GeBBS Healthcare Blog

Specificity of ICD-10 Coding Can Improve Reimbursements for Vaccine Administration

Posted on Wed, Jan 11, 2017 @ 10:15 AM

Administration of vaccines is an important part of healthcare delivery, and a critical contribution to preventive public healthcare. However, risings costs are making it difficult to align vaccine administration expenses with revenues.

There may be some relief to these rising costs and it comes from something that was once seen as a burden for medical practices. That relief comes in the form of ICD-10 coding.

MMRvaccine.png

The transition to ICD-10 was seen as an administrative burden for many practices, but it does offer some relief in aligning vaccination reimbursement with actual costs. Compared to the previous coding system, ICD-10 recognizes the type of vaccine provided by the CPT or HCPCS code entered, negating the need for individual diagnosis codes.

The American Academy of Family Physicians (AAFP) offers specific coding guidance for practice billing patients covered by Medicare Part B and Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) also offers guidance on choosing the right code for adult vaccinations, including the seasonal flu shot.

Correct coding is essential to receiving the proper reimbursements. A robust Health Information Management (HIM) coding program has never been more critical to the success of healthcare organizations than it is now. If your practice is not sure whether or not you have the expertise to code properly and receive the optimum reimbursements you deserve, it’s time to engage with a partner who brings a deep understanding of how proper coding affects the revenue cycle.

GeBBS Healthcare Solutions provides Health Information Management (HIM) solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. We are a leading provider of outsourced medical coding and coding validation audits, and we have a unique insight into your challenges when it comes to data quality and coding accuracy, productivity, and reliability.

Let our team of expertly trained and qualified Health Information Management coders, who adhere to the best practices in the HIM coding field, make sure you receive the optimum reimbursements for your vaccine administrations.

Tags: Revenue Cycle Management (RCM), RCM Solutions, ICD-10, Medical Coding, Medical Coding BPO, coding outsourcing, outsourced coding, outsourced medical coding

Coding Denials “Wait and See What Happens” Will NOT be a Good Strategy When the ICD-10 Grace Period Ends!

Posted on Wed, Sep 28, 2016 @ 11:20 AM

The Centers for Medicare & Medicaid Services’ (CMS) grace period for denials of claims under ICD-10 will end on October 1, 2016. Healthcare providers and billing companies must be prepared for this deadline and its financial effects.

MedicalClaim-Denied.jpg

When CMS instituted the new ICD-10 program last year, it announced that Medicare claims would neither be denied nor audited based on their coding, as long as practices submitted an ICD-10 code from the appropriate family of codes. 

Physicians and hospitals need to be prepared for the end of this grace period, especially with their high-volume diagnoses. The time leading up to the deadline needs to be spent on staff training and ascertaining that you are prepared for the actual, correct ICD-10 coding. Healthcare providers need to be prepared for decreased staff productivity and possibilities of other financial challenges during the remainder of the ICD-10 grace period. 

A recent article in the ICD10monitor entitled “ICD-10 Denials Are Increasing: Fact or Fiction?” written by Kim Charland, BA, RHIT, CCS, stated that, “Several industry experts have been indicating over the last few weeks on ICD10monitor’s weekly Internet broadcast that ICD-10 denials do seem to be increasing. Due to many factors, ICD-10 coding accuracy rates are hovering on average in the 80-percent range, and there seems to be an expectation that denials will begin to increase.”

In addition, a recent ICD10monitor poll conducted to see how provider subscribers are actually doing, found that 71 percent of respondents have seen an increase in ICD-10 claim denials since ICD-10 implementation and 58 percent have experienced an increase in denial dollars since the implementation of ICD-10.

In the article, a past chairman of the Healthcare Finance Management Administration (HFMA) and a former hospital CFO suggested for an average-size hospital, the average increase in denials could be $1 to $3 million.

GeBBS Healthcare Solutions can help you be prepared for the end of the ICD-10 grace period and its effects on your coding denials. We can help you improve your coding accuracy which always carries a significant impact on reimbursement and cash flow. Denials, which will be exacerbated by the end of the grace period, reinforce the need for coding accuracy training. The number one reason for complex RAC denial is inpatient coding error. Eighty-one percent of hospitals report complex denials based on IP coding errors and 40 percent of hospitals report OP coding errors have the largest financial impact.

Is your coding ready for the ICD-10 post grace period?

