Medical Coding in Hospitals: The Fundamentals

The revenue cycle in any healthcare organization revolves around multiple components, from the patient registration process through the visit, and ultimately the full reimbursement for the services rendered by the licensed healthcare provider. Whether the service is an office visit or a complex surgery, one of the most important aspects of the revenue cycle is the coding that takes place after the service. 

While billing and coding are separate processes that are typically performed by different people, they are both necessary for a healthcare organization or physician to receive full reimbursement. Understanding the fundamentals of coding creates a foundation of knowledge on how to maximize an organization’s potential for maintaining a robust revenue cycle.  

What is Hospital Medical Coding and Why is it Important?

Hospital medical coding professionals are trained to extract specific, billable information from clinical documentation or a medical record. Codes are assigned to patient diagnoses, services, and even supplies or circumstances that impact patient treatments, such as discontinuing a procedure. 

Medical coders, therefore, have an excellent understanding of clinical documentation, so at baseline, they comprehend human anatomy and physiology, and can extrapolate the necessary details to assign accurate codes, which ultimately result in the creation of the insurance claim for reimbursement of services rendered.

Coding is the precursor to the billing process, so accuracy of coding is a top priority to ensure that every piece of documentation is captured. Furthermore, coders understand the importance of not under-coding, which may result in less reimbursement, or up-coding for more expensive services than  the actual diagnosis. This practice is considered fraudulent and may incur fines or additional legal issues for a healthcare facility.

Accurate coding is paramount to the revenue cycle for hospitals, but it is also an essential piece of the patient care cycle as well. When hospital medical coding and billing are tied together with appropriate diagnoses and services, the patient is also billed accordingly. Whether the patient has financial responsibility or not, the outcome is a positive patient experience when the codes are correct. 

What are the Challenges Hospitals Face with Medical Coding?

Hospital medical billing is a combination of interpreting clinical notes, assigning accurate codes, and completing the process with the creation of medical claims for third-party and government payers. The process is not without its challenges. The transition to ICD-10 in 2015, and the subsequent transition to ICD-11 in January 2022, bring about the challenge of change within the healthcare industry. 

With over 70,000 codes, the ICD manual is the bible for medical coders, but rapid changes in coding manuals and regulations necessitate the requirement to maintain a high level of focus on accuracy, efficiency, and collaboration with the revenue cycle team. Additional challenges hospital coders face include errors with clinical documentation, constant updates in technology, and lack of communication with the servicing provider. Following some simple tips will help to increase accuracy with hospital medical coding. 

Tips for Maintaining Accuracy with Hospital Medical Coding

• Stay current with regulatory updates – the ICD manual updates annually with new codes, and the Centers for Medicare and Medicaid (CMS) distributes regular updates to regulations related to medical billing and coding. 

• Medical coders need to stay connected to the organizations that provide consistent updates and training that relates to medical coding. The American Academy of Professional Coders (AAPC) is at the forefront of credentialing and training medical coders. They provide the platform for coders to certify, train, and remain current on the changes that affect how they interpret clinical documentation for optimum and accurate coding. 

• Updates with EHR technology – hospitals announce significant EHR updates months before they release. Medical coders can benefit from any updates that relate to the revenue cycle by interfacing with the EHR IT team regarding changes that affect how clinical documentation is accessed, or how a new workflow can create better efficiency for a coder.

• Open communication with providers – medical coders are responsible for the accurate interpretation of clinical documentation. Errors in the analysis and coding of a surgery report or inpatient visit may result without accessibility to the rendering provider. Maintaining open communication between the revenue cycle team – specifically the coders – is essential to ensure that clarification is easily obtained with complex clinical documentation.

How Accurate Medical Coding Helps to Improve the Overall Efficiency of a Hospital

Accuracy in healthcare is paramount to positive patient outcomes. Medical coding is no exception, as it extracts the necessary components of clinical documentation to aid in the creation of the claim for the payer. The intricate process of coding begins with the provider’s assessment of a patient, so the documentation must provide accurate details – to include all diagnoses and procedures. 

Hospital billing services and the entire revenue cycle are integral in the overall efficiency of a hospital, as errors in coding or billing may result in resubmission of claims, lost revenue due to inaccuracies in coding or documentation, and duplication of efforts across multiple departments. If a hospital submits a large amount of claims with coding errors, they increase the potential of audits by commercial or government insurance payers. 

Medical coders can streamline their efforts and create efficiency in a hospital billing department through accurate coding, which is supported by effective communication with providers, utilizing appropriate tools and resources within the organization’s EHR system, and staying up to date on all regulatory changes related to medical documentation and coding. 

