Billing in Ophthalmology: How to Stay Compliant and Get Paid

The ophthalmology medical billing landscape is an ever-changing scene that consumes time and resources. Compliance and accurate billing are required to receive timely reimbursements and boost the revenue cycle.

At Coronis Health, we help facilities remain 100% compliant. We stay up to date on the latest rules, regulations, and coding requirements so you can focus on patient care. Coronis Health provides medical billing and coding for ophthalmology with a personalized touch so that our experts know what regulatory changes are coming, when they will be implemented, and how to prepare your facility.

Understand Billing and Coding Guidelines for Ophthalmology Medical Services

Medical coding and billing for ophthalmology requires two different code sets: E&M codes and eye codes. Medical billing and coding for ophthalmology fall under chapter 11 of CPT codes (evaluation & management) coding guidelines ranging from 90000 – 99999.

Ophthalmology medical billing also requires knowledge of subspecialties, including:

• Pediatric
• Retina
• Glaucoma 
• Ocular plastics

There are official coding guidelines for ophthalmology medical billing codes as stated by CMS. Examples are:

• E&M codes should not be reported separately. 
• The E&M services include general ophthalmological services. Special ophthalmological services represent specific services not included in a general or routine ophthalmological examination. Special ophthalmological services may be reported separately as they are recognized as significant, separately identifiable services.
• For procedures requiring the intravenous injection of dye or other diagnostic agents, insertion of an intravenous catheter and dye injection is integral to the procedure, and therefore, these procedures are not separately reportable. 

Ensure Your Facility Is Using Correct CPT Codes and Modifiers for Ophthalmology Services and Procedures

Ophthalmology services having two sets of codes may add flexibility to your billing, but it can also make the process confusing. To choose the right code, you must consider these decision factors:

• Payer rules and guidelines
• Payer’s medical necessity requirements
• Reimbursement rates
• Elements of exam performed

The ophthalmology CPT medical billing code range for Ophthalmology Services and Procedures 92002-92499 is a medical code set maintained by the American Medical Association.

Ophthalmology Services and Procedures:

92002-92014 – General Ophthalmological Services and Procedures

92015-92287– Special Ophthalmological Services and Procedures

92310-92326– Contact Lens Services

92340-92371 – Spectacle Services (Including Prosthesis for Aphakia)

92499-92499– Other Ophthalmological Services or Procedures

Understand Common Insurance Denials and How to Appeal Them

The following are common reasons for denied claims:

• Missing or invalid modifier
• Diagnosis does not match the procedure performed
• Wrong code used when the global period has expired
• Care is covered by another payer (per coordination of benefits)
• No verification of patient information (patient not eligible on the date of service)
• Invalid patient ID number (unable to identify insured)
• Maximum benefits have been met
• Recommended procedure is viewed as experimental and invalid

While appealing denials is not always successful, there are factors you can take into account to help ensure a smoother process and improve your revenue cycle management (RCM) with medical billing for your ophthalmology practice:

• To successfully appeal a denial, you must first recognize it and then figure out what the reason for the denial is
• Ensure that the correct form is filed. The CMS has a form for appealing Medicare claim denials known as the Medicare Redetermination Request Form. Make sure all information is complete and accurate. Specific data in the report serves as important proof of the validity of your claim. Every piece of documentation is necessary in making your case more compelling.
• The process does not end with submitting the appeal. You must confirm if the appeal has been reviewed and then follow up in 30 days.
• Maintain a record of all your denied claims to compare your reimbursement rate with your denial rate, helping you keep track of your bottom line.

Stay Up to Date On New and Emerging Ophthalmology Billing Regulations

New medical technologies and techniques are constantly being introduced in healthcare, and ophthalmology services are no exception. According to CMS updates, effective January 1, 2022, ophthalmology will undergo critical changes in the billing and coding system. Facilities and their revenue cycle management teams must adapt to these changing trends of code usage because submitting clean claims and getting paid on time is what will keep your ophthalmology facility afloat.

The Easiest Way to Stay Compliant and Ensure Timely Payments? Partner With Billing Experts at Coronis Health

Medical billing for ophthalmology is not exactly a walk in the park. Opportunities for errors are common. These missteps will impact your bottom line or worse, get you into trouble with auditors. As the complexity of ophthalmology billing and coding increases, it could get more challenging for your facility’s in-house staff to keep up with the workload while remaining compliant.

Consider partnering with a revenue cycle management company with experience specifically in ophthalmology medical billing services, so you will benefit from their vast resources and expertise in this area. 