Tags: Medical Coding, Medical Coding BPO, Remote Medical Coding, Outsource Coding

CMS and AHIP Move to Improve Healthcare Quality Measures

Posted on Thu, Apr 28, 2016 @ 04:00 AM

The Obama administration and health insurers took steps recently to standardize and improve the measures that are intended to gauge the quality of healthcare. The CMS and trade group America's Health Insurance Plans (AHIP) have announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. This is a good move!

Quality.gif

Nobody benefits when doctors spend time collecting different data for multiple insurers instead of using those resources to improve the quality of patient care. This agreement to standardize quality measures can accelerate development of capturing data that patients care about most – how fast they recover from any illness or treatment.

The most important aspect of this new quality program will be how it deploys superb clinical documentation and expert medical coders to identify and codify these new quality measures.

Medical coding is the lifeblood of a revenue cycle, regardless of whether or not it is used in pay-for-performance contracts. Accurate and efficient coding is crucial to meet financial and compliance goals. Medical coding can be complex yet time sensitive, where being down even a single coder can impact revenue. Healthcare providers need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient coding.

An expert HIM company can provide immediate, experienced coding professionals to help healthcare providers capture these new quality measures. Whether the medical coders work on-site or remote, U.S. or global, their knowledge and training is top notch. They know the most current coding regulations and keep up to date with the latest in patient care in the clinical and hospital setting. Strict enforcement of coding compliance guidelines, ongoing reviews, and a commitment to continuing education promotes coding accuracy, data integrity, and proper claims submission.

These new quality measures are also making accurate clinical documentation more important than ever. RAC, Medical Necessity, ICD-10, pay-for-performance, and the growth in volumes resulting from the ACA are all impacting healthcare organizations. The ability to get reimbursed is directly dependent on the quality of clinical documentation. Missing, poor, or non-specific clinical documentation will result in lost revenue.

Outsourcing can help you comply with the new quality measures and get you paid faster by improving your clinical documentation. Outsourced CDI specialists are professionals of the highest caliber. They are credentialed, experienced, and they are passionate about getting even the smallest details right. Whether the CDI professionals are assessing your program or supplementing your staff, they can help you develop, improve, and maintain your clinical documentation to meet the new CMS and AHIP quality measures.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding, Offshore Medical Coding, Outsource Coding, Medical Coding BPO

The Climb to Conquer “Mount ICD-10” Is Going to Get Steeper

Posted on Mon, Mar 28, 2016 @ 05:00 AM

The climb to conquer Mount ICD-10 is going to get steeper and more difficult. Be sure you have an experienced guide to help you on this perilous journey. The ICD-10 transition difficulties were lessened by CMS by not dropping all of the thousands of new codes on the healthcare industry at one time. That is going to change.

MountICD-10.jpg

The Centers for Medicare & Medicaid Services (CMS) recently added for review about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for healthcare claims in fiscal year 2017. The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015. The new diagnosis codes are included in the hospital inpatient prospective payment system proposed rule for FY 2017.

There is time to get prepared for onslaught of these new codes. Begin your search for an outsourcing partner who has the expertise to lead your facility on this journey and ensure your revenue cycle is not impacted.

While patient volumes are on the rise with the newly insured, your ability for achieving patient satisfaction, profitability, and compliance goals are increasingly at risk. A robust Health Information Management (HIM) program has never been more critical to the success of healthcare organizations than it is now.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. An experienced outsourcing partner can help you cut through the complexity of the new ICD-10 codes with expertise, operational excellence, and a sophisticated technology approach.

An experienced outsourcing partner can offer a comprehensive range of HIM solutions that will help you comply with these new codes using a diverse portfolio of services, including:

Make sure your facility has an “experienced Sherpa” to help you master the climb to the pinnacle of “Mount ICD-10.”

Tags: Business Process Outsourcing (BPO), HIPAA, Outsource Coding, Medical Coding BPO

There Is NO Substitute for Training & Experience When It Comes to HIPAA Compliance

Posted on Tue, Mar 22, 2016 @ 10:20 AM

By Nitin Thakor, GeBBS President & CEO

The HHS Office for Civil Rights (OCR) recently imposed heavy monetary fines and acceptance of resolution agreements and corrective action plans on two provider organizations following substantial violations of the HIPAA privacy and security rules.

About 30 organizations to date have now agreed to such sanctions after OCR determined they were essentially ignoring HIPAA.

