5 Revenue Optimization Tips for EMS Billing

Your facility can be an excellent provider of emergency medical services but still lose money to revenue cycle mismanagement –and you may not even realize it is happening. Adopting healthy practices is essential to ensure accurate and timely claims, reduce accounts receivables, and increase cash flow. 

Optimizing your revenue won’t just impact your bottom line. It also allows you to make work more manageable for your staff and payments easier for patients. Below are 5 tips on how to optimize your revenue. 

Learn Your EMS Billing Code Structure and Modifiers

Accurate claims submissions are only as good as the billing team handling them. Skilled and experienced billers understand how to review a PCR (patient care report) and accurately determine medical necessity and level of service. Any error may result in denials, delays, and increased accounts receivable.

All insurance providers, including Medicare and Medicaid, reimburse for ambulance and emergency services. However, this involves detailed documentation of unique codes and modifiers, including descriptions for modes of transport (ground, water, fixed-wing, or rotary-wing). 

EMS ambulance billing relies on recorded documentation. Healthcare providers should record correct clinical documentation during a case for reimbursement. Moreover, coding and billing are strictly based on this recorded documentation, so the documentation must be complete and accurate.

The CPT codes for ambulance transportation:

There are seven categories of ground ambulance services (both land and water transportation). These codes are based on the patient’s condition at the time of transport as well as services rendered.

A0425 – Ground mileage, per statute mile

A0426 – Ambulance service, (ALS), non-emergency transport (Level 1)

A0427 – ALS (Level 1), Emergency

A0428 – Basic Life Support, Non-Emergency

A0429 – Basic Life Support, Emergency

A0433 – Advanced life support, level 2 (ALS2)

A0434 – Specialty Care Transport (SCT)

Modifiers are two characters that represent origin and destination, and they are designed to show the origin first and the destination second:

Examples of modifiers for Ambulance Transportation

D – Diagnostic or therapeutic site excluded P or H when these are used as origin codes

E – Residential, domiciliary, custodial facility excluded 1819 facility

G – Hospital-based ESRD facility

H – Hospital

I – Site of transfer between modes

J – Freestanding ESRD facility

N – Skilled nursing facility

P – Physician’s office

R – Residence

S – Scene of accident or such acute event

X – Intermediate stop at physician’s office along the way to the hospital

Examples of second modifiers to be included after the origin and destination modifier. These can include but are not limited to:

CR – Related to a catastrophe or declared disaster

GA – ABN was required and obtained

GM – Multiple patient modes of transport

GW – Hospice patient, unrelated to the hospice diagnosis

GX – ABN was optional and obtained

GY – Service that is statutorily excluded

GZ – ABN was required but not obtained

QJ – Incarcerated patient

QL – Patient pronounced dead after ambulance called

QM – Under the arrangement

Use Technology to Improve Billing Accuracy and Efficiency

You may have team members doing highly repetitive tasks as a part of revenue cycle management, such as follow-ups on claim status, creating a patient statement, or verifying eligibility. Various technologies can easily be utilized to take these tasks and automate them, freeing up members of your team to focus on more complex and value-adding tasks. 

With digital tools at your disposal, you can simplify workflow and optimize timelier reimbursements while you avoid the inefficiencies and inaccuracies that are associated with manual paper processes. By leveraging technology such as EMS billing software, you will be able to automate your revenue cycle management processes, helping organize claims to maximize the efficiency of your staff while ensuring claims that need more attention get handled quickly.

Understand Your Local and State EMS Billing Regulations

Each state will have its own administrative codes and regulations that do more than set standards for urgent care. These regulations also set the requirements for licensure, certification, and recertification of ambulance suppliers, vehicles, and personnel to operate within the United States. 

Laws will also vary from state to state or within a state (for example, as stated by CMS, only in some jurisdictions is an EMT-Basic permitted to operate limited equipment onboard the vehicle, assist more qualified personnel in performing assessments and interventions, and establish a peripheral intravenous (IV) line. 

All these factors affect billing guidelines, and billers must ensure that the bill meets the standards of compliance. Billers typically must follow guidelines laid out by the Health Insurance Portability and Accountability Act (HIPAA), as well as their local and state requirements.

Submit Insurance Claims Accurately and on Time

The sooner a claim is submitted, the quicker you can get reimbursed by the insurance provider. One way to ensure quicker and more accurate claim submission is through technology.

Electronic claim submission is one digital tool you can rely on to facilitate the reimbursement process. Submitting claims electronically will help streamline your billing operations and increase cash flow. By filing claims electronically, you can:

• Increase accuracy and avoid claim rejections
• Track claim status
• Cut down on paperwork
• Decrease overhead costs
• Minimize disruptions to your cash flow

Consider Outsourcing Your EMS Billing Services

Partnering with an EMS billing services vendor is one of the best moves you can make to improve your revenue cycle management.

Outsourcing EMS medical billing services ensures you 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. 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.

Medical billing and collections are critical to the survival and growth of any facility. A skilled medical biller is able to efficiently increase collections and reduce the revenue lost due to denials. In addition, a reputed medical billing company can also help reduce the burden of collections.

EMS billing is a complex process where anything can go wrong. From coding errors and processing delays to dealing with insurance companies and tracking unpaid patient accounts, your in-house billing staff has to juggle many tasks and also manage patient care.

