Orlando-based Revenue Cycle Management Company Billed Right Acquires Miami-based Medical Billing Company Ruffe Systems, Inc. (RSI).

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Orlando, Florida, April 26, 2022 – Billed Right, a nationwide Revenue Cycle Management company founded in 2006, headquartered in Longwood, Florida, announced today the acquisition of Miami-based medical billing company RSI.

“We are thrilled to add RSI to our Billed Right family as we are both driven by the same values of building long-term partnerships, focusing on people, and promoting honesty and trustworthy practices in the services we offer to healthcare organizations. We are driven by our core values and always strive to find and maintain alignment between us, our team, clients, and partnerships; this acquisition is no exception. For over 30 years, RSI. has demonstrated success in providing significant value for practices across several specialties with their expertise and innovation and we are thrilled to have them join forces with Billed Right.” said Saurin Patel, CEO of Billed Right.

This acquisition will complement the experience Billed Right gained over the last 16 years in the medical billing industry for a multitude of medical specialties such as Cardiology, Primary Care, Internal Medicine, Psychiatry, Urgent Care, Pain Management, and many more. It also allows Billed Right to expand its presence to South Florida.

Established in 1982, RSI has consistently delivered services beyond medical billing. RSI specializes in medical billing services for hospital-based physician groups such as pathology and radiology. Ruffe Systems, Inc. was originally created through the collaborative vision of radiologists and a specialized medical software developer. RSI has innovative, best-in-class technology for the specialized needs of physicians’ billing and revenue collection. With Integrity as a core RSI value, it allowed them to deliver revenue success to providers for over 30 years.

With the Global Medical Billing, Outsourcing Market Size projected to register a CAGR increase of 12.6% during the 2021 – 2027 time period, it only makes sense that Billed Right position itself to increase its ability to service more healthcare organizations in different geographical areas. This acquisition will add a second Florida location to Billed Right’s portfolio and will allow them to continue growing their reach in the Florida medical billing market and beyond.

About Billed Right:

Billed Right is a Florida-based company providing leading and innovative expertise in revenue cycle management solutions while building meaningful partnerships with our clients. Guided by our mission, we empower doctors to focus on delivering the best patient care. Driven by our vision, we focus on leading in revenue cycle and operational management for healthcare organizations of all specialties. As a company, we take pride in delivering experience and unsurpassed business solutions to meet and enhance the needs of our healthcare providers.  Website: www.billedright.com

About Ruffe Systems, Inc.

Ruffe Systems Inc. is a medical billing company based out of Miami, Florida. They provide complete billing services for hospital-based physician groups throughout Florida. They specialize in Pathology, Radiology, Cardiology, Emergency, and Urgent Care billing. RSI was founded in 1982.

10 Questions to Ask When Hiring a Medical Billing Company

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The healthcare landscape has changed considerably over the last couple of years thanks to COVID-19. Whether your practice lost revenue due to a reduction of in-person visits, you are struggling with the Great Resignation situation or both. Your goal at this point is to figure out how to lessen expenses, increase staff, and maintain a positive cash flow.

But how do you decrease your expenses and add important staff to your team, all while increasing your revenue? Hiring an experienced medical billing company could be the answer you are looking for. But you don’t want to just hire anyone. You need to be sure that the medical billing company you hire has the knowledge and expertise that can not only help you manage your medical billing but also help grow your practice.

To ensure you are hiring the right medical billing company there are several questions that you should ask when making this critical decision:

  1. How long has the company been in business? You need to understand how long the company has been handling medical billing. As part of this line of inquiry, also ask what their customer retention rate is and the average length of time they have had their clients?
  2. What will it cost? This of course is top of everyone’s mind when looking to outsource. Standard in the industry is a percentage of net revenue collected, normally under 8%. Also ask about any start-up fees, data conversion fees, termination fees, and any other surprise or hidden additional costs.
  3. Have they worked with practices of similar size, scope, and/or specialty as yours? Verifying that the company understands your specific needs is important. You could even ask if they have testimonials or references you could speak to.
  4. What exactly are the services they offer? Do they only do medical billing or are they a true revenue cycle management company that does everything from eligibility verification through collecting on account receivables? Are there services they don’t provide in their rate? Some companies charge extra for patient collection follow-up and other services. Also, do they work in your EHR or will you have to change software?
  5. Will you have access to all the billing information? Your billing information is just that, yours, and you should be able to access it at any time, for any reason.
  6. Are they HIPAA compliant? Protecting patient data is a top priority. Do they ensure compliance with stringent software and encryption practices that minimize the risk of patient data loss?
  7. Do they provide transparency into their performance? Do they provide reports? If so, what are they and how often will you receive them? Can they customize reports based on your needs? How will they communicate with you through the process? What will your responsibilities in the medical billing process be?
  8. What kind of training do their employees receive? Are their coders certified? What kind of training do they get to continually keep up with rules and guidelines? Are they utilizing the most recent guidebooks and resources, for example, CPT, ICD-10, HCPCS?
  9. How are denied claims handled? Although hiring a medical billing company should lessen the number of denied claims due to their expertise, denials will happen. How do they handle them?
  10. What happens when the people on my account get sick or go on vacation? You need to make sure that you will receive the same level of service every day, even if the people who usually work on your account are out. Do they have a team that is cross-trained and can ensure a consistent service level?

 

With the answers to these questions in hand, you will be more prepared to choose the best medical billing company for your healthcare practice.

Who is Billed Right and How Can They Help with Your Medical Billing?

Founded in 2006, Billed Right is a Florida-based company providing leading and innovative expertise in revenue cycle management solutions while building meaningful partnerships with our clients. Guided by our mission, we empower doctors to focus on delivering the best patient care. Driven by our vision, we focus on leading in revenue cycle and operational management for healthcare organizations of all specialties. As a company, we take pride in delivering experience and unsurpassed business solutions to meet and enhance the needs of our healthcare providers.

Contact Billed Right to schedule a consultation and learn more about how becoming a strategic partner with us can benefit your practice.

 

Correctly Handling Medical Balance Write-offs

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You and your staff work hard taking care of patients and deserve to be compensated for your efforts. With third-party payers, uninsured patients, or ones with high deductible insurance, there are unfortunately times when you have to write off some, or all of the charges, for a visit. Medical billing is complicated enough without adding this to the mix, but it is a fact of doing business. It takes well-trained revenue cycle management staff and clear, consistent billing policies and procedures to handle all your billing challenges.

Standard or Expected Write-offs

There can be a number of reasons for write-offs, some of them are approved and even expected, such as the following:

  • Contractual write-offs are the difference between the set fee from the practice fee schedule and the allowable fee schedule the practice has agreed to accept. An example of such an agreement is the one made between a practitioner and an insurance company.
  • Hardship or Charity write-offs happen when a patient is having a hard time financially and is incapable of paying. These write-offs can be due to policy adherence in a faith-based health care system, as part of a community indigent care effort, or a financial assistance program. Documentation of the patient financial hardship and a qualification process must be in place before considering this write-off.
  • Self-pay (no insurance) discounts happen when the patient receives a discount off the set fee schedule for paying their balance in full at the time of service because they are uninsured.

Unexpected or Unnecessary Write-offs

All of the reasons above are standard write-off reasons, however, some situations can happen that are not expected and can get you into trouble either financially, legally, or both, if not handled correctly.

  • Errors in medical claims such as coding issues, documentation issues, or erroneous patient information lead to denials. Once this occurs your staff needs to be able to immediately make corrections and appeal the medical claim denial. If it isn’t appealed promptly the revenue is lost.
  • Missing medical claim filing deadlines for a payer. Each payer has a contracted deadline for filing medical claims and if this is missed you don’t get paid. Each payer is different so ensure you know each payer’s deadline.
  • Un-credentialed provider write-offs happen when you file a claim for a practitioner who has not finalized their credentialing and contracting with payers prior to the filing.
  • Waiving or writing off copays or deductibles by writing these balances off you could be violating regulations including the Anti-kickback Statute, the False Claims Act, the Civil Monetary Penalties Law, and/or some state laws and regulations.
  • Payer Changes happen when a payer makes changes without notifying a practice.
  • Bad debt write-off is debt that, after exhausting all avenues to collect, you decide to write off the debt for good.