How Hospital Medical Coding Affects Patient Care and Reimbursements

Medical coding in hospitals, like any other service in a hospital, affects patient care and reimbursements. Direct patient care from healthcare professionals – through diagnostic testing, surgeries, and care while in the hospital, affects how the patient recovers – faster, more efficient service and treatment is directly related to positive outcomes and recovery for the patient. Conversely, the length of stay for a patient may negatively affect his or her outcome, resulting in a higher cost of care and loss of revenue due to lower patient turnover.

Coding also affects patient care and reimbursement. Medical billing and coding in hospitals relies on the highest level of accuracy as claims are representative of the actual care the patient received, either while admitted or during a surgery or procedure. The more accurate the coding, the higher the quality of care. 

If a provider can identify a patient with a chronic condition by noting a specific code in a chart – their work is streamlined and efficient. If codes are inaccurate or missing – the quality of care is negatively impacted. Hospitals must stress the importance of accuracy in documentation, which crosses over to accuracy in coding, billing, and ultimately, patient care and reimbursement. 

Take your Hospital Medical Coding to the Next Level with Coronis Health

Hospitals do not have to take on the task of coding on their own. The experts at Coronis Health have the solutions you need, and the capabilities necessary to help your organization maximize its revenue so you can concentrate on taking care of your patients. Call Coronis Health today, and find out how you can get more out of your medical coding. 

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https://www.coronishealth.com/blog/medical-coding-in-hospitals-the-fundamentals/

Revenue Cycle Management: Tips for Improving Anesthesia Medical Billing Efficiency

Anesthesia medical billing is a complex component of medicine, requiring accuracy down to the milliliter of dosing for a patient. As intricate as the science of anesthesia is, the revenue cycle is just as challenging. It demands a high level of knowledge from a team that understands the importance of preciseness in coding and billing and the need for overall efficiency. Following these essential tips can help your revenue cycle team create a streamlined process of anesthesia medical billing. 

Leverage Technology to Automate and Streamline Your Anesthesia Billing Process

Anesthesia medical billing software is an essential tool that creates transparency in the billing process. Specialized software allows coders and billers to effectively manage day to day operations with hospitals, ambulatory surgery centers, or medical practices.

The technology contained in the programming for anesthesia billing cuts through the processes that create lag times and increases human error. 

Integrating technology into your facility’s billing process can:

• Improve coding accuracy 
• Streamline claim submissions 
• Enhance data integration
• Creates real-time access to comprehensive dashboards to focus on a streamlined revenue cycle process 

Technology is not isolated to the coding and billing team; smartphones provide access on the go for anesthesiologists who tune into the bottom line of their facility. Whether in the hospital or the office, a provider can connect with reports or view reimbursements. 

From smartphone access to a full suite of online tools, technology provides the necessary tools for a revenue cycle team to streamline the entire billing process. Anesthesia groups can eliminate duplication, improve resubmission rates, and increase reimbursement. 

The anesthesia billing process depends on technology that is current and connects with updated contract rates that match payer databases for accurate reconciliation and customized software that caters specifically to anesthesia services. The coding and billing process is more complex than medical billing, so the revenue cycle team must engage the best technology for the best return. 

An anesthesiologist works with the most current equipment and medicines and should expect that the billing software is just as advanced as the process is streamlined to ensure that claims are reimbursed at the highest level possible. 

Stay Up to Date on Coding Regulations to Reduce Claim Denials

Anesthesia is a complex process – the doctors are highly specialized in a category of medicine that relies on nothing less than absolute accuracy in every aspect of surgery. One mistake could mean the difference between life and death, so just as these physicians pay close attention to their processes, coders and billers must stay up to date with regulations and changes to ensure that claims denials are reduced, if not eliminated altogether. 

Anesthesia medical coding guidelines are updated consistently based on payer contracts or regulatory changes from the Centers for Medicare and Medicaid (CMS). Changes can be frequent, such as updates from ICD-10 codes that change every October, or CPT changes that update at the beginning of the year. 

Certified coders and billers understand the complexities of anesthesia billing, such as the calculation of charges with procedure difficulty, time, and other modifiers that indicate the actual health of the patient. A healthier patient, for example, may not require as much anesthesia, whereas a severely ill patient will require a higher level of anesthesia with stronger medications or more time under the knife. The American Society of Anesthesiologists (ASA) has a specific set of codes and modifiers that relate directly to these factors that determine the amount of reimbursement a payer will remit.

Anesthesia medical coding is not as complicated as anesthesia, but working with experts in anesthesia coding and billing will ensure that reimbursement is maximized. Your facility should rely on a coding and billing team that is in tune with the constant changes that ultimately have a direct effect on revenue. 

Use an EHR System for Your Anesthesia Medical Billing

Electronic health records are designed to house medical documentation, with most systems including a practice management component, but medical billing software for anesthesia is designed to maximize every aspect of care for patient anesthesia. If you plan to use in-house billing, using an electronic health record system that has specific functionality for anesthesia ensures that no stone is left unturned in the coding and billing process. 

