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As the novel coronavirus continues to take hold throughout the country and healthcare facilities attempt to quickly reconfigure care delivery for patients and consumers who are being advised to stay home and not seek non-emergent care at hospitals and other facilities, appointments are being cancelled nationwide. Some care organizations and practices already have telehealth systems in place, while others are scrambling to develop or increase that capacity.
In turn, providers are facing new challenges in preparing to bill for telehealth services when patients can’t make in-facility appointments due to precaution, self-quarantine, containment, and even potential regional quarantines. The Centers for Disease Control and Prevention (CDC), effective immediately, has released new ICD-10 diagnosis codes for billing associated with COVID-19.
Following is an update on and guidance for preparing to use the new codes when delivering services directly or via telehealth technology to patients whose care or care-seeking activities are affected by the coronavirus:
This coding guidance has been developed by the CDC and approved by the four organizations that make up the Cooperating Parties: the National Center for Health Statistics, the American Health Information Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services.
For more information on providing healthcare services during and in light of growing coronavirus cases, refer to the CDC’s COVID-19 clinical presentation: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. Stay up to date on developments by regularly visiting the CDC’s website at https://www.cdc.gov/coronavirus/2019-ncov/summary.html.
Code updates for ICD-10-Procedure Coding System (ICD-1-PCS) and ICD-10-Clinical Modification (ICD-10-CM) went into effect October 1, 2019. Reviewing the code changes will help medical practices avoid claim denials and prevent interruptions to their revenue cycle. The Centers for Disease Control and Prevention (CDC) releases the ICD-10-CM code updates each fall, and practices that familiarize themselves with the changes will be better able to capture the proper and most specific diagnosis codes for patients’ conditions.
There were currently 71,932 ICD-10-CM codes previously, but effective this month there are 72,184, which includes 734 new codes and two revised codes, and 2,056 deleted codes. Many of the deletions made were to allow for the addition of more specific codes. These 2020 ICD-10-CM codes are to be used for patient encounters that occur through September 30, 2020.
The CDC posted the fiscal year (FY) 2020 ICD-10-CM final code changes in June 2019. It’s worth noting that the tabular addendum requires practices and payers to understand and incorporate considerably more coding instructions than in the previous year. The CDC released 23 files for the final FY 2020 ICD-10-CM code set. The full list of updates are accessible at ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2020/. The tabular addenda are at https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2020/icd10cm_tabular_addenda_2020.pdf.
Adjusting to the annual changes often seems a daunting task, but somehow all of us in the billing industry and in physician practices manage.
Some of the changes, additions and deletions affect common neurosurgical procedures. For example, ICD-code Z45.42: “Neuropacemaker” is changed to “neurostimulator,” and brain, peripheral nerve, and spinal cord have been removed, and the ICD-10 code Z96.82: “Presence of neurostimulator” is now added.
The ICD-9 was replaced by a mandatory implementation of ICD-10-CM/PCS in 2015, after years-long delays. The World Health Organization (WHO) first endorsed ICD-10 in May 1990, prompting considerable uncertainty in the medical community at the time. Physicians were so concerned that the Centers for Medicare and Medicaid Services (CMS) offered lines of credit in anticipated revenue disruption for physicians and insurance payers that were not prepared to deal with the code changes.
ICD-9 codes have been used since I was first trained as a medical biller nearly two decades ago. Even though we become used to expecting other changes, this particular shift to ICD-10 sparked panic in the healthcare industry over the change to ICD-10 codes due to concerns about the costs of compliance and the anticipated loss of revenue. As things turned out, the actual transition was not nearly as difficult as any of us expected.
In fact, the move to ICD-10 has benefitted practices because the codes’ structure enables physicians to code with much greater specificity than the ICD-9 codes allowed. For example, Cervical spondylosis with myelopathy in ICD-9 was coded as 721.1. Converting that code to ICD-10 created 13 different ICD-10 codes, ranging from M47.011 Anterior spinal artery comprsn synd, occipt-atlan-ax region, to M47.012 Anterior spinal artery comprsn syndromes, cervical region, to M47.013 Anterior spinal artery comprsn syndromes, cervicothor region, to name a few.
