Complexity of RCM Leads Practices to Outsource

Your facility’s financial success is attributed to multiple factors, with revenue cycle management at the top of the list. From collecting payments at the front desk to handling your AR, managing the complexities of the revenue cycle should not be stressful or taxing on your staffing. Coronis Health provides the specialized solutions for outsourcing your billing and revenue cycle management needs so you can focus on the most important aspect of your business – the patients.

What is RCM?

Revenue cycle management, or RCM, is a full-circle process that culminates with your facility earning revenue from the services delivered to patients. The cycle starts with the simple task of registering a patient and verifying their eligibility and insurance, and ends with the final collection from the patient or insurance payer. The process may seem lengthy, as it involves multiple players, including the patient, facility, billers and coders, and the health insurance companies that reimburse a hospital or healthcare facility. Ultimately, the management of this process falls on the healthcare facility, so a full understanding of the cycle is critical for the success of an organization.

Why Is It So Complex?

Revenue cycle management is not as simple as a retail store collecting money for a sale, which happens instantaneously. Patients receive services before a billing department submits a claim, and if a claim is denied or part of the claim is not covered, the reimbursement process is delayed. Additionally, the changes with ICD-10 create challenges that demand accurate documentation and coding, so if a healthcare facility does not engage in effective billing practices, the rate of denials increase, and accounts receivable (or A/R, the amount of money an insurance company owes a healthcare facility) can soar to an unmanageable level. Increased denials make it difficult to collect earned reimbursement from insurance companies.

RCM Challenges

Revenue cycle management presents challenges that require a healthcare facility to focus on multiple factors to ensure the process is successful. The following challenges demand a savvy team of experienced professionals who know and understand the full circle of revenue cycle management:

• Prior authorizations are necessary for healthcare facilities to ensure that a patient receives care that an insurance company approves prior to the date of service. Providing care or performing a procedure without prior authorization could lead to claim denial, and ultimately place the responsibility of payment with the patient.
• Revenue integrity involves capturing accurate charges, which determine the amount of reimbursement a facility receives. Facilities with specialties may face more challenges as they focus on value-based care, bundle their charges, and perform procedures.
• Accurate coding is essential to ensure that patient encounters, procedures, laboratory and imaging services, and surgery claims capture codes correctly to prevent loss of reimbursement. Incorrect coding can result in a loss of revenue for a facility.
• Management of A/R is critical for a healthcare facility, as it determines how soon reimbursement is received after submitting a claim. Keeping A/R under 30 days needs a team of dedicated individuals who understand and implement effective strategies to lower denial rates and increase collection rates.
• Credentialing and proper enrollment with an insurance payer is required for reimbursement. Physicians or facilities who are not enrolled or not “in-network” with a plan could face negative revenue outcomes, which also affects patients who receive services.

Coronis Health moves past these challenges to create success and alleviate the stress of billing, coding, and the revenue cycle process.

Benefits of Robust RCM

Outsourcing revenue cycle management is a choice that many healthcare facilities are making to ensure they have certified professionals who engage in regulated, proven methods of obtaining prior authorizations, accurate charge capturing and coding, claim submission, denial and A/R management, and collection. A robust revenue cycle management ensures that all pieces of the process are touched with every patient encounter, with zero money left on the table. The effective utilization of a revenue cycle team creates the centralization a healthcare facility needs to meet the challenges the industry presents with enormous amounts of data, changes, and regulations. It also aims to keep a facility operating with its doors wide open to care for patients.

Coronis Offers RCM Services

Don’t think that outsourcing means you lost control – in fact, you are creating more control for your facility as you are creating opportunities to create process improvement in other departments that may have suffered productivity or revenue losses. Let Coronis Health do the heavy lifting with revenue cycle management. Coronis offers services that optimize your facility’s revenue while streamlining your processes:

• Eliminate your concern for staffing shortages
• Provide a dedicated team that addresses changes with payer reimbursements
• Work closely with facilities that change practice management/EHR systems
• Ensure coding compliance, auditing services
• Maximize patient collection
• Decrease A/R to ensure timely reimbursement payments are received
• Offer billing services, to include:
  • Laboratory & Pathology
  • Behavioral Health
  • Hospital and Surgery Center
  • Primary Care and Specialty Physicians
  • Federally Qualified Health Centers/Community Health Centers
  • Anesthesia
  • EMS

Choose Coronis Health for Your Outsourcing Needs

Choose the best – choose Coronis Health for your outsourcing needs. We offer superior medical billing and technology innovation, integrating our services with your needs. We combine 100+ years of experience to tailor solutions and offer more than just medical billing. We go beyond your expectations with the latest technology, forward-thinking, and robust business intelligence. We grow with your processes and provide you with the services that maximize your revenue cycle management. We understand your needs, build trust, and gain a firm perspective of your facility’s goals, mission, and vision. Trust us to create a revenue cycle management team focused on your success.

