Medicare Physician Fee Schedule Final Rule: Calendar Year 2022

Here’s What’s Changing in 2022

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

Medicare Part B Premium & Deductible Rate Increase

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

Payment Increase in Vaccine Administration

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

Split (or Shared) E/M Visits Changes

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

Critical Care Services Updates

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

Telehealth Services

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

Electronic Prescribing of Controlled Substances

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

Medicare Shared Saving Program

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

Billing for Physician Assistant Services

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

Therapy Services

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

In-Home Administration of COVID-19 Vaccines

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

COVID-19 Monoclonal Antibody Reimbursement Rate

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

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

Real Clients, Real Results

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

Efficient Billing for Better Bottom Lines

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

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

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

Healthier Revenue Cycles for Healthier Financials

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

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

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

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

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

Higher Clean Claims Rates Improve Revenue

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

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

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

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

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

Backlog Weighing You Down? Find Freedom with Coronis

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

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

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

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

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

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

Support to Grow Your Practice and Increase Revenue

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

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

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

Partner With Coronis Health

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

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

COVID Relief Aid is on the Way

The country’s hospitals stepped up in unprecedented ways to face COVID-19’s challenges. As outbreaks rose, hospitals had to ramp up testing efforts while treating thousands of patients in an effort to save lives, control the virus’ spread, and safeguard the health of other patients and hospital staff. These challenges have also created significant financial pressures for America’s hospitals. As a response to this crisis, as well as the pressure from medical groups and lawmakers, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is releasing $25.5 billion in new funding available for healthcare providers affected by the COVID-19 pandemic.

At Coronis Health, we understand how the pandemic, just like every other crisis, should allow opportunities for evaluation and change. For hospitals, it could mean adopting new payment schemes, exploring more revenue streams, or reaffirming your vital role in healthcare delivery. By partnering with us, you won’t just remain compliant amid the changing demands of documentation and regulation requirements, but we will help you financially thrive.

The Financial Impact of COVID on Practices

Hospitals rose to the challenge of COVID, to the point of stretching themselves thin. COVID dramatically changed the healthcare system – hospitals had to set up tents, increase supply of general and intensive care unit bed capacity, and cancel non-emergency procedures. Furthermore, the pandemic increased the demand for certain drugs, medical supplies, and equipment such as PPEs, ventilators, and hospital beds. Because of supply chain disruption, the cost of these essential supplies has increased exponentially since the pandemic’s onset.

As a result, the American Hospital Association (AHA) estimates a total four-month financial impact of $202.6 billion in losses for America’s hospitals, or an average of $50.7 billion per month. 

What Has the Government Done to Help?

After the AHA and lawmakers urged HHS to distribute unused funds, the government finally recognized the financial strain caused by the global pandemic and agreed to advocate for policies to support hospitals. Specifically, the HHS, through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. 

“This funding critically helps health care providers who have endured demanding workloads and significant financial strains amidst the pandemic,” said HHS Secretary Xavier Becerra. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.”

What is PRF Phase 4?

Qualified hospitals may receive Provider Relief Fund (PRF) payments for healthcare-related expenses or lost revenues due to the pandemic. These distributions do not need to be repaid to the US government, as long as hospitals comply with the terms and conditions.

According to HHS, 75% of the $17 billion Phase 4 PRF distribution will be based on hospitals’ COVID-19-related lost revenues and expenditures from July 1, 2020, through March 31, 2021. As indicated on their report: 

“Smaller providers will be reimbursed at a higher rate compared to larger providers. Specifically, medium, and small providers will receive a base payment plus a supplement, which will be higher for smaller providers. Large providers will receive a payment based on a percentage of their lost revenues and expenses. HHS will determine the exact amount of the payments after analyzing the applications received. The remaining 25% of the $17 billion will be distributed in the form of bonus payments for providers based on the amount and type of services they provide to Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) patients. These payments will generally be made at Medicare rates. Providers who serve any patients living in rural areas, as defined by the Federal Office of Rural Health Policy (FORHP), and who otherwise meet the eligibility criteria, will receive a minimum payment.”

How Much Funding?

The HHS reports that the funding includes “$8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.”

Who Will Get It?

The grants are divided into two different portions: $17 billion for hospitals who can prove they have losses and $8.5 billion for rural hospitals and health care providers.

