Top 13 Reasons to Outsource Your Medical Billing

Medical billing can be a challenging responsibility for many medical facilities that don’t have access to the necessary skills and manpower required to perform these tasks efficiently.

Even if in-house employees can do an excellent job contributing to the organization’s success, these individuals may often lack the time and availability to keep up with the healthcare industry’s ever-changing landscape, especially when it comes to medical billing. By outsourcing medical billing, your facility can free up time to focus on what you do best while achieving the most accurate and cost-effective billing processing possible. 

With over 100 years of combined experience supporting healthcare facilities, we’ve brought together the best healthcare revenue cycle management and medical billing professionals at Coronis Health. Our industry-leading innovations and high-touch expertise allow you to focus on delivering care while maintaining your independence and financial security. While handing billing over to a third-party provider can feel intimidating, our clients quickly experience the benefits of doing so. Below, we share 13 reasons why it’s a better option to outsource medical billing.

1. Save Money 

There can be a lot of hidden expenses when it comes to employing an in-house medical billing team. Having to cover training costs, full salaries, benefits, insurance, and modern billing software, relying on your billing department can become an unwise investment. Not all facilities have the disposable income to maintain a billing department or the time to find and train a replacement every time an employee leaves. By outsourcing your medical billing, you can reduce, if not eliminate, fixed expenses. Therefore, a medical billing firm can provide a more efficient, sustainable, and controlled approach to revenue cycle management.

2. Pay When You Get Paid

By outsourcing medical billing, you get to convert fixed labor costs into variable costs. This conversion means you only pay for the services you consume instead of paying full salaries year-round. Outsourcing gives you the flexibility that allows you to scale your consumption according to your business’s needs, whether it’s picking up or slowing down. In other words, you can base the pricing on how much you avail of their services. You only pay when you get paid. By outsourcing medical billing, you get the benefit of only paying for the services you consume while retaining the reliability of a skilled, qualified, and dedicated professional team.

3. Fewer Mistakes

Incorrect patient data, duplicate billing, and authorization errors can be a source of unnecessary expenses. Outsourcing medical billing allows you to benefit from experienced billing experts who specialize in billing and coding. They also have quality assurance measures in place, which means committing far fewer errors. Fewer errors can result in a more streamlined workflow, reduced amount of denied or rejected claims, and increased revenue for your medical facility.

4. Steady Cash Flow

Denied claims and delays in payments contribute to a reduction in cash flow. Outsourcing billing can keep your billing process moving more efficiently, which means timely submission of bills and an increase in the influx of cash. At Coronis Health, we invest in your financial success. We understand that consistent cash flow is the lifeblood of the business. With an outsourced billing service, you can submit claims faster and collect payment quickly.

5. More Time to Focus on Patient Care

No one goes to medical school hoping to spend most of their time filling out paperwork and negotiating with insurance companies. It only makes sense to invest your time into your core competencies and leave the business functions to providers trained and experienced in executing them. By allowing a medical billing company to do their job for you, you get to free up more time to care for your patients.

6. Stay Compliant

The healthcare industry is highly dynamic, and it can be burdensome having to stay on top of government regulations. The latest version of the ICD-10, for instance, can be a source of concern amongst medical facilities. New coding and billing changes can have a massive impact on healthcare providers’ payment outcomes and time management. Coronis Health’s expert billing team stays on top of these changes and implements them into our processes right away. You can eliminate the headache of keeping track of the ever-changing rules and regulations because we are always on top of these changes. At Coronis Health, we adapt to these changes and have the skills to apply new rules and follow guidelines, giving your facility one less thing to worry about.

7. Keep Patients Happy

Having to juggle so many tasks within a day can make it challenging to meet all your patients’ expectations. The added stress can also lead to more errors, which will only frustrate patients. By outsourcing medical billing, you are relieving your staff of the time-consuming task of managing the billing process. In doing so, your facility can better attend to patients’ needs, which means happier patients and higher satisfaction rates.

8. Gain Efficiency 

When you outsource medical billing, your in-house employees can have more time to assess their primary responsibilities and focus on other critical administrative functions and operational areas. This means the demanding task of medical billing will no longer derail your office productivity, resulting in more efficiency within your organization.