Hiring a professional medical billing company can reduce many of these time-consuming tasks for you and your staff so you can focus more on patient care. The billing company will manage denials and appeals and use proven billing and collection strategies to reduce outstanding accounts receivables and optimize collection results.

Coronis Health Offers EMS Billing Solutions 

At Coronis Health, we recognize the need for your services and respect your roles as frontliners. While you are committed to saving lives, we are committed to protecting the resources that allow you to do what you do best.

Specifically, Coronis provides the following services:

• Customized billing services
• Delinquent accounts collection
• Follow-up procedures
• Staff training
• Audit services
• Patient services

We offer superior medical billing and technology innovation, integrating our services with your needs. We have 35+ years of experience to tailor EMS billing 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. 

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What Is Revenue Cycle Management for Hospitals, and Why Is It Important?

Managing revenue is critical to the success of hospitals, as it ensures that cash flow is sufficient to pay for outgoing expenditures while sustaining the capacity to deliver high-quality patient care.

A healthy hospital revenue cycle management process helps ensure steady collections, timely revenue, and financial viability for your hospital, allowing you to focus on delivering excellent care to patients.

Unfortunately, many hospitals do not have access to the expertise necessary to maximize the RCM process. Below, we provide a hospital revenue cycle management overview, including the reasons why it is integral to healthcare. 

Hospital Revenue Cycle Management (RCM); Key Components

Revenue cycle management is a strategy hospitals and other healthcare providers use to manage administrative and clinical functions involved in the capture, management, and collection of patient service revenue.

The cycle begins as soon as a patient schedules an appointment up to the point that all of the patient’s payments have been collected, and there is a zero balance in their account. 

Steps in the revenue cycle management process include, but are not limited to:

• Pre-authorization and eligibility verification – a hospital collects information from the patient in order to establish a patient account. This step includes collecting insurance information and verifying their insurance eligibility.
• Charge capturing and coding – the process by which patient services are translated, transcribed, and documented into billable charges using universal medical codes, which allow insurers to determine reimbursement amounts.

• Claims submission – after coding, the claim is sent to the insurance company for approval. RCM keeps track of the claim to ensure it is processed quickly.
• Payment collections – once the claim is approved, the insurer reimburses the provider based on the patient’s eligibility. If after the insurance reimbursement there is any remaining balance, the hospital will be responsible for collecting the outstanding balance from the patient.

The Challenges Hospitals Face With Revenue Cycle Management

The following are the most common hospital revenue cycle management challenges that affect both cash flow and the quality of patient care:

Precise Coding and Accurate Billing 

Hospital medical coding and billing are vital to any hospital, and if done accurately and timely, can establish a smooth and successful revenue cycle.

Some of the billing and coding challenges that present themselves in hospitals include:

• Difficulty staying updated on new codes – specialties like Cardiology, Orthopedics, Pain Management, and Nephrology codes change continually, and it’s often difficult for hospitals to stay updated on the latest changes. 
• Failure to provide accurate and complete documentation – when documentation problems occur, it slows down your entire revenue cycle, leaves room for inconsistencies in coding, and decreases your billable expense reimbursements. Any documentation gaps for procedures can result in the loss of codable components and potential codes. Changes in a procedure can always occur, so it’s essential that providers provide thorough and complete documentation to coders. 
• Not coding to the highest degree of specificity – failure to code to the highest degree of specificity can result in lower reimbursement. Providers need to chart all relevant chronic and comorbid diseases completely. hen possible, providers should document the diagnosis, not just the symptom. The difference in diagnosis codes can impact the way care is graded or reimbursed, so coding to the highest degree of specificity has a direct impact on hospital revenue. 

Compliance Standards

A revenue cycle management system must uphold Healthcare Insurance Portability and Accountability Act (HIPAA) regulations to protect a patient’s personal information. Any form of healthcare fraud and abuse can result in penalties, which can negatively impact your hospital. You must always safeguard the privacy and confidentiality of protected health information (PHI) by complying with HIPPA’s mandated protocols.

HIPPA requires:

• Standardization of the medical codes
• A regular compliance audit of the facility
• Electronic filing of medical claims
• Foolproof workstations

Inefficiency in Exchange Information

Patient access management allows doctors to easily integrate data with the available records. However, exchanging information remains a challenge due to the complexity of health information with its many segments and nomenclature for various procedures.

Without the right interface ICT tools and strategies, it would be difficult to adopt standardized healthcare terminology and achieve interoperability, which is necessary to solve the data exchange problem between doctors, labs, hospitals, and pharmacies to a large extent.

Maintaining a Consistent Cash Flow

A consistent cash flow would translate to a fiscally healthy hospital. But if you have mounting rejected claims and have a slow A/R collection, you will need to find ways to increase collections and boost your cash flow.

Data Analytics

Data analytics plays a major role in healthcare delivery. It can organize and streamline health information, as well as optimize a clinician’s time and your revenue. However, most hospitals are slow in tapping the potential of utilizing consolidated data analytics in healthcare. They may be stuck relying on non-technical staff and inexperienced vendors.

Following-up with Payers

Around 10% of claims get rejected on the first attempt. If you do not have a skilled hospital revenue cycle management on board, your rejected claims will just continue to accumulate and consequently, impact your bottom line.

Patient-centered Care

Any physician must focus their time and effort on caring for their patients rather than managing the hospital’s revenue cycle. You need to provide quality patient care in order to keep your hospital running.

