Charles Colligan Joins Coronis Health

Coronis Health is welcoming Charles Colligan to their expert team to oversee the financial and operational performance of the company as the Chief Financial and Administrative Officer, supporting Coronis Health’s continued success in providing niche clients with the best-of-the-best solutions in revenue cycle management.

Charles “Charlie” Colligan brings 30 years of experience in developing and leading major strategic initiatives in the healthcare, technology, real estate, and financial services sectors. He served as Chief Financial Officer at Aledade, which quadrupled revenue and became profitable during his 2-year tenure. His service there earned him a finalist spot for the 2020 CFO of the Year Award for the Greater Washington region.

“Coronis Health is a growth company, and Charlie will be a valuable addition to the senior leadership team. Charlie’s success and experience as a CFO in the healthcare industry will drive success and help us achieve our strategic goals.” 

Stephen Grubbs, CEO

Before Aledade, Charles was the treasurer of CoStar Group, where he helped scale the business from $200M revenue to $1.2B and increase market capitalization from $1B to $15B. Prior to these roles, he was the senior vice president of finance for Sallie Mae. He began his career on Wall Street at Merrill Lynch in the Capital Markets Group after graduating with honors in economics from Harvard University. 

Charles will be focussing on growing Coronis Health while maintaining the personal touch with clients that we’re known for.

“I’m thrilled to become part of the outstanding Coronis Health team. I look forward to helping the company increase its growth and achieve our strategic goals in partnership with our customers. It’s especially meaningful to join at this exciting stage of the company’s evolution.” 

Charles Colligan, Chief Financial & Administrative Officer

About Coronis Health

Coronis Health offers the best-of-the-best solutions and technology in medical billing. With a team of experts who combined have 100+ years of experience in their fields, Coronis serves niche clients across the healthcare industry using the latest technology and billing processes. Coronis staff members are thought-leaders who create tailored solutions for clients, no matter how large or small their practices are. As Coronis Health has grown its resources, the company has maintained the feel of a small business, keeping a personalized touch with each client. Coronis Health provides data-driven, action-focused plans that help medical practices grow revenue so doctors can remain independent and concentrate on caring for their patients.

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https://www.coronishealth.com/blog/charles-colligan-joins-coronis-health/

Coronis Health Adapting to Added Telehealth Services Covered By Medicare

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

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

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

11 New Approved Telehealth Services

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

1. 93797: Cardiac rehab

2. 93798: Cardiac rehab/monitor

3. 93750: In-person ventricular assist device interrogation

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

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

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

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

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

9. G0422: Intensive cardiac rehab with exercise

10. G0423: Intensive cardiac rehab, no exercise

11. G0424: Pulmonary rehab with exercise

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

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

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

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

The Future of Telehealth Services

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

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

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

Schedule an Assessment With Coronis Health

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

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

Coronis Health Implementing New Mandatory Medicare ABN

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

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

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

The New ABN Form

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

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

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

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

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

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

Furthermore, they also state:

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

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

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

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

Why Compliance Is Necessary

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

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

Get Your Free Financial Checkup with Coronis Health

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

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

How to Avoid Medical Billing and Coding Errors

Given the many intricacies of medical billing and coding, it is no surprise that mistakes can occur during the 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. Therefore, by knowing how to eliminate medical billing and coding errors, you can lower rejected claims, maximize your reimbursements, and keep your patients happy.

With more than 100 years of combined experience in various healthcare niches, including hospitals of all sizes, anesthesiology practices, and more, Coronis Health offers customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. We are composed of the top medical billers in the country, pooling our global resources to bring customers the best in medical billing and revenue cycle management.

We constantly seek a level of professionalism and analysis you won’t find elsewhere, and we are committed to helping any medical practice reach the next level of financial success. Below are ways to avoid medical billing and coding errors, making your life easier by eliminating the headaches of the revenue cycle, lowering your risk, and increasing your collections.

