Revenue Cycle Management: The Key to Successful Hospital Medical Billing

Efficient and effective revenue cycle management (RCM) is integral to running a profitable facility. Not only does it streamline billing and revenue collection processes to improve your cash flow, but it allows you to continue doing what you do best –providing excellent patient care.

How Revenue Cycle Management Can Improve Patient Care

RCM’s goal of improving profitability and overall financial performance benefits the patient above everyone else. When a facility implements efficient revenue cycle management, it no longer has to spend time and resources on administrative and clinical functions, including correcting billing errors and appealing claims –enabling hospitals to devote more time and money to the quality of patient care they provide.

With a greater focus on patient care, effective hospital medical billing results in the improvement of the overall patient experience. Patients can expect not only a simplified process from scheduling appointments to billing but receive more targeted and comprehensive care that will reduce their likelihood of re-admittance.

Tips for Improving Each Stage of the Hospital Medical Billing Revenue Cycle

The entire revenue cycle management process is driven by two critical components –time and efficiency of your workflow. 

Optimize the RCM process and help maximize patient collections with the following workflow tips:

• Empower the front desk to aid the billing process – strengthen the functionality of the front desk in terms of performing crucial tasks that help streamline the billing process. To achieve this, train your staff to perform the following:
  • Accurate data capture – whether the data is collected through a phone call, online booking platform, or the front desk, all details should be accurate and complete (e.g., correct name, mailing address, birth date, and other patient demographics)
  • Double-check eligibility and benefit verifications – check for validity status, modifications in packages from the previous visit, or location changes. With the available information, you can accurately and quickly verify if a treatment will be covered by the existing insurance plan and educate the patient about their benefits.
  • Preauthorize the patient to ensure reimbursement before treatment – the front-end staff can optimize their collections by pre-authorizing claims. It provides a level of guarantee of getting reimbursed for the quality of care provided.

• Take advantage of technology – technology is the key to streamlining the billing process. Advanced hospital medical billing software and technology enable the use of electronic medical records, automated verification checks and claims scrubbing, and patient self-services features (e.g., digital communication, e-statements, and credit card payments). 

Software systems may also suggest correct medical codes and check for insurance payer rules for reimbursement. At its most basic, technology allows for seamless digital transactions and enables various departments to connect and create a more harmonious workflow. By utilizing technology in your clinical and administrative functions, you will save staff hours and avoid errors, denials, and poor collections overall.

• Improve coding practices – hospital medical billing and coding should be handled by experts to ensure accuracy. Any wrong or missing code leaves you with potentially zero reimbursements. To avoid errors and claim denials:

• Educate staff on compliance – the healthcare landscape has ever-changing rules and regulations. Arrange for regular staff training to update them on the latest coding practices.
• Coding audit – to improve your RCM process, schedule regular audits at your facility. Auditing enables you to analyze the entire billing cycle and your payment policies and helps detect coding issues and other inefficiencies affecting your bottom line.

• Improve clean claims rates – rejected and denied claims will only consume more staff time and slow down cash flow. To generate clean claims, you must:

• Use scrubbing software to verify claims and identify errors and omissions.
• Keep track of claims statuses and be prepared for the appeal process. The faster you can shift denied claims to approval-worthy claims, the better for your accounts receivable. 

Common Challenges Hospitals Face in Terms of Medical Billing

There are many reasons why hospitals and other organizations struggle to maintain an efficient RCM workflow, including:

• Ineffective hospital medical billing process – failure to capture accurate information during patient registration, errors in coding, and declining to verify insurance eligibility can adversely affect your revenue cycle.
• Manual claims processing – given the complexities around submitting claims and the time and resources required to manage denials, relying on manually-operated tasks not only contributes to administrative burden but increases the risk of errors in billing.
• Inaccurate coding –with the constant implementation of new rules and regulations, it is no surprise that mistakes can occur during the billing and coding process. The most common errors, no matter how trivial they seem, can lead to claim denials, loss of revenue, fines and penalties, and may even impact patient care. 
• Lack of staff education and training – when staff members are not properly educated and trained on how their role fits into the overall process, they become more susceptible to performing errors that can cost your facility tens of thousands of dollars a year.

How to Overcome These Challenges and Improve Your Hospital’s Bottom Line

To address challenges that impact RCM, hospitals must have a strategic focus on:

• Clarification of roles and workflow – good revenue cycle management depends upon strong communication. That said, each staff member should know his or her role and how it fits into the overall process of the hospital receiving its payments. Clear role assignments will ensure smarter workflows wherein each and every staff member is aware of their part of the process.
• Adoption of automated processes – technology can turn manual and mundane tasks into automated processes that generate multiple benefits for many healthcare systems. Hospitals collect and store large amounts of patient data and records each day, and it’s easy for the human eye to get data wrong. 

