3 Reasons “Less is More” in Hospital Charting

For decades, healthcare providers have voiced their issues with the growing amount of data entry required for Evaluation and Management (E/M) visits.

Some have even complained about spending twice as much time on the documentation process related to caring for patients. For the first time in almost 30 years, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have finally made significant changes to the documentation requirements for the coding and billing of E/M codes. These new documentation and hospital billing guidelines, which took effect on January 1, 2021, will reduce the administrative burden on outpatient office visits by requiring less documentation from physicians. 

At Coronis Health, we understand that by simplifying and streamlining your hospital medical billing, coding, and revenue process, you will not only cultivate financial success but establish better patient care as well. Comprising top medical billers in the country pooling their global resources, we can bring customers the best in medical billing and revenue cycle management. We can offer high-touch relationships and solutions tailored to your needs.

E/M Changes Could Result in Less Required Documentation

The new guidelines aim to simplify the way physicians bill Medicare for E/M visits. “Physicians spend a huge amount of time meeting burdensome documentation requirements during patient interactions, which takes time away from patients and contributes significantly to burnout and professional dissatisfaction,” said AMA President Patrice A. Harris, MD, MA. “Our aim is to reduce excessive documentation burden and provide physicians more time with patients, not paperwork.” And most providers would agree that less documentation may translate to increased productivity. Here are three reasons why less documentation may benefit your facility:

1. Specific Notes Keep Focus on Patient Needs 

Changes in E/M codes will benefit any physician’s note-taking process. Physicians no longer need to keep track of everything discussed during a patient’s visit but simply focus on what the patient is seeking treatment for. This change means more precise and more concise notes that the physician can easily reference when needed. And since the history and physical examination elements will no longer be factored into the office/outpatient E/M code selection, this will allow providers to decide how much pertinent history and examination should be documented to allow for a “medically appropriate history and/or examination.” 

“The whole point was to have people, not document stuff that was not necessary, not relevant to the clinical management of the patient,” according to Dr. Peter Hollmann, a former chair of the CPT Editorial Panel and current lead of an E/M workgroup for the AMA.

2. Excessive Documentation Leads to Physician Burnout

A survey from Medscape looked into provider well-being and asked physicians about their feelings on burnout and depression. When asked what was contributing to their burnout, 56% cited too many bureaucratic tasks like charting and paperwork, and 24% said the increasing computerization of healthcare (EHRs) contributed to their burnout. Another study published in the Journal of the American Medical Informatics Association that examined the impact of information technology on stress and burnout found that physicians commonly experience stress by physicians who use EHRs.

Therefore, by streamlining documentation, simplifying billing in hospitals, and lessening the amount of data entry required, not only will providers get to spend more time on direct patient care, but they can lower their stress levels too.

3. Clear Documentation Ensures Accurate Hospital Medical Billing

Accurate medical billing drives the business of healthcare, and the foundation of accurate medical billing is clear and complete documentation. While physicians train to document the services they perform, the medical reimbursement industry is continually evolving, requiring strict documentation standards. Having an experienced documentation professional who has the knowledge and skills for medical coding and billing on your team, therefore, can be a considerable asset and time-saver. 

How Coronis Health Can Ease the Pressure of Your Hospital Billing Services

The changes made on the coding of E/M visits intend to reduce documentation, making billing in hospitals more efficient and giving physicians more time to focus on patient care. However, it also requires you to reassess your documentation system in general.

With more than 100 years of combined experience in hospital billing services, Coronis Health has been assisting healthcare facilities to adapt to changing regulatory guidelines for a very long time. Not only do we stay updated with the latest CMS announcements and hospital billing guidelines, but we remain fully integrated with the newest software so we can input coding instantly and execute collections fast and efficiently. We understand that no matter how regulations and requirements change, documentation can be a burden, no matter your facility size. While we make sure you are 100% compliant, we can also help lighten your load by handling your hospital medical billing and coding responsibilities. We are also 100% transparent, so you will receive valuable facility reporting, allowing you to stay up to date and have access to all your information at all times.