This is just one example of the changes for 2020. It’s important for medical practices to review all the ICD-10 PCS guidelines and code sets annually so coding is not only accurate but also that procedures are coded to the fullest specificity available. The latest updates are accessible at https://www.cms.gov/Medicare/Coding/ICD10/2020-ICD-10-CM.html.
Sources: Information included in this article was obtained through resources from the American Academy of Professional Coders (AAPC), the CDC and CMS.
What It Takes To Be a Medical Biller:
Many medical insurances, Medicare and Medicaid plans included, are now recognizing the need for Telehealth services. This is due to varying reasons including medical provider and patient convenience and even cost efficiencies for the medical insurance companies. Medical insurances are now paying for this service to accommodate both the medical practice and patient needs.
Why should I be billing for these services?
Providers are already taking calls on the phone from patients both on and off hours and now can get paid for these medical services easily. Basically you may already be doing this work and now you can also be paid for it. This can even help medical providers expand their medical service delivery hours and medical service types while reducing costs. It also allows for patients in remote areas that don’t have locally needed medical specialists to have access they may not otherwise get as well as to those who are too ill, too elderly, or disabled to travel. There is also a growing need for both psychiatry and psychology services in the market today, often referred to now as Teletherapy.
Recent surveys have shown that over 64% of the population surveyed would be willing to have Telehealth visits with their medical doctor. Studies have also shown that Telehealth visits can reduce cost by over $100 per medical visit and that 83% of patient issues are resolved during the first Telehealth visit. More than 50% of doctors surveyed are willing to see patients using Telehealth. 78% of emergency room, urgent care, and doctor’s visits can be handled safely and effectively over the phone. 74% of patients are comfortable with Telemedicine visits using technology instead of in person medical visits. 76% of patients care more about access to medical care than the human connection. 67% of patients say it increases their satisfaction with medical care. 30% of patients already use mobile devices to check medical test results or other medical information. 21% of patients said not having to travel was the top benefit. 53% of patients said Telemedicine somewhat or significantly increased their participation in medical treatment decisions.
What is the difference between Telemedicine and Telehealth?
Telemedicine is the use of electronic technologies to improve the patient’s health by connecting the patient with a healthcare provider who is not in the same location. This visit may take place via phone calls, video chats or emails, on tablets, smart phones, and other wireless devices.
Telehealth is a broader term which may also involve a nurse, pharmacist, or any health professional. There is also mobile health, which is the use of the consumer grade wireless devices and cell phones used for telemedicine services for clinical care technology allowing for greater provider and patient flexibility.
The terms Telemedicine and Telehealth are commonly used interchangeably. Telehealth in this article will encompass all health services and health providers, the use of which varies by state and payer.
To completely embrace the virtual world in healthcare you must identify the value of Telemedicine or Telehealth for your medical practice, your insurance companies, and to your patients.
Challenges include different payers having different compliance requirements which will take research into each insurance payer or insurance plan. Additionally there are new computer systems to navigate, the latest medical billing rules, different medical insurance payer parameters, training, and tracking to keep up with. Commercial medical plans can be more easily handled depending on state regulations and insurance payer policies, and may even allow communication via popular platforms such as Skype or FaceTime. Also certain prescription drugs require an in person medical visit with the prescribing medical provider initially or periodically. Basically each state is different and you need to know your own state regulations. Medicaid programs in 48 states and the District of Columbia currently allow Telehealth in some form. Some medical insurance plans pay a full fee for the service billed, others a reduced fee.
Allowable medical providers include Physicians, Nurse practitioners (NPs), Physician Assistants (Pas), Nurse-midwives, Clinical nurse specialists (CNSs), Certified registered nurse anesthetists, Clinical psychologists (CPs), Clinical social workers (LCSWs), Registered dieticians, and Nutrition professionals.
