New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. In a recent article in Physician’s Practice, we discussed the challenges surrounding getting paid for telehealth this year and beyond . This is an essential issue for independent practices, but it’s not the only one. New legislation, as well as changes in patient expectations, present a host of challenges and opportunities for getting paid for service this year. E/M Office and Outpatient Guidelines Changes For the first time in more than two decades, the AMA has revised the guidelines for office and outpatient visit evaluation and management (E/M) codes. It’s been a long time coming—effective this year, CMS has aligned E/M coding with the changes adopted by the AMA. For many providers, this means an increase in their revenue because they will finally be compensated for time spent in activities related to patient care that were previously...

A new code for COVID-19 discharges offers a 20% bump in the assigned MS-DRG payment from CMS. Clinicians should know that a positive test result is not required to establish a COVID-19 diagnosis for coding purposes. If a patient admitted with a respiratory diagnosis then tests positive for COVID-19, coders can link the result to the respiratory illness. With new legislation such as the Coronavirus Aid, Relief and Economic Security (CARES) Act supplying grants to help stabilize hospitals and health systems, documentation and coding become increasingly vital for providers to capture the available funding. An unprecedented off-cycle adoption of code U07.1, COVID-19 , effective with discharges on and after April 1, 2020, was announced by the Centers for Disease Control and Prevention in mid-March.  As provided in the ICD-10-CM Official Guidelines for Coding and Reporting, the coding guidance for COVID-19 has unique features that all coding professionals and clinical documentation special...

Revenue cycle leaders share approaches to keeping up with new codes and evolving payment guidelines during COVID-19. Understanding all that’s required to secure healthcare payment during a pandemic — especially for services related to COVID-19 — demanded that revenue cycle teams quickly refine denials management processes to protect their organization’s financial health. It also necessitated a spirit of patience and understanding toward payers, which faced a similar learning curve, according to Richard Madison, network vice president for St. Luke’s University Health Network in Bethlehem, Pennsylvania. “It takes two parties to get this right,” Madison said. While Madison and his peers encountered many obstacles that have complicated the task of denials management — including adapting to the needs of a remote workforce and dealing with the uncertainties surrounding payment for an unprecedented volume of telehealth services — their experiences also point to key factors in protecting reven...

In the aftermath of COVID-19, payment flexibility, digital engagement, and transparency are crucial to improving patient financial experience, recent reports show. In the wake of COVID-19, calls for patient financing flexibility, a shift to digital payment methods, and a need for increased bill transparency have providers changing course when it comes to improving patient financial experience. Two recent reports, one from Patientco and another by VisitPay , revealed new insights on the impact of the pandemic on patient financial behaviors and preferences. Both reports concluded that patients are more wary than ever about healthcare costs. “As the pandemic forced consumers to scrutinize their finances and prioritize which bills to pay, it’s become clear that health systems must offer flexible, tailored payment options to help patients manage medical bills in ways most convenient to them,” said Kent Ivanoff, co-founder and CEO of VisitPay, in a press release . VisitPay’s report compiled...

A new survey shows that staff shadowing preceding automation integration is disruptive to employees and has negative impacts on revenue cycle productivity. More than half of health systems found staff shadowing to be disruptive and to have negative effects on revenue cycle productivity, according to a national survey . The survey, commissioned by AKASA and conducted through the Healthcare Financial Management Association’s (HFMA) Pulse Survey program, included answers from over 350 chief financial officers and revenue cycle leaders at health systems across the country. Of the health systems surveyed, 68 percent had experienced staff shadowing. Revenue cycle staff shadowing typically happens ahead of implementing automation or other technology tools in order for consultants to document workflows and processes, according to the press release. About one-fourth (23.6 percent) of health systems responded that shadowing only captured a limited number of workflows and the documentation was of...

  A survey shows that 70% of physicians are disengaging from their employers, spelling future physician retention trouble for healthcare organizations. Physician retention is a common challenge for healthcare organizations and the COVID-19 pandemic may have made it worse, according to survey results from Jackson Physician Search. A survey of 400 practicing physicians between October 2020 and November 2020 found that about 70 percent of physicians report being actively disengaged from their employers. The same survey also found that 54 percent of physicians are planning to make an employment change, with most of these physicians (50 percent) saying they are planning to leave their current employer for another. Another 36 percent of physicians planning an employment change said they are considering early retirement or leaving the practice of medicine altogether. Yet just 30 percent of the smaller pool of healthcare administrators surveyed—86 administrators total—reported losing phys...

The antitrust settlement will resolve allegations that Sutter Health engaged in anticompetitive practices, resulting in higher healthcare prices for self-funded plan members. A Superior Court of California judge has granted preliminary approval for a $575 million antitrust settlement Sutter Health proposed to resolve a case alleging that it engaged in anticompetitive practices that drove up healthcare prices in Northern California. The Sacramento-based health system reached the settlement agreement over a year ago with plaintiffs, including California Attorney General and current HHS Secretary nominee Xavier Becerra and the United Food and Commercial Workers International Union (UEBT). The settlement agreement will now be heard by a court for final approval on July 19, 2021. The settlement resolves a class action lawsuit brought on by UEBT in 2014 claiming that Sutter’s anticompetitive business practices caused them to pay more for healthcare items and services than necessary. Attorn...