Showing posts from 2022

Telehealth services billing unchanged at least through 2023

  Q:   Are there any changes to the telehealth billing in 2023? A:  For CY 2023, Medicare is finalizing a number of policies related to services, including making several services that are temporarily available as telehealth services for the Public Health Emergency (PHE) available at least through CY 2023. This allows additional time for the collection of data to help in determining whether or not Medicare will include service(s) as permanent additions to the Medicare Telehealth Services List. Centers for Medicare and Medicaid Services (CMS) has finalized their proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE. This confirms CMS' intention to implement the telehealth provisions to ensure a smooth transition after the end of the PHE. These policies, such as allowing telehealth services to be furnished in any geographic area and in any originating

No Surprises Act regulations remain a moving target for compliance

  Amid all the rules stemming from the No Surprises Act, a looming mandate for providers to send cost estimates to health plans looks like the biggest stress inducer. Various regulations under the No Surprises Act have created strain for healthcare finance professionals since the initial rules were published in mid-2021, but one pending requirement is the consensus choice as the heaviest lift. The obligation to provide an advanced explanation of benefits (AEoB) to insured patients will necessitate a level of interoperability between providers and health plans that doesn’t exist. How to make it happen is a vexing question for industry stakeholders. It's uncertain “how anybody’s going to do that, because nobody has the tools yet to make it successful," said Sandy Lood, vice president of revenue cycle with Cottage Health in Santa Barbara, California. The U.S. Departments of Health and Human Services, Labor and Treasury, which together oversee implementation of the No Surprises Ac

Outsourcing your medical billing protects against fraud

There are many reasons why you should outsource instead of trying to perform your medical billing in house with employees.  One big reason, is fraud protection.  Your hourly employees are only invested in their paycheck.  If they can't figure something out, they have no incentive to find the answer since they don't gain anything by taking the time to get a single, complicated claim paid.  And, they don't care enough to check for fraud risk.  LEVEL Medical Billing is motivated to work EVERY claim; and one of the screens LEVEL has is against fraud.  If we see a claim that has abnormal or potentially fraudulent data, we notify you to make sure there's not a discrepancy.  This saves you time and money against RAC audits, medical record reviews, and legal fees.

How Time-Based Billing Impacts Physician Reimbursement for E/M Visits

  For 90-minute new patient E/M visits and 45-minute return patient E/M visits, annual physician reimbursement was $409,894 under time-based billing and $188,065 under medical decision-making-based billing. Time-based billing was associated with higher physician reimbursement for longer evaluation and management (E/M) visits, while billing based on medical decision-making (MDM) led to higher reimbursement for shorter visits, according to a  study  published in  JAMA Network Open. Under a fee-for-service model, physicians are reimbursed for E/M services based on the number and complexity of problems addressed during a patient’s visit, known as the medical decision-making method. However, physicians may spend time on tasks that are not reportable under  MDM-based billing , such as medical record review, coordination of care, and documentation. This can lead to one to two hours of unreimbursed work for physicians. Time-based billing is an alternative method that reimburses physicians base

AMA Releases 2023 CPT Code Set, Aims to Reduce E/M Coding Burden

  The 2023 CPT code set will update the rest of the E/M code section after significant changes in 2021, as well as revise AI and virtual care codes. The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for evaluation and management (E/M) visits. Providers use the CPT code set to document patient visits, including all services provided, and the codes are used to track utilization, measure quality of care, and create medical claims for payer reimbursement. Recently, the documentation and coding requirements for E/M visits were updated by CMS to streamline the process and address administrative burdens. Specifically, in the  2020 Medicare Physician Fee Schedule Final Rule , CMS revised the code descriptors and documentation standards for E/M office visit CPT codes 99201 through 99215 as adopted by the AMA CPT Editorial Panel. Starting in 2021, the agency allowed provi