Streamlining your coding and billing process requires that the EHR system falls in line with some simple but critical guidelines:

• Consider the size of your facility – how many physicians or advance-practice nurses (CRNAs) are providing services (smaller EHR might better suit smaller facilities)
• Choose a certified EHR (that is HIPAA compliant and a certified vendor of electronic health record systems)
• Choose what works best for your team – software that is installed on site or a cloud-based service
• Ability to integrate with technology and equipment
• Interpreting and interacting with provider documentation
• Database of current ICD and CPT codes specific to anesthesiology
• EHR focused on specific sub-specialties (pediatric anesthesia, obstetrics, cardiac anesthesia)

When you choose the right billing system, you are on the way to maximizing your reimbursement with a robust revenue cycle management system built into your EHR. 

Follow Up With Insurance Companies to Ensure Proper Reimbursement

Claim submission is not a guarantee of payment from an insurance company. The rigorous process of analyzing a claim requires that the insurance payer follow every guideline and rule related to anesthesia billing. This includes accurate documentation, reporting of base and time units, using appropriate modifiers, and using qualifying circumstances. 

One error can lead to a claim denial, but an experienced team of coders and billers will investigate denials to accomplish three tasks:

• Determine what error(s) caused the denial
• Correct the error
• Resubmit the claim

Prior to claim submission, a seasoned team of coders and billers may question potential errors to mitigate denials, but some mistakes are inevitable. Investigating claim denials directly with the insurance companies will guarantee a second look at a claim that could result in higher reimbursement, a reversal of denial, and more revenue for the facility. Encouraging the coding and billing team to keep claim denials at a lower percentage is ideal, but following up on denied claims will ensure that revenue is not left hanging in the wings. 

Consider Outsourcing Your Anesthesia Medical Billing

Outsourcing your medical billing does not mean you will lose control of your revenue cycle process. Providing your team with a higher level of flexibility and more time to focus on important administrative tasks will accomplish more than just an increase of employee satisfaction. Outsourcing your medical billing for anesthesia improves your bottom line. 

Experienced anesthesia medical billing services, like Coronis Health, can provide your facility and anesthesiologists with peace of mind and confidence that your denial rates and rejections will decrease, while reimbursements will continue to grow. A dedicated team of experts who focus solely on anesthesia coding and billing can provide you with time to focus on what counts the most – your patients. When you want the best for your facility and for your patients, choose what will make the difference. Choose Coronis Health for your anesthesia billing needs – contact us today to start earning more revenue for your facility. 

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https://www.coronishealth.com/blog/revenue-cycle-management-tips-for-improving-anesthesia-medical-billing-efficiency/

How Outsourcing FQHC Medical Billing Services Can Increase Your Bottom Line

Every healthcare facility relies on a steady cash flow to run smoothly, and at the forefront of every robust revenue cycle is efficient coding, billing, and compliance. By outsourcing FQHC medical billing, you can streamline your processes and increase efficiency, turning your billing department into one of the most profitable areas of your business.

The Benefits of Outsourcing Your FQHC Medical Billing Services

By outsourcing medical billing to a professional medical billing company, you ensure that you optimize your revenue cycle for consistent cash flow.

Below are the advantages of outsourcing your medical billing services.

Ongoing Support and Consultation

Billing companies have a team of FQHC billing experts who are trained to handle challenging tasks daily. Outsourcing their services means access to industry knowledge and the best practices in billing. They work with you every step of the way on training and guidance by providing ongoing support that contributes to billing efficiency and maximum reimbursements to ensure long-term success.

Increase Efficiency and Improve Cash Flow

When you outsource FQHC medical billing, you can rest assured that billing remains a top priority. This keeps the job constantly moving efficiently and effectively. With reduced billing errors, payments and reimbursements are received faster, resulting in improved cash flow. 

By partnering with a medical billing company, you can reap the benefits of streamlined workflows, quick and accurate billing, and increased revenue.

Streamline Your FQHC Claims and Reimbursement Processes

Outsourcing medical billing helps your facility optimize claims management tasks, such as the filing and submission of claims. The complexity of the billing process requires management from trained and experienced experts to yield the best results. A billing team’s knowledge, along with the utilization of technology to automate tasks, allows for better claims scrubbing and simplified workflows that minimize errors and optimize FQHC reimbursements. Billers are also proactive in tracking claims to ensure your facility receives timely payments.

Ensure FQHC Coding & Regulation Compliance

FQHC medical billing is complex because of the many technicalities involved and the frequent changes in the healthcare landscape. FQHC billing codes, payer rules, regulations, and industry protocols are updated constantly, and without a dedicated staff staying abreast of the most recent changes, your facility can easily fall behind. An outsourced team ensures billing accuracy, compliance, and the best billing practices for your specialization.