9. Accurate Credentialing

Medical credentialing is necessary for a physician to provide care for patients covered by their insurance carrier. However, credentialing is a laborious process with possible delays or rejections. By outsourcing this task, you can rely on dedicated individuals to take charge and provide these services for you. Fast and accurate credentialing from a third-party service provider will simplify the process and provide quick results, reducing the stress on your already overworked office.

10. Lessen Penalties 

No matter how small, errors can result in denied claims, fines, penalties, and loss of revenue. An example of improper billing is upcoding, which is when the medical coder reports a procedure that has a higher reimbursement cost than the one the patient underwent. This can occur when the billing staff makes a mistake when entering diagnosis and treatment codes. Since codes for specific procedures and tests demand higher payments, this illegally inflates your revenue and can not only lead to claim denials but can also cause your facility to undergo an audit or be penalized. At Coronis Health, our certified professionals have a strong understanding of Medicare and Worker’s Compensation regulations, as well as the latest knowledge of all medical billing codes. Our professionals know how to avoid medical billing and coding errors, which can lower your rejected claims and maximize your revenue.

11. No More Missed Collections 

Collections are critical to the growth of a medical facility. By outsourcing medical billing, skilled and experienced professionals can increase collections and efficiently reduce revenue loss due to denials. They can submit claims in a timelier manner, leading to quicker payments. 

Coronis Health goes after the last dollar using our seasoned team of tireless and tough negotiators. You’ll receive timely, relevant, and accurate information in a way you can understand. We don’t just help you get money; we help you financially grow.

12. Happier Staff

A staff that has to split their time and efforts between their primary duties and medical billing can become stressed and frustrated. By outsourcing medical billing, responsibilities are better compartmentalized, and your staff can focus on the jobs they were trained to do. They will be less overwhelmed, making them happier and more productive.

13. Better Technology 

Relying on your billing department means having to stay technologically equipped to handle the billing process internally efficiently. This requires additional expenses to cover the billing software that must meet industry demands, and this can be very costly because of the constant changes within the billing process. By outsourcing medical billing, you don’t need to worry about purchasing new equipment and software or training your staff to use them.

At Coronis Health, we integrate with the latest software, so we input coding instantly and execute collections fast and efficiently. We’re so confident in our billing and coding abilities that we are fully transparent with our services.

Let Coronis Health Empower Your Healthcare Facility

Any medical facility can benefit from the expertise of an experienced revenue cycle management company. Do you need to reassess your healthcare billing process? To learn more about how Coronis Health can help meet your specific needs and allow you to get back to treating patients, schedule an appointment with us today or request a free financial checkup.

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https://www.coronishealth.com/blog/top-13-reasons-to-outsource-your-medical-billing/

COVID-19 Vaccine Codes

By Allison Bloom, Director of Coding Operations, and Lisa Messina, Corporate Compliance Officer, FQHC Division of Coronis Health

The COVID pandemic has had tremendous emergent impact upon medical care, testing, and supplies. In response, the AMA’s CPT Editorial Panel has had to rapidly create and establish new CPT codes for COVID reporting, tracking, and analysis to support data-driven planning and resource allocation.

On November 10, 2020, the AMA announced the coding methodology to be applied for new vaccine and vaccine administration codes that apply specifically to COVID vaccine products. The codes become effective upon Emergency Use Authorization (EUA) approval of the vaccines.  

As new vaccines continue to become available, instructional parenthetical notes are added throughout the code set directing coders to the applicable COVID-19 vaccine codes. In addition to the new unique vaccine specific codes, the AMA releases administration codes unique to each vaccine and dose.  

The first COVID Vaccine, a Pfizer product, was granted an Emergency Use Authorization (EUA) on December 12, 2020, allowing providers to begin administering the vaccine to the American public. Moderna’s EUA was granted December 18, 2020, bringing a second vaccine to the public. Janssen’s single dose vaccine received it’s EUA on February 27, 2021. The AstraZeneca vaccines are continuing through the EUA process; however, the AMA has already provided the codes for these vaccines to give providers the necessary lead time to set them up in their record and billing systems. 

