2022 Updates You Need to Know

Medicare Clinical Laboratory Fee Schedule Private Payor Data Reporting – Delayed until 2023

The Protecting Medicare and American Farmers from Sequester Cuts Act delayed the Clinical Laboratory Fee Schedule private payor reporting requirement:

• Next data reporting period is January 1 – March 31, 2023
• Reporting is based on the original data collection period, January 1 – June 30, 2019

The Act also extended the statutory phase-in of payment reductions resulting from private payor rate implementation:

• No payment reductions for Calendar Years (CYs) 2021 and 2022
• Payment won’t be reduced by more than 15% for CYs 2023 through 2025

COVID-19 Vaccine & Monoclonal Antibodies : Changes for MA Plans Starting January 1, 2022

If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.

Pneumococcal Conjugate Vaccine, 15 Valent 

Medicare began covering pneumococcal conjugate vaccine,15 valent on July 16. CMS suggests submitting separate claims for this vaccine (HCPCS code 90671).

• Part A and B Medicare Administrative Contractors will hold claims for vaccines provided after December 31 until pricing is set
• CMS will deny claims for vaccines provided before July 16 

Average Sales Price Files: January 2022

CMS posted the January 2022 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2022 ASP Drug Pricing Files webpage.

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims. The 2% sequestration cut that would apply to all Medicare rates beginning January 1, 2022 is postponed until April 1, 2022:

• No payment adjustment through March 31, 2022
• 1% payment adjustment April 1 – June 30, 2022
• 2% payment adjustment beginning July 1, 2022

New Telehealth POS codes

The Centers for Medicare & Medicaid Services (CMS) has published new guidance on the reporting of telehealth/telemedicine Place of Service (POS) codes.

For reporting Medicare telehealth services, CMS had recommended reporting the POS code that would have been reported if the service had been furnished in person. This recommendation was intended to allow CMS to make appropriate payments for services furnished via Medicare telehealth at the same rate as in-person services.

The POS code listed on a claim provides information on the location or setting for the services rendered. This information is necessary to pay claims correctly.

To meet the widespread use of telehealth during the public health emergency, CMS is now updating the 2022 POS code set by revising the description of existing POS code 02, Telehealth Provided Other than in Patient’s Home, and adding new POS code 10, Telehealth Provided in Patient’s Home. According to CMS’ October MLN Matters, the POS changes will go into effect on Jan. 1, 2022, and will be implemented on April 4, 2022.

POS 02: Telehealth Provided Other than in Patient’s Home

The location where health services and health-related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health-related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home

The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

from
https://www.coronishealth.com/blog/2022-updates-you-need-to-know/

Surprise! It’s the No Surprises Act

Starting January 1, 2022, consumers will have new billing protections from receiving surprise medical bills for emergency services (including air ambulances) and non-emergency services provided at an in-network facility.

Patients’ out-of-pocket costs will be limited to the costs they would have paid if they had received services from an in-network doctor, hospital, or other health care provider.

Background – Surprise Billing and the Need for Greater Protections

Providers and facilities that are not part of a plan or issuer network (out-of-network or “OON” providers) usually charge higher amounts than the contracted rates the plans or issuers pay to in-network providers.

In many cases, the OON provider may bill the individual for the difference between the charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing. A “balance bill” may come as a surprise for many people. A surprise bill is an unexpected bill from a health care provider or facility.

The No Surprise Act (NSA) will protect consumers from surprise medical bills by:

• requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans
• prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.

Emergency Services  – Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. Without any prior authorization (i.e., approval beforehand).

Non-emergency services provided at in-network facilities – The NSA covers non-emergency services

provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead, they bill independently and do not necessarily participate in the same health plan networks. 

Doctors and hospitals must not bill patients more than the in-network cost sharing amount for surprise bills

For services covered by the NSA, providers are prohibited from billing patients more than the applicable in-network cost sharing amount; a penalty of up to $10,000 for each violation can apply.

How will consumers know if a bill or claim constitutes a surprise medical bill? – It is up to both providers and health plans to identify bills that are protected under the NSA. Providers and facilities must post a one-page disclosure notice summarizing NSA surprise billing protections on a public website and give this disclosure to each patient for whom they provide NSA-covered services.

Some providers can ask consumers to waive rights

An exception to federal surprise billing protections is allowed if patients give prior written consent to waive their rights under the NSA and be billed more by out-of-network providers. 