Why is Revenue Cycle Management Important for Hospitals?

With so many critical players and rules involved, coupled with the rapidly changing healthcare landscape, committing errors that result in lost revenue becomes increasingly probable.

Improving hospital revenue cycle management is an opportunity to streamline processes, automate tasks, and improve efficiency, enabling your processes to minimize errors that could potentially save millions in realized cash flow. Furthermore, a healthy RCM process gives you a competitive advantage by allowing you to provide the best patient care possible.

The Benefits of Outsourcing Revenue Cycle Management Services for Hospitals

Outsourcing revenue cycle management services provides hospitals with numerous benefits, including:

Optimized Workflow and Reduced Administrative Burden

Outsourcing RCM helps hospitals remain efficient and productive by having streamlined processes, from patient pre-registration to payment reminders. A hospital that runs like a well-oiled machine will not only ensure steady collections that make your organization financially viable but also lowers the administrative burden on your staff. 

An electronic workflow can help streamline all system facets, such as coordinating front and back communication, concluding a patient’s journey with timely payments, and eliminating lost paper documentation. This frees up more time for you to focus on delivering quality care.

Reduced Errors 

RCM services can assist hospitals to achieve a more efficient and accurate medical billing process. Having a team of expert billers results in reduced and timely detection of errors.

Faster Collections Process 

When your RCM services provider combines the right set of software solutions with automation tools, all the time-consuming tasks, such as data collection, insurance verification, and coding will take significantly less time compared to doing them manually.

By automating the cycle’s steps, from eligibility checks and payment follow-ups to data charge entry, you can expedite the entire process. When you streamline tasks, you become more efficient and effective as you provide a more straightforward system to your administrative staff and fellow physicians, resulting in faster collections and improved cash flow.

Better Claim Scrubbing for Fewer Denials

Denials are the result of payment claim errors. Optimized revenue cycle management brings accuracy to your facility’s system, leaving little room for mistakes. By getting coding right the first time, you get to reduce claim denials and receive your reimbursements faster. 

Improved Patient Experience

Skilled revenue cycle management professionals and the right technology will contribute to an efficient process that minimizes standard billing and coding errors. This means simplifying the process and improving all the touchpoints involved in the patient experience. 

Coronis Health is a global revenue cycle management company offering specialized solutions to healthcare practices and facilities. By using industry-leading technology combined with high-touch relationship building, Coronis Health allows healthcare practitioners to focus on patient care, maintain financial independence, and cultivate financial success.

Whether it’s collections, billing, denial management, or pre-registration authorization, our experienced group of collectors, billers, and healthcare professionals are ready to work with you as an extension of your current business environment. Attaining RCM improvements on your own can be a slow process. Overworked and under-trained staff, oftentimes, result in lower overall collection rates and shrinking margins.

Hospitals that have a forward-thinking approach to today’s hospital revenue cycle management and healthcare industry challenges give themselves a competitive advantage, and the extended solutions from Coronis allow hospitals to achieve that competitive advantage swiftly.

Are you ready to increase your revenue, reduce denials, and accelerate your cash flow? Contact Coronis Health to learn more about the importance of revenue cycle management in hospitals and how our decades of experience and data-driven solutions can help optimize your revenue cycle. You may also request your free financial checkup today.

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Hospital Medical Billing and Coding; How to Improve Your Processes

The success of your hospital largely depends on an efficient billing process. Without having an experienced biller on board, it is increasingly difficult to minimize errors, adhere to new regulations, and optimize the billing system. These challenges will only lead to an obstruction in your cash flow or worse, not getting paid.

Below are strategies you can use to help improve your billing workflow and help your hospital maintain financial independence.

Common Mistakes to Avoid in Hospital Medical Billing and Coding

Your hospital staff may be so focused on delivering top-notch patient care that they may overlook errors in the billing process. Unfortunately, failure to follow hospital medical billing guidelines may negatively affect your bottom line.

These are the most common hospital medical billing and coding errors you must avoid:

• Duplicate hospital billing – This happens when you bill a patient at least twice for the same test, exam, procedure, or treatment. It is typically the result of a staff member failing to determine whether the patient has already paid for the service. This can lead to additional administrative work for both your staff and payer. 
• Incorrect billing/Coding errors – This occurs when you bill a patient for incorrect services or for those they never received. Wrongful billing also means billing a patient for a service that was scheduled and then later canceled. Even simple errors such as incorrect patient information or contact information for the provider, as well as incorrect, mismatched, or missing codes (incorrect modifiers) can result in denied claims.

• Unbundling – There are hospital medical billing codes that are designed to be used for a group of procedures frequently performed together. When these services are billed under separate codes, it is known as unbundling, which is an illegal practice because it can inflate the profits for your hospital. 
• Upcoding and Undercoding – Upcoding occurs when you submit codes for more serious and expensive diagnoses or procedures than what you diagnosed or performed. This illegally inflates your revenue by demanding higher payments than you should receive. Undercoding, on the other hand, happens when you leave off a medical billing code for less expensive procedures in the hopes of avoiding an audit or saving money for a patient. Although it can occur due to simple oversight, it can appear suspicious and result in serious consequences for your hospital. 