To bill for Telehealth effective as of January 1, 2017 use POS code 02 Telehealth with your standard CPT medical coding for services rendered. New for 2018 was that Telehealth medical billing modifier GT was eliminated for professional services, being replaced with POS 02 as providing attestation of interactive audio-visual communication. Other plans use medical billing modifier 95 which denotes a telehealth system that provides two-way, real time audiovisual conferencing between a patient and the medical provider. It is extremely important for compliance reasons that a medical billing modifier is used when indicated by the payer and to always maintain proper medical documentation. For more additional information please call 718-668-1874 or visit https://www.bymedicalbilling.com.
Are you a mental health or medical provider wondering if there are medical billing companies near me whose medical billers know how to submit electronic medical billing claims for TeleHealth? Now you can look no further because Barbara Young Medical Billing Services is rated among the best medical billing companies in NY and medical billing companies in NJ. We are a rare medical billing company in NYC that offers these medical billing and coding services. Additionally we don’t just offer medical billing services in New York, we are one of few medical billing agencies that offer national medical billing services, so that we are always available when you need medical billing services near me, no matter where you are. We are the top medical billing company located in Staten Island, NY. Clients have free medical billing software access provided by our medical billing software. Instead of paying a medical billing and coding salary per hour, we offer cheap and affordable medical billing, coding, and collection services for medical billing outsourcing.
Information included in this article has been obtained through resources provided by the American Academy of Professional Coders (AAPC).
I am really good at some things and really bad at others. I am really good at money, making money, spending money, handling other people’s money, and really bad at parking. Even with my new front sensors and backup camera, I still do not know how to park, so we will stick to what I know, and that is all about money. I used to think that I was good at money because at the time I had a good income, always paid my bills on time, and had a great credit score. The truth was that I was in debt and living month to month but I thought that was normal. They don’t teach you about how to handle money in school and I didn’t learn from my parents. I really thought I was doing well because I was always so much better off than other people my age, and then I got a book one Christmas called “The Total Money Makeover”. I became so engrossed in the book that I finished it by that New Year’s Eve. Basically I learned that everything I knew about money was wrong. The book taught me that I didn’t need to live out of my means to impress other people and that owing money is in fact bad. These are really hard concepts because this is what “normal” is nowadays. We buy cars with money we don’t have because we are “Keeping Up with the Kardashians” to impress people we don’t even like. I found out a lease is the most expensive way to have a car and not to buy brand new cars. I was skeptical but also hopeful because I wanted to be out of debt so I figured it wouldn’t hurt to at least give it a try. The author of the book also has a daily radio show and podcast and I would additionally listen to him taking calls and answering people’s questions about money and how to get out of debt. There were also days people would do their “Debt Free Screams”. I would listen and it gave me hope. Listening really got me to become a believer and I have most of what was taught ingrained in my brain now because it was really the same questions and answers over and over. I hope I am able to teach you how to live debt free and stay debt free.
Now I do not believe in every single thing that I read because in the book it specifically says that medical billing careers working for yourself don’t work and I am living proof that it does, so I am the exception to this. So with that being stated, let’s get started. This is a lifestyle change, similar to a diet. I know people who have read the book, gone debt free, and gotten right back into debt, so this is something once learned that you have to follow through all the way and never look back. Most people, doctors included, live month to month, in debt, have student loans, new cars financed, and 30 year mortgages, and so it has become normal in society to live like this. Although I can tell you from experience that you don’t have to and how great it feels to know now that if I have an emergency I do not have to use a credit card and that I can sleep with peace of mind knowing that I own everything instead of the banks owning me. So if you will live like no one else, later you can live like no one else. You have to understand credit, debt, and money. Your credit score is actually a score made up of how good you are at borrowing money. If you were to stop using credit it would be a 0 as if you were dead. Credit card companies make it seem like a status. I remember my first credit card. They make it an emotional experience for us. Mine was leopard print and I was so proud to have it and I kept growing my credit and soon had a whole wallet full of cards to every store I shopped at. The truth is stores make more money in selling you their credit cards than in the actual merchandise. Saving any money the day you open a credit card, or the points, or air miles you get are not worth it. No millionaire has even gotten rich by credit card rewards. I remember when I first got my Black Card invitation. It’s a status symbol, but it’s actually bad. I have all credit card offers turned off now. There are studies that paying with cash actually hurts. It is much easier to hand over a card and spend a lot of money than it is to do with cash. Everyone else is broke too and when they see you making changes they will make fun of you. For example I choose to drive my 14 year old car. Everyone likes to make fun of my car, but in reality I love my car because I am proud to own it. Money problems are also the #1 cause of divorce, so you have to do this with your spouse if you are married. You both have to be on the same page. Your children will learn from you, like mine did, and you will be changing your family tree.