Notice and Consent Waiver Not Permitted for:

• Emergency services
• Unforeseen urgent medical needs arising when non-emergent care is furnished
• Ancillary services, including items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology
• Items and services provided by assistant surgeons, hospitalists, and intensivists
• Diagnostic services including radiology and lab services
• terms and services provided by an out-of-network provider if there is not another in-network provider who can provide that service in that facility

Good Faith Estimates for Uninsured (or Self-pay) – Requirements for Providers & Facilities

When scheduling an item or service, providers and facilities are required to inquire about the individual’s health insurance status. The provider or facility must provide a good faith estimate of expected charges for items and services to an uninsured (or self-pay) individual, meaning an individual that:

• Does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal health care program
• Has benefits for such items/services under a group health plan, group or individual health insurance coverage offered by a health insurance issuer but does not seek to have a claim submitted to their plan, issuer, or carrier for the item or service.

The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities. 

Determining Out-of-Network and Cost-Sharing Rates:

The total amount to be paid to the provider or facility, including any cost sharing, is based on:

• An amount determined by an applicable All-Payer Model Agreement under section 1115A  of the Social Security Act.
• If there is no such applicable All-Payer Model Agreement, an amount determined by a specified state law.
• If there is no such applicable All-Payer Model Agreement or specified state law, an amount agreed upon by the plan or issuer and the provider or facility.
• If none of the three conditions above apply, an amount determined by an independent dispute resolution (IDR) entity.

Patient-Provider Dispute Resolution

In a situation where an uninsured (or self-pay) individual receives a good faith estimate and then is billed for an amount substantially in excess of the good faith estimate

A patient’s bill will be determined eligible for the patient-provider dispute resolution process if the patient received a good faith estimate, if the process is initiated within 120 calendar days of the patient receiving the bill, and if the bill is substantially in excess of the good faith estimate.

HHS has defined “substantially in excess” as the billed charges being at least $400 more than the good faith estimate for any provider or facility listed on the good faith estimate.

Learn more at: https://www.cms.gov/nosurprises

from
https://www.coronishealth.com/blog/surprise-its-the-no-surprises-act/

Medicare Physician Fee Schedule Final Rule: Calendar Year 2022

Here’s What’s Changing in 2022

With numerous changes on the horizon for 2022, Coronis Health can help make sure you stay informed.

Medicare Part B Premium & Deductible Rate Increase

• The standard premium for Medicare Part B will be $170.10 next year, up $21.60 (14.5% increase) from $148.50 this year.
• The annual Medicare Part B deductible for all beneficiaries will be $233, up $30 (14.8% increase) from the annual deductible of $203 in 2021.
• The bigger-than-anticipated increase is attributed to rising prices and utilization across the healthcare system and congressional action that limited the increase in the 2021 Part B premium.
• The deductible for Medicare Part A (hospital coverage) per benefit period (which generally starts when you are admitted to the hospital) will be $1,556 in 2022, up $72 from this year’s $1,484.

Payment Increase in Vaccine Administration

• Effective January 1, 2022, CMS will pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines. Depending on locality, this is an increase of $10-$15 per vaccine administration.
• CMS will maintain the current payment rate of $40 per does for the administration of the COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends.

Split (or Shared) E/M Visits Changes

• The visit should be billed by the physician or practitioner who provides the substantive portion of the visit.
• Split (or shared) visits can be reported for new as well as established patients.
• A modifier is required on the claim to identify these services to inform policy and help ensure program integrity. The modifier has yet to be released by CMS.
• Documentation in the medical record must identify the two individuals who performed the visit. The individual providing the substantive portion must sign and date the medical record.

Critical Care Services Updates

• Critical care services may be paid on the same day as other E/M visits by the same practitioner or another practitioner in the same group of the same specialty if the visit was medically necessary and the services are separate and distinct.
• Practitioners must report modifier -25 on the claim when reporting these critical care services.

Telehealth Services

• Services added during the COVID-19 PHE list pertaining to Telehealth will remain on the list through December 31, 2023.
• An in-person, non-telehealth visit must be furnished at least once every 12 months.
• CMS is amending the current definition of interactive telecommunications system for telehealth services to include audio-only technology.

Electronic Prescribing of Controlled Substances

• CMS will delay the start date for compliance actions related to electronic prescribing of controlled substances to Jan. 1, 2023, and delay the compliance start date for Part D prescriptions written for beneficiaries in long-term care facilities to Jan. 1, 2025.

Medicare Shared Saving Program

• CMS will delay the increase in the quality performance standard Accountable Care Organizations must meet to be eligible to share in savings until program year 2024.

Billing for Physician Assistant Services

• Medicare currently can only make payment to the employer or independent contractor of a PA. Beginning January 1, 2022, PAs may bill Medicare directly for their professional services.

Therapy Services

• CMS will implement the use of new modifiers (CQ and CO to identify and make payment at 85 percent of the Part B payment amount for physical therapy and occupational therapy services for dates of service on and after January 1, 2022.