Verify Hospital Coding Accuracy With Audits and Reviews

While billing software and other medical technologies help streamline the coding process, audits and reviews are still an integral aspect of a comprehensive coding improvement strategy. 

Coding audits can be retrospective, which reviews submitted claims, or prospective, which analyzes prebilled claims. They can also be random or a mix of both. Whichever the approach, a coding audit includes internal or external reviews of medical coding and billing accuracy, procedures and policies in place, and other components that affect the documentation process of medical records. 

Hospital coding audits allow you to catch potential compliance errors that could result in future liabilities. These compliance-related issues can also impact your revenue, your hospital’s reputation, and the quality of care you deliver to your patients.

It is critical that audit results are analyzed, so you can prepare for proper education and training, then initiate performance improvement strategies when necessary.

Use Technology to Your Advantage – EHR Systems, Automated Claims Submission, Etc.

By automating repetitive tasks like individual claims filing, payment reminders, and coding updates, you can create a more efficient billing process 

Electronic Health Records (EHR) and Automated Claims Submission systems eliminate the traditional paper-heavy process of filing claims while improving the quality and accuracy of medical coding. 

Other technologies, like Computer-Assisted Coding (CAC) solutions, can also analyze healthcare documents by identifying the appropriate medical codes for clinical documentation. 

All these technologies accelerate the medical coding process and liberate your staff from billing tasks, while allowing them to focus on better patient care. 

Stay Up-To-Date on Hospital Coding Changes and Regulations

Coding is a key component of the healthcare revenue cycle. By using standardized codes and guidelines to translate medical documentation, coders will help support your hospital’s quality compliance. Compliant coding will help streamline your workflow, reduce claim denials, and ensure adherence to governmental regulations.

The healthcare landscape, including medical coding in hospitals, however, changes at a rapid pace. 

From payer rules and billing codes to fee schedules and other compliance requirements, staying abreast of changing protocols requires a dedicated team of experts who can remain up-to-date on new regulations as frequently as they are made and implemented. 

Having a team focused on billing ensures submissions are as clean and accurate as possible while allowing your billing process to stay compliant at all times.

Outsource Your Hospital Medical Billing Services

Without the assistance of professional hospital medical billers, you might be missing out on valuable income. By hiring the services of a medical billing company, you are investing in your hospital. 

Medical billing professionals have years of experience and are specifically trained to understand the medical billing process. As a result, they can navigate various issues that may arise during the medical billing process. 

Medical billing professionals are also up-to-date on the current medical codes to use when filing claims. They can make billing quick, efficient, organized, and accurate. Since they focus all their time and energy managing your billing, you can focus on providing quality patient care.

At Coronis Health, we offer a personal, high-touch service. We have brought together the most innovative and thought-advancing leaders in medical billing and revenue cycle management to progress this industry into the modern, technological age. 

We know the challenges in juggling high-quality patient care with the business of running a profitable hospital. We’re a valuable resource with decades of experience that provides you with dedicated collection and claims processing, among other services, to help you get paid – quickly and easily.

Contact us today to learn more about our medical billing services and request a free financial checkup.

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What Rural Hospitals Need to Know About Billing and Revenue Cycle Management Services

Hospitals around the nation flourish through a focus on various goals and metrics that ensure they are maximizing their revenue and providing the best service for their patients. Healthcare organizations as a whole experience challenges with revenue cycle management (RCM), but the demands placed on rural hospitals, such as physician shortages, unique patient demographics, and a higher level of poverty and mortality rates, contribute to operating on negative margins. Facing these challenges requires a deep understanding of billing and revenue cycle management.

The Importance of Billing and RCM Services for Rural Hospitals 

Hospital billing services vary from one organization to the next, and rural hospitals are no exception. Maintaining a robust revenue cycle is imperative to ensure that every aspect of billing is captured, from the simplest evaluation and management (E&M) codes to the more complex with surgery and specialty services. 

No matter the service, rural hospitals tend to operate within negative margins due to a lack of resources, lower reimbursement rates, a challenging patient population, and a lack of attention to the full revenue cycle – not just when the patient shows up for a visit. 

Billing and revenue cycle management services are all-encompassing. Comprehensive billing and RCM service begin before the patient arrives, with the negotiation of payer rates (aside from the standard Medicare and Medicaid rates), provider credentialing, and full-price transparency for patients. The tail end of these services completes the cycle – claim submission, tracking Accounts Receivable (AR), and analyzing the data, metrics, and goals set forth by the organization. The importance of each cog in the wheel of a rural hospital’s billing and RCM service are critical, and ultimately means the difference between operating within – or under margin. 

The Challenges That Rural Hospitals Face When It Comes to Billing

Location is not the only challenge that rural hospitals face. Patients in rural eastern Kentucky, for example, have one hospital that services multiple counties with a high rate of patients on Medicaid and other state assistance programs. Residents in rural New Mexico have limited choices for critical care – driving one or two hours to the closest hospital. One of the most demanding regions in the United States – Alaska, battles the challenges of extreme weather, rugged terrain, and remote villages, with air travel as the only option for many patients to receive specialty care in Anchorage. 

Aside from location, higher rates of poverty and unemployment, an aging population, and higher instances of chronic conditions that increase the cost of care – all contribute to the challenges a rural hospital faces with billing and revenue. 