How to Get It

Hospitals can apply for a share of $17 billion in grants if they can prove they had losses or expenses due to COVID-19 between July 2020 and March 2021. To expedite and streamline the application process and minimize administrative burdens, HHS recommends hospitals apply for both programs in a single application. 

For more information about eligibility requirements, the documents and information hospitals needed to complete the application, and the application process for PRF Phase 4 and ARP Rural payments, visit https://www.hrsa.gov/provider-relief/future-payments.

Let Coronis Help You Get Your Practice Back on Track

Because of our industry-leading technology, global solutions, and highly experienced team, Coronis Health has quickly become the trusted partner in COVID-19 billing throughout the pandemic. 

We understand that hospitals can become buried in claims processing with the continuous rise of COVID-19 testing, vaccinations, and treatment. This does not deter us. We are equipped to help you clear your billing backlog, recover critical payments, and create new revenue streams in the process. In fact, we were able to help a client clear a 250,000+ test backlog in just two weeks. We’re forward-thinking innovators who utilize the latest technology to support and assist your hospital’s administration department. From quick implementation to artificial intelligence (AI), we understand that constant evolution is what drives success. With a team of experienced medical coders, we can ensure accurate coding and billing for your COVID-19 long-hauler patients. We are confident that our medical billing services can increase your internal revenue. 

And we know that even in this pandemic, each client will need customized, scalable solutions that meet their immediate needs and help hit long-term goals. Our relationship-centric approach means we will not give you a one-size-fits-all solution. We are an agile company possessing global capabilities but with a personal touch. We are a full-service billing and management company with over 30 years of experience in helping hospitals with billing, practice management, and revenue cycle optimization. 

Partner With Coronis Health For Your Revenue Cycle Management Needs

Healthy finances lay the foundation for a solid practice. Our goal is to maximize your profits and reduce your administrative costs, so you can continue providing quality care for your patients and stay financially independent. Allow us to help you during this stressful time. To learn more, contact Coronis Health today or request your free financial checkup.

from
https://www.coronishealth.com/blog/covid-relief-aid-is-on-the-way/

Worried about Staffing Shortages? Coronis Can Help

As COVID-19 infection rates continue to surge across the nation, U.S. medical facilities are facing increasing pressure to implement vaccine mandates for all employees. A blanket mandate may seem like the right call to curb infection rates and reduce hospitalization numbers, but the reality isn’t quite so black and white. 

Medical facilities are currently experiencing staffing shortages due to the pandemic — particularly in rural areas — and a vaccine mandate may only exacerbate the problem. To prepare for this anticipated exodus of health care workers, the Biden Administration has set up funding for rural medical facilities to provide financial support during this lapse in staffing coverage. 

Coronis Health understands how the pandemic has disproportionately affected rural medical facilities. With over 100 years of combined experience in various specialties, we’ve made it our mission to assist rural facilities in any way we can.

This impending staffing shortage doesn’t have to ripple through your entire organization. Coronis offers a number of services to help support shortages within the administrative side of your facility. We have teams of experienced medical billers and coders to temporarily cover your gap in staffing so that you can continue providing high-quality medical care.

The Staffing Problem

The data is clear: COVID-19 infection rates are increasing in every state in the continental U.S. Several different factors are influencing these numbers, but the fast-spreading delta variant and number of unvaccinated individuals are, without question, the dominant determinants. 

With infection rates on the rise, health care workers are feeling stretched thin. According to recent studies, up to 30% of medical professionals have considered leaving the industry altogether. Physical and mental exhaustion, burnout, and disillusionment of the medical field are just a few reasons the healthcare industry is struggling to find and retain high-quality staff.

Another culprit behind the shortage? Vaccines. With the introduction of the COVID-19 vaccine — currently offered by Pfizer, Moderna, and Johnson & Johnson — many health care workers have expressed wariness. 

The problem seems to be twofold. A recent survey of nursing home caregivers suggests that many workers worry about vaccine safety and side effects due to lack of information. According to the American Medical Association, others feel that the vaccine was developed too quickly for their comfort, while some believe they’ve developed long-term antibodies after repeated virus exposures.

Whatever the reason may be, unvaccinated healthcare workers are at risk of becoming infected with COVID-19 and of passing it on to immunocompromised patients, which increases infection rates within the entire system. As hospital beds fill up and staff call out sick due to infection, medical facilities are continuing to operate without the number of workers they need to properly care for their patients.

Are Vaccine Requirements Coming?