The new vaccine administration codes are specific to each coronavirus vaccine as well as to the dose in the required schedule. This level of specificity offers the ability to track each vaccine dose and include the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.  Because the federal government is purchasing and distributing initial vaccines to healthcare entities across the country, the administration codes will be especially important in specifying which vaccine has been given as well as dosage and which dose (first or second) was given. Unlike the other vaccines, Janssen’s EUA application is for a single-dose vaccine. 

AMA President Susan R. Bailey, MD on why these new codes are important: “An effective national immunization program is key to bringing the coronavirus pandemic to an end. Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States.”

New Vaccine and Vaccine Administration Codes

Vaccine Code Description	Vaccine Code	Vaccine Administration Description	Vaccine Code
Pfizer Vaccine (EUA December 12, 2020): Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use	91300	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first doseImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose	0001A 0002A
Moderna Vaccine (EUA December 18, 2020): Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use	91301	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first doseImmunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose	0012A  0011A
AstraZeneca Vaccine (EUA Pending): Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use	91302	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; first doseImmunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage; second dose	0021A 0022A
Janssen Vaccine (EUA February 27, 2021 ): Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use	91303	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, single dose	0031A

It is important to note that 90460—90474 should not be reported for the administration of the SARS-CoV-2 vaccines. 

Vaccine Code and Vaccine Administration Codes Crosswalk

A new Appendix Q is also being added to the CPT code set and will list the product, administration codes, dosing timelines and manufacturer. This crosswalk will also be used for tracking and reporting outcomes and efficacy of specific vaccines. EUA- approved vaccine product codes will appear with the  symbol for AMA tracking for FDA approval status. Once a vaccine is FDA approved, the symbol will be removed. 

Table Source: https://www.ama-assn.org/system/files/2020-11/covid-19-immunizations-appendix-q-table.pdf

The AMA plans to introduce more vaccine-specific CPT codes as more vaccine candidates are close to being approved for Emergency Use by the FDA. Currently, the AMA has not provided direction on using a combination of vaccines. This blog will be updated as more information becomes available.

FAQs

Please note that the guidance is changing on an almost-daily basis. It is important to check with your payers to get the most accurate information specific to your health center. 

Q:  How will Medicare payments to health centers for COVID-19 vaccines and their administration be implemented?
A:  Payment will be implemented the same way flu/pneumococcal vaccines are currently provided. According to the NACHC, these vaccines and their administration are paid at 100 percent of reasonable cost through the cost report. No visit is billed if it is a vaccination-only encounter, and these costs should not be included on the claim. Cost sharing is waived. CMS has provided COVID vaccine policies and guidance: https://www.cms.gov/covidvax.

Q: How will Medicaid reimburse providers for COVID vaccines and administration?
A:  Medicaid programs must compensate Medicaid providers for vaccines and administration. If the vaccine is free to patients, Medicaid must still compensate providers for the administration fee or office visit. It is important to note that Medicaid reimbursement varies by state and type of arrangement (i.e., Managed care or FFS) and communication with the plan’s point-of-contact for details on how to submit claims is important.

Q:  We received the COVID vaccine toxoid for free, can we bill for the vaccine administration?
A:  The vaccine administration code applicable to the product and dose should be submitted on the claim. For tracking purposes, the applicable vaccine toxoid code should also be submitted with no fee attached.

Q: How will I get reimbursed for administering the COVID vaccine to my uninsured patients? 
A: Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine, can request reimbursement for COVID-19 vaccine administration through the CARES Act Provider Relief Fund, see https://www.hrsa.gov/CovidUninsuredClaim. The program will provide vaccine administration codes to use for claims submission on their webpage, so be sure to check there frequently.

Q: If a patient is coming in for a COVID vaccination only, do I use an E&M Code? 
A: No, for vaccination-only visits, code the specific vaccine and the corresponding administration code for the vaccine. If the vaccine is free, code only the administration code.

Q:  What about Medicare Advantage?
A:   If you participate in a Medicare Advantage Plan, CMS advises providers to submit the COVID-19 vaccination claims to Original Medicare through your MAC.

Reference Sources

https://public-inspection.federalregister.gov/2020-26815.pdf

https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance

https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf

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https://www.coronishealth.com/blog/covid-19-vaccine-code-update/

This is What Software Agnostic Means at Coronis Health

From electronic health records and practice management to billing and patient engagement, you can expect a seamless experience with a software agnostic approach.