Ensure Patient Information is Correct and Properly Aligned with Data

When managing a medical practice, information can be mismatched if a medical biller is not careful. Incorrect or missing patient names, addresses, birth dates, gender, insurance information, and dates of treatment can be grounds for claim rejection. Busy billing departments can sometimes overlook these details. 

Inaccurate information can be avoided by taking the time to double-check all fields and verifying all pieces of information about a patient before submitting a claim.

Avoid Upcoding

Upcoding is when the medical coder reports a procedure that has a higher reimbursement cost than the one the patient actually underwent, such as when tests are performed by techs but are coded as being done by physicians. This can occur when the billing staff makes a mistake when entering diagnosis and treatment codes, or if the employee misunderstood the information provided by the physician. Since codes for certain procedures and tests demand higher payments, this illegally inflates your revenue as well. Upcoding will not only lead to claim denials but can also cause your practice to undergo an audit or be penalized.

Utilize the Latest Medical Coding Manual

Medical coding guidelines are constantly changing, so if you are using an outdated reference manual, your claim may be denied, impacting your reimbursement process. It is important that medical coders are up-to-date with the latest billing rules and regulations. This can be done by coders having the latest coding manuals and attending seminars to refresh their coding strategies. By keeping abreast of current codes, you can have a seamless processing of claims in a timely manner without loss in revenue.

Avoid Duplicate Billing

This occurs when a patient is billed multiple times even though they only underwent a procedure once. This common error can magnify the chance of claims being denied, leading to not only delays in payment, but also a bad reputation in the industry or possibly a fraud investigation. While it may seem easy to avoid, this can occur when there are large amounts of data due to disorganization when submitting claims. To avoid this, turn to auditing to minimize errors. By carrying out chart audits, you can prevent these errors from accumulating.

Verify Insurance Benefits and Coverage in Advance

One reason why medical billing claims get rejected is because of a medical practice failing to verify insurance coverage. Insurance companies all have different policies regarding what types of services they cover. More importantly, the details of a policy can change at any time. Even if a patient is a regular client, a practice cannot simply use their recently entered information. This can lead to errors if there has been a change in the patient’s policy limit, terms of service, or insurance provider.

To avoid claims being denied, your practice must independently verify the patient’s eligibility each and every time services are rendered. Verify and communicate details such as healthcare benefits, coverage terms with the insurer, and co-payment options. All this information is necessary for billing the patient without errors.

Hire A Professional Medical Biller

Medical billers are responsible for keeping practices on solid financial ground by maintaining a reliable and efficient system for processing insurance claims. It is not an easy job. Medical billers are constantly faced with challenges, from getting claims rejected to having to dispute them. But when you place the responsibility of your billing and revenue cycle management on yourself or your employees, you are not only adding to the stress at work, but also increasing the likelihood of medical billing mistakes, resulting in loss of income.

By outsourcing to a professional medical biller, you can avoid mistakes that are caused by inexperienced medical billers and coders. Having a team of qualified medical billers and coders who can expertly keep track of the thousands of medical codes, diagnoses, and outpatient procedures can help you reduce claim denials. This also ensures that your staff will no longer need to spend time on these billing concerns. You and your staff can then use this freed-up time to focus on patient care.

Recognized by Healthtech Outlook as one of the Top 10 Medical Billing and Coding Solution Providers in 2019, Coronis Health offers experienced, courteous, and professional staff members dedicated to providing comprehensive medical billing and coding services. We are a full-service provider of medical billing and revenue cycle management solutions, and no matter the size or scope of your business, we can help. By using industry-leading technology combined with high-touch relationship building, Coronis Health will allow you to focus on patient care, maintain financial independence, and cultivate financial success. Not only do we save you money by outsourcing all billing and coding, but we help you find lost revenue, close aged payments, and lower your time in AR. We are invested in your financial success. 

Improve Your Medical Billing and Coding Systems With Coronis Health

Hiring the best medical billers will provide your practice with countless benefits. From a streamlined process and consistent payment schedule to the correct usage of codes and submitting claims in a timely manner, you get to spare your practice from undue stress while safeguarding your practice’s revenue into the future. To learn more about how Coronis Health can help your practice function more smoothly with an optimized revenue cycle, contact Coronis Health today, or request a free financial checkup.