Suggestions for Managing Write-offs

To ensure you are managing your write-offs it is suggested that you start with basic write-off categories and add more as needed. Also, decide which write-offs need manager approval. Although not all write-offs should require approval, as this can complicate the process more, there are times when it is prudent to get an approval.

It is also advised that you do write-offs monthly and track them to see if you spot any trends.  But remember, if you raise your fees but don’t renegotiate your contracts with payers, your contractual write-offs will start trending higher. Also, keep in mind that sending a balance to collections is not the same as writing off a debt. The monies owed are not forgiven but transferred to a third party to collect for you.

And it is a good idea to audit your write-offs periodically to ensure they are being handled correctly. Knowing they are being checked can keep your staff vigilant and you will know you are making business decisions on accurate information.  Overall, try to keep your write-offs to a minimum.

Ensuring the financial health of your practice is a priority and being in control of the unnecessary write-offs can help to support a healthy financial situation.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue.  As a strategic partner, we look to streamline your revenue cycle and operational management thus helping you to grow your healthcare practice.

 

Contact Billed Right to learn more about how we can become your strategic partner.

MGMA Poll Shows Need for Prior Authorizations Continues to Increase

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A recent poll by MGMA showed that 79% of those polled indicated that prior authorizations (PA) requirements had increased when asked “How did payer prior authorization requirements change in the past 12 months?”. Only 19% said they stayed the same and 2% stated they had decreased.

They also noted significant challenges associated with the increase in PA requirements:

  • Slow or lack of response from payers on approvals
  • An increase in time spent by staff to obtain PAs, which has been compounded by the shortage in staff amid the tightened labor market
  • Patient care delays due to lack of PAs

A study, by the AMA, showed that 88% of physicians responded that handling PA requests are either a “high” or an “extremely high” burden on them and their staff. Over 90% of respondents stated that PA requests “often”, “always”, or “sometimes” hold up patient care. The survey also found that an average of 13 hours a week are spent by medical staff completing PA requirements for medications, medical services, and procedures that are needed. That is the equivalent of almost two days per week spent obtaining prior authorizations.

Patient Care Suffers

A concerning downside to the increase of prior authorizations has to do with actual patient care. When asked, 29% of physicians said they waited at least three business days to receive a response from the payer, and 64% said they waited one business day. A number of physicians have reported that prior authorizations have led to adverse patient events due to not receiving a PA promptly. Or patients have abandoned treatment completely due to the time-consuming nature of prior authorizations and not being able to move ahead with treatment immediately.

Insurance Companies Keeping Costs In Line

It is understood that insurance companies want to keep costs in line. Prior authorizations are their way to control costs by determining if a procedure or medication is medically necessary, being duplicated, if there is a less expensive option, or if it is even covered under the patient’s insurance plan. However, prior authorizations take a lot of administrative time to procure. There are forms to complete and sometimes follow-up calls or faxes that need to happen. All to ensure that the PA is received promptly to minimize any delay in medical care and avoid a medical claim denial.

How to Reduce the Stress

In an effort to streamline the process for your practice, without taking on the burden of another employee, which includes salary, benefits, training, and unfortunately, turnover, outsourcing this function can be the answer. Hiring a company that specializes in obtaining prior authorizations can save you time and increase revenue. Easing the stress on you and your office staff and allowing the focus to return to providing your patients the quality care they deserve.

How Billed Right Can Help with Prior Authorizations

At Billed Right, we specialize in revenue cycle and operational management, including offering a prior authorization service as an add-on solution. We can provide you with peace of mind that your PAs are being requested, followed up on, and filed appropriately in your EHR software. This helps avoid medical claim denials, patient frustration, and loss of staff time.

Our team of experts understands all the ins and outs of obtaining prior authorizations and submit authorization requests within 12 – 24 hours, follow-up with payers ensuring that they are received quickly, and work within your EHR so that your staff has access to them when they are needed.

We are more than a vendor, we are a strategic partner, working hard to support your practice’s growth.

Contact us today to learn more about how we can help by handling your prior authorizations!

Research Shows the Outsourcing Medical Billing Market Will Increase

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According to the Global Medical Billing Outsourcing Market Size study, the global medical billing outsourcing market was worth US$10.2 billion in 2020 and is projected to register a compound annual growth rate (CAGR) of 12.6% during 2021-2027.