At Coronis Health, we do not confine ourselves to just one billing software. Our team is expertly familiar with all the major systems and trains on new ones as they become relevant. With this knowledge and flexibility, our team can get to work for your practice immediately, regardless of which system you use.

Coronis Health understands that integrating with our clients’ technological systems means quick implementation and painless changeover. We are fully knowledgeable with the latest software and top billing and practice management software applications such as Kareo and AdvancedMD. Coronis integrating with your established system results in 100% transparency because you’ll be able to see precisely how your numbers look and how they affect your business.

Why Coronis Health is Software Agnostic

At Coronis Health, we are technological innovators who focus on business intelligence and keeping abreast of new systems and applications, allowing us to promptly assist you without first learning the software you are currently using. Software agnosticism also enables 100% transparency (because you are granted unparalleled visibility into your operations) and specialized solutions for seamless integration, increased efficiency, more streamlined cash flow, and peace of mind.

Coronis Health’s Technology Partners 

To ensure our clients receive the best possible services and are always ahead of the curve to achieve financial success, Coronis Health partners with top practice management/billing systems. We also utilize various software platforms that are not listed below. Our technological expertise and adaptability mean we learn to accommodate your preferred software platform quickly.

Kareo

Kareo is the only cloud-based and complete medical technology platform purpose-built to meet independent facilities’ unique needs. Their integrated modules work together as part of a seamless platform. Kareo allows you to quickly set patient schedules, manage accounts and collections, store patient documents, confirm insurance coverage, customize reports, and manage all your facility’s primary functions through one intuitive system. Similarly, one of the main goals of Coronis Health is to allow facilities to remain independent. With our data-driven solutions, advanced software such as Kareo, and action-focused planning, we can help you achieve financial independence while you focus on practicing medicine.

Allscripts

Allscripts provides healthcare information technology solutions that connect people, places, and data across an Open, Connected Community of Health, empowering providers to make better decisions and deliver better care for patients. Notably, they offer BOSSnet, a comprehensive digital health record solution with paperless workflows that improve financial, clinical, and operational performance. At Coronis Health, we practice scalability to offer specialized financial and medical billing solutions to all types of hospitals, FQHCs, SNFs, LTCs, and surgical centers. AllScripts’ ability to cater to independent facilities, large health systems, and everything in between, allows us to do just that.

AdvancedMD

AdvancedMD supports independent physicians and their staff with a comprehensive suite of solutions, including practice management, electronic health records, telemedicine, patient relationship management, business analytics reporting, and physician-performance benchmarking. They offer their entire suite of software and data storage on the Amazon Web Services (AWS) cloud hosting platform, which allows for unwavering data security, fast and reliable access to all your information, and simplified storage with automatic backup. Coronis Health knows the importance of having a unified workflow with cutting-edge security as thought-leaders who specialize in tailored solutions. AdvancedMD allows us to organize, safeguard, and manage your billing process with a perfectionist approach to execution, accuracy, follow-up, and timeliness.

NextGen

NextGen focuses exclusively on helping ambulatory care providers of all sizes and the communities they serve. Their comprehensive, integrated technology and services platform provides clinical care solutions that include specialty-specific EHR content, a convenient patient portal, and a revenue cycle management system in one integrated platform. They help facilities optimize their strategy for delivering high-quality care while improving financial outcomes and enriching patient experience. Coronis Health understands the priority of providing excellent patient care. With over 100 years of combined experience, we’ve seen the value of having a dedicated, specialized, and professional staff focused on running your business so that you can focus on doing what you do best–caring for your patients.

TriZetto Provider Solutions

TriZetto Provider Solutions aims to simplify healthcare by combining intuitive products and customer-focused services with in-depth industry knowledge. With their innovative solutions in revenue cycle management, claims management, and patient management, they help facilities maximize revenue by securing accurate reimbursements, decreasing claims rejections, and improving turnaround time for patient payments. At Coronis Health, we exemplify our motto, “You Care, We Collect,” and we have partners like TriZetto to help us achieve this by accelerating revenue with innovative solutions. Coronis goes after the last dollar using our seasoned team of tireless and tough negotiators. You’ll receive timely, relevant, and accurate information in a way you can understand. We don’t just help collect your earnings. We help you financially grow.

eClinicalWorks

eClinicalWorks provides comprehensive EHR and practice management solutions with its advanced, customizable documentation, population health, patient engagement, and revenue cycle management services. They cater to independent, ambulatory practices and ensure every aspect of patient care is under control, from scheduling and check-in through documentation, labs, prescribing, billing, and follow-up. Echoing their objectives, Coronis Health utilizes leading-edge technology to help medical facilities reduce costs, augment cash flow, and improve patient care quality. We’ve developed an advanced technological system that learns who to collect from and how to collect efficiently and cost-effectively.