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https://www.coronishealth.com/blog/how-to-avoid-medical-billing-and-coding-errors/

5 Strategies to Improve Your Medical Billing Process

Efficiency is the cornerstone of any healthcare setting. For you to succeed, you must employ innovative ways to deliver quality care and enhance patient experience while lowering your costs and avoiding mistakes.

An efficient medical billing system, therefore, is of paramount importance to achieve these goals. Without an experienced biller working for your practice, it is incredibly difficult to minimize errors, adhere to the latest regulations, and optimize the billing process. And a flawed system could mean not getting paid.

The medical billing process in the United States does not have to remain immensely challenging for both patients and healthcare providers. At Coronis Health, we make sure our partners are 100% compliant and able to receive patients and bill out-of or in-network. We go after the last dollar using our seasoned team of tireless and tough negotiators. We don’t just help you get money, but we help you financially grow. 

A sound medical billing process does not happen automatically, but we can help you get there. We help you employ the right practices to ensure that you reduce debt and unpaid bills while maximizing your profits. Below are five strategies you can use to help improve your billing workflow, helping you maintain financial independence and cultivate success.

#1 Diligently Follow Up With Inquiries

The billing department is in constant communication with various parties, such as insurance companies and patients. Even if bills are sent or emails are exchanged, it is still important to conduct follow-ups to keep track of all the parties’ inquiries and concerns quickly. Without a follow-up procedure, a claim may be denied or your income may be delayed. A successful follow-up procedure can:

• Help maintain a steady flow of revenue, contributing to your financial stability
• Help your practice recover overdue payments without any hassle
• Minimize the amount of time that accounts are allowed to remain outstanding
• Avoid missing claims, which is the biggest reason for delays in payments
• Help recover claims that are still pending due to additional information needed

At Coronis Health, we understand that your most important financial asset is your billed services and accounts receivable. We make sure that this asset is safeguarded, well-organized, tightly managed, and carefully maintained by a professional team possessing a perfectionist approach to execution, accuracy, follow-up, and timeliness. Our United States team works quickly to get billing and A/R follow-up running so you can start collecting and hitting and surpassing financial targets. 

#2 Accurately and Thoroughly Gather Patient Information

Whether you are billing an insurance provider or collecting payment from a patient, everything begins by having accurate information. When you gather all necessary patient information upfront, you’ll avoid a lot of mistakes along the way.

Accurately billing the patient is highly dependent on hiring a front desk staff that is meticulous, organized, and thorough. One way to help the front desk achieve an efficient system is by digitizing your process. Replace old-school questionnaires with tablets that patients can conveniently use to enter their information. By utilizing technology, you get to avoid discrepancies due to poor penmanship or misplaced files. To streamline all your processes, make sure all the financial information your medical billing department handles is easily accessible. Because by knowing where every file and report is, they will save on time and energy.

#3 Be Open About Your Costs

Being upfront about costs will not only inform patients about their financial responsibility, but it also allows the staff to easily ask for payment and to give providers a better understanding of the costs of the services they recommend. Besides, cost transparency will improve customer service and influence patient loyalty, too. This survey shows that patients are more likely to recommend their provider and/or pay a higher portion of the bill ahead of time if they are given an estimate of the cost in advance. It is therefore highly recommended for medical practices to provide patients with a cost estimate to the best of their knowledge.

#4 Dispute Denied Health Insurance Claims

Even when a claim has been coded and filed correctly, there is still a chance it will be denied. In order to get paid, the medical biller will need to follow up with the insurance provider to try and collect the payment. Experienced medical billers will know how to scrutinize a bill and break down each detail. By understanding the language used in the insurance industry, billers can effectively challenge the claim, facilitate an appeal, and negotiate substantial reductions.