Interested to learn more? Request your free financial checkup and find out why Coronis Health is the optimal choice for your healthcare facility. 

from
https://www.coronishealth.com/blog/complexity-of-rcm-leads-practices-to-outsource/

Breaking Down the No Surprises Act

Overview:

Effective in 2022, the No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers. It also establishes an independent dispute resolution process for payment disputes between plans and providers, and provides new dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the good faith estimate they get from the provider.  The Act is better understood by breaking it down into two parts.

• Part one is intended for emergency care, in-patient and facility providers (e.g. hospitals, facilities, etc).
  • If a patient has health coverage and receives emergency care; the act bans most common types of surprise bills.
• Part two is transparency of medical services and costs being provided.  Supplying patients with a Good Faith Estimate (GFE) of care.  This includes INN, OON and out-patient.
  • If a patient is self-pay,  uninsured or plans not to use their health coverage; the act states a GFE of the cost of care is to be provided before visit.

It is good to note that everyone’s understanding of the act is evolving and we should be prepared to pivot based on what is discovered and what provisions are made to the act.  This act also does not change the cost of service and is meant to protect individuals from large patient responsibility they did not agree to, as well as transparency in medical service costs.  

Part 1: No Surprise and Balance Billing

The No Surprises Act requires health plans and issuers to apply in-network cost-sharing terms and prohibits out-of-network providers, facilities, or providers of air ambulance services from billing individuals more than these in-network cost-sharing limits in 3 main scenarios: 

• A person gets covered emergency services from an out-of-network provider or out-of network emergency facility 
• A person gets covered non-emergency services from an out-of-network provider delivered as part of a visit to an in-network health care facility
• A person gets covered air ambulance services provided by an out-of-network provider of air ambulance services.

In-network facilities with IN providers currently don’t need to do anything different when accepting allowable amounts.
Out-of-network facilities and providers will need to provide a GFE.  This must cover expected charges, customized per patient and added to the patient’s chart.  More to follow on this in part 2.

In-network rates for out-of-network providers.  The processes for determining the patient’s cost sharing and the amount the plan must pay the OON facility or other OON provider are similar, with one significant difference.
First, if the care is provided in a state that participates in an All-Payer Model Agreement with the Centers for Medicare and Medicaid Services (CMS), then the amount the state approved under that Agreement as adequate payment for a given service is the amount the health plan must pay, and also serves as the basis for determining the patient’s cost sharing.
Maryland and Vermont are currently the only states that have these agreements with CMS and the agreements do not apply to all services or payers so the below rule will apply.
Secondly, many states have protections against balance billing, rules that establish procedures for calculating provider reimbursements.  The new federal law keeps intact these state-specific rules.
Finally, the act sets a process for determining both the patient’s cost-sharing responsibility for OON care and the plan’s payment obligation. The law establishes a general rule that the patient’s cost-sharing amount is based on the median in-network rate paid by all plans of the plan sponsor for similar items or services provided in the prior year, plus a cost -of living adjustment.
Example: Jerry participates in a self-insured health plan.  The plan requires 10% coinsurance for in-network emergency care and applies no deductible. Jerry receives emergency care from an OON physician in a state without an All-Payer Model Agreement.  The physician typically charges $5,000 for services rendered but the plan determines a typical allowable charge for such services from an in-network physician would be $2,500, which thus becomes the qualifying payment amount. Accordingly, the plan determines that Jerry’s co-insurance amount is $250.
As of 1/2022 states with laws already in place:
Emergency and Non-emergency laws by states:

Emergency & Non-emergency laws	Emergency situation laws only	Air Ambulance laws	No related laws
Arizona	Indiana	Montana	Alabama
California	Iowa	North Dakota	Alaska
Colorado	Missouri		Arkansas
Connecticut	Nevada		Hawaii
Florida	North Carolina		Idaho
Georgia	Pennsylvania		Kansas
Illinois	Vermont		Kentucky
Louisiana	Wisconsin		Nebraska
Maine			Ohio
Maryland			Oklahoma
Massachusetts			South Carolina
Michigan			South Dakota
Minnesota			Utah
Mississippi			Wyoming
New Hampshire
New Jersey
New Mexico
New York
Oregon
Rhode Island
Tennessee
Texas
Virginia
Washington
West Virginia

Patients that you are providing care for do have the option to continue seeing an OON provider, however a waiver must be provided and signed by the patient prior to balance billing.  CMS-consent form

If a provider drops out-of-network they must still provide INN rates for 90 days.  A provider must also maintain their directory. 

Part 2: Good Faith Estimate (GFE)

A GFE is simply an anticipated cost of care and services.  When scheduling a patient the individual fielding the call must ask if the patient intends to apply insurance benefits.  At this time, if the patient intends to bill insurance a GFE does not need to be issued.  The act states that each individual patient that is uninsured, self pay or not intending to use insurance benefits is to receive a GFE, which will be an administrative burden to practices.  A GFE must include:

• Patient name, date of birth and diagnosis
  • Acceptable to use tentative diagnosis (z or dx codes)
• Provider name, NPI, TIN and location of services
• Billing codes for each service
• Cover date of service or dos range if recurring services are to be rendered
  • Recurring up to 12 months

A practice can create their own GFE template including the required information.  Here is an example of a GFE from cms.gov: https://www.cms.gov/files/document/good-faith-estimate-example.pdf

At this time a patient/guarantor signature is not required, but should be considered as best practice in the case a complaint is filed that a patient never received a GFE.  

The act further states that the patient gets to determine how they receive the GFE and the provider must comply with their request.  Anyone held financially responsible is subject to receive a GFE.  Some forms of delivery:

• Paper
• Electronically (secure)
• Verbal (follow up must be done in writing)

With the GFE comes other guidelines that are required.  

• The convening provider (scheduling provider) is responsible for providing a full GFE by gathering estimates from all other providers or co-providers pertaining to the treatment of care
  • Estimates of co-provider must be provided within 1 business day of GFE request from scheduling provider
• Disclaimer on each GFE stating
  • Only an estimate and costs can change
  • Other services might be needed
  • Patient has the right to initiate dispute
  • GFE is not a contract and does not require patient accept services from provider

Deadlines and Timelines:
There are some confusions with how quickly a GFE is to be required.  The 10-3; 9-1 method is so far the most simplistic way to approach this. 

• 10-3 → if a scheduling call is 10 or more business days in advance; must provide GFE within 3 business days
• 9-1 → if a scheduling call is 3-9 business days in advance; must provide GFE within 1 business day
• If a scheduling call is less than 3 business days in advance; a GFE does not need to be provided, however best practice is still to provide a patient with a GFE in 1 business day
• If no appointment is scheduled and an individual requests a GFE; must provide GFE within 3 business days

Patient disputes and when to issue a new GFE 

If what is billed to the patient is more than $400 above the GFE the patient has the right to file a dispute ($25 administrative fee) with the Department of Health and Human Services.  The provider does have the ability to negotiate with the patient prior to come to a resolution.  If this is not done and the patient wins there could be additional fines and penalties given, the patient gets billed what was stated on the GFE and the provider will need to pay the $25 administrative fee the disputer was required to pay to initiate the dispute.  As a provider you might think to inflate the cost of services on the GFE.  Within the act there are statutes to prevent this as it is a “good faith” estimate and providers can be penalized for inflating costs.  With this all being said, when is a good time to update or provide a new GFE?

• Change in course of treatment
• Change in treatment costs
• Realization cost of services will exceed current GFE
• Change of diagnosis
  • Due to having to issue a tentative diagnosis on initial GFE.  If the diagnosis changes after care a new GFE should be provided
  • During the course of treatment if a diagnosis changes but the diagnosis does not change the treatment or cost; a second GFE is not required

What if my state has a surprise billing law?