Rural hospitals also provide a higher rate of charity care, resulting in uncompensated care. Patients in these areas may rely on state or federal government insurance plans and are unable to pay out of pocket for non-covered services. This reality heightens the burden for rural hospitals – owed money is never paid – even with payment plans, or patients just don’t have the ability to pay. 

Rural areas are home to a considerably high number of people – but the number of physicians employed in these hospitals is much lower, reducing access to care and continuing the cycle of higher costs of care for unhealthy residents. 

Hospital billing and collection services depend on effective guidance from the experts in the revenue and billing departments, but because the direction on optimizing RCM is geared towards larger organizations, even those that are non- or not-for-profit, they benefit from a seemingly more robust RCM. 

Healthcare consultants, however, can provide solutions to help offset these challenges with value-based reimbursement, which helps to lower the cost of care and payment plans that encourage patients to make timely payments. The result is the capture of lost revenue and a path toward healing a broken revenue and billing cycle. 

How Outsourcing Billing and RCM Services Can Help Rural Hospitals Overcome These Challenges

Outsourcing medical billing and revenue cycle services is a proven method of creating efficiency in any healthcare organization. Hospital revenue cycle management challenges are more than burdensome for a rural hospital, as they have a need to focus on recruiting physicians, improving access to care, and reducing the cost of care for patients with chronic conditions and limited means to pay for specialty care. 

Outsourcing billing and RCM services for a rural hospital means that every component of the billing cycle is captured, from patient registration to patient collections. With a dedicated team of billing experts, rural hospitals will see a higher rate of clean claims, a decrease in rejections, and a higher rate of reimbursement that is otherwise lost without a team of billing experts. 

A significant plus is adding the revenue cycle management piece, which provides a strong focus on analytics and goals for the organization. More importantly, on the front end – before the revenue cycle even starts, an outsourced team can focus on the peripherals – physician enrollment and contract negotiations. The complete picture of billing and RCM comes full circle with a committed team of experts in the field. 

How to Choose the Right Billing and RCM Service Provider for Your Hospital

Hospital revenue cycle management and medical billing services are specialized in multiple areas, from simple office visits to complex surgeries, and understanding the characteristics of a functional revenue cycle. Choosing a billing and RCM service provider must stem from not only improving the billing processes and increasing revenue but also from improving the overall patient experience. 

When hospital operations are streamlined, patients have better access to care and they develop a higher level of trust with the people who provide that care. Billing and revenue cycle management are not immune to the patient component of healthcare. They are essential for providing patients with the services they need – care with a high level of quality, ease of access, and creating a billing structure that helps patients to understand every part of their health, including the financials.

When your hospital decides to transition to an outsourced service provider for billing and RCM, focus on the following:

• Company employs certified billers and coders
• Number of years in business
• Number of claims processed per year
• Rejection rate
• Payment rate
• How many specialties or services the company provides
• What technology platforms the company is familiar with (EHRs and analytics software applications)
• Services available for patients
• Revenue cycle management tools, training, and analytics available

Your hospital’s revenue cycle keeps the doors open and should provide more than cash flow and an operating margin. The right billing and RCM team can give you the flexibility to focus on your mission and vision, and make the patient experience the best it can be. 

Questions About Hospital Billing Services? Contact Coronis Health Today!

Outsourcing hospital billing services is a choice that many hospitals have made to accomplish the goal of improving efficiency, streamlining processes, and increasing cash flow. Create more flexibility for your organization by choosing Coronis Health for your hospital billing and revenue cycle management needs. 

When you want more for your patients and your hospital, outsourcing is the best option and removes the burden of dealing with the challenges of managing what Coronis can manage for you. If you have questions about how you can improve your organization’s billing and RCM, call Coronis Health today. 

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Billing in Ophthalmology: How to Stay Compliant and Get Paid

The ophthalmology medical billing landscape is an ever-changing scene that consumes time and resources. Compliance and accurate billing are required to receive timely reimbursements and boost the revenue cycle.

At Coronis Health, we help facilities remain 100% compliant. We stay up to date on the latest rules, regulations, and coding requirements so you can focus on patient care. Coronis Health provides medical billing and coding for ophthalmology with a personalized touch so that our experts know what regulatory changes are coming, when they will be implemented, and how to prepare your facility.

Understand Billing and Coding Guidelines for Ophthalmology Medical Services

Medical coding and billing for ophthalmology requires two different code sets: E&M codes and eye codes. Medical billing and coding for ophthalmology fall under chapter 11 of CPT codes (evaluation & management) coding guidelines ranging from 90000 – 99999.

Ophthalmology medical billing also requires knowledge of subspecialties, including:

• Pediatric
• Retina
• Glaucoma 
• Ocular plastics

There are official coding guidelines for ophthalmology medical billing codes as stated by CMS. Examples are:

• E&M codes should not be reported separately. 
• The E&M services include general ophthalmological services. Special ophthalmological services represent specific services not included in a general or routine ophthalmological examination. Special ophthalmological services may be reported separately as they are recognized as significant, separately identifiable services.
• For procedures requiring the intravenous injection of dye or other diagnostic agents, insertion of an intravenous catheter and dye injection is integral to the procedure, and therefore, these procedures are not separately reportable. 