Essentially, a medical biller’s job involves more than just issuing bills. They are problem solvers too. They will be in constant communication with patients and insurance providers, especially when payments are late or when something unexpected happens in the billing process. An experienced medical biller will also have the ability to notice any discrepancies in payment. If these payment discrepancies pile up, your practice can lose revenue.

#5 Hire a Medical Billing Professional

Without the assistance of a professional medical billing staff, you might be missing out on valuable income. Hiring the services of a medical billing company is an investment you can make for your practice. Medical billing professionals have years of experience and are specifically trained to understand the medical billing process. As a result, they are able to navigate through various issues that may arise during the medical billing process. Medical billing professionals also know what medical codes to use when filing claims. They can make billing quick, efficient, organized, and accurate. Since they will focus all their time and energy managing your billing, you can focus on providing quality patient care.

But of course, you will want to make sure you are choosing the best medical billing company for your needs–one that is hands-on, experienced, organized, HIPAA-compliant, and will suit your practice’s scale and specialty. 

At Coronis Health, we offer a personal, high-touch service. We have brought together the most innovative and thought-advancing leaders in medical billing and revenue cycle management to progress this industry into the modern, technological age. We seek a level of professionalism and analysis you won’t find elsewhere, helping you increase your revenue and streamline business operations while safeguarding patient relationships in every step of the billing process. We are also technological innovators. We are fully integrated with the latest technologies, helping to improve efficiency and your practice’s overall revenue performance.

Schedule a Medical Billing Consultation 

Coronis Health is comprised of the top medical billers in the United States, pooling their global resources to bring customers the best in medical billing and revenue cycle management. With more than 100 years of combined experience in various niches including hospitals of all sizes, we offer customers tailored solutions and high-touch relationships you won’t find at a “big box” medical billing company. We employ the latest software and techniques so we can input coding instantly, execute collections fast and efficiently, and get that “last dollar” in a cost-effective manner. Get your free financial check up by scheduling an assessment with us today.

To learn more about how you can achieve long-term financial success while providing top-notch patient care, contact Coronis Health today.

from
https://www.coronishealth.com/blog/5-strategies-to-improve-your-medical-billing-process/

Coronis Health Implementing New CHART Payment Model for Rural Healthcare Facilities

The Centers for Medicare & Medicaid Services (CMS) Innovation is launching a new payment model that aims to give a boost to Americans’ access to quality rural healthcare and telehealth services, and to shift U.S. healthcare providers toward more value-based payments.

Specifically, the agency announced on August 11 that the new Community Health Access and Rural Transformation (CHART) Model will help build better healthcare systems by providing up-front investments and capitated payments to healthcare organizations in these rural areas.

Coronis Health is well-prepared for the new payment model implementation for our rural healthcare facilities clients. As a global company that is committed to providing personal, high-touch service, we seek a level of professionalism and analysis you won’t find elsewhere. With 100+ years of combined experience, we can provide cost-effective and fast services to help rural facilities thrive and serve their communities better. We don’t just help you get payments, but we will also help you maintain financial independence and cultivate financial success.

What is the Community Health Access and Rural Transformation (CHART) Model?

From limited transportation options to shortages in healthcare services, Americans living in rural communities face unique needs and challenges when seeking healthcare services. As a result, rural Americans (approximately 57 million) will face worse health outcomes compared to those residing in larger metropolitan areas. According to CMS, it is the goal of the CHART Model to help address these disparities by providing a way for rural communities to transform their healthcare delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities.

The objectives of the Model are:

• To increase the financial stability for rural providers through more innovative ways of reimbursing providers that provide up-front investments and predictable, capitated payments that pay for quality and patient outcomes
• To remove the regulatory burden by providing waivers that increase operational and regulatory flexibility for rural providers
• To enhance the beneficiaries’ access to healthcare services by ensuring rural providers remain financially sustainable for years to come and to offer additional services such as those that address social determinants of health (e.g., food and housing)

The new Model will include two options for participation (as stated by CMS): 

1. The Community Transformation Track 

CMS will select up to 15 Lead Organizations for this track. A Lead Organization is a single entity that represents a rural community, comprised of either (a) a single county or census tract or (b) a set of contiguous or non-contiguous counties or census tracts. Examples of entities eligible to serve as Lead Organizations include, but are not limited to, state Medicaid agencies, State Offices of Rural Health, local public health departments, Independent Practice Associations, and Academic Medical Centers.