So I had been in debt before and paid it off and the way I did it was that I had paid off the highest interest rates first because that was what financially made sense to me. I didn’t have the rest of the pieces put into place so when I had an emergency I went back into debt. All of the pieces to living debt free are broken down into 7 baby steps.
Baby Step #1 is to make a $1,000 emergency fund and put it somewhere easily accessible, but not to easily, for emergencies. Now you also have to know what an emergency is and what it is not for this money. This money is if you get an unexpected flat tire, not to buy something that is not budgeted for and you just want to buy. You will see once you have this emergency money that due to Murphy’s Law it will no longer seem like an emergency when something unfortunate happens. Now I mentioned budget and it’s a scary word. I actually avoided doing budgets for a long time because I didn’t understand exactly what a budget was and how to do it and it also just doesn’t sound fun. I now have budget software and since I started, I realized it actually is not a bad word, and when you have a budget instead of not knowing where your money went, you are actually just telling it where to go. I do not deprive myself of anything. If I have the money and I want to buy myself a present, I just have to put in on my budget. Last year for my birthday I got $2,000 diamond earrings and it was actually ok to spend that money because I had it on my budget. So do a budget every month and you will actually find money you didn’t know you had and see how much you spend on things you didn’t know you were spending.
Baby Step #2 is called the Debt Free Snowball. Instead of paying your debts with the highest interest rate, you are going to list all of your debts from the smallest to largest. All of the extra money you find in your budget you will use to start paying off your smallest debt first, and then once that is paid off you get a momentum going and put that extra money to the 2nd smallest debt and so the snowball begins. Paying them off gives faster gratification and will get you motivated to make more money to be able to do it faster. You should also think of others ways to increase income. Work more hours, start selling things you don’t need. If you have a financed car, sell it, and drive a beat up car that will get you to and from work until you are out of debt and can upgrade. Cars are most expensive when new and lose their value right away. Millionaires buy certified pre-owned 2 or 3 year old vehicles with cash! Sell so much stuff the kids are scared they are next. Cash talks. People can tell you it doesn’t but it does. Those diamond earrings I bought for myself, well the first store didn’t care that I had cash; the second store did and got my business. Everything becomes negotiable when you have cash in your hand. Also during the paying off of debts it was advised to make a personal sacrifice with something that would hurt, so my personal sacrifice at the time was getting my nails done.
Now once you are out of debt, you have to follow the rest of the steps to stay out of debt.
Baby Step #3 is a fully funded emergency fund and this will be a different amount for everyone but this is the peace of mind that you will have cash for an emergency instead of having a credit card emergency. I keep mine in a CD (they also have liquid CDs). It should be three to six months of expenses if you lost your income.
Baby Step #4 is to start saving for retirement, if you haven’t started already.
Baby Step #5 is College Funds for your kids so that they can go to college debt free.
Baby Step #6 is paying off the home mortgage. Imagine living completely debt free including your home! Yes this is possible! Think of all the money you will have with no debt or payments and the great things you can do with it!
Baby Step #7 is to build wealth. We do this with long term high interest mutual funds. We are now at the point where your money is making money.