Greenway Health

Greenway Health helps empower your high-performing facility with its cloud-based EHR and practice management solutions, revenue cycle management, and end-to-end facility solutions, including telehealth, population health, and analytics. Greenway also partners with organizations and progressive providers across multiple specialties, allowing for improved patient outcomes, increased revenue, and a highly efficient billing process while remaining compliant with federal and state regulations. At Coronis Health, we also pool our global resources to bring customers the best in medical billing and revenue cycle management. With our high-touch relationship building and ability to manage through industry change, we help medical professionals improve their quality of care while meeting regulatory requirements.

Waystar

Waystar uses a cloud-based platform that streamlines workflows and improves healthcare providers’ financials while creating more transparency for the patients’ financial experience. Their single sign-on platform lets you manage commercial, government, and patient payments all in one place. This innovative platform simplifies eligibility verification and prior authorization processes, helping patients understand their financial responsibility and giving providers visibility into patient propensity to pay and more. This way, you can provide patients with the transparent and positive interactions they deserve. At Coronis Health, what also contributes to our 100% transparency is our use of technology and analytics to access and analyze information. As a result, you get a broader view of your revenue cycle, helping you make more informed decisions that will lead to improved financials and patient satisfaction.

Partner With Technological Innovators

We are proud to work with many of the country’s most stand-out practice management and health information systems. Our expertise equips us to give your facility the intuitive solutions it needs to make your workflow more efficient and your jobs easier. To learn more about how software agnosticism can help your revenue cycle run smoothly and keep your patients happy, contact Coronis Health today or request your free financial checkup.

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https://www.coronishealth.com/blog/this-is-what-software-agnostic-means-at-coronis-health/

How to Avoid Hospital Claims Denials

The American Hospital Association (AHA) surveyed more than 200 hospitals and health systems in 2019 to explore how commercial health plans employed utilization management practices for patients and providers.

They found that 89% of the respondents have experienced an increase in claims denials over the past three years. 51% of them even described such increase as “significant,” with the failure to obtain prior authorization as one of the major reasons for claims denials. 

Claims denials will not only impact your revenue performance but also the quality of the patient care you provide. In addition to identifying the root causes of your claims denials, it is crucial to consider leveraging the expertise of a medical billing and coding company to avoid delays and rejections. Coronis Health is a healthcare revenue cycle management company offering global capabilities and specialized solutions. Our seasoned team of tireless and tough negotiators goes after the last dollar, so you’ll receive timely, relevant, and accurate information in a way you can understand. We don’t just help you get money, we help you financially grow.

Why Are Claims Denials Up?

Knowing the common reasons for claims denials is key to preventing them. These are the top reasons why your claims are getting denied:

• Failure to obtain prior authorization
• Non-compliance with medical criteria
• Non-compliance with procedures/eligibility issues
• Invalid claim data
• Unspecified billing issues
• Downcoding
• Missing or incorrect information
• Outdated insurance information/use of out-of-network provider
• Missing or invalid explanation of benefits
• Services not covered

How Claims Denials Harm Hospitals 

Healthcare providers are focused on two things: providing patients with the highest quality of care and getting paid for that care. Denied claims, however, are a huge obstacle to receiving timely and complete reimbursements. Denials are not only time-consuming to process, but they are also costly to appeal since you will need additional labor and manpower for it. Furthermore, the time spent by your billing department in reviewing and resubmitting claims can slow down their productivity. As a result, denied claims can negatively impact your facility by reducing your cashflow, delaying payment for your services, and disrupting your team’s efficiency. More importantly, dealing with these frequent billing errors and mistakes can lead to physician burnout which results in patients having to wait for proper care.

