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Alex Peter

Healthcare Expert

Highly Neglected Revenue Cycle Processes.


Medical Billers and Coders. MBC. Importance of insurance eligibility verification during COVID-19. Coronavirus or the novel COVID-19 disease has affected millions of people across the world.

Importance of insurance eligibility verification during COVID-19

The communicable disease is caused by a family of viruses that results in acute respiratory illnesses, such as impaired lung and kidney functions, pneumonia, and even multi-organ failure. Across the globe, there has been a closure of businesses as well as the loss of jobs and lives. The general economic situation is a global recession. Impact of COVID-19 on Health Insurance Industry The coronavirus (COVID-19) outbreak is causing extensive concern and increasing economic suffering for businesses, consumers, and communities. The number of people eligible for Medicaid has increased drastically. Insurance Verification Eligibility Insurance Eligibility Verification is the procedure of verifying a patient’s insurance with regards to Eligibility status, Coverage status, and Inactive or Active status. Without this information, healthcare services may be derailed. Estimating and Collecting Patient Responsibility.

Estimating and collecting patient responsibility is a challenging task.

Estimating and Collecting Patient Responsibility

Not only you must collect money directly from your patients but also you need to ensure patient satisfaction that guarantees repeat visits and positive online reviews. Patients who have an exact idea how much they owe are more likely to pay, which increases collections and ultimately improves practice cash flow. What thanksgiving means for patients and providers? Thanksgiving is a federal holiday in the United States, celebrated on the fourth Thursday of November celebrating the harvest and other blessings of the past year.

What thanksgiving means for patients and providers?

The word thanksgiving means giving of thanks to God, especially in a religious ceremony. Thanksgiving is that time of year when you have to be grateful for everything you have and celebrate the basic things: friends, health, family, and happiness. Contributions of Medical professionals to Society Most medical professionals view medicine as a calling to help others. Doctors dedicate themselves to public service.

This has never been truer than in the current Pandemic. Burnout issue Among The Medical Professionals During this pandemic, physician burnout has become a real issue. ONC's update on Sync for Science pilot project. Leading healthcare providers and developers across the country joined the Office of the National Coordinator for Health Information Technology’s (ONC) Sync for Science (S4S) Pilot Project to support patient-directed sharing of health information with research using a standards-based API.

ONC's update on Sync for Science pilot project

ONC said in a report that 4 healthcare IT developers and 6 healthcare providers were participated in the S4S Pilot Project for Precision Medicine, to learn how to develop and implement the required patient-facing application programming interfaces (APIs), which will enable patients to manage their care through a third-party app. Sync for Science (S4S) was launched in February 2016 as a public-private collaboration between the ONC, the National Institutes of Health (NIH), and Harvard Medical School’s Department of Biomedical Informatics with the initial goal of enabling patients to share their EHR data with researchers in support of the Precision Medicine Initiative (PMI). How does modifier 62 affect reimbursement? Modifier 62 will be added to claims for procedures designated as “co-surgeon allowed” when a claim for the same procedure code with modifier 62 has been previously submitted and processed for a different provider.

How does modifier 62 affect reimbursement?

Claims for more than one surgeon should have each surgeon’s provider identification number. The following situations are considered co-surgery: Two surgeons of different specialties working together to perform a specific procedure with a single procedure code.Two surgeons of the same or different specialties simultaneously performing parts of the procedure (e.g., heart transplant).Two surgeons simultaneously performing the same or similar procedure(s) on bilateral body parts, which shortens the total anesthesia time required for one surgeon to perform the same set of bilateral procedures consecutively (e.g., bilateral knee replacements). Medical Billing Tips for Ophthalmology. Every practice owner wants to submit clean claims to get paid fast and in a timely manner.

Medical Billing Tips for Ophthalmology

But anyone who is involved in ophthalmology billing knows that it’s not that easy. Any small errors in billing can impact on your revenue. Medicare Payment for Monoclonal COVID-19 Infusion. In order to make sure immediate access during the Coronavirus pandemic, Medicare will cover and pay for these infusions in accordance with section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

Medicare Payment for Monoclonal COVID-19 Infusion

CMS intends to address potential refinements to payment to for bamlanivimab and its administration through future notice and comment rulemaking. Payment for Infusion At preliminary, for the infusion of the bamlanivimab product, the Medicare payment rate for the administration of bamlanivimab will be $309.60. This payment rate is based on the below things: Tips for Telehealth Visits. What is Hospital-Acquired Condition Reduction Program? According to CMS, the Hospital-Acquired Condition (HAC) Reduction Program inspires hospitals to improve patients’ protection and reduce the number of conditions people experience from their time in a hospital, such as pressure sores and hip fractures after surgery.

What is Hospital-Acquired Condition Reduction Program?