Automated software will help identify discrepancies and coding errors, provide in-depth audits, reduce workloads, and ensure cleaner claims and compliance.

• Investing in staff training – to help staff better understand their roles, you must constantly train and educate them on all revenue cycle management practices. Technology won’t work without humans providing the right instructions. 

Applying analytics

Optimizing revenue cycle management relies on focusing on the best industry practices and being committed to continuous improvement. To achieve this focus, hospitals must employ end-to-end revenue cycle analytics by performing comparison analyses.

You may use technology, business intelligence, and AI-powered analytics to identify issues in both internal revenue cycle processes and payer behavior. By measuring the quality of each step of the process, you can use your resources more effectively and make the best business decisions that will positively impact your hospital’s financial standing.

Outsourcing your RCM Services

Leaving the hospital medical billing services and other administrative functions to the expert professionals spares you from time-consuming tasks and helps you focus on patient care. From pre-authorization, clinical documentation, and coding to collections and denial management, outsourced revenue cycle management can streamline your workflow and ensure the best results. 

Outsourcing also means having access to the latest technology and other resources that will help speed up collections and increase your profitability without compromising privacy rights and compliance.

Questions About Revenue Cycle Management for Your Hospital? Contact an Expert at Coronis Health Today!

Hiring the best revenue cycle management company will provide your facility with countless benefits that include streamlined processes and a consistent payment schedule. You can relieve your facility from undue stress while safeguarding your organization’s revenue into the future. 

At Coronis Health, we provide tailored and flexible solutions to meet the needs of your facility. With more than 35 years of experience in various healthcare niches, including hospitals of all sizes, 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.

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/revenue-cycle-management-the-key-to-successful-hospital-medical-billing/

EMS Medical Billing; What to Know

As an integral part of public health and safety, Emergency Medical Services (EMS) include first-line emergency medical care for patients. Medical billing for EMS can be more complicated than other healthcare industries, leading to frequent denials and delayed reimbursements. Maintaining a healthy EMS revenue cycle requires a strong understanding of the intricacies of EMS medical billing. 

What Services Are Included in EMS Medical Billing?

EMS medical billing involves every component of emergency medical services, including dispatch, personnel, ambulance transportation, fire departments, and hospitals that operate conjunctly with these services to provide emergency care. EMS personnel include emergency medical responders (EMRs), emergency medical technicians (EMTs), advanced EMTs (AEMTs), paramedics, intensive care nurses, and EMS medical directors.

To simplify, most EMS services fall into three main groups:

• EMS agencies that respond to 911 emergencies, with or without transport
• EMS agencies that provide scheduled medical transport (otherwise referred to as non-emergent transport)
• EMS agencies known as specialty care transport that provide interfacility transport from one healthcare facility to another

Emergency medical transportation is considered the base of medical billing and coding for EMS. Any time this transportation is used, a service fee is charged. Typically, these charges are included in the premiums patients pay through private insurance companies, Medicare, and Medicaid. This means if the patient has health insurance, the fee is billed to the insurance organization. 

With a private insurance agency, patients may have to pay a deductible or co-pay if there’s a difference in coverage. In some cases, patients might not need to pay this difference if they’re a resident. However, a non-resident will have to cover the remaining balance. 

What Are Some Common Mistakes Made in EMS Medical Billing?

Medical billing and coding for EMS gets complicated with the complex regulations set forth by The Center for Medicaid and Medicare Service (CMS). Submitting claims that are accurate and compliant with these regulations is difficult to manage. Frequent denials, poor reimbursement rates, inefficiencies, and inconsistent cash flow are commonly seen with the unique challenges EMS medical billing brings. 

Common errors seen with ambulance billing typically involve:

• Fee schedules. Under Medicare, a national fee schedule exists that applies to all ambulances. This schedule is complicated and changes frequently, leading to errors in charges, and eventually, denied claims.
• Coding errors. Ambulance charges are reimbursed once insurance companies, Medicare, and Medicaid deem emergency medical transportation necessary. This is determined through a specific coding system called the International Classification of Disease (ICD) code. Mistakes are easily made if staff members aren’t adequately trained and qualified in the ICD coding system.
• Procedural errors. Medical staff aren’t typically well-versed in EMS medical billing software and the guidelines set forth by insurance, Medicare, and Medicaid, leading to procedural errors and delayed reimbursements.