There are some other tricks I have incorporated into my financial life. I read an article about making an email address just for bills and have done that and now have all my bills sent electronically to that email. I also pay my bills with online banking. Instead of going to multiple sites to pay bills, it is one site and it is done much faster. They also send checks for me on my behalf so I am not handing out my account number. It is easier to keep track of everything this way. I save all the invoices on my computer instead of having paper bills. I also read a book on tax deductions. I am not an accountant but my accountant was not allowing me to deduct what I should have been deducting. I switched accountants. I also keep receipts for every single thing I buy. I was surprised to hear at a place I frequent for pizza that I am the ONLY person that ever wants the receipt. There are services to have receipts scanned for you if you are not a paper fan and then if you wanted to you can even have incorporated into QuickBooks. I use my bank debit card as a credit card. Your bank card offers all of the same protections as a credit card and can be used at all of the same places you would normally need to use a credit card instead of using actual credit. If you must use a credit card be prepared to pay it the exact same day. The credit card websites will not even let you pay it the same day, but you can with online bill pay or write a check and put it in the mail the same day, to avoid having any credit add up. Learn more about the “Total Money Makeover”, the “Complete Guide to Money”, and “EntreLeadership” by going to daveramsey.com. There are also free budgeting tools and apps on the site. This has changed my life and I hope it can change yours too!
I must also add for good measure, that finding the “right” medical billing services for you, will absolutely add to you saving more money. Giving is also something that is taught in the lessons and I find it is more rewarding for me to help people on a more personal level. Call and ask directly for me at 718-668-1874 or email me at email@example.com and tell me you have started your own “Debt Free Journey” and I will guarantee you my best services and offer them at the lowest prices that I can afford to help you achieve your own Debt Free Dream. Please visit www.bymedicalbilling.com for more information on my medical billing company located in Staten Island, New York. We have fast medical billing services and affordable medical billing services and even specialize in surgical billing. Keep in mind that even though our medical billing firm is located in Staten Island, New York that our medical billing consultants can perform all medical billing services outside of medical billing in Staten Island or medical billing in New York as well. We are able to handle medical billing claims electronically easily anywhere that the best medical billing services are requested within the United States.
(written by Alex T.)
Scheduling inefficiencies mostly occur when there are no patients to fill appointment slots, and while certain medical specialties are more predisposed to experience missed appointments, it is essential to determine what the key reasons for scheduling inefficiencies are.
This process begins with analyzing Appointment Scheduling Efficiency Score which can be calculated by dividing the number of patients seen per day by the number of available appointments, and then multiplying the result by 100. Reasons for a low score may be due to a high number of un booked appointment slots, no-shows, or cancellations. In each of these cases, your practice may be missing out significant revenue opportunities.
When evaluating reasons, one strong indicator is that staff behavior may be responsible for scheduling inefficiencies is when you see a pattern of unused appointment slots occurring at a specific time of the day, or day of the week—for example right before a lunch break or on Friday afternoons.
Fortunately, with some imagination, and a couple of motivators, it is possible to change staff behavior. You’ll have to spend some money; however, it will not be even close to the amount that missed revenue opportunities are costing. When a change in behavior is required cross-functionally—i.e., front office staff, nurses, and clinicians—it’s best to create a program that incentivizes a change in group behavior; and when it’s at the individual level or specific to any one team, a good option is to offer more incentives.
Read More: How CancerLinQ Improving Physicians Performance
Before offering incentives, it’s always a good idea to communicate with all team members the specific metrics you will use to measure performance. Following measures are commonly used:
When choosing incentives, first decide what will be more effective in driving results—something that appeals to the individual, or an offer for the entire team? The following are three incentives that appeal to individuals:
You may also find it effective to reward the entire team, such as the front office staff, nurses and fellow providers. In this case, a good practice is to offer a team experience and add a personal touch, such as a team dinner where you can also offer tokens of appreciation or gifts to individuals.
Best practices to boost scheduling efficiency do not always require automation, however, without technology, these methods can often be time-consuming.
Tools to optimize appointment booking
Automation for reducing No-Show Rates
An effective way to reduce the number of un booked appointment slots and increase revenue is by improving no-show and no-call rates.
Finally, while there are many great tools out there, it is essential to focus more on critical technology features that help the very people responsible for scheduling. First in the list is the “first available” scheduling look-up feature—if your incentive program is to have zero unused appointment slots, you need a tool that will navigate your staff members directly to the first available option and help them instantly see slots that are open. Another critical feature to invest in is one that can manage a double booking policy, enabling you to hedge your bets against no-shows and cancellations. Enterprise grade scheduling systems allows double booking.