Importance of HAC Reduction Program The HAC Reduction Program important because this program encourages hospitals for: • Increase patient’s protection. Patients are looking for healthcare price transparency? 70% percent of consumers in a Pioneer Institute survey said they would like to know information on provider pricing, yet half of them said they were not aware of seeking the information despite healthcare price transparency laws.

Patients are looking for healthcare price transparency?

Many consumers living in a state with some of the most comprehensive healthcare price transparency laws have never thought to get the information about provider services pricing. Almost 17 percent of the 500 adults in Massachusetts surveyed for the Pioneer Institute said they thought prices would be the same regardless, and 54 percent said they never thought of trying to obtain price information about healthcare services. 12 percent were thought that pricing information would be too complicated to obtain. 10 percent of consumers didn’t know how to obtain pricing information. 2 percent were embarrassed to ask for pricing information to the provider. 12 percent consumers were not aware that they could get this pricing information.

Finding healthcare prices. HIPAA and Cybersecurity Alerts. In spite of the 2020 election, the second half of October 2020 has a major impact on the healthcare industry through alerts and financial penalties that cannot be ignored.

HIPAA and Cybersecurity Alerts

It is not new to healthcare in particular hospitals are “target-rich” environments for cybercriminals. According to Maggie Miller from the Hill, “Hospitals and health care institutions preparing for a fall wave of coronavirus cases are bracing for more cyberattacks after hackers seeking to take advantage of the pandemic launched several successful attacks this year that severely disrupted patient services.” End result of cyberattacks are more concerning, “There are hundreds of cases we have now seen where we can draw a direct line between the cyberattack and deaths,” said Pienaar, whose firm helped form the Cyber Alliance to Defend Our Healthcare, a group of nearly 40 major cybersecurity companies that defend health organizations.

Are you still facing the impact of COVID-19? If your practice is still facing the impact of COVID-19 then you are not alone. According to the American Medical Association, loss of in-person visits of physicians is coupled with higher than usual expenses for physician practice capability. Your practice capability is under the COVID-19 pandemic threat as physicians continue to see low patient visits in their office, according to a new survey report from the American Medical Association. The AMA conducted a survey in July and August, 3,500 physicians participated in this survey. Almost 81 percent of physician’s responses were, revenue is still lower than pre-pandemic levels by August 2020. One out of every five physicians reported that their revenue declined by 50+ percent, although the average revenue drop was 32 percent.

QN Modifier in Ambulance Transportation – you ought to know. For Medicare, modifiers are 2-digit codes which are appended to procedural codes and HCPCS codes. These modifiers are used to give more details about the billed procedure. The addition of modifiers in a claim can directly impact payment. You can get a list of modifiers on the internet any time where you will get modifier description and instructions.

Additionally, you also can get information whether the modifier affects the Medicare payment or not. QN modifier is the sub-category of HCPCS modifiers and acts in almost exactly the same way like CPT codes. How to do billing for Radiology during COVID? Radiologists who are practicing in an imaging center or other non-hospital facility have updates available which will potentially allow them to reimburse some of the added costs related to safety precautions taken during the COVID-19 emergency. CPT code 99072: Radiologist can take leverage of this code Current Procedural Terminology (CPT®) code 99072 was added by the American Medical Association (AMA) Editorial Panel on Sept 8, 2020, approved for immediate use.

Payment for this CPT code is yet not available from Medicare, it might be reimbursed by some commercial insurance companies. DME Repairs and Maintenance. Durable Medical Equipment at some point needs repair and/or maintenance from your DME supplier. Repair: DME repairs by a DME supplier include fixing equipment that is damaged or worn. Maintenance: This simply means cleaning, checking, and servicing the patient’s DME. If possible, patients are expected to do regular maintenance themselves using the owner’s manual. But DME suppliers are expected to perform maintenance if the task is more complicated and requires a professional. Providers need to know that Medicare’s coverage of more specialized DME maintenance and repairs totally depends on the whether patient or the supplier owns the equipment.

Performance Decline for U.S. Healthcare Organizations during COVID-19. THE current COVID-19 pandemic situation is creating uncertainty for health systems; this may appear to be taking hits on both the physician practice and hospital sides of their business. According to the latest National Hospital Flash Report from consulting firm Kaufman Hall, the median hospital operating margin index stands well below CY 2019 performance at 2.7 percent year to date (YTD) through September and -1.9 percent without CARES Act funding. Although Federal aid from the CARES Act funding to the healthcare system. Without CARES act funding the median hospital operating margin index is -1.9 percent. The Kaufman Hall Earnings before Interest, Taxes, Depreciation, and Amortization (EBITDA) margin index stands at 7.5 percent year to date with CARES act funding and 3.2 percent without CARES act funding.