Some of the driving forces behind this projected growth come from the pandemic and private physicians needing to trim their budgets and generate more income.  The industry was struck hard when the ability to see patients in person was derailed by COVID 19 and fear of being exposed to the virus kept patients home. The drop in some physicians’ revenue, according to research, was as much as 50%, but on average was about 30-35%. Physicians will be looking to save on overhead costs and make up some of their lost revenue by outsourcing their medical billing.

Another reason is the shortage of healthcare workers. The pandemic has seen an unprecedented reduction in workers while seeing an increase in the need for medical care, both due to COVID infections and in the specialty area of mental health.  For example, the two states most impacted by the pandemic are New York and California. These states may see their labor forces drop by as much as 500,000 by 2026. However, patient visits are estimated to increase by another 10% by 2026. Outsourcing will be a way to eliminate the void left by the staffing shortage and keep cash flowing into practices.

Medical billing is an important part of the health of a medical practice and ensuring that it is executed successfully is critical. Although it may seem counter-intuitive, outsourcing medical billing can be the answer. Looking at the overall cost of salaries, benefits, and continually training staff to keep up with this complex job, having an outside company that focuses solely on medical billing can actually save you money. It can also give your office staff back critical time, allowing them the ability to provide a good patient experience. Not having to be divided between following up with payers on medical claims and handling patients can increase the happiness of not only your patients but your workers as well.

Here is a list of benefits that can come from outsourcing your medical billing.

  1. Reduces Billing Errors. A medical billing company’s sole responsibility is to ensure they provide exceptional medical billing services. Which means staying compliant and up to date on the most current medical codes and payer guidelines. This helps to reduce the number of denials and rejected claims due to billing errors. They can also provide feedback to help maximize income from future claims.
  2. Improves Cash Flow. Most practices have only a few people that handle their medical billing, some only have one. What happens when your biller goes on vacation, gets sick, or worse leaves? Medical claims have to wait and cash flow slows down. By outsourcing to a medical billing services company you never have to worry about that as they have teams dedicated to ensuring your claims go out promptly.
  3. Ensures Billing Compliance. We all know that healthcare is an ever-changing industry. Keeping up with Medicaid, Medicare and private payers is what makes billing complex and hard to stay on top of. Since all medical billing service companies do is focus on the billing cycle they have to stay up-to-date on the latest in government regulations and private payer guidelines in order to maintain compliance and the submission of clean claims.
  4. Increases Revenue. Understanding that by outsourcing your billing you can save money on overhead expenses such as salaries, benefits, training, office space, and supplies, you can see how there would be an increase in revenue. Also, outsourced medical billing service companies can help you clarify your medical claims to ensure you are obtaining the most reimbursement for your patient care. This is done by reviewing documentation and pointing out modifiers that should be listed based on the notes. And by getting clean claims out on time, you will also see an increase in revenue due to fewer claim denials.
  5. Improves Patient Satisfaction. Having to handle both billing paperwork and face–to–face patient interaction can be challenging at the best of times. Reducing the stress on your staff by removing the burden of medical billing frees them up to provide exceptional customer service and focus on what is important – the patient’s experience.

How Outsourcing Your Medical Billing Can Impact Your Bottom line?

We understand that the decision of hiring a medical billing company requires a great deal of thought. We also know that outsourcing can positively impact your bottom line if you partner with the right company. You can lower your overhead expenses and increase your cash flow. With an entire medical billing team focused on your revenue cycle management, your internal staff can focus on providing quality patient care.

Let Billed Right become your strategic partner. With over 15 years of experience handling a variety of medical specialties, we understand all the pain points and how to eliminate them from your daily workflow.  From understanding claim profitability, navigating complex payor rules, keeping up-to-date on everchanging reimbursement methodologies, and analyzing denial trends impacting your practice, we partner with you to navigate all the facets of the revenue cycle.

Contact Billed Right today to learn how we can be your strategic partner and not only increase your revenue but grow your practice.

 

 Six Tips to Avoid Telehealth Claim Denials

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The pandemic brought with it a shift in how medical care is carried out. Due to the fear associated with catching COVID 19, the rules surrounding telehealth were relaxed. As a result, it brought telehealth to the forefront, and providers were able to care for their patients even through the stay-at-home orders and social distancing mandates.