Combat Claims Denials 

Handling claims denials is not easy without enforcing a structured plan. A comprehensive analysis of the revenue cycle can help combat claims denials and guarantee timely payments for the services provided. Streamlining your claims management process is key, and this can be done by employing new strategies in updating your systems, maintaining clean records, and using data analytics. By constantly having a team trained and experienced in claims management, as well as applying the best practices in medical billing, you can significantly cut down the rate of your claims denials and get more approvals faster. Below are ways you can combat claims denials:

Create an Improvement Plan from Claims Analytics 

You can address denials with an analytics-driven approach. This can help empower your staff to identify errors in the process that contribute to denials. One way to do this is by assessing your medical billing software and technology. See why claims are being denied, determine which tools and resources are helpful, and eliminate anything that is deemed unnecessary. Ask your employees which tools help them work more efficiently and what they need to help enhance their productivity. By analyzing your billing software’s step-by-step process, you can better evaluate your workflow and shed light on what areas need improvement. This will then lead you to create a strategic plan for fixing any errors and expediting your processes. 

Hire Expert Billers 

When the efficiency and profitability of your revenue cycle are at stake, you need to have expert billers on your team to ensure your facility’s success. These experts will still need consistent training so they can stay up-to-date on the latest technologies and coding regulations. Maintaining this level of expertise on your staff can be costly and time-consuming, which is why many hospital facilities choose to outsource their medical billing to help free up their staff and leave the more challenging collections to the experts.

Expert billers are experienced, constantly trained, and knowledgeable about the challenges associated with denial management. As a result, patients can come to terms with their outstanding bills, your staff will no longer be burdened by unhappy patients, and your cash flow will significantly improve.

How Coronis Prevents Denials

With over 100 years of combined experience in various niches including hospitals of all sizes, Coronis Health 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, our team’s process involves analyzing your system and determining the exact reasons for claims denials. We will analyze the collected data and create strategic solutions to help combat denials and increase your revenue. 

We also generate solutions from analytics from the billing software used. Our medical billing software works independently from your practice management (PM) system, meaning there is no need to change your current PM system. Coronis Health is well-versed in many of the top PM systems. Our proprietary medical billing and coding denial management software also tracks claim status, allowing us to improve your first-pass rate significantly. As technological innovators, we make sure that our software can identify medical billing trends, giving us the ability to avoid future denials before they happen and allowing you to collect timely payments for your services provided. Coronis Health will take care of everything for you. We will ensure your collections are easy to manage and denials are kept to a minimum.

Partner With Coronis Health

Coronis Health is comprised of the top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. We are adept in not only understanding client challenges, but creating effective solutions when it comes to reducing denied claims and improving your cash flow. If you are looking for a reliable partner who will be focused on cultivating your financial health, contact Coronis Health today.

from
https://www.coronishealth.com/blog/how-to-avoid-hospital-claims-denials/

3 Reasons “Less is More” in Hospital Charting

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

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

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

E/M Changes Could Result in Less Required Documentation

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

1. Specific Notes Keep Focus on Patient Needs 

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

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

2. Excessive Documentation Leads to Physician Burnout

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

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

3. Clear Documentation Ensures Accurate Hospital Medical Billing

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

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

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

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

Schedule An Assessment With Coronis Health

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

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

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

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

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

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

CPT Codes for COVID-19 Vaccinations 

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

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

Pfizer-BioNTech and Moderna

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

AstraZeneca

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

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

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

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

ICD-10 Codes for COVID-19 Vaccinations 

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

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

Vaccination Reimbursement 

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

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

Other provisions indicated in the rule include:

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

Hospital Billing Guidelines for COVID-19 Vaccine 

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

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

The following are valid types of bills for roster billing:

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

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

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

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

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

Schedule an Assessment with Coronis Health

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

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

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

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

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

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

Changes that Will Affect Hospital Medical Billing

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

E/M Requirements

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

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

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

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

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

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

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

Current Procedural Terminology (CPT) Changes

Other key changes to coding include the following:

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

Telehealth for Medicare Updates

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

Telehealth services added to the Medicare telehealth list include:

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

You may view all updates on policy changes here.

How Coronis Can Help Your Hospital Stay Compliant

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

Schedule an Assessment with Coronis Health 

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

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