Common Medical Billing Errors. Medical billing errors are possibly more common than anyone can think, and these errors could be costing you revenue loss. Tips for Anesthesia Billing. Delayed Implementation of Radiation Oncology Model. The Radiation Oncology (RO) Model goals to improve the quality of care for cancer patients getting radiotherapy (RT) and move toward an easy and predictable payment system. Why pediatricians require Medical Billing Services? Pediatricians help to stay children healthy and safe, which is not any small feat. What Constitutes Behavioral health Billing Services? Use these 3 techniques for effective medical billing process. Medicalbillersandcoders. In DME medical billing, your DME coders require correct HCPCS codes along with correct modifiers that are used for providing more details about the equipment.

If your medical coders are unable to use modifiers or not using them in the correct manner, then the claims may get denied from the insurance company. Impact of COVID-19 pandemic on Orthopedics. 11 new services to the Medicare telehealth services. CMS updated the Medicare telehealth services list on Oct 14 with 11 new services to qualifying the services for Medicare reimbursement through the coronavirus pandemic emergency. The added new telehealth services cover some cardiac and pulmonary rehabilitation services, in addition to certain neurostimulator analysis and programming services.

These services added to the Medicare telehealth list were made in response to President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care. Importance of Artificial Intelligence in Eye-Care (Part 2) In the near future, AI will play an increasingly helpful role in many points within the chain of prevention, diagnosis, and treatment of ophthalmic disease.

Importance of Artificial Intelligence in Eye-Care (Part 1) Uninsured COVID-19 Patients with Limited Reimbursement. Use of Modifiers 54, 55, and 56. COVID-19 - CPT Codes for Multi-Virus Tests. CMS announcement for durable medical equipment suppliers. Texas Medical Billing and Coding Services. When will elective surgeries resume? Effective Cost-of-Care Conversations with Patients. Chiropractic Coding: CPT Codes 98940-98942. Telehealth is the future of Healthcare in the U.S.? Value-Based Reimbursement in Behavioral Health. Are you billing for Telemedicine? Medicare Advantage and Part D Advance Notice for CY 2022. DME Prior Authorization Programs – GAO. Avoid the Part D late enrollment penalty. How to keep your independent practice strong during COVID-19? Strategies to Advance Value-Based Care. The Evolution of Interoperability in Healthcare. Optimize Patient Payment Collection during Pandemic.

The BPCI Advanced Clinical Episodes, Prices. COVID-19 - CPT code 99072. Post Pandemic: Will Telehealth Reimbursement. Post Pandemic: Will Telehealth Reimbursement. Role of Artificial Intelligence in Radiology. How can your patients prevent Medicare fraud? CY 2020 Update for Durable Medical Equipment. Are you in confusion over COVID-19 coding and claim requirements? Impact of Pandemic on Value-Based Contracts. Extension of Prior Authorization for Repetitive. AMA’s CY 2021 CPT Codes Set Release. Advance Beneficiary Notice of Non-coverage (ABN) Updates. Experts in Cardiology Billing Services for Kentucky, KY. Evaluation and Management (EM) Services Guidelines. Invasive, Non-invasive and Interventional Cardiology. ICD-10 code for diabetes mellitus type 2. Percutaneous Coronary Intervention CPT® Coding. CY 2020: Common DME Modifiers. Outpatient Coding and Inpatient Coding. Moderate Sedation Coding. Targeted Probe and Educate (TPE) Medicare Shared Savings Program – 2020.

Streamline your DME Billing with MBC. HRSA Uninsured COVID-19 Program: How to Verify Patient Eligibility? AHA wants improvements for Accelerated Medicare Payments. CMS: Proposed Physician Fee Schedule for CY 2021. EOB: Claims Adjustment Reason Codes List. Are You Ready to Send Consolidated Statements? What is EOB or ERA in healthcare? What are the most common Family Practice CPT codes? Telehealth During and After the Pandemic. Prior Authorization Process for DME during COVID-19 – Provider Burden Relief FAQs. Important Updates about COVID-19 Billing and Coding for Healthcare Providers! CMS and CDC - Provider Reimbursement Update. CMS waivers during COVID-19. Physicians new recruiting engagements dropped by over 30% Are you prepared for repayment of Medicare Loans? AI-driven approach to optimize Revenue Cycle Management. Will uninsured population grow by end of 2020?

Healthcare Providers Paycheck Protection Program Loans. HIPAA Compliances during the COVID-19 national emergency. COVID-19: How to Mitigate your Radiation Oncology Clinic Risk? Difference between medical coding and medical transcription. Medicare Provider Enrollment Flexibilities during COVID-19. Oncology Care Model (OCM) are willing to take on two-sided risk. How to use CPT Codes? Ambulance Transportation CPT Codes and Modifiers. Cardiology Billing and Coding 2020 - Changes and Best Practices. Key Trends in Value-based Care of Oncology. CARDIAC CATHETERIZATION CPT CODE 2020. How medical charge entry process can strengthen your practice revenue?