Lead Organizations will be responsible for working closely with key model participants (e.g., including Participant Hospitals and the state Medicaid agency) and driving healthcare delivery system redesign by leading the development and implementation of Transformation Plans with their community partners. The Transformation Plan is a detailed description that outlines the community’s plan to implement the healthcare delivery redesign strategy.

Lead Organizations and their community partners will receive upfront cooperative agreement funding, financial flexibilities through a predictable capitated payment amount (CPA) for Participant Hospitals in a community, and operational and regulatory flexibilities.

2. ACO Transformation Track

CMS will select up to 20 rural-focused ACOs to receive advanced payments as part of joining the Medicare Shared Savings Program (Shared Savings Program). Building on the success of the ACO Investment Model (AIM), the advanced shared savings payments are expected to help CHART ACOs engage in value-based payment efforts that will improve outcomes and quality of care for rural beneficiaries.  A CHART ACO will be able to receive the following shared savings payments:

• A one-time upfront payment equal to a minimum of $200,000 plus $36 per beneficiary to participate in the 5-year agreement period in the Shared Savings Program.
• A prospective per beneficiary per month (PBPM) payment equal to a minimum of $8 for up to 24 months.

Model Timeline

CMS anticipates the Notice of Funding Opportunity (NOFO) for the Community Transformation Track will be available in September on the Model website. The Request for Application (RFA) for the ACO Transformation Track will be available in early 2021. 

The CMS plans to select up to 20 rural ACOs to participate in the ACO transformation track in fall 2021, with the first performance period beginning in January 2022. Up to 15 rural communities will also be selected to participate in the community transformation track in early 2021, and the first performance period will begin in July 2022. 

How Can Coronis Health Assist You With These Changes?

Coronis Health offers specialized financial and billing solutions to not just all types of hospitals and surgical centers, but rural community facilities, specifically. We understand how you provide vital care for communities across the country and how it can be a struggle to keep your doors open or to keep enough staff.

Our team is constantly vigilant and compliant amid the changes that take place in governmental/carrier billing and documentation regulations, compliance requirements, and new payment models. We strive to be not just a vendor for our clients but a true resource. Our clients know that if they have a question or need advice around the revenue cycle, we’re always there to help. We provide monthly education sessions for our providers in addition to one-on-one coaching around specific claims.

Our team goes above and beyond to ensure our rural healthcare facilities clients are receiving the best performance from our team. We constantly search for ways to improve our processes to ensure your revenue cycle is performing at the highest level. We are also proud to be fully transparent in our work. We provide regular reporting and analytics so our rural healthcare facilities clients can be confident knowing exactly what’s happening with their revenue cycle at all times. Coronis works diligently to be proactive in alerting clients of potential challenges as well as making suggestions on how to be more profitable.

Schedule an Appointment to See How We Can Reduce Your Rural Healthcare Clinic Costs Today

We support the goal of empowering rural communities to create a system that will deliver high-quality healthcare services to patients by supporting providers through more efficient payment structures. We can help you navigate these new changes and help meet the needs of your practice. To learn more, contact Coronis Health and schedule a consultation.

Let’s Talk

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https://www.coronishealth.com/blog/coronis-health-implementing-new-chart-payment-model-for-rural-healthcare-facilities/

Does Your Hospital Qualify For COVID-19 Medicare Pay Hike?

Starting on September 1, hospitals that have cared for patients who are Medicare beneficiaries diagnosed with COVID-19 will see a 20% boost in payments if they prove a positive diagnosis, CMS announced on Aug. 17.

The pay hike comes from a provision in the CARES Act that directed the Department of Health and Human Services (HHS) to increase pay for hospitals caring for these Medicare beneficiaries during the COVID-19 public health emergency.