In-Home Administration of COVID-19 Vaccines

• CMS will continue the additional payment of $35.50 for COVID-19 vaccine administration in the home under certain circumstances through the end of the calendar year in which the PHE ends.

COVID-19 Monoclonal Antibody Reimbursement Rate

• CMS will continue to pay for COVID-19 monoclonal antibodies. CMS will maintain the $450 payment rate for administering a COVID-19 monoclonal antibody in a health care setting.

from
https://www.coronishealth.com/blog/medicare-physician-fee-schedule-final-rule-calendar-year-2022/

Real Clients, Real Results

Coronis Health is comprised of the top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. With over 35 years of combined experience in various niches, including hospitals of all sizes, Coronis offers customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. We are more than capable of turning your practice or hospital’s challenging situation into an opportunity for growth. How? Our clients’ success stories say it best.

Efficient Billing for Better Bottom Lines

A Hendersonville, NC-based FQHC experienced COVID-related obstacles. With the state of emergency, they faced the challenge of directing all of their administrative personnel to work remotely. They had to develop systems and processes for remote supervision, communication, motivation, and staff direction. Now, they consider the work they do with Coronis as seamless. Coronis has become a valued partner in their billing operation. “They fit right into our new overall workflow with no disruption,” this FQHC shares.

The FQHC initially reached out to us to supplement their in-house billing staff, because qualified medical billing and collection staff in their semi-rural area are in great demand. Since they couldn’t always compete with the compensation demanded by experienced staff, they usually just hired new employees and went through the repetitive process of training them and eventually losing them to bigger hospitals or group practices in Asheville. As a result, their billing staff was perpetually undertrained, and their AR over 90 days had, as they described, “begun to grow like mold in these damp mountains.” 

Coronis Health offers experienced, often more qualified, professional staff at affordable rates. Additionally, we guarantee a minimum level of productivity and are very focused on ROI and quality of work. Within 4 months or so, we were able to help reduce their over 90 commercial insurance AR from $2 million to less than $400K and cleared a denials backlog that was just over a year old. “We’ve increased our commercial insurance collections dollars by more than 28% since partnering with Coronis Health,” they proudly state.

Healthier Revenue Cycles for Healthier Financials

Care Alliance Health Center, a mid-size health center located in Cleveland, Ohio, began its partnership with Coronis Health as a revenue cycle client. Care Alliance is one of six FQHCs Coronis supports in Ohio and our third partner working on the OCHIN EPIC installation. Our billing team assumed responsibility for all billing functions post-charge capture, including claim submission, rejection and denial work, payment posting, and overall management of accounts receivable. Coding and the review of coding errors remained on the task list of the Care Alliance internal staff and providers.

Coronis Health’s billing team and the internal Care Alliance team noticed a concerning trend. Pending charges requiring a certified coder review were rapidly accumulating, creating a backlog of accounts receivable and putting charges at risk of aging beyond the filing limit. Despite the valiant efforts of the internal staff, the lists continued to grow. The impact ballooned to a high of over eight days of charges pending by the end of their fiscal year.

As we monitored this growing list of pending inventory, the Coronis Health Coding team began to review the type of pending items. We realized our expertise and available resources could efficiently collaborate with our billing team and our partners at Care Alliance to reduce open accounts receivable and increase revenue for these services.

The collaboration of the Coronis Health coding and billing staff with our partners at Care Alliance produced significant improvement in the entire revenue cycle. Improved time to pay, increased collections, and reduction in aging are all key indicators of a healthy revenue cycle. Monitoring these, as well as offering resources and expertise to assist with all aspects of an FQHC revenue cycle were vital to their success.

“Our internal team was consistently behind on addressing our coding edits due to the sheer volume and the workflow required to address them. The assistance and expertise provided by the Coronis Health coding and billing teams have turned that tide –we were even recognized for our improvement by our system host’s most recent client scorecard,” shares Yulanda Lee, Revenue Cycle Director of Care Alliance Health Center.

Higher Clean Claims Rates Improve Revenue

Mizell Memorial Hospital was first established in 1949 as a small rural hospital operating with a 29-bed capacity. To meet the community’s needs, they needed more beds and more services. These changes in services included facility expansion with additional beds and other new services, including nuclear medical services, a sleep center, senior behavioral healthcare, a wellness center, and a clinic for primary care. 

With no professional resources in the local community with knowledge to code and complete patient charts, collect outstanding balances, and perform other daily RCM functions, they partnered with Allegiance Group who also partnered with Coronis to provide professional coding services. With the continued success of our coding team, Allegiance expanded their services by adding revenue cycle management and full lift outsourcing of the business office. This included cash posting and day one billing.