How to Find the Right FQHC Medical Billing Experts 

Choosing the right FQHC medical billing company is essential to making your billing process more efficient and ensuring a steady cash flow for your facility. Here are four things to look for in a billing company:

• Experience in your specialty – Consider the company’s industry experience in FQHC medical billing. Different specialties come with their own unique billing and coding challenges, and you must make sure your team has the knowledge and experience to cater to your specific needs.
• Transparency – A good medical billing company keeps its partners up to date on the progress made with claims and backend operations. They must prepare accessible and detailed reports to keep you well informed. These reports allow you to oversee your workflow and enforce proper management of your RCM.
• HIPAA-compliant – Partnering with a HIPAA-compliant billing partner ensures that they are dedicated to protecting your patients’ rights and your facility’s reputation. 
• Ongoing customer support – You need a billing company that offers quick responsiveness to your needs. You want to ensure you receive fast customer support and helpful resources whenever needed. In addition, you need support throughout the entire revenue cycle. You must receive services that guide you through every step of the process.
  

With decades of experience, Coronis Health is a leading revenue cycle management company offering tailored solutions to healthcare facilities. With advanced technology and actionable intelligence, we provide the best medical billing solutions that ensure that aging AR, appeals, and denial management processes are always highly effective and efficient. This helps our partners stay ahead with greater revenue through efficient FQHC billing services and faster reimbursement practices. To learn more about how Coronis Health can help FQHC facilities like yours achieve bottom-line goals, contact us today to request your free financial check-up.

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https://www.coronishealth.com/blog/how-outsourcing-fqhc-medical-billing-services-can-increase-your-bottom-line/

How to Maximize Revenue With Behavioral Health Billing Services

Behavioral health covers numerous treatment services for people who suffer from mental health conditions or addiction. Psychiatrists, psychologists, and other mental health specialists undergo extensive training to assess and diagnose complex conditions and implement plans of care. The distinct nuances of billing for behavioral health create variabilities that do not occur in the medical billing process. Maximizing revenue with behavioral health requires a clear understanding of this specialized billing process.

What Is Revenue Cycle Management (RCM) for Behavioral Health Organizations?

Behavioral health facilities, like other healthcare facilities, depend on a steady stream of revenue to function. Behavioral health revenue cycle management is similar to the typical revenue cycle management for medical billing, but it does require a foundational understanding of the intricacies of the specialized billing process. 

From verifying eligibility to collecting payments, or coding and electronic claims processing to rejection appeals management, managing the revenue cycle is critical to ensure that physicians and other clinicians are reimbursed accurately and in a timely manner. 

Behavioral billing has some significant differences and can be more complex than medical billing, including:

• Visit duration – Behavioral health visits are limited to a certain number of minutes, such as 30 minutes or 60 minutes. The coding for visit duration varies, which does not occur in medical billing.
• Visit limits – Insurance payers limit the number of visits in a month or year, so verifying eligibility is critical to ensure that limits are not exceeded.
• Multiple components – Behavioral health billing can incorporate two components – psychotherapy and psychiatric evaluation.

Experienced coders and billers have a firm grasp of these unique aspects of behavioral health billing by the payor and understand how each facet ties in with the complete revenue cycle. Managing the big picture of this special process requires a team of experts who can connect one workflow action to the next. Establishing a cohesive protocol from beginning to end sets the tone for the facility’s ability to maximize the essence of the behavioral health revenue cycle. 

Challenges and Considerations When It Comes to Behavioral Health Revenue Cycle Management

Revenue cycle management for behavioral health does not need to burden a facility. The focus of any behavioral health organization is to provide effective and safe patient care, not stress about the process of revenue cycle management. There are, however, challenges that must be considered when engaging the workflow of coding and billing, understanding that they can be overcome. 

• Verifying eligibility – This is a common error in many facilities. Best practices demand eligibility checks prior to a patient arriving for an appointment, or at least when they check in. Failure to capture a complete eligibility check may result in services rendered without coverage, inaccurate coding, or a denied claim. Often self-funded plans available from an employer carve out behavioral health coverage. You must call the benefits department to ask this specific question. 

• Prior authorizations or referrals – Many insurance payers require authorization for services, or a referral from a primary care physician, prior to rendering treatment. Without a valid authorization or referral, claims may be rejected.

• Delayed payments – This could relate to multiple factors, from errors with coding or billing, or lack of adequate coverage or authorization at the time of service. There can be issues with credentialing if the facility profile is inaccurate or a provider is not linked to a contract. A facility’s revenue is negatively impacted if payments are unnecessarily delayed.

• Dynamic regulations – Change is constant in healthcare. This does not exclude behavioral health in terms of the regulatory requirements in place for coding and billing. Regulations are in a constant state of flux, so coders and billers must stay up to date on the latest changes to remain compliant. 