Schedule An Assessment With Coronis Health

Stay focused on patients, not the paperwork. When you select Coronis Health’s medical billing and coding services, you gain a committed partner to your facility’s success. Using industry-leading technology combined with high-touch relationship building, Coronis Health allows you to focus on patient care, accelerate your revenue cycle, and maintain financial independence. To learn more about our hospital billing services, contact Coronis Health today, or request a free financial checkup.

from
https://www.coronishealth.com/blog/3-reasons-less-is-more-in-hospital-charting/

Are You Properly Billing and Coding COVID-19 Vaccinations At Your Hospital?

Now that we have approved and recommended COVID-19 vaccines (Pfizer-BioNTech and Moderna), it’s time to execute the correct medical billing and coding strategy to sustain the country’s vaccination efforts properly.

These medical codes were nonexistent a year ago. Still, since we face a global pandemic, healthcare practitioners must quickly adapt to these new guidelines to accurately account for the novel coronavirus. 

At Coronis Health, we understand hospital billing services’ complexity and embrace the critical importance of remaining constantly vigilant amid the changing chorus of hospital medical billing and coding requirements. We continue to adapt to the ever-changing environment that COVID-19 brings to the healthcare industry. We will make sure you are 100% compliant and provide you with tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company.

CPT Codes for COVID-19 Vaccinations 

The CPT Editorial Panel has approved a unique CPT code for each of the three coronavirus vaccines: Pfizer-BioNTech, Moderna, and AstraZeneca (awaiting authorization) as administration codes unique for each vaccine. For better tracking, reporting, and analysis, the new CPT codes clinically distinguish each coronavirus vaccine. The CPT codes are already made available before their public availability for facilities to update their electronic healthcare systems and learn how to execute billing for them efficiently.

For your reference, these are the same Category I CPT codes and long descriptors for the three vaccines, as indicated by the American Medical Association (AMA).

Pfizer-BioNTech and Moderna

• 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use.
• 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use.

AstraZeneca

• 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use

To document the administration of the vaccines, AMA has also created codes 0001A, 0002A, 0011A, and 0012A. Code 0001A describes the administration of the first dose of the Pfizer-BioNTech vaccine, while 0002A describes the second dose of the vaccine. For the Moderna vaccine, 0011A is used for the first dose and 0012A for the second dose.

Also stated by AMA, these CPT codes account for the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers, as well as updating the electronic record. All the vaccine-specific CPT codes are available for use and effective upon each new coronavirus vaccine receiving emergency use authorization or approval from the FDA.

The complete list of codes and descriptors can be accessed here.

ICD-10 Codes for COVID-19 Vaccinations 

The Centers for Medicare and Medicaid Services (CMS) has developed more than 20 International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes for documenting COVID-19 treatments and vaccines, and six of these codes are for vaccine administration. Those exact codes are:

• XW013S6: Introduction of COVID-19 vaccine dose 1 into subcutaneous tissue, percutaneous approach, new technology group 6
• XW013T6: Introduction of COVID-19 vaccine dose 2 into subcutaneous tissue, percutaneous approach, new technology group 6
• XW013U6: Introduction of COVID-19 vaccine into subcutaneous tissue, percutaneous approach, new technology group 6
• XW023S6: Introduction of COVID-19 vaccine dose 1 into muscle, percutaneous approach, new technology group 6
• XW023T6: Introduction of COVID-19 vaccine dose 2 into muscle, percutaneous approach, new technology group 6
• XW023U6: Introduction of COVID-19 vaccine into muscle, percutaneous approach, new technology group 6

Vaccination Reimbursement 

A new interim final rule with a comment period ensures that there will be Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus, just as long as the vaccines are authorized for emergency use or approved by the FDA.

The final rule also states that Medicare will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. But if an approved COVID-19 vaccine will require multiple doses, CMS will reimburse providers $16.94 for the initial dose and $28.39 for the administration of the final dose.

Other provisions indicated in the rule include:

• Both inpatient and outpatient reimbursement changes will only last for the duration of the COVID-19 public health emergency and come with some strings attached. 
• COVID-19 hospitalizations that involve the use of certain new products authorized or approved to treat the virus will qualify for the enhanced payment, which will be the lesser of 65 percent of the operating outlier threshold for the claim or 65 percent of the cost of a COVID-19 stay beyond the operating Medicare payment, including the 20 percent add-on payment for COVID-19 hospitalizations authorized by the CARES Act.
• Medicare will reimburse hospitals separately for the use of drugs and biologicals.
• Medicaid reimbursement rates will vary by state and type of arrangement, for example, fee-for-service or managed care.
• Reimbursement rates will also vary among private payers. Federal regulations also require the payers to cover COVID-19 vaccines and administration even if they are provided through an out-of-network provider.