With telehealth becoming a growing topic for providers, payers, patients, and the overseeing governmental agencies, attention needs to be paid to ensuring that providers are getting reimbursed correctly.  Research shows that by 2020 there will have been an estimated 158.4 million telehealth video sessions compared to just 19.7 million in 2014.  Even with the relaxation of rules and regulations around telehealth services the billing process can be complex as the guidelines are constantly changing and will more than likely change again once the public health emergency has been lifted.

There are several things providers should do to ensure they are filing telehealth medical claims correctly:

  1. Verify exact coverage – Medicare has listed the services covered under the Medicare Physician Fee Schedule however, not all commercial payers follow this list. Your best option is to call and verify each payer’s telehealth policy to ensure it is covered. Questions to ask could include:
    • What telemedicine health care services can be done?
    • Is live video telemedicine specifically covered?
    • Are there limits on the total number of telemedicine visits the patient may have each year?
    • Are there conditions that must be met, or restrictions, before patients qualify to be covered for telemedicine services? (Ex: established patient vs new patient, patient consent in writing, specific distance from provider)
    • What are the specific CPT codes that are considered payable when services are provided via telehealth?
  1. Documentation requirements – Although most payers are required to cover telehealth visits at the same or similar rate as in-person visits, they may have different requirements on how to document the visit so it is important to research each payer’s guidelines.
  2. Accuracy in coding – Unfortunately, not all payers follow the same rules, so like with your standard in-office billing, you must be diligent and understand what code is appropriate when billing for telehealth.
  3. Make a list – Compile a list of all payers along with any specific requirements for POS codes or additional documentation. Having this at hand can help to ensure you are coding claims correctly thus lessening the opportunity for a claim denial.
  4. Monitor denials – Like with all denials, monitoring telehealth claim denials will allow you to avoid continuing to make the same mistake or give you a heads up that a payer has changed their policy. Denials may be the only way that you know if something has changed. Also, should a claim be denied, make sure you file a timely appeal to ensure you don’t lose revenue.
  5. Keep up – Things are changing rapidly and therefore require you to stay informed on any new rules, regulations, or laws pertaining to telehealth services.

 

As telehealth becomes more utilized we can hope that a set of clear guidelines and rules will get adopted across payers. Until then being vigilant through the entire telehealth billing process is what it will take to ensure correct and timely reimbursement.

Technology advances are happening daily and the demand for flexibility and convenience is growing. The benefits of telehealth and telemedicine will continue to increase and remain an integral part of healthcare, which is good news for patient outcomes, care continuity, and chronic care management.

How Billed Right Can Help

With the ever-changing landscape, it is important to have someone who is keeping up with the new rules and guidelines. That is where Billed Right comes in. As a strategic partner, focused on ensuring that your medical billing is done correctly and on time, utilizing our revenue cycle management services can take the burden off your staff.  We employ AAPC certified coders and experienced medical billers to ensure we maximize your revenue potential and keep you educated and updated along the way.

Contact us today to learn more about how outsourcing your medical billing with Billed Right gets you a strategic partner focused on growing your business and optimizing your operational management.

What is Remote Patient Monitoring?

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Remote Patient Monitoring (RPM) is a subset of telehealth that involves reporting and collection of a patient’s health data and thus the evaluation of a patient’s health. This is done by utilizing mobile devices, smartphone apps, and internet-enabled devices outside of traditional physical medical settings.  Example: Someone with diabetes may have a glucose monitor or someone with high blood pressure may have a blood pressure monitor that sends information to their doctor via an app on their smartphone or device connected to the internet.

This technology allows a practitioner to monitor patients with chronic conditions continually and be able to make medical decisions that enhance the medical care of the patient on an ongoing basis.  This window into the daily vitals of chronic patients helps to reduce hospital admissions and lower healthcare costs.

Types of RPM

There are several types of RPM devices on the market however the most common ones are:

  • Blood Pressure Monitor
  • Weight Monitor
  • Blood Glucose Monitor
  • Pacemaker

These devices allow for real-time information to be sent to a patient’s physician from anywhere at any time.

There are two ways that these devices can be connected and send information. The first is via cellular. This option allows for the RPM device to transmit data from anywhere the service provider has coverage. This type of device may also offer two-way communication depending on what device is being utilized. These devices are easier for patients who may not be comfortable with hi-tech equipment as they are essentially ready to use out of the box. You just add batteries and turn them on.