• Claim denial management – All healthcare and behavioral health facilities have to manage denied claims, whether the denial relates to eligibility or coding errors. Regardless of the reason, a process for managing denials is essential. Many organizations have a small team of experts who are solely responsible for managing denied claims. 

• Non-covered services – Behavioral health is a unique subspecialty in healthcare. Some services are not covered by insurance, requiring the patient to pay out of pocket. Claims can also be rejected, for instance, if psychotherapy services are delivered by an unlicensed provider.

These are challenges that may appear to be insurmountable to the novice coder or biller. An experienced team can analyze these challenges and develop a plan to tackle any of these challenges with reasonable resolutions. 

How We Can Help With RCM Services

You have enough on your plate with the demands of delivering effective and safe patient care; your patients demand the best, and you strive to give your best. Take the worry of revenue cycle management off your shoulders and allow a team of experts to manage the flow. Revenue cycle management for behavioral health is about maximizing your efforts with a dedicated team, not taxing your existing team with extra tasks or the burden of complex responsibilities. Coronis Health offers a comprehensive suite of services, from credentialing to benefits verification, collection services to account management, and financial analysis to utilization review. 

When you look at the full picture of how Coronis Health can guide your behavioral health facility to a higher level of revenue cycle management, the decision to outsource is easy. 

Outsourcing Behavioral Health RCM

Outsourcing your behavioral health revenue cycle management does not mean you are relinquishing control – you just recognize that you can function better with a team that is dedicated to the success of your revenue cycle. Consider the following to determine if you should outsource your behavioral health coding, billing, and overall revenue cycle management:

• Coding, billing, and collections are overly burdensome to your administrative team. 

• A higher rate of turnover creates more work and additional responsibilities for the coding and billing team.

• Challenges with retaining talented Utilization Review staff that have relationships with the care managers.

• Lack of knowledge related to behavioral health coding and billing, resulting in lower reimbursement. 

• Decrease in resources for patients if providers are focused on revenue cycle management instead of patient care. 

• Errors with, or incomplete insurance payer credentialing or enrollment.

• Consistent errors with eligibility verification, or complete lack of verification prior to rendering services. 

• Not adhering to coding and billing standards, such as using inaccurate or outdated codes. 

• Timely billing 

Coronis Health can solve your problems and calm your worries. Outsourcing your behavioral health revenue cycle management is the next step in creating success for your facility. The first step is contacting Coronis Health for a free financial check-up. 

Why Partner with Coronis Health for Behavioral Health Revenue Cycle Management?

The picture is quite clear – revenue cycle management for behavioral health organizations is a complex process, just as behavioral health is a unique and specialized service. Your patients deserve 100% of your time and expertise, so you should partner with a company that can offer you the same peace of mind with your facility’s financial health. 

Coronis Health can kickstart your journey to revenue cycle management success by offering a one-on-one consultation with customized recommendations. We cater our services to meet your needs, but most of all, we cater to the success of your facility so you can focus on your patients. 

Contact Coronis Health today and take action with your revenue cycle management. Schedule a free financial check-up, and learn how we can partner with you to improve your financial future.

from
https://www.coronishealth.com/blog/how-to-maximize-revenue-with-behavioral-health-billing-services/

Guidelines for FQHC Medical Billing

Federally qualified health centers (FQHCs) are funded by the government and provide necessary care to those who live in underserved areas, or for those with little to no insurance coverage. 

Accuracy is a key component with FQHC medical billing services to ensure the facility remains compliant and can continue providing the valuable services that result in positive patient outcomes.  

What Is FQHC Medical Billing? 

FQHC medical billing is not that dissimilar to billing for an outpatient private practice, but certain stipulations are in place to ensure the facility remains compliant. 

FQHCs must collect Medicare coinsurance, provide after-hours access for patients, and use a sliding scale for the services offered in the facility. Reimbursement is based on services that are bundled together, so it’s imperative for FQHCs to follow the strict guidelines set forth by the Centers for Medicare and Medicaid (CMS) to avoid denied claims. 

Additionally, the entire process of billing, from patient registration to collecting unpaid patient balances, needs constant attention to protect the facility from losing revenue or losing the ability to treat its patients. Hiring an expert billing team is the start to creating success for an FQHC.  

Understand the Billing and Coding Guidelines for FQHCs 

Medical billing for FQHCs is more involved than billing for a standard private practice. The guidelines for billing and coding services for an FQHC are strict, if not set in stone. FQHC claims submitted to CMS with billing and coding errors, such as incorrect current procedural terminology (CPT) and healthcare common procedure coding system (HCPCS) codes, will not be paid. 

These guidelines are in place to ensure that coders review documentation with a fine-toothed comb and use current codes that apply to ICD-10. Billers must also focus on what services are billable. 