The number of major health networks requiring that employees be vaccinated is growing fast. California, for example, has mandated that all healthcare workers in the state be vaccinated against COVID-19 by the end of September. Those who refuse will be subject to regular testing. Connecticut, New Jersey, and Virginia have issued similar mandates, while numerous private facilities are following suit. In June, more than 150 Houston Methodist employees were fired or resigned over the facility’s vaccine mandate.

But not all states are requiring vaccinations for healthcare workers. Montana state law prohibits any employer from requiring workers to be vaccinated. Additionally, employers cannot discriminate against workers based on vaccination status. Likewise, a 32-year-old law in Oregon prevents employers from independently mandating vaccines for healthcare workers, prompting Gov. Kate Brown to issue new guidance regarding health and safety in healthcare settings.

Help on the Horizon

As the uptick in medical facilities requiring proof of vaccination grows, the White House has a close eye on rural hospitals, where COVID-19 infection rates sit higher than at urban facilities and staffing shortages hit all-time highs in many regions. 

Fortunately, federal assistance is on the horizon, with The U.S. Department of Health and Human Services (HHS) allocating $8.5 billion in American Rescue Plan funding to help support healthcare providers serving rural Medicare, Medicaid, and Children’s Health Insurance Plan (CHIP) patients. 

The U.S. Department of Agriculture (USDA) will also allocate $500 million in American Rescue Plan funding to create the Emergency Rural Health Care Grant Program. This program is expected to increase access to COVID-19 testing and vaccines, food assistance, telehealth, medical supplies, and more. One primary goal of this new funding is to boost staffing in rural facilities that are most impacted by COVID-19.

How Coronis Can Help

The need for proper staffing in rural medical facilities is critical right now. As vaccine mandates grow, it’s important for these facilities to prepare for additional staffing shortages. Coronis Health has the skill and experience to shoulder the burden. We’re here to make sure your medical billing and coding processes continue to run smoothly in spite of staffing shortages and changes. 

We provide the highest quality medical billers and coders to optimize your revenue cycle while you tend to more urgent duties pertaining to patient care. From simplifying the collection process to scrubbing claims and reducing denials, Coronis Health can help keep the administrative side of your facility running smoothly.

To learn more about how Coronis Health can help you maintain success during staffing shortages, contact a financial consultant for a free financial checkup today.

from
https://www.coronishealth.com/blog/worried-about-staffing-shortages-coronis-can-help/

Long Haul Covid Modifiers: What You Need to Know

As the COVID-19 pandemic approaches its second year, medical practitioners are uncovering new repercussions stemming from the infection. It’s becoming clear to those in the medical community that symptoms of COVID can linger long after patients recover. Referred to as COVID “long-haulers,” these patients continue to suffer a broad range of peculiar symptoms related to the infection, including brain fog and memory loss.

Treating patients with obscure symptoms from COVID is difficult enough, but billing for them is a challenge in itself. Coding and documentation for COVID long-haulers can be tricky. Since these patients experience an array of different symptoms, sometimes months after their initial infection, determining the right coding and billing information for long-haulers is confusing and time-consuming.

All too often, facilities spend substantial time and countless resources applying the right medical codes for insurance claims and proper payment. Billing for COVID-19 is complicated, given the complex symptoms actively infectious patients face, but long-haulers present an entirely new challenge for the administrative side of your facility.

Coronis Health has more than 30 years of experience offering medical billing solutions. We have first-rate medical coders and billers to help your facility navigate COVID’s every-changing consequences without losing revenue.

What Is A COVID-19 Long-Hauler?

COVID-19 long-haulers are patients who continue to struggle with the effects of the infection long after recovering. The aftereffects of COVID are still a mystery to medical experts nearly two years after the first case was reported in the U.S. Though it remains unclear exactly why some patients experience long-term symptoms of COVID, while others don’t, one thing is certain: We’re all in this for the long haul.

COVID-19 Long-Hauler Symptoms

What makes COVID long-haulers unique is the unspecificity of their symptoms. While their symptoms are undeniably tied to their original infection, medical experts don’t yet understand why. Long-term effects of COVID can range from mild acute symptoms to severe chronic conditions.

COVID-19 long-haulers face a wide range of long-term symptoms, such as:

• Anxiety and depression
• Brain fog
• Joint and muscle pain
• Fatigue
• Memory loss
• Blood clots
• Lost sense of smell or taste
• Increased heart rate
• Chest pain
• Lung damage
• Organ damage
• Difficulty concentrating
• Fever
• Dizziness
• Cough

Connecting these symptoms back to COVID requires proper documentation from all practitioners, meaning accuracy in preparing these documents is critical.