The No Surprises Act supplements state surprise billing laws; it does not supplant them. The No Surprises Act instead creates a “floor” for consumer protections against surprise bills from out-of-network providers and related higher cost-sharing responsibility for patients. So as a general matter, as long as a state’s surprise billing law provides at least the same level of consumer protections against surprise bills and higher cost-sharing as does the No Surprises Act and its implementing regulations, the state law generally will apply. For example, if your state operates its own patient-provider dispute resolution process that determines appropriate payment rates for self-pay consumers and Health and Human Services (HHS) has determined that the state’s process meets or exceeds the minimum requirements under the federal patient-provider dispute resolution process, then HHS will defer to the state process and would not accept such disputes into the federal process.

As another example, if your state has an All-payer Model Agreement or another state law that determines payment amounts to out-of-network providers and facilities for a service, the All-payer Model Agreement or other state law will generally determine your cost-sharing amount and the out-of-network payment rate.

Other key facts

• ProBono care does not need a GFE
• Third Party Payer (funding source other than patient or insurance) it is unclear at this time if a GFE will be required.
  • If providing care after third party funding it is best practice to provide a GFE
• Insurance GFE: there are provisions within the act that may require GFEs to be submitted to insurance companies.
• Enforcement: there will be leeway until 2023 so don’t panic.  First step is showing an attempt at compliance.
• Non-medical fees (medical records) are not to be included in a GFE
• Providers and facilities must post notices in prominent locations within the office including front desk regarding patient’s right to GFE and disputes

from
https://www.coronishealth.com/blog/breaking-down-the-no-surprises-act/

2022 Updates You Need to Know

Medicare Clinical Laboratory Fee Schedule Private Payor Data Reporting – Delayed until 2023

The Protecting Medicare and American Farmers from Sequester Cuts Act delayed the Clinical Laboratory Fee Schedule private payor reporting requirement:

• Next data reporting period is January 1 – March 31, 2023
• Reporting is based on the original data collection period, January 1 – June 30, 2019

The Act also extended the statutory phase-in of payment reductions resulting from private payor rate implementation:

• No payment reductions for Calendar Years (CYs) 2021 and 2022
• Payment won’t be reduced by more than 15% for CYs 2023 through 2025

COVID-19 Vaccine & Monoclonal Antibodies : Changes for MA Plans Starting January 1, 2022

If you vaccinate or administer monoclonal antibody treatment to patients enrolled in Medicare Advantage (MA) plans on or after January 1, 2022, submit claims to the MA Plan. Original Medicare won’t pay these claims.

Pneumococcal Conjugate Vaccine, 15 Valent 

Medicare began covering pneumococcal conjugate vaccine,15 valent on July 16. CMS suggests submitting separate claims for this vaccine (HCPCS code 90671).

• Part A and B Medicare Administrative Contractors will hold claims for vaccines provided after December 31 until pricing is set
• CMS will deny claims for vaccines provided before July 16 

Average Sales Price Files: January 2022

CMS posted the January 2022 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2022 ASP Drug Pricing Files webpage.

Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare Fee-for-Service (FFS) claims. The 2% sequestration cut that would apply to all Medicare rates beginning January 1, 2022 is postponed until April 1, 2022:

• No payment adjustment through March 31, 2022
• 1% payment adjustment April 1 – June 30, 2022
• 2% payment adjustment beginning July 1, 2022

New Telehealth POS codes

The Centers for Medicare & Medicaid Services (CMS) has published new guidance on the reporting of telehealth/telemedicine Place of Service (POS) codes.

For reporting Medicare telehealth services, CMS had recommended reporting the POS code that would have been reported if the service had been furnished in person. This recommendation was intended to allow CMS to make appropriate payments for services furnished via Medicare telehealth at the same rate as in-person services.

The POS code listed on a claim provides information on the location or setting for the services rendered. This information is necessary to pay claims correctly.

To meet the widespread use of telehealth during the public health emergency, CMS is now updating the 2022 POS code set by revising the description of existing POS code 02, Telehealth Provided Other than in Patient’s Home, and adding new POS code 10, Telehealth Provided in Patient’s Home. According to CMS’ October MLN Matters, the POS changes will go into effect on Jan. 1, 2022, and will be implemented on April 4, 2022.

POS 02: Telehealth Provided Other than in Patient’s Home

The location where health services and health-related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health-related services through telecommunication technology.