It’s important to have a comprehensive understanding of EMS medical billing and coding, insurance, and Medicaid and Medicare services to avoid these common mistakes and maintain a low denial rate and healthy revenue cycle.

How Can Outsourcing Your Medical Billing Help Your Facility?

EMS medical billing brings unique challenges that, if incorrectly managed, can lead to an unsustainably high denial rate and financial loss—jeopardizing the growth of your EMS organization. EMS billing done right requires expertise that medical personnel don’t often have. Outsourcing your medical billing allows your facility to thrive by leaving the complexity of EMS medical billing to the experts. This way, your facility will sustain greater financial health and your team can focus on what’s most important—your patients.

How to Avoid EMS Claim Denials

To obtain a successful billing process, these factors must be handled efficiently:

• A robust pre-billing system to ensure insurance verification before submitting a claim
• Proper coding identifying the services provided
• A structured billing procedure and collections process
• Consistent efforts to stay up-to-date and compliant with changing CMS regulations
• Proper EMS medical billing software that provides data analytics to track workflow and measure success
• Expert management and analysis of your EMS medical billing procedures to establish an overall healthy revenue cycle

It’s crucial to understand each of these factors in the EMS medical billing process to avoid claim denials and maximize reimbursement and revenue. 

Questions About EMS Medical Billing? Contact an Expert at Coronis Health Today!

Coronis Health has over three decades of experience in providing expert EMS medical billing services to achieve a higher reimbursement rate and improve EMS revenue cycle. Our team of certified medical coding and billing professionals utilize cutting-edge EMS medical billing software and provide customized, transparent reporting, so you can be sure your facility is in great hands. We understand the complexity of EMS medical billing and stay abreast of the latest regulation changes, so you can focus on patient care.

Contact us today to learn more about what Coronis Health EMS medical billing services can do for your team and take advantage of our free financial health check-up that finds missing revenue in 95% of cases.

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

Outsourcing Your Anesthesia Medical Billing; What to Know

Do you want to learn the many ways you can benefit from outsourcing anesthesia medical billing or how you can find the best billing company to partner with? Here’s a quick guide on what you need to know before outsourcing your billing services.

The Benefits of Outsourcing Your Anesthesia Medical Billing

Outsourcing your anesthesia medical billing and coding to an experienced billing company provides the following advantages:

• Reduced overhead costs – outsourcing anesthesia medical billing reduces the liabilities of additional equipment, software, education and training expenses, and staff members. And if staff turnover is high, costs multiply. Outsourcing eliminates these expenses while enabling facilities like yours to gain extra physical space, which can be used to expand services and generate more income. 
• Reduce medical billing errors – partnering with anesthesia billing experts ensures you are updated with the latest codes, conversion factors, and regulations. Their expertise reduces errors and declined/rejected claims, and the accurate, compliant, and timely return of your facility’s documentation conveniently expedites the payment process.

• Increased revenue – the right billing company streamlines and optimizes your processes, produces cleaner claims, and rigorously follows up on rejected claims to boost your revenue. 
• Improved patient care – when you outsource your medical billing, you can avoid the time-consuming task of filling out paperwork and focus on caring for patients. 
• Reduced overhead costs – outsourcing anesthesia medical billing reduces the liabilities of additional equipment, software, education and training expenses, and staff members. And if staff turnover is high, costs multiply. Outsourcing eliminates these expenses while enabling facilities like yours to gain extra physical space, which can be used to expand services and generate more income. 
• Reduce medical billing errors – partnering with anesthesia billing experts ensures you are updated with the latest codes, conversion factors, and regulations. Their expertise reduces errors and declined/rejected claims, and the accurate, compliant, and timely return of your facility’s documentation conveniently expedites the payment process.
• Increased revenue – the right billing company streamlines and optimizes your processes, produces cleaner claims, and rigorously follows up on rejected claims to boost your revenue. 
• Improved patient care – when you outsource your medical billing, you can avoid the time-consuming task of filling out paperwork and focus on caring for patients. 

How to Find the Right Anesthesia Medical Billing Company for Your Facility

Here are critical factors to consider when selecting an anesthesia medical billing company to partner with:

• Find a company with expertise in medical billing for anesthesia – each healthcare specialty comes with unique billing and coding requirements and challenges. Find a medical billing company that has billing and coding expertise in anesthesiology. They have the knowledge and training required for accurate coding and compliance to ensure you avoid errors and claim denials. 
• Look for comprehensive support – your facility needs more than billing services. Search for a company that can support you throughout the entire revenue cycle management – from before a patient’s appointment to claims. reimbursement. The company you partner with must be skilled and experienced at every step of the billing process.