How Proper Documentation Influences Coding and Billing

Proper patient care can’t exist without clinical documentation. Without accurate documentation of a patient’s medical history, it can be difficult for practitioners to correctly diagnose and treat medical issues as they arise. Clinical documentation directly impacts the care they need. It also influences how medical facilities bill patients and their insurance companies. To minimize denied insurance claims and optimize facility revenue, medical coders must apply the correct codes during the billing process. 

This can be complicated for practitioners and medical facilities caring for COVID long-haulers. With a seemingly endless range of long-term side effects attributed to the original infection, proper documentation is more important than ever before for accurate coding and billing.

Regulatory Changes Muddy the Waters

Medical facilities across the country have been shouldering the brunt of the pandemic, with healthcare workers on the frontlines. Adding to this stress has been an abundance of recent regulatory changes that complicate coding and billing, including:

• Evolving COVID coding guidelines
• Fluctuating effective dates for insurance waivers
• Complicated query forms
• Changing guidance over telehealth modifiers
• New instructions for change of service codes
• New developments surrounding beneficiary cost sharing

There’s no doubt that the lasting symptoms that COVID long-haulers experience complicates the entire documentation, coding, and billing process for medical facilities. Without precise coding, facilities are often left with denied claims that significantly impact revenue. This leaves facilities without the proper funding needed to hire new staff, update medical equipment, invest in innovative technology, and more. 

How Coronis Health Can Help

Navigating the billing and claims process takes time and resources away from facilities that are already struggling to keep up with the many challenges that have arisen during the pandemic. At Coronis Health, we provide data-driven solutions for all your medical coding and billing needs. 

We’re forward-thinking innovators who utilize the latest technology to support and assist the administrative side of your facility. From quick implementation to artificial intelligence (AI), we understand that constant evolution is what drives success. With a team of experienced medical coders, we can ensure accurate coding and billing for your COVID long-hauler patients to increase your internal revenue. 

Our goal is to maximize your profits and reduce your administrative costs so you can continue providing quality care for your patients.

Get Your Free Financial Checkup with Coronis Health

To schedule a free financial checkup with a trusted adviser, contact the experts at Coronis Health today.

from
https://www.coronishealth.com/blog/long-haul-covid-modifiers-what-you-need-to-know/

5 Measurements Your Hospital Should be Tracking to Improve Financial Health

With our 30+ years of experience and industry thought leadership, Coronis Health understands most hospitals struggle to achieve long-term sustainability. Positive financial margins can allow you to maintain a healthy cash flow and invest in new technologies and treatments to provide better patient care. One way to remain financially viable is by closely monitoring the following five indicators that measure your financial health.

1. Aggregate Volume and Provider Utilization Trends

These numbers provide an overall view of your hospital’s finances, offering a quick view for all managers, department heads, and other leaders.

2. Operating Ratios

This includes your expenses as a component of your net operating revenue. You must also monitor labor, supply, and purchased services costs.

3. Labor Costs

Regularly check costs relative to patient volume. Gauge the productivity in each department against their staffing targets, including overall FTE per adjusted occupied bed target in your hospital as a whole.

4. Patient Revenue Indicators

These numbers include your bad debt percentage and net to gross percentage by payer class. Determine if there are shifts in the payer mix that need attention.

5. Liquidity Ratios

These should cover net days in patient accounts receivable and cash collections as a percentage of your net revenue. Determine the steps needed to improve your cash flow.

Ways to Improve Your Hospital’s Performance 

By tracking the above data points and creating and implementing strategic planning, you can create a roadmap for financial success.

Seek Federal Funding 

Many rural hospitals received federal funding to aid them during the crisis. Whether obtained from a PPP loan or the CARES ACT grant, hospitals should adequately manage and control financing, as well as restrict its use, so you do not deplete your financial reserve. In some cases, the federal government will require a hospital to document fund usage. But in any case, hospitals should closely monitor these funds.

Understand the “Why”

The key to improving your hospital’s performance is answering, “Why?” Addressing this question means finding your financial distress’s root cause. The process also enables clear communication of your hospital’s goals and expectations, contributing to achieving your desired changes. By gathering all the necessary information and establishing clear objectives, you become better equipped to target the root of your difficulties.