POS 10: Telehealth Provided in Patient’s Home

The location where health services and health-related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.

from
https://www.coronishealth.com/blog/2022-updates-you-need-to-know/

Surprise! It’s the No Surprises Act

Starting January 1, 2022, consumers will have new billing protections from receiving surprise medical bills for emergency services (including air ambulances) and non-emergency services provided at an in-network facility.

Patients’ out-of-pocket costs will be limited to the costs they would have paid if they had received services from an in-network doctor, hospital, or other health care provider.

Background – Surprise Billing and the Need for Greater Protections

Providers and facilities that are not part of a plan or issuer network (out-of-network or “OON” providers) usually charge higher amounts than the contracted rates the plans or issuers pay to in-network providers.

In many cases, the OON provider may bill the individual for the difference between the charge and the amount paid by their plan or insurance, unless prohibited by state law. This is known as “balance billing. A “balance bill” may come as a surprise for many people. A surprise bill is an unexpected bill from a health care provider or facility.

The No Surprise Act (NSA) will protect consumers from surprise medical bills by:

• requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans
• prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.

Emergency Services  – Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. Without any prior authorization (i.e., approval beforehand).

Non-emergency services provided at in-network facilities – The NSA covers non-emergency services

provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead, they bill independently and do not necessarily participate in the same health plan networks. 

Doctors and hospitals must not bill patients more than the in-network cost sharing amount for surprise bills

For services covered by the NSA, providers are prohibited from billing patients more than the applicable in-network cost sharing amount; a penalty of up to $10,000 for each violation can apply.

How will consumers know if a bill or claim constitutes a surprise medical bill? – It is up to both providers and health plans to identify bills that are protected under the NSA. Providers and facilities must post a one-page disclosure notice summarizing NSA surprise billing protections on a public website and give this disclosure to each patient for whom they provide NSA-covered services.

Some providers can ask consumers to waive rights

An exception to federal surprise billing protections is allowed if patients give prior written consent to waive their rights under the NSA and be billed more by out-of-network providers. 

Notice and Consent Waiver Not Permitted for:

• Emergency services
• Unforeseen urgent medical needs arising when non-emergent care is furnished
• Ancillary services, including items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology
• Items and services provided by assistant surgeons, hospitalists, and intensivists
• Diagnostic services including radiology and lab services
• terms and services provided by an out-of-network provider if there is not another in-network provider who can provide that service in that facility

Good Faith Estimates for Uninsured (or Self-pay) – Requirements for Providers & Facilities

When scheduling an item or service, providers and facilities are required to inquire about the individual’s health insurance status. The provider or facility must provide a good faith estimate of expected charges for items and services to an uninsured (or self-pay) individual, meaning an individual that:

• Does not have benefits for an item or service under a group health plan, group or individual health insurance coverage offered by a health insurance issuer, federal health care program
• Has benefits for such items/services under a group health plan, group or individual health insurance coverage offered by a health insurance issuer but does not seek to have a claim submitted to their plan, issuer, or carrier for the item or service.

The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities. 

Determining Out-of-Network and Cost-Sharing Rates:

The total amount to be paid to the provider or facility, including any cost sharing, is based on:

• An amount determined by an applicable All-Payer Model Agreement under section 1115A  of the Social Security Act.
• If there is no such applicable All-Payer Model Agreement, an amount determined by a specified state law.
• If there is no such applicable All-Payer Model Agreement or specified state law, an amount agreed upon by the plan or issuer and the provider or facility.
• If none of the three conditions above apply, an amount determined by an independent dispute resolution (IDR) entity.

Patient-Provider Dispute Resolution

In a situation where an uninsured (or self-pay) individual receives a good faith estimate and then is billed for an amount substantially in excess of the good faith estimate

A patient’s bill will be determined eligible for the patient-provider dispute resolution process if the patient received a good faith estimate, if the process is initiated within 120 calendar days of the patient receiving the bill, and if the bill is substantially in excess of the good faith estimate.

HHS has defined “substantially in excess” as the billed charges being at least $400 more than the good faith estimate for any provider or facility listed on the good faith estimate.

Learn more at: https://www.cms.gov/nosurprises

from
https://www.coronishealth.com/blog/surprise-its-the-no-surprises-act/

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/