HIPAA-Compliance.jpg

This action reinforces the importance for healthcare providers to deal with experienced vendors and outsource organizations when it comes to HIPAA compliance. There is no substitute for intense training on how to handle protected health information (PHI). PHI touches almost every aspect of healthcare delivery from revenue cycle management to patient care, and healthcare providers must ensure they are dealing with a partner that completely understands all aspects of HIPAA compliance.

Whether it’s an HIM solution, end-to-end revenue cycle management, insurance billing, or a patient access solution, the company applying these applications to help healthcare providers must understand, and more importantly, apply ALL HIPAA compliance regulations as they use these solutions in the actual delivery of healthcare. Training and experience are the key factors in delivering on HIPAA compliance.

An experienced outsource company will have in place a business associate agreement (BAA) that addresses risk analysis and all potential vulnerabilities to a client’s electronic protected health information. They will examine where and how their solutions impact PHI and address its protection enterprise-wide throughout the client’s IT infrastructure.

When it comes to PHI and HIPAA compliance, training and experience do make a big difference.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding BPO

CMS Chronic Care Management (CCM) Initiative Can Help Improve Bottom Line for Physicians

Posted on Fri, Mar 18, 2016 @ 05:00 AM

In today’s healthcare delivery environment, physicians are constantly looking for new ways to earn and increase their bottom lines. For example, the 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT code 99490 -- Chronic Care Management (CCM), which reimburses 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.

NEW-01-Home-Health-Care-Feature.jpg

The good news is that chronic care management, as well as the medical coding for these services, can be fulfilled by professional outsourced companies. 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 and medical coding professionals. These outsourced coding companies can work hand in hand with a medical practice’s CCM to provide end-to-end professional services. 

It’s not a coincidence that more than 80% of practices who want to offer CCM services to their patients ultimately end up outsourcing their CCM service and their medical coding. 

The billing physicians are still responsible for creating their critically-ill patients’ care plans and directing the efforts of their professional outsourced staff. 

CMS allows physicians who bill for the 99490 code 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 medical coding and care management of chronic diseases to their patients who need it the most and at the same time create a new revenue stream.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO

Medical Coding Outsourcing is More Than Staffing

Posted on Thu, Feb 18, 2016 @ 06:00 AM

Outsourced medical coding's traditional approach has been staff augmentation. It has been typically used to meet short-term gap needs due to turnover, extended absences, or electronic medical record (EMR) changes. In other words, it has been used when a healthcare provider needed temporary additional resources to supplement its existing resources. However, from our experience, this traditional staff augmentation model is not keeping up with the rapidly changing needs in the healthcare industry.

IAOP---2016-email-signatureStacked.jpg

There is a growing demand for healthcare services to meet the needs of an aging population and the burgeoning impact from newly-insured patients resulting from the Affordable Care Act. The effect is a trickle down that has increased staffing needs all along the revenue cycle from coding to accounts receivables to collections. With the industry’s transition to ICD-10 with its new codes and processes, and computer-assisted coding (CAC), providers have been challenged to keep up with this evolution.  There is a need for coders -- not just new coders, but also current coders who have been trained to work in today's new coding world.

As a result, there are some healthcare providers who have spread their outsourcing needs across multiple vendors to meet this demand. Invariable, the quality can suffer with inconsistencies among different vendor processes and management. Further, the vendor has limited economic incentive to make meaningful investments to ensure success due to the limited or unknown contract length. Short-term traditional approach engagements face ramp-up challenges, since even experienced coders may need 45 or more days to reach full efficiency. Coders working in these environments may not capitalize on the values of synergy in processes and technology that using outsourcing professionals from a single vendor offers.  

GeBBS, which was recently selected to this year's IAOP Global 100 Outsourcing List, has seen this trend with its long-term investment and delivery of end-to-end revenue cycle management (RCM) solutions. These solutions provide not only coders, but also HIM technology platforms for coding and audits to improve coding efficiency, accuracy and control. This combination of coders and a comprehensive audit and management capability creates transparency for higher coding performance that meets client standards. The byproduct from higher coding performance is the reduced number of claim denials, which ultimately improves the provider’s revenue flow.  This long-term investment is just as true with accounts receivable and patient access, where the strength of GeBBS’ outsourced RCM is not just outsourcing staffing, but also the infrastructure backbone supporting the staffing. The net impact that healthcare providers are seeing include cohesive outsourcing benefits across all of the elements of people, processes and technology.  So when you think of outsourcing, realize the important value that outsourcing can provide is not only people, but also the processes and technology to support those people.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO, Coding Accuracy

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