The following simple, but critical, guidelines must be followed for FQHCs: 

• Face-to-face encounters – Only designated healthcare providers may render services to patients in a FQHC, and they must be in person in an outpatient setting. Encounters in a skilled nursing facility (SNF) where Medicare Part A applies are permitted. 
• Mental health providers or social workers – may meet with family members, but may only bill for the services rendered to the patient 
• Preventive services – Annual wellness visits (AWV), physicals, and screenings are billable through FQHCs. Additional services – screening electrocardiograms, end-of-life planning, and follow-up counseling related to test results – are also billable. 

CMS also outlines specific codes for encounters, including time spent with the patient, amount of time counseling, if two billable encounters were completed on one day, or if the patient received advanced care planning (ACP) or chronic care management. 

Understanding the high level of specificity of billing and coding requires the attention of an expert who is always up to date on the latest changes with ICD-10 and HCPCS codes and billing regulations set forth by CMS.  

Stay Up to Date on Changes With FQHC Medical Billing Regulations 

FQHC billing regulations are in a constant state of flux. CMS uses the prospective payment system (PPS) for a more controlled rate of reimbursement for rendered services, but the rates within the PPS are updated annually to ensure they are in line with market variations and the cost of goods and services. FQHC billing experts understand the importance of these changes and how they can affect the accuracy of coding and claims submission. 

The CMS website has one full page dedicated to FQHCs and news related to billing and payments for everything from the pandemic to telehealth. Overall, these changes can significantly affect the outcomes of revenue cycle management for an FQHC.     

Use the Correct FQHC Billing Codes to Ensure Timely Reimbursements 

FQHC billing is quite different from the typical outpatient or hospital clinic as it requires a higher level of specificity that correlates with the PPS. The following are unique codes relate to patient encounters in a FQHC: 

• G0466 – new patient 
• G0467 – established patient 
• G0468 – initial preventive physical exam (IPPE) or annual wellness visit (AWV) 
• G0469 – new patient, mental health 
• G0470 – established patient, mental health 

This is just a sampling of encounter codes, but claims must also include specific FQHC revenue codes with the appropriate HCPCS code. Timing for special visits such as Advanced Care Planning (ACP) also requires unique CPT codes and modifiers to designate how much time was spent with a patient. Additionally, “incident to” billing is allowable from an FQHC with appropriate coding for the services rendered by a non-physician provider, such as a nurse practitioner or physician assistant. From preventive medicine to telemedicine, all claims submitted by an FQHC must be accurate down to the modifier to avoid any delays in reimbursement.   

Tips for Reducing Denials and Improving Collection Rates 

FQHC medical billing can be complex, but you don’t want denials or problems with collections to turn that complexity into an impossibility. Claim denials and a reduced collection rate can easily spell disaster for the revenue cycle of an FQHC, but taking action with these tips can give you peace of mind and a path for improving both your denial and collection rates. 

• Focus on capturing accurate eligibility information – ensure your staff is well-versed in collecting accurate demographic and insurance information on each patient, and all benefits are verified prior to rendering services.  
• Transition to automated tools – use electronic health records and electronic billing systems to create more efficiency in the clinic. 
• Have open, informative conversations regarding financial responsibility with patients –  encourage them to use their patient portal to inquire about bills. 
• Focus on your processes – make sure you have as much of your process automated as possible to save time and reduce errors on gathering patient information for registration, checking eligibility, and coding for an office visit. 
• Ensure your coders and billers are always updated – ensure they stay abreast of compliance changes and regulatory updates with CMS to avoid potential claim denials. 

If your employees are bogged down with so much of the revenue cycle process that it affects collections and reimbursement, consider outsourcing your coding and billing to experts who can ensure that your claim denials disappear and your collection rates skyrocket.  

Why Choose Coronis Health As Your Revenue Cycle Management Partner 

FQHC billing experts understand the importance of coding specificity and billing regulations that result in a high rate of reimbursement, a low rate of claim denials, and an overall efficient revenue cycle management process. When you outsource your revenue cycle management to Coronis Health, you recognize that the most important mission of your clinic is caring for the patients. Give your team the freedom to focus on patients, and let Coronis Health take care of your coding, billing, financial reporting, and revenue cycle management process. Request your free financial checkup and get started today. 

from
https://www.coronishealth.com/blog/guidelines-for-fqhc-medical-billing/

Last Minute Changes: Congress Comes Through in the Clutch

In the closing days of December, Congress passed a massive spending bill that made multiple revisions to previous federal health provisions.

The $1.7 trillion omnibus spending package included a moderation in Medicare provider pay cuts that had been previously mandated by the 2023 Medicare Physician Fee Schedule (PFS) Final Rule (FR).  The bill also contained other changes, including the extending of federal rural hospital programs.  The massive bill was signed by the president on December 29, making it the law of the land.

Provider Reimbursement

The omnibus package establishes a Medicare PAYGO physician pay cut of two percent, beginning in January 2023.  This will increase to 3.5 percent in 2024.  The new legislation will avoid a 4.5 percent pay cut to providers that had been otherwise mandated back in November.