Stay Competitive

Technology is constantly evolving. You have to keep up to remain relevant and competitive. One crucial way to stay on the cutting edge, especially during the COVID-19 crisis, is telemedicine. Telehealth is rapidly becoming a fixture in healthcare delivery, so every hospital must adapt and take the necessary steps to provide care in a virtual capacity.

Fully Use Resources 

Given these unprecedented changes, loss of revenue, and higher expenses, building new facilities is not a feasible option, but you can maximize your available resources. If you have extra space, find ways to rent it out or use it so you can care for more patients at once. Sometimes, it’s the money that you save that matters. Simple changes in improving your communication systems to ensure better responsiveness or checking and updating equipment and technology to prevent outages can already help streamline your processes and increase patient satisfaction. 

Promote Wellness and Environmental Programs

Wellness programs help keep employees healthy and happy. It’s a means of implementing “self-care” because when healthcare providers take care of themselves, they can better care for patients. A healthy staff also decreases the likelihood of absences and gives your hospital an overall positive image.

Green initiatives can complement your wellness programs too. Your efforts in contributing to a healthier environment will benefit you and your community. While environmental programs may bring upfront costs, they pay off in the long run. According to a guide published by the American Hospital Association, “By trimming just 5 or 10 percent from energy bills, hospitals, and care systems can make a real impact on their finances.”

How Coronis Can Help 

Coronis Health assists hospitals in evaluating processes and workflows. With industry-leading innovations and business solutions, Coronis Health can deliver value to healthcare organizations of all sizes. We allow you to focus on providing patient care while maintaining your independence and financial security. With our 100% transparency guarantee, you see what we see. Our tailored solutions include clear and comprehensive reports that allow you to make the best financial decisions for your hospital. Furthermore, when your hospital frees itself from the time-consuming task of billing, your business can better thrive because all your focus and energy is directed toward your patients. Rewards will grow when all parties work together towards a mutual goal.

Partner With Coronis Health

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https://www.coronishealth.com/blog/5-measurements-your-hospital-should-be-tracking-to-improve-financial-health/

MIPS Overview & How to Avoid the 9% Payment Adjustment:

What is the Merit-based Incentive Payment System?

The Merit-based Incentive Payment System (MIPS) is one way to participate in the Quality Payment Program. Under MIPS, CMS evaluates your performance across multiple categories that lead to improved quality and value in the healthcare system.

The performance threshold for 2021 is 60 points, which means:

• A MIPS score below 60 points will result in a negative payment adjustment
• A MIPS score above 60 points will result in a positive payment adjustment

2021 Final Performance Threshold & Payment Adjustment

How is MIPS Scored?

The MIPS performance categories have different “weights,” and the scores from each of the categories are added together to give you a MIPS Final Score.

Step 1: Check Your Current Eligibility

MIPS payment adjustments are only applicable to clinicians deemed “MIPS eligible.”

The low volume threshold includes 3 aspects of covered professional services:

Step 2: Select and Perform Your Measures and Activities

Quality Category 40% of MIPS Score

Sixty (60) performance points are needed to earn full credit for the Quality category. Most clinicians must select 6 measures, including 1 outcome/high priority measure, by exploring these measures and collecting data for each measure for the 12-month performance period (January 1- December 31, 2021).

NOTE: Clinicians in SMALL practices automatically receive six points in their quality category if at least one quality measure is reported. This is called the small practice bonus.

Improvement Activity Category 15% of MIPS Score

Easiest category and points to earn! Forty (40) performance points are needed to earn full credit for the improvement activity (IA) category. Practices receive full credit for the IA category when they complete:

• 2 high-weighted activities,
• 1 high-weighted activity and 2 medium-weighted activities, or
• 4 medium-weighted activities

How Should You Submit Data? There are 3 submission types you can use for improvement activities, depending on which submitter type you are. The submission types are:

• Sign in and attest
• Sign in and upload
• Direct submission via API

Promoting Interoperability Category 25% of MIPS Score

One hundred (100) performance points are needed to earn full credit for the promoting interoperability (PI) category. All required PI measures must be reported or excluded. When a measure is excluded, the points are reallocated to a different, assigned PI measure. You must submit collected data for certain measures from each of the 4 objectives measures (unless an exclusion is claimed) for 90 continuous days (or more) during 2021. Additional requirements for this category include use of a 2015 edition certified electronic health record (EHR) and you must provide your EHR’s CMS Identification code from the Certified Health Product List and submit a “yes” to:

• The Prevention of Information Blocking Attestation,
• The ONC Direct Review Attestation, and
• The security risk analysis measure.