The second is via Bluetooth. These RPM devices utilize short-range wireless connections to transmit data to an internet-connected device. These devices do not offer two-way communication, however, it does allow for a wider selection of devices that are more readily available online and in stores. They are more cost-effective as they don’t require a cellular data connection.  The downside to these is they can be difficult to set up and may require connections to be established more than once if the device needs to be reformatted or updated.

Benefits of Remote Patient Monitoring

  1. Improves patient outcomes
  2. Ability to monitor patient vital information outside the medical office setting
  3. Reduction of hospital visits and length of stays
  4. Decreases healthcare costs
  5. Improves patient-physician relationship

How Much is RPM Utilized?

In 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on changes to the Medicare Part B Physicians Fee Schedule creating new billing codes for RPM. The following are the codes established and when to use them:

  • 99453 – Initial Set Up and patient education on the use of equipment
  • 99454 – Device(s) supply with daily recording or programmed alert transmission, each 30 days
  • 99457 – 20 minutes of monitoring per month
  • 99458 – Additional 20 minutes per month for monitoring services
  • 99091 – 30 minutes monitoring each 30 days that doesn’t require interactive communication

With the pandemic has come opportunities to utilize RPMs for more than chronic conditions but acute conditions as well. For instance, in the case of patients with COVID 19 who have recovered enough to be sent home.  Those patients can be supplied an oxygen saturation monitor, or spirometer, to continue to evaluate their oxygen levels and lung function; but releasing them to continue to recover at home opens up hospital beds for those who need in-hospital care.

The Future of RPM

According to a study conducted by the Consumer Technology Association, 68% of physicians polled strongly intend to utilize remote patient monitoring technology in the future. This study also showed big benefits of using RPM which included: (49%) improved patient outcomes, (44%) improved compliance rates, and (42%) of patients taking ownership over their health. In addition, researchers observed that among patients, the top three benefits from RPM were (43%) detailed information on personal care, (42%) faster access to health care services, and (38%) stated more influence over their well-being. Interestingly, the survey also showed that over half (52%) of consumers said they would use an RPM as part of their treatment if their doctor recommended it.

The global market for RPM is projected to reach US$117.1 billion by 2025 up from US$23.2 billion in 2020.  That is a CAGR of 38.2%. This is due to the rising geriatric population and the growing need to expand healthcare access.

Miniaturization is the next trend in RPM technology. Technology makers are going to be making their devices smaller and less invasive while partnering with new companies to grow the technology and expand the market share. As this technology advancement continues, it only stands to reason that there will be a positive effect on both the patients and the health care providers who treat them.

 

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a strategic partner to promote practice growth.

Contact Billed Right to learn more.

 

 

CMS Medicare Physician Fee Schedule Final Rule CY 2022

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The CY 2022 Medicare Physician Fee Schedule Final Rule was released on November 2, 2021, and with it came some important changes including updates to payment rates for 2022, expanding the use of telehealth for mental health, and allowing PAs to bill Medicare directly.

Conversion Factor Decrease

A significant change was made to the conversion factor which was decreased to $33.59. This is $1.30 lower than the CY 2021 conversion factor.  This decrease accounts for statutory changes to relative value units (RVUs) and the expiration of the 3.75% temporary CY 2021 payment increase that was approved by Congress through pandemic-related legislation.

Telehealth Changes

As telehealth becomes more important in providing healthcare, the rule also eliminates geographic barriers when it comes to utilizing telehealth for behavioral healthcare. The rule allows patients to access telehealth services from their homes versus a qualifying healthcare site for diagnosis, evaluation, and treatment of mental health disorders.

CMS also finalized an extension for services added to the telehealth list originally due to the COVID-19 pandemic. It includes the extension of some cardiac and intensive cardiac rehabilitation codes on the telehealth list through the end of CY 2023.

Additional services added to the Medicare telehealth list are to remain through Dec. 31, 2023, allowing time to evaluate whether the services should be added permanently following the cancelation of the COVID-19 public health emergency (PHE).