Ensure Your Facility Is Using Correct CPT Codes and Modifiers for Ophthalmology Services and Procedures

Ophthalmology services having two sets of codes may add flexibility to your billing, but it can also make the process confusing. To choose the right code, you must consider these decision factors:

• Payer rules and guidelines
• Payer’s medical necessity requirements
• Reimbursement rates
• Elements of exam performed

The ophthalmology CPT medical billing code range for Ophthalmology Services and Procedures 92002-92499 is a medical code set maintained by the American Medical Association.

Ophthalmology Services and Procedures:

92002-92014 – General Ophthalmological Services and Procedures

92015-92287– Special Ophthalmological Services and Procedures

92310-92326– Contact Lens Services

92340-92371 – Spectacle Services (Including Prosthesis for Aphakia)

92499-92499– Other Ophthalmological Services or Procedures

Understand Common Insurance Denials and How to Appeal Them

The following are common reasons for denied claims:

• Missing or invalid modifier
• Diagnosis does not match the procedure performed
• Wrong code used when the global period has expired
• Care is covered by another payer (per coordination of benefits)
• No verification of patient information (patient not eligible on the date of service)
• Invalid patient ID number (unable to identify insured)
• Maximum benefits have been met
• Recommended procedure is viewed as experimental and invalid

While appealing denials is not always successful, there are factors you can take into account to help ensure a smoother process and improve your revenue cycle management (RCM) with medical billing for your ophthalmology practice:

• To successfully appeal a denial, you must first recognize it and then figure out what the reason for the denial is
• Ensure that the correct form is filed. The CMS has a form for appealing Medicare claim denials known as the Medicare Redetermination Request Form. Make sure all information is complete and accurate. Specific data in the report serves as important proof of the validity of your claim. Every piece of documentation is necessary in making your case more compelling.
• The process does not end with submitting the appeal. You must confirm if the appeal has been reviewed and then follow up in 30 days.
• Maintain a record of all your denied claims to compare your reimbursement rate with your denial rate, helping you keep track of your bottom line.

Stay Up to Date On New and Emerging Ophthalmology Billing Regulations

New medical technologies and techniques are constantly being introduced in healthcare, and ophthalmology services are no exception. According to CMS updates, effective January 1, 2022, ophthalmology will undergo critical changes in the billing and coding system. Facilities and their revenue cycle management teams must adapt to these changing trends of code usage because submitting clean claims and getting paid on time is what will keep your ophthalmology facility afloat.

The Easiest Way to Stay Compliant and Ensure Timely Payments? Partner With Billing Experts at Coronis Health

Medical billing for ophthalmology is not exactly a walk in the park. Opportunities for errors are common. These missteps will impact your bottom line or worse, get you into trouble with auditors. As the complexity of ophthalmology billing and coding increases, it could get more challenging for your facility’s in-house staff to keep up with the workload while remaining compliant.

Consider partnering with a revenue cycle management company with experience specifically in ophthalmology medical billing services, so you will benefit from their vast resources and expertise in this area. 

Coronis Health features top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. With over 40+ years of combined experience in various niches including ophthalmology offices of all sizes, Coronis offers customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. 

While most billing companies just submit claims, Coronis Health’s process allows us to identify and correct the root cause of denials, resulting in increased revenue for your facility. Our practice managers remain constantly vigilant and compliant amid the changing chorus of governmental/carrier billing and documentation regulations and compliance requirements. It is this proactive approach to billing that helps our clients get results. We ensure your collections are easy to manage and denials are kept to a minimum.

To learn more or to request your free financial checkup, contact Coronis Health today.

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https://www.coronishealth.com/blog/billing-in-ophthalmology-how-to-stay-compliant-and-get-paid/

Anesthesia Medical Billing RCM: What to Know

Adhering to the medical billing rules and guidelines specific to anesthesia care is required in order to accurately report anesthesia services and get reimbursed in a timely manner. Anesthesia medical billing can be complex and time-consuming, which is why most facilities choose to partner with a medical billing company to achieve a more efficient workflow, prevent denials, and ensure maximum reimbursement.

What Is Anesthesia Billing and Revenue Cycle Management (RCM)?

Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during, and after surgery. Its key aspect is the use of anesthesia and anesthetics to safely support the patient’s vital functions through the perioperative period.

There are different types of anesthesia providers, such as anesthesiologists, certified registered nurse anesthetists (CRNA), and anesthesiologist assistants (AA). Each will bill separately for their professional services, just as surgeons and other physicians bill for their services rendered.

Medical billing for anesthesia can become a complicated process, as it requires documenting several records, including:

• Pre-operative review
• Anesthesia sheet
• Post-operative review

The success of a facility that provides anesthesiology services relies on its ability to generate and collect revenue, and an integral element of a seamless anesthesia billing process includes efficient revenue cycle management.

Revenue cycle management (RCM) is every step of the claim lifecycle. It works at the functional core of a healthcare organization as it covers the entire spectrum of a facility’s operations, from front desk and scheduling, eligibility verification, care delivery, documentation, anesthesia medical billing and coding, and claim processing. The main goal of RCM is to optimize the profitability of a healthcare facility by automating manual processes and reducing the costs of making collections.