• Require excellent customer service – you want to work with a billing company that offers quick responsiveness whenever you need it. Fast and reliable customer service throughout the partnership ensures that your facility is always equipped to handle issues and remain financially successful.
• Consider transparency of data – your staff sometimes needs access to records in the medical billing system. The right medical billing company gives you real-time access to any data that you are looking to review. 

What to Expect During the Transition Process

The transition process is when you begin to build and test the partnership, and careful planning and execution are imperative. 

An efficient outsourcing partner creates a smooth transition through effective planning and implementation involving the following steps:

• Pre-planning sessions – since the transition phase is never a one-way process, pre-planning sessions require you and your outsourcing partner to discuss your objectives and determine which processes can be performed in the existing business model and which ones need to be modified or removed. Pre-planning sessions establish an effective communication plan that identifies roles and responsibilities to ensure all parties agree on the services being outsourced and how they are delivered.
• Staff training – Your staff must learn new system processes and understand how they impact your business operations.
• Systems integration – are you maintaining or switching software systems? During the transition phase, you and your outsourcing partner should decide on the technologies to be used and how to train your staff in adopting these new tools.
• People management – your staff and other key people in your facility are kept informed about all the changes and how it affects them. The more transparent the transition process, the better. Transparency prevents resistance to change and allows everyone to be involved, easing the the transition.

Making the transition to outsource your medical billing can be a daunting task, but it’s one of the most impactful ways that facilities of all sizes can reduce costs and improve efficiency. Your facility can focus more on patient care while experts in anesthesia medical billing solutions ensure you are hitting your bottom-line goals. 

How to Get the Most Out of Your Anesthesia Medical Billing Partnership

There are tips you can follow to ensure the success of your partnership:

• Keep communication lines open – effective communication is key to any successful relationship. Set clear expectations, and don’t hesitate to ask questions. Constant communication ensures you are always on the same page. 
• Set goals – be clear with your goals and how you want to achieve them. 
• Be flexible – accept the fact that things change. As your business grows, your needs may also change. Be sure your medical billing partner can continue to meet your needs.
• Trust your partner – you hired your partner for their expertise, and you must trust their credentials. They are the experts, after all. Let them handle the tasks you hired them to do.

Questions about Outsourcing Your Medical Billing? Contact Us at Coronis Health Today!

Outsourcing your medical billing and coding is one of the most significant business decisions your facility will ever make. Coronis Health brings together the top medical billers in the country, pooling their global resources to bring customers the best in medical billing and revenue cycle management. With the latest technology and robust business intelligence, we’ll work with you to build data-driven solutions that meet your specific needs, allowing you to get back to treating patients while maximizing your revenue.

We can partner with you without a complete upheaval of your operations, ensuring a smooth transition and more efficient revenue cycle management overall. 

When experts manage your anesthesia medical billing, you can minimize errors, reduce administrative burden, and increase workflow efficiency –all contributing to increased cash flow. Contact  Coronis Health to learn more about how outsourcing medical billing can benefit your facility. You may also request your free financial checkup today.

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

What to Know About the MIPS Program in 2023

The Merit-based Incentive Payment Systems (MIPS) program is entering its eighth year of operation, and it is still a hotbed of confusion, anxiety, and—depending on who you ask—misinformation. These feelings are largely because participation in MIPS is extremely dependent on the specialty, group, reporting option and clinician’s commitment to continued participation. For several years, providers were offered an exemption to the program due to the COVID-19 pandemic, but 2023 will not likely continue to enjoy this backstop. To help dispel some of the stress of navigating MIPS, this alert will walk through the requirements of 2023 reporting and be a resource to review if you have any question about how you need to participate next year.

MIPS Category Review

At the high level, there are only two categories that need to be considered under MIPS: Quality and Improvement Activities. These two categories comprise 70 percent of your overall MIPS composite score, as Cost is automatically calculated by CMS, based on your billing.

When added together, these three categories must total 75 points or more to avoid a penalty in 2023. For example, at the end of the year when each category score is calculated, and your results are 80 percent in Quality, 100 percent in Improvement Activities, and CMS awarded 75 percent in Cost, your total would be as follows:

If the total score is above or below the 75-point threshold, bonuses or penalties will be assessed on a linear sliding scale. This may seem daunting, but you can be excluded from the entire program if you bill less than $90,000 in traditional Medicare allowed per provider. If you are curious about your status, click here for the MIPS participation lookup tool. We will review this on your behalf, as well, but feel free to check anytime. 