Vaccinations

Through this final rule, CMS will support an additional priority from the COVID-19: administration of vaccinations. The final rule addresses a higher Medicare reimbursement rate for the administration of certain vaccines. The rule outlines that Medicare will pay $30 per dose for administering the vaccinations for influenza, pneumococcal, and hepatitis B virus, nearly doubling the amount paid for these vaccines and will continue to pay $40 per dose for the administration of the COVID-19 vaccines.

Direct Billing for PAs

Starting January 1, 2022, physician assistants (PAs) will be able to bill Medicare directly for their professional services along with being able to reassign payment. This only applies to Medicare and does not affect Medicaid reimbursement policies or commercial payers. This will benefit those PAs who want to work as independent contractors or want to own a practice or medical corporation.

One thing to remember is that Medicare regulations defer to state law, so if the state law or regulations prohibit a PA from receiving direct payments then this doesn’t apply unless the state has also updated its regulation.

Split or Shared Evaluation and Management Visits

CMS finalized an update to the definition of split or shared E/M visits provided in a facility setting with a physician and a non-physician practitioner in the same group. The determination is that the visit is to be billed by whichever person provides the substantive portion of the visit.  The substantive portion of the visit is defined as more than half of the time spent with the patient whether it is gathering history, physical exam, or medical decision making.

Other requirements that have to be met are:

  • Physician/NPP must work for the same group;
  • Physician/NPP must see the patent on the same calendar day;
  • Services must be performed in a hospital, facility, or hospital outpatient office;
  • Must have a claims modifier to indicate a split, or shared, service for monitoring purposes by CMS;
  • Documentation must identify the physician and PA or nonphysician provider who performed the visit. And the individual who provides the substantive portion (spends the most time) of the visit must sign and date the medical record as well as bill for the visit.

Statement from CMS

“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in an announcement of the new rule. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

Click here to read the press release from CMS.

Other Topics

The 2022 PFS Final Rule addresses a wide range of other material topics, besides those listed above including clinical labor practice expense values, changes to the Stark Law Regulations, Medicare diabetes prevention program expanded model, Quality Payment Program Provisions to name a few.

Click here to read the entire rule.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a partner in strategy to promote practice growth.

 

Contact Billed Right to learn more.

What is Telehealth vs Telemedicine?

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We all have witnessed how the COVID 19 Pandemic has brought on new, little-known terminology to the healthcare forefront. Terms like telehealth and telemedicine have now become more mainstream in the healthcare community and not many are aware of the subtle differences in definition.

 

What is Telehealth?

Telehealth is defined as the broader method of delivery of health-related services (clinical or non-clinical) including provider and patient education, medical care, health information services, and self-care via telecommunications and digital communications technologies.

Although telehealth and telemedicine often are used interchangeably, telehealth has become the overarching term for the broader array of digital healthcare activities and services.

 

What is Telemedicine?

Telemedicine is defined as the remote diagnosis and treatment of patients utilizing telecommunications technology for clinical services  This means that telemedicine is more around the utilization of technologies and telecommunication systems in administering healthcare to patients such as cell phones, video calling, and internet-connected computers in clinical, vs. Non-clinical services

COVID 19 made this opportunity more relevant as a way to allow patients medical care without running the risk associated with having to go into the doctor’s office.

 

Telehealth Applications and Services

The internet and mobile devices have become commonplace in our lives and it is only natural that we would want to be able to leverage that technology for convenience, improved care, and promotion of access to healthcare.

Some of the things that telehealth can help with are:

  • Addressing physician shortages
  • Providing access to specialists in less-resourced hospitals
  • Education and training both of patients and practitioners
  • Patient engagement
  • Better communication between providers for treatment collaboration

The Future of Telehealth/Telemedicine

To get a better idea of the future of telehealth MGMA did a Stat Pol in February 2021 asking healthcare leaders what they expected to happen to their organization’s telehealth utilization in 2021. The results where 2 out of 3 expected their telehealth utilization to change – 31% said they thought it would increase, 35% said they thought it would decrease and 34% saw no change. Among those who saw an increase, they stated that patient demand and the convenience of it would be the driving factors. For those that said they saw a decrease moving forward, they expressed coverage concerns, expecting payers to discontinue current reimbursement levels. They also noted their patients and/or practitioners preferred in-person visits.

