delayed payments.

Managed care agreements have added another level of complexity. Patient access representatives must know when to obtain preauthorization and referrals, and to verify the appropriateness of the place of service. Even the most sophisticated "managed care matrix" cannot address every scenario for every plan. Within a specific carrier, the rules can differ down to the level of a particular employer. 

Healthcare providers must become highly creative in implementing best practices for patient access management to address today’s patient registration challenges. 

Tags: Patient Access Management, Insurance Billing Solutions, Revenue Cycle Management (RCM)

Healthcare Consumerism and Patient Access Management

Posted on Tue, Oct 21, 2014 @ 11:59 AM

Healthcare consumerism is going to be an important factor in the new healthcare financial environment where many patients are going to be responsible for a large portion of their healthcare costs. Consumer self-service is already becoming common place in healthcare today. Access to healthcare kiosks and patient portals will become an expectation in patients’ healthcare delivery processes. Allowing healthcare consumers to research costs, schedule appointments, receive online statements and make electronic payments are just some of the options consumers are demanding.

The healthcare revenue cycle is just beginning to feel the effects of this consumerism as employers focus on containing healthcare costs. Revenue cycle solutions that extend the capabilities of a healthcare organization’s hospital information system are the key to improving access management, responding to healthcare consumerism, accelerating cash collection and improving payer performance.

Patient Access Management

The expanding role of patient access professionals in the revenue cycle is the next step in responding to healthcare consumerism. In the future, these professional will become the “face” of many healthcare providers to the general public. Patient access representatives, used early in the healthcare delivery process, can help providers not only determine insurance eligibility, but also the consumers’ ability and willingness to pay for their healthcare costs. Including medical necessity checking during registration, scheduling and ordering can also help reduce Medicare denials and increase reimbursement by providing medically necessary services or by issuing an ABN for non-covered services.

With the growing financial pressures on healthcare organizations, due to the influx of high-deductible consumer/patients, providers need to seek innovative strategies to improve their revenue cycle performance. The use of patient access management early in the revenue cycle may be a way to avoid financial disaster downstream.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Management (RCM), Patient Access Management, Insurance Billing Solutions