Coronis Health Adapting to Added Telehealth Services Covered By Medicare

One industry that has exponentially grown due to the COVID-19 pandemic is telehealth.

Telehealth services have been on the rise for several years now, addressing the need for making high-quality healthcare more accessible, especially to rural, and isolated communities, but it is now on a paradigm shift as the current pandemic is hastening its demand and growth. And as a response to President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans, the Centers for Medicine & Medicaid Services (CMS) has taken action to increase adoption across the country by expanding the list of telehealth services payable under Medicare when provided via telehealth.

At Coronis Health, we understand the critical importance of remaining vigilant and compliant amid the changing chorus of government and carrier billing regulations and requirements. With 100 years of combined experience, we are here to help organizations adapt to not just changes in healthcare policies but new technologies as well.

11 New Approved Telehealth Services

Since the beginning of the pandemic, CMS has added more than 135 services to the Medicare telehealth services list, including emergency department visits and initial inpatient visits. On October 14, CMS added 11 new services to the list of telehealth services Medicare will reimburse during the COVID-19 public health emergency. Effective immediately and through the duration of the pandemic, Medicare will pay eligible practitioners who provide these newly added telehealth services:

1. 93797: Cardiac rehab

2. 93798: Cardiac rehab/monitor

3. 93750: In-person ventricular assist device interrogation

4. 95970: Electronic analysis of implanted neurostimulator pulse without programming

5. 95971: Electronic analysis of implanted neurostimulator pulse generator/transmitter with programming

6. 95972: Electronic analysis of implanted neurostimulator pulse generator/transmitter

7. 95983: Electronic analysis of implanted neurostimulator pulse generator/transmitter, by physician or other qualified healthcare professional; with brain neurostimulator pulse generator/transmitter programming; first 15 minutes face-to-face with physician or other qualified healthcare professional

8. 95984: Electronic analysis of implanted neurostimulator pulse generator/transmitter, by physician or other qualified healthcare professional; with brain neurostimulator pulse generator/transmitter programming; each additional 15 minutes face-to-face with physician or other qualified healthcare professional

9. G0422: Intensive cardiac rehab with exercise

10. G0423: Intensive cardiac rehab, no exercise

11. G0424: Pulmonary rehab with exercise

To view the full list of services, visit cms.gov.

How Coronis Health is Keeping Up With the Ever-Changing Healthcare Industry

Throughout the pandemic, Coronis Health has quickly become the designated expert for COVID testing billing. We’re trusted to handle tens of thousands of claims because of our experience, innovative mindset, and ability to quickly and accurately adapt to changes. More importantly, we are committed to ensuring our clients comply with these changes as well. 

We are a global company with a personal, high-touch service. Our private practice service group offers custom solutions to healthcare practices of every medical specialty and size. Our hospital, facility, and surgery group offers specialized financial and medical billing solutions to all types of hospitals, FQHCs, SNFs, LTCs, and surgical centers. We seek a level of professionalism and analysis you won’t find elsewhere. As technological innovators, we are also fully integrated with the latest software, allowing us to input coding instantly and execute collections fast and efficiently. We’ve developed an advanced technological system that learns how to collect, who to collect from, and how to get that “last dollar” in an efficient and cost-effective manner.

The Future of Telehealth Services

Demand for telehealth is expected to soar by 64.3% in 2020, according to a recent Frost & Sullivan report. The released report also predicts that telehealth in the U.S. will grow seven-fold by 2025. What this is suggesting is that telehealth may become the new normal for healthcare providers and patients alike.

While telehealth services fill a need, especially during the current crisis, the opportunity for telehealth products and services to become a standard of care is growing. More and more physicians are now recognizing the values of digital health tools in achieving efficiency and safety in healthcare. The pandemic has given them a broader opening and a growing acceptance of exploring better ways to connect with patients. Especially with the constant advancement of technology with devices, apps, programs, and other digital solutions proving to be effective, the demand for telehealth services will persist beyond COVID-19. If patients can receive high-quality care through digital technologies along with exceptional convenience, this enhanced experience will likely drive the traditional healthcare system to embrace this new, digital approach.

And now that lawmakers are recognizing the value of telehealth and agencies are responding with new reimbursement codes, we can foresee greater adoption of telemedicine by providers as payments will align correspondingly to the services delivered.

Schedule an Assessment With Coronis Health

Changes in payment models and new regulations are just a few of the many factors contributing to the dynamic healthcare landscape. Contact Coronis Health today to learn how you can consistently stay on top of these changes while reaching the next level of financial success and to schedule your free financial checkup.

from
https://www.coronishealth.com/blog/coronis-health-adapting-to-added-telehealth-services-covered-by-medicare/

Coronis Health Implementing New Mandatory Medicare ABN

The Centers for Medicare and Medicaid Services (CMS) have revised the Advanced Beneficiary Notice of Noncoverage (ABN) form and have announced that it will delay the regulation requiring physicians to use the new version of the form (Form CMS-R-131).