Since the start of the pandemic, Medicare telehealth usage has increased exponentially due to the increased flexibilities brought about by congressional and regulatory action. But most of the flexibilities hinged upon the COVID-19 public health emergency (PHE) remaining in effect.

The question everyone is looking to have an answer to is “what happens to the expanded access to Medicare telehealth once the PHE expires?” Some flexibilities can only be modified by Congress. There are efforts underway to permanently repeal statutory restrictions that, previous to COVID-19, served as roadblocks.  The challenges in making these waivers permanent are the lack of cost data to the Medicare program and quality outcomes. However, incremental steps have been made by Congress recently in expanding Medicare telehealth by allowing for greater flexibilities for specific services.

Only time will tell how much the COVID-19 pandemic has impacted the way telehealth is viewed and if lawmakers will see the benefits once the PHE is over.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a partner in strategy to promote practice growth.

 

Contact Billed Right to learn more.

 

Are Your Accounts Receivables Going in the Wrong Direction?

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A recent MGMA poll, asking “How have your days in A/R changed in 2021?”, found that 49% of respondents said their time in A/R has increased in 2021. Thirty-seven percent (37%) said they stayed the same, but is that good? Only 15% said that it had decreased.

It is well known that the longer a debt goes unpaid, the harder it is to collect.  A study from Debt.com found that 50% of Americans have medical debt, increasing from 46% in 2020. They also found that more than half of that, 57%, owe at least $1,000, if not more, due to diagnostic tests, emergency room visits, or hospitalizations. In all, debt collectors hold approximately $140 billion in medical debt, not including credit cards and medical debt that hasn’t been reported to consumers’ credit reports yet.

The Good and the Bad

A number of the respondents shared some of the challenges and successes concerning their revenue cycle. For those practices whose A/R aging improved, the following are some of the reasons provided:

  • New billing rules were implemented that increased the number of clean claims being sent out.
  • Renewed enrollment in ACA marketplace plans reduced the number of uninsured patients, making collecting balances easier.
  • Outsourcing all or portions of their revenue cycle management or utilizing new AI or machine learning tools to lessen repetitive tasks.

As for those practices that stated their A/R had increased:

  • Lack of office staff to work outstanding balances or large learning curves for new employees.
  • Some declared that they felt that payers played a role by issuing questionable medical claim denials and delays in reviewing appeals.
  • Whereas prior authorizations were called out as an issue for several of the practices.

There are a couple of ways you can start collecting on these outstanding balances:

  • Set up payment plans for those who can’t pay off large balances.
  • Require the payment of copays, deductibles, or outstanding balances before providing services.
  • Require down payments for expensive procedures like surgeries.

Your revenue cycle management is what keeps your practice doors open.  Part of that management is ensuring that your A/R is under control, with no more than approximately 14% of your aging over 90 days. If your revenue cycle management team is on top of things, then claims are going out clean, passing the clearinghouse the first time and denials are being appealed immediately.  They are managing to obtain eligibility before a patient’s visit so they can collect copays, deductibles, or amounts owed upfront. If not, then there is an issue that needs to be addressed.

Medical Staffing Shortage

One of the biggest issues the healthcare industry is facing right now is a shortage of staff, putting existing employees under intense pressure to do more and more administrative work – taking the focus off quality care for your patients. Another poll by MGMA showed that 42% of respondents stated that recruiting was their number one issue. Thirty percent stated that revenue was their top concern, but how can you increase your revenue if you don’t have the right people in place for your revenue cycle?

Outsourcing RCM Can Help

A way to help eliminate this issue is to outsource your revenue cycle management, allowing them to do what they do best while you and your staff focus on your patients. By outsourcing, you put an entire team of professional billers, coders, and A/R experts to work for you without the added expense of salary, training, or staff turnover.

At Billed Right we partner with you to ensure that your revenue cycle runs efficiently and effectively. With a team of AAPC certified coders and experienced billers, we are with you every step of the way. An additional benefit of outsourcing with us is that we provide reports weekly, monthly, quarterly, and annually so you know exactly what is happening and can keep track of your practice’s financial health.

We see our role as a strategic partner, not just a vendor, and work to optimize your entire revenue cycle to help you grow your practice!

To learn more about how you can partner with Billed Right for your prior authorizations please contact us today!