Additional help on this category: PI Requirements, Hardship Exceptions, How to Submit Data Links

Cost Category 20% of MIPS Score

You do not have to submit ANY data for this performance category!

For performance year 2021, CMS will use cost measures that assess: the overall cost of care provided to Medicare patients with a focus on the primary care they received, the cost of services provided to Medicare patients related to a hospital stay, and costs for items and services provided.

CMS determines measure achievement points by comparing performance on a measure to a benchmark. CMS calculates cost measure benchmarks using performance data from the performance period, rather than historical benchmarks.

Additional Help on this Category: Cost Quick Start Guide

Step 3: Understand How COVID-19 Relief Efforts Affect 2021 MIPS Payment Adjustments

The COVID-19 pandemic has impacted all clinicians across the United States and territories. However, CMS recognizes that not all practices have been impacted by COVID-19 to the same extent. For PY2021, CMS will continue to use the extreme and uncontrollable circumstances policy to allow clinicians, groups, virtual groups, and APM Entities to apply requests for reweighting of performance categories due to the current COVID-19 public health emergency.

There are two exception applications available to clinicians in PY2021:

• The Extreme and Uncontrollable Circumstances Exception application allows you to request reweighting for any or all performance categories if you encounter an extreme and uncontrollable circumstance or public health emergency, such as COVID-19, that is outside of your control.
• The MIPS Promoting Interoperability Performance Category Hardship Exception application allows you to request reweighting specifically for the Promoting Interoperability performance category if you qualify for one of the reasons identified below. This application is available for the following specified reasons:
  • You’re a small practice
  • You have decertified EHR technology
  • You have insufficient Internet connectivity
  • You face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress or vendor issues
  • You lack control over the availability of CEHRT

What Happens If Your Application is Approved?

If your application is approved, you don’t have to report for the requested MIPS performance category or categories, and those categories will be reweighted.

• Application deadlines are December 31, 2021 at 8PM ET.

Step 4: Report Categories Based on YOUR Circumstances:

The MIPS 2021 final rule is for calculating the MIPS payment adjustment for your composite score. Remember you only need 60 points to avoid the negative payment adjustment of -9% in 2023:

Scenarios to Avoid the Adjustment include:

• Scenario 1: You do not have an EHR. If you do not have a 2015 edition certified EHR, you CAN still participate in MIPS. You can report the Quality and IA categories and apply for a PI Hardship Exception, because you are a SMALL practice.
• Scenario 2: You have an EHR. If you have a 2015 edition certified EHR, you can submit data in the Quality, IA and PI categories or just the Quality and IA categories, if you submit a PI Hardship Exception application and it is approved.
• Scenario 3: The PI category is automatically reweighted. If you are a clinician type listed below, CMS automatically re-assigns the PI category points to the Quality category. As a result, you only need to report the Quality and IA categories to earn 60 points.

• Scenario 4: The PI category is reweighted due to an approved PI Hardship Exception Application. If you are a clinician or group and one of the following circumstances applies, you can submit a PI Hardship Exception application. If the application is approved, you only need to report the Quality and IA categories.

Step 5: Submit Your Data

• Submit data yourself or with the help of a third-party intermediary, such as a Qualified Registry or Qualified Clinical Data Registry (QCDR), between January 3 and March 31, 2022.
• Visit the Quality Payment Program Resource Library  to review the lists of CMS-approved Registries Qualified Registries  and QCDRs.

Step 6: Review your Feedback

Review your preliminary feedback, available once data is submitted. Review your final performance feedback and payment adjustment information in July 2022.

When you successfully submit a valid quality data code (QDC), the RA/EOB will list the RARC code N620 which means that the QDC got to our NCH database.

• If you bill with $0.00 charge on a QDC line item, you’ll get an N620 code on the EOB. N620 says: Alert: This procedure code is for quality reporting/informational purposes only.

Questions:

• Please visit the Quality Payment Program web portal – https://qpp.cms.gov/
• Contact CMS – call the Quality Payment Program Service Center at 1-866-288-8292

from
https://www.coronishealth.com/blog/mips-overview-how-to-avoid-the-9-payment-adjustment/