With the assistance of Coronis coders and the RCM team, Mizell now has all major insurance payers set up to send and receive electronic claims and payments that were previously sent by paper. Coronis also helped to streamline the electronic claim submissions by utilizing a claims scrubber (Waystar) to improve the clean claim rate. The average maintained weekly clean claim rate is now 90% and above. 

Coronis RCM staff has also assisted with chargemaster updates and the complete transition of Mizell Memorial clinics to Rural Health Certified. This included new payer codes, chargemaster setup, and NPI registration in the host system as well as the claim scrubber. Mizell staff coordinated with Coronis staff to update existing accounts with the new RHC information. This included the coding team and RCM teams to re-code accounts to RHC standards and re-bill all accounts with the new RHC information which totaled more than 500 accounts and $100K.

Coronis continues to help streamline RCM operations and processes with the Mizell business office staff. When the Coronis RCM team was added to Mizell, they were adjusting 100% of all accounts over 365+ days in age, not pursuing denials. Coronis now collects every possible dollar on aged accounts, because it is our goal to assist and improve our client’s collections on outstanding balances and reduce their AR aging by improving operational effectiveness. 

Backlog Weighing You Down? Find Freedom with Coronis

Another client began their business as an urgent care group and during the pandemic’s early phases. They were able to manage, handle, and provide COVID-19 testing to their state population while also managing telehealth visits, drive-thru testing at multiple locations and sites, and staying on top of the ever-changing rules for COVID-19 billing. The client also expected that at the beginning of 2021, they would be a top vaccination center for their state. As the pandemic dragged on, and the client was overwhelmed by COVID-19 testing, they found themselves drowning in COVID-19 billing. While staying on top of the ever-changing rules and laws, the client could not handle the volume.

This client was too focused on the quality assurance of the COVID testing to maintain high levels of efficiency and they neglected their manual billing process. The tedious process involved physically entering all charges into their billing software from their LIS and manually posting all insurance payments.

The client approached us and sought credentialing assistance because they needed to pull staff to help with the COVID-19 billing. Once we began talking to the client, we quickly identified that we would be able to help, and the volume was something that we had successfully handled in the past. 

With assistance from our offshore team working 24 hours a day, 5 days a week, a dedicated onshore onboarding team, and a focused onshore revenue cycle team with certified professional coders that specialize in coding and billing for COVID-related expenditures, we were able to clear the backlog. 

We uploaded, scrubbed, and submitted all claims to the HRSA Uninsured Program, the government, and commercial payers, and began seeing payments within one week of going live. We quickly set up electronic fund transfers and electronic remittance advice for all insurance payments. We also provided coding and billing guidance to help capture additional revenue, performed e/m level audits on the telehealth visits, and provided the necessary bandwidth with staffing to turn a very stressful situation into a positive one.

At present, this client has recouped millions in revenue and is now successfully billing and administrating tens of thousands of COVID vaccines. We are also assisting this client with staffing and laboratory compliance regulations while providing a customized reporting dashboard, coding guidance on expanding urgent care services and laboratory panels outside of Covid vaccines and testing, and customized eligibility verification, ensuring their long-term growth and success post the pandemic.

Support to Grow Your Practice and Increase Revenue

Crossroads is an Arizona Department of Health Services licensed substance abuse treatment provider with proven expertise in serving addicted men, women, and veterans. Crossroads had an in-house revenue cycle team of billers, collectors, and payment posters, along with utilization review representatives. Their management team was frustrated with the lack of accountability, consistent and timely claims submissions, and payment posting. The company had never considered a third-party revenue cycle partner until Coronis Health was referred to them by their EMR.

Coronis Health accepted the partnership. As a partner, we pride ourselves on not only being transparent with all issues, but also working to maximize revenue, provide coding and claims submission expertise, and helping clients financially grow. Our reporting and analysis ensure Medicaid compliance while providing daily, weekly, and monthly data to run the business. This partnership has freed management to grow the business, adding a 65-bed Detox facility in Q4 rather than managing the staff that were not performing.

“I can’t wait to log into our bank account to check deposits each morning. Cash flow is consistent, which was not the case prior to working with Coronis,” says Tammy Wilson, Chief Financial Officer of Crossroads.

Partner With Coronis Health

Coronis Health’s focus on financial independence and innovative use of tech saves you money by outsourcing all billing and coding. But we do so much more. Our top revenue cycle management can help your hospital or facility find lost revenue, lower your time in AR, close aged payments, and handle collections efficiently. To learn more about how we can help your business grow and let you focus on your patients, contact Coronis Health for a free financial check-up today.

from
https://www.coronishealth.com/blog/real-clients-real-results/