Hospital Billing Guidelines for COVID-19 Vaccine 

According to CMS, you can either bill on single claims for COVID-19 shot administration or submit claims via a roster billing for multiple patients at one time. And when COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. You must not include the vaccine codes on the claim when the vaccines are free.

If using roster billing in a hospital for institutional claims, you must administer shots to at least five patients on the same date, unless the institution is an inpatient hospital, says CMS. You can also submit individual claims.

The following are valid types of bills for roster billing:

• 12X, Hospital Inpatient (Medicare pays for the COVID-19 vaccine shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X for hospitalized patients)
• 13X, Hospital Outpatient (Medicare pays for the COVID-19 vaccine shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X for hospitalized patients)
• 22X, Skilled Nursing Facility (SNF) covered Part A stay (paid under Part B) & Inpatient Part B
• 23X, SNF Outpatient
• 34X, Home Health (Part B Only)
• 72X, Independent and Hospital-based Renal Dialysis Facility
• 75X, Comprehensive Outpatient Rehabilitation Facility
• 81X, Hospice (Non-hospital)
• 82X, Hospice (Hospital)
• 85X, Critical Access Hospital

CMS also indicates that providers need to be enrolled in Medicare to bill the public payer for COVID-19 vaccine administration. 

How Coronis Can Help Your Hospital Medical Billing for COVID-19 Vaccinations 

What makes hospital medical billing a challenging responsibility is keeping up with the changes in Medicare, Medicaid, and third-party payers. Facilities must stay up to date on the latest changes in regulations to maintain compliance and to ensure the submission of clean claims. Particularly, proper medical billing for the COVID-19 vaccinations is essential not only for reimbursement but also for government reporting purposes.

As a medical billing company with more than 100 years of combined experience, Coronis Health is committed to constantly adapting to the healthcare industry’s dynamic landscape. We keep abreast of hospital billing guidelines, report on current and emerging health issues, and make sure your hospital billing services are aligned with new regulations. We will work as your partner and provide you with medical billing and coding solutions that ensure your collections are easy to manage and that denials are kept to an absolute minimum.

Schedule an Assessment with Coronis Health

Ensuring compliance with hospital billing guidelines can be a daunting and time-consuming task. Still, with the help of Coronis Health, you can effectively manage compliance. Get your facility COVID-19 vaccine ready with Coronis Health as your partner. Contact us today to schedule an assessment or request a free financial checkup.

from
https://www.coronishealth.com/blog/are-you-properly-billing-and-coding-covid-19-vaccinations-at-your-hospital/

How the 2021 Medicare Rule Changes Will Affect Your Hospital Billing Guidelines

The Centers for Medicare & Medicaid Services (CMS) aims to reduce the burden placed on physicians required to adhere to the current coding system and reward them accordingly for their time spent managing and evaluating patients.

In the final rule, the CMS makes several changes to streamline reporting processes. This rule affects office and patient evaluation and management (E/M) services, particularly to align E/M coding with the AMA CPT Editorial Panel for office/outpatient E/M visits and to indicate their growing support for telehealth services by making some expansions from the COVID-19 PHE permanent. This rule went into effect on January 1st, 2021. 

Similarly, Coronis Health is committed to ensuring that you can spend as much time as possible with your patients while staying on top of hospital billing guidelines by dedicating our services to simplifying hospital billing services. We are a global company with a personal, high-touch service. Our 100+ years of combined experience has allowed us to bring together the most innovative and thought-advancing leaders in hospital medical billing and revenue cycle management, progressing this industry into the modern, technological age. We make sure you can address any operational or administrative workflow adjustments, so you stay in front of any changes while focusing on patient care.