Coronis Health features top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. With over 40+ years of combined experience in various niches including ophthalmology offices of all sizes, Coronis offers customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. 

While most billing companies just submit claims, Coronis Health’s process allows us to identify and correct the root cause of denials, resulting in increased revenue for your facility. Our practice managers remain constantly vigilant and compliant amid the changing chorus of governmental/carrier billing and documentation regulations and compliance requirements. It is this proactive approach to billing that helps our clients get results. We ensure your collections are easy to manage and denials are kept to a minimum.

To learn more or to request your free financial checkup, contact Coronis Health today.

from
https://www.coronishealth.com/blog/billing-in-ophthalmology-how-to-stay-compliant-and-get-paid/

Anesthesia Medical Billing RCM: What to Know

Adhering to the medical billing rules and guidelines specific to anesthesia care is required in order to accurately report anesthesia services and get reimbursed in a timely manner. Anesthesia medical billing can be complex and time-consuming, which is why most facilities choose to partner with a medical billing company to achieve a more efficient workflow, prevent denials, and ensure maximum reimbursement.

What Is Anesthesia Billing and Revenue Cycle Management (RCM)?

Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during, and after surgery. Its key aspect is the use of anesthesia and anesthetics to safely support the patient’s vital functions through the perioperative period.

There are different types of anesthesia providers, such as anesthesiologists, certified registered nurse anesthetists (CRNA), and anesthesiologist assistants (AA). Each will bill separately for their professional services, just as surgeons and other physicians bill for their services rendered.

Medical billing for anesthesia can become a complicated process, as it requires documenting several records, including:

• Pre-operative review
• Anesthesia sheet
• Post-operative review

The success of a facility that provides anesthesiology services relies on its ability to generate and collect revenue, and an integral element of a seamless anesthesia billing process includes efficient revenue cycle management.

Revenue cycle management (RCM) is every step of the claim lifecycle. It works at the functional core of a healthcare organization as it covers the entire spectrum of a facility’s operations, from front desk and scheduling, eligibility verification, care delivery, documentation, anesthesia medical billing and coding, and claim processing. The main goal of RCM is to optimize the profitability of a healthcare facility by automating manual processes and reducing the costs of making collections.

The Benefits of Working With an Experienced RCM Company for Your Anesthesia Medical Billing Needs

Implementing efficient revenue cycle management is an invaluable component of your facility’s success. By partnering with an experienced RCM company, you gain the following advantages:

• Optimized workflow – With automated processes, you can bring efficiency to your system, and payments can be made much faster. This means minimizing errors and denials while maximizing cash flow. An electronic health record (EHR) system, for instance, can simplify your facility’s workflow. By improving tasks such as scheduling, coding and billing, and payment processing, you get to achieve a more effective and efficient system that saves you time for non-administrative tasks like caring for your patients.
• Streamlined processes – A facility that runs like a well-oiled machine will not only ensure consistent collections that make your facility financially viable but will also lessen the administrative burden on your staff. An electronic workflow can help streamline all system facets, such as coordinating front and back communication, concluding a patient’s journey with timely payments, and eliminating lost paper documentation. 
• Enhanced patient experience – A skilled RCM team coupled with the right technology will contribute to an efficient process that minimizes standard billing and coding errors. This means simplifying the process and improving all the touchpoints involved in your patient experience. A streamlined process reduces unnecessary stress and results in higher patient satisfaction.
• Improved claim scrubbing – Denials are the result of payment claim errors. Optimized revenue cycle management brings accuracy to your facility’s system, leaving little room for mistakes. By getting coding right the first time, you get to reduce claim denials and receive your reimbursements faster. 
• Faster collection process – With the right set of software solutions and automation tools, all the time-consuming tasks such as data collection, insurance verification, and coding will take significantly less time compared to doing them manually. By automating each step of the cycle, from eligibility checks and payment follow-ups to data charge entry, you can expedite the entire process. 