The American Hospital Association (AHA) announced its support for the legislative package, as it meets many of the concerns previously and intensely voiced by both its membership and other organizations representing the provider community.  The AHA’s president and CEO, Rick Pollack, released the following statement:

The AHA is pleased that, on a bipartisan basis, Congress recognizes the immense pressure America’s hospitals, health systems and our caregivers are facing.  This legislation will deliver critical support and resources so we can better care for our patients and create healthier communities.

The AHA’s leader went on to stress the importance of continuing to pursue greater legislative efforts on behalf of the organization’s fuller agenda, which includes addressing the following: patient discharge backlogs, provider shortages, patient safety and help for hospitals facing a disparity in payer mix.

Medicaid and CHIP

Another part of the bill signed into law affects Medicaid redeterminations.  Though previously paused due to the public health emergency (PHE), the new bill requires a resumption of such redeterminations, beginning in April 2023, regardless of PHE status.  HealthcareDive is reporting that the Robert Wood Johnson Foundation recently determined that “as many as 18 million Medicaid enrollees could lose their health insurance once the PHE expires.” 

This somewhat comports with an August study performed by the U.S. Department of Health and Human Services (HHS), indicating that up to 15 million individuals could lose their Medicaid coverage.  In an effort to mitigate such lost coverage, lawmakers extended funding for the Children’s Health Insurance Program (CHIP) until fiscal year 2029.

Rural Hospitals

The omnibus bill also extends Medicare rural hospital program funding, to include the Small Rural Hospital Improvement Grant Program.  According to HealthcareDive, “Rural hospitals specifically have been hit hard by the COVID-19 pandemic, jeopardizing care access as many facilities face long-term pressures.”  You may recall that HHS awarded $60 million to strengthen rural healthcare workforces back in August. 

Telehealth and More

During the initial months of the PHE, the Centers for Medicare and Medicaid Services (CMS) created waivers and certain flexibilities in the telehealth arena.  The recently signed legislation will extend these waivers and flexibilities for two years.  This extension also applies to the hospital at home programs.

So, to recap and augment, the new law contains the following provisions:

• Reduces the PFS pay cut from 4.5 percent to two percent for 2023 and approximately three percent for 2024
• Prevents the four percent Pay-As-You-Go (PAYGO) sequester for two years
• Extends for two years critical rural Medicare programs, telehealth flexibilities and the Acute Hospital Care at Home
• Provides 200 additional Medicare-funded graduate medical education positions, half of which would be dedicated to psychiatry and psychiatry subspecialty residencies
• Takes several steps to improve access to behavioral health services
• Makes improvements to the government’s ability to prepare for future emergencies

On the whole, many in the healthcare community are receiving this late-December action by Congress and the administration as a move in the right direction.  

With decades of experience in revenue cycle management, Coronis Health can help providers navigate the latest changes to federal health provisions. Schedule a free financial health checkup to find out how Coronis can support and maximize revenue for healthcare facilities.

from
https://www.coronishealth.com/blog/last-minute-changes-congress-comes-through-in-the-clutch/

Revenue Cycle Management: The Key to Successful Hospital Medical Billing

Efficient and effective revenue cycle management (RCM) is integral to running a profitable facility. Not only does it streamline billing and revenue collection processes to improve your cash flow, but it allows you to continue doing what you do best –providing excellent patient care.

How Revenue Cycle Management Can Improve Patient Care

RCM’s goal of improving profitability and overall financial performance benefits the patient above everyone else. When a facility implements efficient revenue cycle management, it no longer has to spend time and resources on administrative and clinical functions, including correcting billing errors and appealing claims –enabling hospitals to devote more time and money to the quality of patient care they provide.

With a greater focus on patient care, effective hospital medical billing results in the improvement of the overall patient experience. Patients can expect not only a simplified process from scheduling appointments to billing but receive more targeted and comprehensive care that will reduce their likelihood of re-admittance.

Tips for Improving Each Stage of the Hospital Medical Billing Revenue Cycle

The entire revenue cycle management process is driven by two critical components –time and efficiency of your workflow. 

Optimize the RCM process and help maximize patient collections with the following workflow tips:

• Empower the front desk to aid the billing process – strengthen the functionality of the front desk in terms of performing crucial tasks that help streamline the billing process. To achieve this, train your staff to perform the following:
  • Accurate data capture – whether the data is collected through a phone call, online booking platform, or the front desk, all details should be accurate and complete (e.g., correct name, mailing address, birth date, and other patient demographics)
  • Double-check eligibility and benefit verifications – check for validity status, modifications in packages from the previous visit, or location changes. With the available information, you can accurately and quickly verify if a treatment will be covered by the existing insurance plan and educate the patient about their benefits.
  • Preauthorize the patient to ensure reimbursement before treatment – the front-end staff can optimize their collections by pre-authorizing claims. It provides a level of guarantee of getting reimbursed for the quality of care provided.