Changes that Will Affect Hospital Medical Billing

These changes are a response to the issues encountered with the healthcare documentation system. Physicians have always expressed concern about how accomplishing the healthcare documentation process takes so much of their time away from caring for patients. Furthermore, the final rule changes conform to the “Patients Over Paperwork” initiative of CMS to cut the “red tape” by removing regulatory obstacles. By reducing administrative burdens, billing in hospitals can be more efficient and patient-centric. The new CPT changes will reduce the time needed for physicians to complete the documentation process of visits, allowing them to spend less time on hospital medical billing and spending more time on patient care.

E/M Requirements

Previously, E/M “time” only covered how long physicians spent on face-to-face activities with patients. But effective Jan. 1, it now includes non-face-to-face work on the date of service, and providers must document the visit on either time or Medical Decision Making (MDM). Activities that may count as non-face-to-face include:

• Reviewing documents (e.g., test results, medical history) in preparation for a patient’s visit
• Counseling and educating the patient, family, or caregiver
• Care coordination
• Ordering medications, tests, or procedures
• Referring and communicating with other health care professionals 
• Documenting clinical information 
• Independently interpreting results and communicating results to the patient, family, or caregiver

If MDM is used to determine the E/M code for the outpatient visit, the physician will weigh certain factors depending on the site of service. For an office setting, factors in MDM include:

• Number and complexity of problems addressed
• Amount and/or complexity of the data reviewed and analyzed
• Risk of complications and/or morbidity of patient management

For an evaluation made in an inpatient setting, factors include:

• Number of diagnoses or management options
• Amount and/or complexity of data to be reviewed
• Risk of complications and/or morbidity

If time is used to determine the E/M code, new time values will be applied. The definition of time has changed from “typical face-to-face time” to “total time spent on the day of the encounter.” Providers will now focus on increments of time spent on the day of the encounter with the patient. For example, for new patient codes, times begin at 15–29 minutes for CPT code 99202 and then advance in 15-minute increments with 99205 assigned 60–74 minutes. For existing patients, the time element was removed from CPT code 99211. For CPT code 99212, the time for the encounter will be 10–19 minutes. Ten-minute increments are used for codes 99213 and 99214. CPT code 99215 has a 15-minute time frame and is utilized for exams 40–54 minutes in duration.

Current Procedural Terminology (CPT) Changes

Other key changes to coding include the following:

• Eliminating history and physical exam as elements for code selection
• Allowing physicians to choose whether their documentation is based on MDM or total time.
• Promoting payer consistency with more detail added to CPT code descriptors and guidelines
• Retaining five levels of coding for established patients
• Reducing the number of levels to four for office/outpatient E/M visits for new patients
• Revising the code definitions
• Revising the times and MDM process for all codes

Telehealth for Medicare Updates

Telehealth has proven to become a valuable healthcare asset during the PHE. Recognizing its value in improving healthcare accessibility, the Final Rule has created an expanded list of covered telehealth services specific to the PHE. Also, certain temporary codes added during the onset of PHE are now permanent.

Telehealth services added to the Medicare telehealth list include:

• GPC1X – Visit Complexity Associated with Certain Office/Outpatient E/Ms, 
• 99417 – Prolonged Services
• 99334, 99335 – Domiciliary, Rest Home, or Custodial Care Services
• 99347, 99248 – Home Visits

You may view all updates on policy changes here.

How Coronis Can Help Your Hospital Stay Compliant

At Coronis Health, we understand the importance of staying abreast with new hospital billing guidelines, and we are here to help you smoothly navigate through the ever-changing field of hospital billing services. Staying informed is essential in this industry. Therefore, our practice managers remain constantly vigilant and compliant with these billing and documentation regulations and compliance requirements. Your most vital financial asset is your billed services and accounts receivable, so we make sure it is well-organized, tightly managed, and safeguarded by a professional team. As trusted advisors and technological innovators, we can input coding instantly and execute collections fast and efficiently.

Schedule an Assessment with Coronis Health 

Changes in regulations for billing in hospitals can be challenging, especially for smaller private practice physicians. You will need a partner who can help you adapt by providing proper education and medical billing & coding solutions, improving your productivity, and achieving financial success. To learn more, schedule a consultation with Coronis Health today or request a free financial checkup.

from
https://www.coronishealth.com/blog/how-the-2021-medicare-rule-changes-will-affect-your-hospital-billing-guidelines/