It was previously reported that CMS would require the use of the new form starting Aug. 31, but due to the COVID-19 public health emergency, the agency pushed that date to Jan. 1, 2021. An ABN form is used to inform a patient in advance of receiving a service wherein Medicare may deny payment for that specific procedure or treatment. This form shifts financial liability from the physician to the patient who will be personally responsible for full payment if Medicare does not pay for the services. ABNs, therefore, can have significant financial implications for your practice, and staying on top of these changes will help maximize your profitability while focusing on patient care.

With 100 years of combined experience, Coronis Health understands the critical need for remaining up to date with the most current regulations in order to meet the ever-changing demands of the healthcare industry. We also know that your most important financial asset is your billed services and accounts receivable. We work to safeguard this asset and help you avoid medical billing and coding errors by employing a professional team possessing a perfectionist approach to accuracy, execution, organization, and timeliness.

The New ABN Form

The revised ABN replaces the ABN form that was last released in June 2017. You can use the new ABN version immediately if desired, but all uses of the older version must cease on January 1, 2021.

There are non-substantive changes to the ABN form itself, but the guidelines for dual eligible beneficiaries (patients who are dually enrolled in both Medicare and Medicaid) have been added to the form’s instructions. These individuals may be classified as a Qualified Medicare Beneficiary (QMB). A provider—whether a Primary & Specialty Physician, Hospital and Surgery Center, or Behavioral Health practice—who is treating a QMB patient may not collect deductibles or copayments for covered services. For a claim to be submitted for Medicare adjudication, dually eligible beneficiaries must be instructed to check Option Box 1 on the ABN form. The official instructions on the form state:

“Special guidance for people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible individuals (has a Qualified Medicare Beneficiary [QMB]Program and/or Medicaid coverage) ONLY:

Dually Eligible beneficiaries must be instructed to check Option Box 1 on the ABN in order for a claim to be submitted for Medicare adjudication.”

Medicare asks you to strike through some of the phrases in Option Box 1 if the beneficiary is dually eligible. In the Instructions, they note:

“Strikethrough Option Box 1 as provided below: OPTION 1. I want the (D) listed above. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.”

Furthermore, they also state:

“These edits are required because the provider cannot bill the dual-eligible beneficiary when the ABN is furnished. Providers must refrain from billing the beneficiary pending adjudication by both Medicare and Medicaid in light of federal law affecting coverage and billing of dual-eligible beneficiaries.”

Medicare will review the other considerations pertaining to dual-eligible beneficiaries and how those claims are processed. Also included in the instructions are details regarding when it is acceptable to charge and collect from the beneficiary in advance and when it is not.

Should Medicare deny a claim where an ABN was needed to transfer financial liability to the beneficiary, the claim may be handed over to Medicaid for adjudication based on State Medicaid coverage and payment policy. Medicaid will then issue a Remittance Advice based on this determination.

Click here to access the newest version of the ABN Form and instructions for use.

Why Compliance Is Necessary

While ABNs can have a significant impact on your practice’s finances, they also serve a critical fraud and abuse compliance function. Under Medicare law, billing for unnecessary services could result in sanctions in the form of administrative, civil, and criminal penalties ranging from monetary fines and damages to prison time and exclusion from the Medicare program. ABNs can serve as a tool for rebutting an argument that claims were submitted with fraudulent intent. Particularly, these forms serve as records of the patients’ acknowledgment that the services may not be covered or may be considered medically unnecessary. The form also validates their decision to still undergo the procedure or treatment.

Adapting to the use of the new ABN form can be taken as a beneficial opportunity to assess your organization for improvements that can augment your revenue. There is no better time than now to familiarize yourself with these new rules and incorporate them into your practice. At Coronis Health, we understand that it is of critical importance that practice managers remain constantly vigilant and compliant amid the changing chorus of governmental or carrier billing and documentation regulations and compliance requirements. Allow us to help you focus on patient care as we guide you through the dynamic structure of the healthcare landscape. We adapt to new policies and regulations with accuracy and we make sure clients are 100% compliant and able to receive patients and bill either out-of or in-network. Coronis Health goes after the last dollar using our seasoned team of tireless and tough negotiators. Our clients receive timely, relevant, and accurate information in a way they can understand. We don’t just help them get money, but we help them financially grow.

Get Your Free Financial Checkup with Coronis Health

With rising operational costs and minimal reimbursement, every possible dollar collected for services is critical to your practice’s financial health. It is therefore necessary to be aware of payment rules that can help increase your revenue. Contact Coronis Health today and learn how we can help you achieve financial success and to schedule your free assessment, in which Coronis Health finds missing revenue in 95% of the assessments we perform.

from
https://www.coronishealth.com/blog/coronis-health-implementing-new-mandatory-medicare-abn/