The Most Common Challenges With Anesthesia Billing and Reimbursement and How an RCM Partner Can Help Overcome Them

Anesthesia billing is more complicated than billing for most other medical fields. Between time units, modifiers, and other anesthesia codes in medical billing, it can be challenging for facilities to understand how to manage these complexities and still maximize revenue. Below are the components of the general formula and unique features used for calculating anesthesia charges:

• Base units – These reflect the complexity of the surgical procedure. Each procedure has a corresponding code with a base unit value. More difficult procedures that require a higher skill level will have a higher base unit. 
• Time units – A time unit is usually 15 minutes in length, but the valuation can change by contract. Time accrues while the physician assumes patient care, and remains in attendance caring for the patient until the patient is no longer under their care, and the report has been completed.
• Modifying units – Emergencies and certain conditions in a patient’s health are considered modifying units. Modifiers are indicators that will help identify relevant details on a claim. Accurate usage of modifiers will help ensure proper claims payment. Modifiers also help avoid duplicate billing and unbundling.
• Contracted rate – This rate refers to the contractually agreed upon amount between the anesthesiologist and insurance provider.

To ensure proper reimbursement for anesthesia services, billers must include:

• Number of minutes of anesthesia administration
• Procedure anesthesia codes (00100-01999)
• Modifiers (e.g., modifier codes for physical status) 
• Proper identification by including any performing provider(s) NPI on the claim form.

The best way to leverage these challenges in billing is to partner with an experienced anesthesia revenue cycle management company. This means having access to billing expertise that will help reduce risks of errors, claim denials, and delays.

Your RCM partner will have certified medical billers and coders who understand the regulations that govern how insurance payors reimburse and how facilities must document to receive reimbursement. They are trained on how to apply coding that correctly correlates with clinical documentation and are consistently updated on any changes that apply to coding or billing procedures. 

Outsourcing your medical billing ensures that you are working with a team that focuses 100% of their time on the revenue cycle. You will see an improvement in compliance, as your outsourced billing is following the guidelines and regulations set forth by the government and CMS. 

Finding a Reputable Revenue Cycle Management Company for Your Anesthesia Medical Billing Needs

If you find your medical facility is putting more time into collecting bills than into actual care of your patients, it may be time to update your revenue cycle management solutions.

Here’s what to look for when choosing a reputable RCM company:

Expertise in Anesthesiology 

Different specialties come with unique billing and coding challenges. This means it is important to find a medical billing company that has coding expertise in anesthesiology. Failure to go with a company that has expertise in your specialty may result in coding inaccuracies and claim denials that make it more difficult for you to reach those bottom-line goals.

Services You Need

Revenue cycle management should be handled by experts who are familiar with all aspects of anesthesia medical billing services. You must identify your expectations about which tasks you want to oversee in your facility and which services you want the billing company to provide. 

Long-Term Partnership Potential

Ideally, you will not switch RCM partners often. You need to know if that partner will be there for the long haul. Some of the most important things to know are if the partner will provide phone support for your in-office hours and what sort of issues are handled by the partner. 

Transparency of Data

Will your staff have all access to records that are transferred into the medical billing system? The right partner will give you real-time access to any information that you are looking to review. 

Your facility’s financial health depends on the quality of your RCM partner – do your research and choose a company that is not just a business partner, but also a team member who truly understands your facility’s mission and vision to offer the best services to your patients. 

How an Outsourced Billing Service Like Coronis Health Can Streamline Your Anesthesia Billing and RCM

Coronis Health will look at every portion of your billing process as an opportunity to increase revenue by identifying and then correcting the root cause of any problem. We understand how medical billing and collections are critical to the survival and growth of your facility, and patient collections can become a daunting task for your staff. 

We believe that behind every successful facility is a robust practice management and billing software system. Our financial team will analyze your current system, go over your organization’s objectives and concerns, and then determine the best options for streamlining your anesthesia billing and other processes to achieve more efficiency and give your revenue a boost. 

Coronis Health will provide tailored and flexible solutions to meet your facility’s needs. With 35+ years of experience, our experienced consultants understand the importance of working down AR. As technological innovators, we utilize the latest software and employ actionable intelligence so we can assist you in getting your AR under control and most importantly, get you paid.

Let’s Work Together To Build the Best Revenue Cycle Management System

Would you like to increase your revenue, reduce denials, and accelerate your cash flow? Contact Coronis Health to learn more about how our data-driven solutions can help optimize your revenue cycle. You may also request your free financial checkup today.

from
https://www.coronishealth.com/blog/anesthesia-medical-billing-rcm-what-to-know/

Why CPT Code Modifiers Are Essential for Anesthesia Billing Claims

Common procedural terminology (CPT) modifiers are special codes – usually numeric or alpha – used by medical billers to indicate additional information or pricing associated with a specific CPT code. Anesthesia billing, like all other medical billing, includes the use of these modifiers, which are critically important for the purpose of reimbursement from payors.