Now that we have a general understanding of MIPS at a high level for next year, let’s look at some details.

Category Details

Thankfully, little has changed within each category for 2023. For example, the data completeness requirement remains at 70 percent for quality category reporting, meaning clinicians will need to report on 70 percent of each measure’s eligible population to be counted.  The big news is that a widely reported quality measure will be retired. MIPS 76 (Prevention of Central Venous Catheter – Related Bloodstream Infections) is no longer an eligible measure because most clinicians were compliant and therefore didn’t differentiate “good” providers from “bad” providers. Additionally, several Improvement Activities were retired for 2023, but this may not have a material effect on anesthesia providers due to some other changes within the program. 

For those who are a little more interested in some of the details, the three-point floor for measures without a benchmark has been removed. This served as a point floor for any providers reporting QCDR measures that were not widely adopted in the industry; but, again, this will not likely have an effect on any anesthesia providers moving forward. 

The one other detail important for anesthesia providers is to confirm your Non-Patient Facing status with CMS. This status exempts anesthesia clinicians from reporting the Promoting Interoperability category, which is the old “Meaningful Use” program. The reason this is important for 2023 is that CMS will not automatically exclude CRNAs with this status; and, if you are identified as a patient-facing clinician, we need to review this special situation. We will be proactively checking your status; but, to confirm your own status, click here.

Lastly, CMS has finalized the 2023 measures but has not yet published them. CMS has advised the publication date could be as late as January 1, 2023. Hopefully, they will allow registries to make them available earlier. Stay tuned!

If all of this seems a little overwhelming, I have great news and a solution for you. It is called the MIPS Value Pathways (MVP).

MIPS Value Pathways

To simplify the entire process of reporting measures to CMS, the creation and use of an MVP for anesthesia is available next year. The MVP bundles a set of measures to report rather than burden providers to choose. For 2023, the compliance requirement for an MVP is to report four quality measures to include an outcome measure and two medium-weighted or one high-weighted improvement activity. The only catch to an MVP is that you must proactively register between April 1, 2023 and November 30, 2023, which we can do on your behalf. 

The measures to choose from are as follows:

Quality (Choose 4)

• #404: Anesthesiology Smoking Abstinence
• #424: Perioperative Temperature Management
• #430: Prevention of Post-Operative Nausea and Vomiting (PONY) – Combination Therapy
• #463: Prevention of Post-Operative Vomiting (POV)- Combination Therapy (Pediatrics)
• #477: Multimodal Pain Management (MIPS CQMs Specifications)
• AQI48: Patient-Reported Experience with Anesthesia
• AQI69: Intraoperative Antibiotic Redosing

Improvement Activities (2 Medium or 1 High)

• IA_BE_6: Regularly Assess Patient Experience of Care and Follow Up on Findings – High
• IA_BE_22: Improved practices that engage patients pre-visit – Medium
• IA_BMH_2: Tobacco use – Medium
• IA_CC_2: Implementation of improvements that contribute to more timely communication of test results – Medium
• IA_CC_15: PSH Care Coordination – High
• IA_CC_19: Tracking of clinician’s relationship to and responsibility for a patient by reporting MACRA patient relationship codes – High
• IA_EPA_1: Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient’s Medical Records – High
• IA_PSPA_1: Participation in an AHRQ-listed patient safety organization – Medium
• IA_PSPA_7: Use of QCDR data for ongoing practice assessment and improvements – Medium
• IA_PSPA_16: Use of decision support and standardized treatment protocols – Medium
• IA_PSPA_20: Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes – Medium

To illustrate how this works, we can automatically continue to report on your relationship codes through billing operations (measure IA_CC_19), and you can choose to report the following four quality measures to be fully compliant next year.

• #424: Perioperative Temperature Management
• #430: Prevention of Post-Operative Nausea and Vomiting (PONV)
• #463: Prevention of Post-Operative Vomiting (POV)- Combination Therapy (Pediatrics)
• #477: Multimodal Pain Management

This is the easiest way to meet compliance in 2023; but, if you are interested in learning more about this program, you can review the CMS website. 

Schedule a free financial health checkup with Coronis Health to learn more.

from
https://www.coronishealth.com/blog/what-to-know-about-the-mips-program-in-2023/