At Coronis Health, we understand that it is of critical importance for hospital administrators and practice managers to remain constantly vigilant and compliant amid the changing chorus of governmental/carrier billing, documentation regulations, and compliance requirements. With 100+ years of combined experience, our use of industry-leading technology, and our high-touch relationship building, we can provide specialized solutions for your health systems, helping you focus on patient care, maintaining financial independence, and cultivating financial success.

New COVID-19 Policies

The following are the new COVID-19 Policies for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act, from the Centers for Medicare & Medicaid Services (CMS):

• Effective with admissions occurring on or after September 1, 2020, claims eligible for the 20 percent increase in the MS-DRG weighting factor will also be required to have a positive COVID-19 laboratory test documented in the patient’s medical record. Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with CDC guidelines. The test may be performed either during the hospital admission or prior to the hospital admission.
• A viral test performed within 14 days of the hospital admission, including a test performed by an entity other than the hospital, can be manually entered into the patient’s medical record to satisfy this documentation requirement. For example, a copy of a positive COVID-19 test result that was obtained a week before the admission from a local government-run testing center can be added to the patient’s medical record. In the rare circumstance where a viral test was performed more than 14 days prior to the hospital admission, CMS will consider whether there are complex medical factors in addition to that test result for purposes of this documentation requirement.
• The Pricer will continue to apply an adjustment factor to increase the MS-DRG relative weight that would otherwise be applied by 20 percent when determining IPPS operating payments for discharges that report the ICD-10-CM diagnosis code U07.1 (COVID-19). CMS may conduct post-payment medical review to confirm the presence of a positive COVID-19 laboratory test and, if no such test is contained in the medical record, the additional payment resulting from the 20 percent increase in the MS-DRG relative weight will be recouped.
• A hospital that diagnoses a patient with COVID-19 consistent with the ICD-10-CM Official Coding and Reporting Guidelines but does not have evidence of a positive test result can decline, at the time of claim submission, the additional payment resulting from the application at the time of claim payment of the 20 percent increase in the MS-DRG relative weight to avoid the repayment. To do so, the hospital will inform its MAC and the MAC will notate the claim with MAC internal claim processing coding for processing. The Pricer software will not apply the 20 percent increase to the claim when that MAC internal claim processing coding is present on a claim with the ICD-10-CM diagnosis code U07.1 (COVID-19). The updated Pricer software package reflecting this change will be released in October 2020, and additional operational guidance will be provided in implementation instructions in the near future.

Why Seek Assistance From a Healthcare Revenue Cycle Management Company

Keeping the billing office running during this pandemic is key to keeping all types of hospitals and surgical centers open for infected patients requiring care. We know this can be a challenge, especially for independent and smaller organizations, as well as critical access hospitals. By outsourcing your billing and coding, you can focus on your patients while we handle the coding for you. Coronis Health’s is an experienced medical billing and coding company well-versed with the most current changes in healthcare laws and regulations. This way, you can be sure your coding is being handled accurately and that you’re being compensated appropriately for the services you provide. Our use of cutting edge tech, personalized service, and global capabilities means you’re receiving unprecedented care and attention.

At Coronis Health, we know that your most important financial asset is your billed services and accounts receivable. This asset needs to be safeguarded, well-organized, tightly managed, and carefully maintained by a professional team possessing a perfectionist approach to execution, accuracy, follow-up, and timeliness. We will deliver exceptional, personalized service, and with our scalable capabilities, we can service your practice as it grows.

Find Out How Coronis Health Can Serve You

COVID-19 is creating challenges not just around the healthcare revenue cycle but also in resource allocation and patient financial responsibility. To learn more about how a healthcare revenue cycle management company can be of assistance to your hospital during this time and how our thought leadership can help your medical practice reach the next level of financial success, contact Coronis Health today and schedule your free financial checkup.

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from
https://www.coronishealth.com/blog/does-your-hospital-qualify-for-covid-19-medicare-pay-hike/