What Are CPT Code Modifiers, and Why Are They Important for Anesthesia Billing Claims?

Modifiers are codes (both CPT and HCPCS) that divide into two categories and levels of information:

• Level I – two numeric digits, maintained and updated regularly by the American Medical Association (AMA).
• Level II – alpha digits (two letters, AA to VP), and updated annually by the Centers for Medicare and Medicaid Services (CMS). 
  • Codes are for the purpose of pricing or providing additional information
  • Pricing modifiers are listed first, followed by the informational codes

Anesthesia codes in medical billing are especially critical, as they represent not only the documentation, but also the start and end times of a surgery or procedure. The CPT code modifiers pull in critical pieces of information, such as a patient’s physical status, how many anesthesiologists provided services (or if services were provided by a CRNA), or whether the procedure was related to a screening examination. Anesthesia modifiers are so specific that they indicate the health status of the patient from a normal, healthy patient (CPT modifier P1) to a patient declared to be brain-dead, with organs being removed for donor purposes (CPT modifier P6).

These modifiers are necessary for anesthesia medical billing to ensure that anesthesia providers are reimbursed based on the work and the reason for the additional work, such as the following:

• Increased intensity
• Time 
• Technical difficulty
• Severity of patient’s condition
• Screening procedure resulting in diagnostic procedure

Leaving just one component of the CPT code modifiers out of an anesthesia medical billing claim could mean the difference between full reimbursement and a significant decrease in payment.

How Do CPT Code Modifiers Impact Anesthesia Billing and Reimbursement Rates From Insurance Providers?

CPT code modifiers for anesthesia billing are crucial and must reflect many components of services provided during a procedure. For example, per payor rules and regulatory requirements, the start and stop time are required in the documentation to indicate the amount of time spent with a patient during surgery. This is one of many modifiers that must be included on any anesthesia claim to receive full reimbursement. 

Anesthesia coding is challenging enough, and not including the appropriate modifiers can result in denied claims and loss of revenue.

Which CPT Code Modifiers Should Be Used for Anesthesia Billing Claims, and Why?

Anesthesia CPT modifiers are divided into two categories – pricing and informational codes. 

• Pricing modifiers indicate the number of anesthesiologists, physicians, or CRNAs involved in a procedure or surgery. Codes range from AA to QZ and provide detailed specificity, such as anesthesia services provided by an anesthesiologist or CRNA services without the direction of a physician.
• Informational codes break into more detail and are the critical component for anesthesia medical billing. They indicate the physical status or health of the patient – whether a normal, healthy patient or severely/chronically ill. Codes include P1 to P6. 

Anesthesia is critical for maintaining life support for a patient during surgery. Documentation for these services must be accurate and include critical variables like the number of anesthetists providing the service. There are also CPT code modifiers to document who did not provide support (i.e. CRNS service: without medical direction by a physician), which should also be included in billing claims.

How Can Incorrect Use of CPT Code Modifiers Lead To Denied Anesthesia Billing Claims?

Medical billing is about accuracy, and leaving any component of accuracy out of a claim will create errors and result in a loss of revenue. With anesthesia medical billing and coding, accuracy is even more critical, as it could result in a significant loss of revenue for an anesthesiologist or anesthetist. Pricing modifiers are straightforward, but information modifiers are complex and require extensive knowledge of anesthesia billing and coding. 

One missing code could mean the difference between a full reimbursement and a significant decrease in revenue. A billing expert must have consistent focus and attention to detail on the billing and coding process to ensure that claims are clean.

What Steps Can You Take To Ensure Accurate Coding and Billing of Your Anesthesia Services Using CPT Modifiers?

Accurate coding and billing for anesthesia are necessary, and the best way to ensure that your anesthesia services are captured accordingly is to use CPT code modifiers. Additionally, outsourcing your anesthesia medical billing services with Coronis Health ensures that you are receiving the highest possible reimbursement for the services you provide. 

Whether your anesthesia facility is hospital-owned, a private practice, or part of a university system, your coding and billing challenges will be handled by experts who are focused solely on anesthesia coding and billing. Coronis understands the importance of using CPT modifiers for all anesthesia services and understands even more about what happens if the codes are not included on a claim. Outsourcing is one step you can take to facilitate accurate billing and coding – and the best step is using Coronis Health for your billing and coding needs. If you want to step away from your burdens of billing, give Coronis Health a call.

from
https://www.coronishealth.com/blog/why-cpt-code-modifiers-are-essential-for-anesthesia-billing-claims/