• Take advantage of technology – technology is the key to streamlining the billing process. Advanced hospital medical billing software and technology enable the use of electronic medical records, automated verification checks and claims scrubbing, and patient self-services features (e.g., digital communication, e-statements, and credit card payments). 

Software systems may also suggest correct medical codes and check for insurance payer rules for reimbursement. At its most basic, technology allows for seamless digital transactions and enables various departments to connect and create a more harmonious workflow. By utilizing technology in your clinical and administrative functions, you will save staff hours and avoid errors, denials, and poor collections overall.

• Improve coding practices – hospital medical billing and coding should be handled by experts to ensure accuracy. Any wrong or missing code leaves you with potentially zero reimbursements. To avoid errors and claim denials:

• Educate staff on compliance – the healthcare landscape has ever-changing rules and regulations. Arrange for regular staff training to update them on the latest coding practices.
• Coding audit – to improve your RCM process, schedule regular audits at your facility. Auditing enables you to analyze the entire billing cycle and your payment policies and helps detect coding issues and other inefficiencies affecting your bottom line.

• Improve clean claims rates – rejected and denied claims will only consume more staff time and slow down cash flow. To generate clean claims, you must:

• Use scrubbing software to verify claims and identify errors and omissions.
• Keep track of claims statuses and be prepared for the appeal process. The faster you can shift denied claims to approval-worthy claims, the better for your accounts receivable. 

Common Challenges Hospitals Face in Terms of Medical Billing

There are many reasons why hospitals and other organizations struggle to maintain an efficient RCM workflow, including:

• Ineffective hospital medical billing process – failure to capture accurate information during patient registration, errors in coding, and declining to verify insurance eligibility can adversely affect your revenue cycle.
• Manual claims processing – given the complexities around submitting claims and the time and resources required to manage denials, relying on manually-operated tasks not only contributes to administrative burden but increases the risk of errors in billing.
• Inaccurate coding –with the constant implementation of new rules and regulations, it is no surprise that mistakes can occur during the billing and coding process. The most common errors, no matter how trivial they seem, can lead to claim denials, loss of revenue, fines and penalties, and may even impact patient care. 
• Lack of staff education and training – when staff members are not properly educated and trained on how their role fits into the overall process, they become more susceptible to performing errors that can cost your facility tens of thousands of dollars a year.

How to Overcome These Challenges and Improve Your Hospital’s Bottom Line

To address challenges that impact RCM, hospitals must have a strategic focus on:

• Clarification of roles and workflow – good revenue cycle management depends upon strong communication. That said, each staff member should know his or her role and how it fits into the overall process of the hospital receiving its payments. Clear role assignments will ensure smarter workflows wherein each and every staff member is aware of their part of the process.
• Adoption of automated processes – technology can turn manual and mundane tasks into automated processes that generate multiple benefits for many healthcare systems. Hospitals collect and store large amounts of patient data and records each day, and it’s easy for the human eye to get data wrong. 

Automated software will help identify discrepancies and coding errors, provide in-depth audits, reduce workloads, and ensure cleaner claims and compliance.

• Investing in staff training – to help staff better understand their roles, you must constantly train and educate them on all revenue cycle management practices. Technology won’t work without humans providing the right instructions. 

Applying analytics

Optimizing revenue cycle management relies on focusing on the best industry practices and being committed to continuous improvement. To achieve this focus, hospitals must employ end-to-end revenue cycle analytics by performing comparison analyses.

You may use technology, business intelligence, and AI-powered analytics to identify issues in both internal revenue cycle processes and payer behavior. By measuring the quality of each step of the process, you can use your resources more effectively and make the best business decisions that will positively impact your hospital’s financial standing.

Outsourcing your RCM Services

Leaving the hospital medical billing services and other administrative functions to the expert professionals spares you from time-consuming tasks and helps you focus on patient care. From pre-authorization, clinical documentation, and coding to collections and denial management, outsourced revenue cycle management can streamline your workflow and ensure the best results. 

Outsourcing also means having access to the latest technology and other resources that will help speed up collections and increase your profitability without compromising privacy rights and compliance.

Questions About Revenue Cycle Management for Your Hospital? Contact an Expert at Coronis Health Today!

Hiring the best revenue cycle management company will provide your facility with countless benefits that include streamlined processes and a consistent payment schedule. You can relieve your facility from undue stress while safeguarding your organization’s revenue into the future. 

At Coronis Health, we provide tailored and flexible solutions to meet the needs of your facility. With more than 35 years of experience in various healthcare niches, including hospitals of all sizes, 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.

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/revenue-cycle-management-the-key-to-successful-hospital-medical-billing/