State Surprise Billing Laws Impact Out-of-Network Provider Charges

  Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges for out-of-network care, according to a  Health Affairs  study . Prior to the  federal No Surprises Act , many states passed laws protecting patients from surprise billing. They also established a process to determine the out-of-network rate when  surprise billing occurred . Under state surprise billing laws, payment rates are usually determined by a payment standard or an  independent dispute resolution (IDR) process . Some state laws allow arbitrators to use IDR processes that consider provider charges. The No Surprises Act, which went into effect on January 1, 2022, prohibits arbitrators from considerin

Ohio Medicaid Enrollment update

Ohio Medicaid is 15 days away from activating their new enrollment system from old MITS.  Only time will tell if it is as advertised in being more efficient as a one stop shop for credentialing vs going through each MCOs process.

How Much are You REALLY Paying for In-House Medical Billing?

Each new year introduces the latest challenges and complexities related to the healthcare industry. These challenges include MIPS, a switch from FFS to Value-Based Reimbursement, Meaningful Use, ACA, HIPAA, ACOs, ICD-10, PQRS, Bundled Payments, declining reimbursement rates, or increased patient payment responsibilities, to name a few. Because of these changes, many practices partner with an outsourced medical billing or revenue cycle management firm. In-house medical billing may seem like the path to save your practice money. But is it saving you money? It is essential to know how much in-house medical billing is costing you to see if you'd benefit from outsourcing your medical billing to save your practice time and money. Before choosing a medical billing and reimbursement path, skim this list to see your practice's costs: Salary and wages: Your total cost includes the salary and all additional annual monetary payments of individuals involved in the billing and reimbursement

Governor DeWine Announces Local Government Payments from National Opioid Settlement Begin

    Ohio Governor Mike DeWine announced Friday that the first payments of funds to local governments from the OneOhio settlement with national opioid distributors have been made electronically. Local governments will determine how to use the payments, totaling more than $8.6 million, to best combat the opioid epidemic in their own communities. Following these initial payments, governments will continue receiving payments from the settlement over the next 18 years. In 2017, as Ohio Attorney General, Governor DeWine was one of the first in the nation to sue opioid makers and drug distributors for their role in flooding the market with massive amounts of highly addictive opioids. A complete list of payments made to eligible and participating political subdivisions may be found at . The list also indicates if the payment was made directly to the entity or, if less than $500, was redirected to the county. Questions about payments can be dir

CO Supreme Court: Hospital Cannot Enforce $229K Surprise Bill

The surprise bill stemmed from the hospital’s chargemaster rate, but the hospital did not provide this information to the patient before her surgery. The Colorado Supreme Court has ruled that a woman is not liable for her $229,000 surprise bill from a Centura Health hospital, as the hospital did not disclose the amount to her before the procedure. Lisa Melody French received spinal surgery at St. Anthony North Hospital in Westminster, Colorado, in 2014. The hospital initially estimated that the surgery would cost $57,601, with French responsible for paying $1,337 out-of-pocket. But the cost increased to $229,112 following the surgery. According to the court document, the new price tag reflected Centura’s full chargemaster rates for the surgery. Additionally, Centura determined that it had misread French’s insurance card and she was an out-of-network patient. French was left with the nearly $230,000 bill after her insurance paid $73,597 of the new charge, which was over $300,000. Fren

IMPORTANT UPDATE: Ohio Medicaid is upgrading its provider enrollment system

Effective August 1, 2022, ODM will not be accepting new provider enrollment applications or continue any in-progress enrollment applications through the MITS Provider Enrollment System. Details on the process for enrollment of new OhioRISE providers from August 1 to October 2022 will be communicated prior to August 1st. Effective October 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) portal. After its implementation, the PNM portal will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service. Provider Network Management Portal and Centralized Credentialing Beginning on October 1, 2022 the Provider Network Management (PNM) portal will accept Medicaid provider enrollments and carry out centralized credentialing functions. This transition will reduce administrative burden for providers and enable providers to focus on the more meaningful and importan