The Benefits of Working With an Experienced RCM Company for Your Anesthesia Medical Billing Needs

Implementing efficient revenue cycle management is an invaluable component of your facility’s success. By partnering with an experienced RCM company, you gain the following advantages:

• Optimized workflow – With automated processes, you can bring efficiency to your system, and payments can be made much faster. This means minimizing errors and denials while maximizing cash flow. An electronic health record (EHR) system, for instance, can simplify your facility’s workflow. By improving tasks such as scheduling, coding and billing, and payment processing, you get to achieve a more effective and efficient system that saves you time for non-administrative tasks like caring for your patients.
• Streamlined processes – A facility that runs like a well-oiled machine will not only ensure consistent collections that make your facility financially viable but will also lessen the administrative burden on your staff. An electronic workflow can help streamline all system facets, such as coordinating front and back communication, concluding a patient’s journey with timely payments, and eliminating lost paper documentation. 
• Enhanced patient experience – A skilled RCM team coupled with the right technology will contribute to an efficient process that minimizes standard billing and coding errors. This means simplifying the process and improving all the touchpoints involved in your patient experience. A streamlined process reduces unnecessary stress and results in higher patient satisfaction.
• Improved claim scrubbing – Denials are the result of payment claim errors. Optimized revenue cycle management brings accuracy to your facility’s system, leaving little room for mistakes. By getting coding right the first time, you get to reduce claim denials and receive your reimbursements faster. 
• Faster collection process – With the right set of software solutions and automation tools, all the time-consuming tasks such as data collection, insurance verification, and coding will take significantly less time compared to doing them manually. By automating each step of the cycle, from eligibility checks and payment follow-ups to data charge entry, you can expedite the entire process. 

The Most Common Challenges With Anesthesia Billing and Reimbursement and How an RCM Partner Can Help Overcome Them

Anesthesia billing is more complicated than billing for most other medical fields. Between time units, modifiers, and other anesthesia codes in medical billing, it can be challenging for facilities to understand how to manage these complexities and still maximize revenue. Below are the components of the general formula and unique features used for calculating anesthesia charges:

• Base units – These reflect the complexity of the surgical procedure. Each procedure has a corresponding code with a base unit value. More difficult procedures that require a higher skill level will have a higher base unit. 
• Time units – A time unit is usually 15 minutes in length, but the valuation can change by contract. Time accrues while the physician assumes patient care, and remains in attendance caring for the patient until the patient is no longer under their care, and the report has been completed.
• Modifying units – Emergencies and certain conditions in a patient’s health are considered modifying units. Modifiers are indicators that will help identify relevant details on a claim. Accurate usage of modifiers will help ensure proper claims payment. Modifiers also help avoid duplicate billing and unbundling.
• Contracted rate – This rate refers to the contractually agreed upon amount between the anesthesiologist and insurance provider.

To ensure proper reimbursement for anesthesia services, billers must include:

• Number of minutes of anesthesia administration
• Procedure anesthesia codes (00100-01999)
• Modifiers (e.g., modifier codes for physical status) 
• Proper identification by including any performing provider(s) NPI on the claim form.

The best way to leverage these challenges in billing is to partner with an experienced anesthesia revenue cycle management company. This means having access to billing expertise that will help reduce risks of errors, claim denials, and delays.

Your RCM partner will have certified medical billers and coders who understand the regulations that govern how insurance payors reimburse and how facilities must document to receive reimbursement. They are trained on how to apply coding that correctly correlates with clinical documentation and are consistently updated on any changes that apply to coding or billing procedures. 

Outsourcing your medical billing ensures that you are working with a team that focuses 100% of their time on the revenue cycle. You will see an improvement in compliance, as your outsourced billing is following the guidelines and regulations set forth by the government and CMS. 

Finding a Reputable Revenue Cycle Management Company for Your Anesthesia Medical Billing Needs

If you find your medical facility is putting more time into collecting bills than into actual care of your patients, it may be time to update your revenue cycle management solutions.

Here’s what to look for when choosing a reputable RCM company:

Expertise in Anesthesiology 

Different specialties come with unique billing and coding challenges. This means it is important to find a medical billing company that has coding expertise in anesthesiology. Failure to go with a company that has expertise in your specialty may result in coding inaccuracies and claim denials that make it more difficult for you to reach those bottom-line goals.

Services You Need

Revenue cycle management should be handled by experts who are familiar with all aspects of anesthesia medical billing services. You must identify your expectations about which tasks you want to oversee in your facility and which services you want the billing company to provide. 

Long-Term Partnership Potential

Ideally, you will not switch RCM partners often. You need to know if that partner will be there for the long haul. Some of the most important things to know are if the partner will provide phone support for your in-office hours and what sort of issues are handled by the partner. 

Transparency of Data

Will your staff have all access to records that are transferred into the medical billing system? The right partner will give you real-time access to any information that you are looking to review. 

Your facility’s financial health depends on the quality of your RCM partner – do your research and choose a company that is not just a business partner, but also a team member who truly understands your facility’s mission and vision to offer the best services to your patients. 

How an Outsourced Billing Service Like Coronis Health Can Streamline Your Anesthesia Billing and RCM

Coronis Health will look at every portion of your billing process as an opportunity to increase revenue by identifying and then correcting the root cause of any problem. We understand how medical billing and collections are critical to the survival and growth of your facility, and patient collections can become a daunting task for your staff. 

We believe that behind every successful facility is a robust practice management and billing software system. Our financial team will analyze your current system, go over your organization’s objectives and concerns, and then determine the best options for streamlining your anesthesia billing and other processes to achieve more efficiency and give your revenue a boost. 

