GeBBS Healthcare RCM Blog

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.

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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, Outsource Coding, Remote Medical Coding, 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.

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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.

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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

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

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