Coronis Health will provide tailored and flexible solutions to meet your facility’s needs. With 35+ years of experience, our experienced consultants understand the importance of working down AR. As technological innovators, we utilize the latest software and employ actionable intelligence so we can assist you in getting your AR under control and most importantly, get you paid.

Let’s Work Together To Build the Best Revenue Cycle Management System

Would you like to increase your revenue, reduce denials, and accelerate your cash flow? Contact Coronis Health to learn more about how our data-driven solutions can help optimize your revenue cycle. You may also request your free financial checkup today.

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

Why CPT Code Modifiers Are Essential for Anesthesia Billing Claims

Common procedural terminology (CPT) modifiers are special codes – usually numeric or alpha – used by medical billers to indicate additional information or pricing associated with a specific CPT code. Anesthesia billing, like all other medical billing, includes the use of these modifiers, which are critically important for the purpose of reimbursement from payors.

What Are CPT Code Modifiers, and Why Are They Important for Anesthesia Billing Claims?

Modifiers are codes (both CPT and HCPCS) that divide into two categories and levels of information:

• Level I – two numeric digits, maintained and updated regularly by the American Medical Association (AMA).
• Level II – alpha digits (two letters, AA to VP), and updated annually by the Centers for Medicare and Medicaid Services (CMS). 
  • Codes are for the purpose of pricing or providing additional information
  • Pricing modifiers are listed first, followed by the informational codes

Anesthesia codes in medical billing are especially critical, as they represent not only the documentation, but also the start and end times of a surgery or procedure. The CPT code modifiers pull in critical pieces of information, such as a patient’s physical status, how many anesthesiologists provided services (or if services were provided by a CRNA), or whether the procedure was related to a screening examination. Anesthesia modifiers are so specific that they indicate the health status of the patient from a normal, healthy patient (CPT modifier P1) to a patient declared to be brain-dead, with organs being removed for donor purposes (CPT modifier P6).

These modifiers are necessary for anesthesia medical billing to ensure that anesthesia providers are reimbursed based on the work and the reason for the additional work, such as the following:

• Increased intensity
• Time 
• Technical difficulty
• Severity of patient’s condition
• Screening procedure resulting in diagnostic procedure

Leaving just one component of the CPT code modifiers out of an anesthesia medical billing claim could mean the difference between full reimbursement and a significant decrease in payment.

How Do CPT Code Modifiers Impact Anesthesia Billing and Reimbursement Rates From Insurance Providers?

CPT code modifiers for anesthesia billing are crucial and must reflect many components of services provided during a procedure. For example, per payor rules and regulatory requirements, the start and stop time are required in the documentation to indicate the amount of time spent with a patient during surgery. This is one of many modifiers that must be included on any anesthesia claim to receive full reimbursement. 

Anesthesia coding is challenging enough, and not including the appropriate modifiers can result in denied claims and loss of revenue.

Which CPT Code Modifiers Should Be Used for Anesthesia Billing Claims, and Why?

Anesthesia CPT modifiers are divided into two categories – pricing and informational codes. 

• Pricing modifiers indicate the number of anesthesiologists, physicians, or CRNAs involved in a procedure or surgery. Codes range from AA to QZ and provide detailed specificity, such as anesthesia services provided by an anesthesiologist or CRNA services without the direction of a physician.
• Informational codes break into more detail and are the critical component for anesthesia medical billing. They indicate the physical status or health of the patient – whether a normal, healthy patient or severely/chronically ill. Codes include P1 to P6. 

Anesthesia is critical for maintaining life support for a patient during surgery. Documentation for these services must be accurate and include critical variables like the number of anesthetists providing the service. There are also CPT code modifiers to document who did not provide support (i.e. CRNS service: without medical direction by a physician), which should also be included in billing claims.

How Can Incorrect Use of CPT Code Modifiers Lead To Denied Anesthesia Billing Claims?

Medical billing is about accuracy, and leaving any component of accuracy out of a claim will create errors and result in a loss of revenue. With anesthesia medical billing and coding, accuracy is even more critical, as it could result in a significant loss of revenue for an anesthesiologist or anesthetist. Pricing modifiers are straightforward, but information modifiers are complex and require extensive knowledge of anesthesia billing and coding. 

One missing code could mean the difference between a full reimbursement and a significant decrease in revenue. A billing expert must have consistent focus and attention to detail on the billing and coding process to ensure that claims are clean.

What Steps Can You Take To Ensure Accurate Coding and Billing of Your Anesthesia Services Using CPT Modifiers?

Accurate coding and billing for anesthesia are necessary, and the best way to ensure that your anesthesia services are captured accordingly is to use CPT code modifiers. Additionally, outsourcing your anesthesia medical billing services with Coronis Health ensures that you are receiving the highest possible reimbursement for the services you provide. 

Whether your anesthesia facility is hospital-owned, a private practice, or part of a university system, your coding and billing challenges will be handled by experts who are focused solely on anesthesia coding and billing. Coronis understands the importance of using CPT modifiers for all anesthesia services and understands even more about what happens if the codes are not included on a claim. Outsourcing is one step you can take to facilitate accurate billing and coding – and the best step is using Coronis Health for your billing and coding needs. If you want to step away from your burdens of billing, give Coronis Health a call.

from
https://www.coronishealth.com/blog/why-cpt-code-modifiers-are-essential-for-anesthesia-billing-claims/