Blog Categories: Medical Billing

What Is Telemedicine?

Telemedicine uses video or telephone communication to connect patients with a medical professional for the exchange of information electronically. As a patient, you can see your provider in this manner instead of an in-person visit. During a telemedicine visit, the physician can evaluate, diagnose, and treat the patient, including dispensing prescriptions, lab orders, or other orders deemed necessary in the patient’s care. This can all occur over an electronic device such as a smartphone, computer or tablet. The telemedicine visit occurs with the same level of quality and care as it would in person. It is important to keep in mind that outpatient telemedicine visits are not used for emergency-related health concerns such as strokes or heart attacks.

10 Tips

1. Choose your tech. It is helpful to decide ahead of time what device you may use for your telemedicine visit. It can be a computer, laptop, smartphone, or tablet. It may also matter if it is Apple, Google, Windows, or Android-based. Having a reliable internet connection is also important.

2. Set up prior to your appointment. Make sure you ask your physician’s office about any technology setup that may need to occur ahead of your telemedicine visit. This may include downloading an app or creating a new account. You should also ask for a contact number in case there is a problem during your telemedicine visit. Doing this will reduce the stress of managing new technology during the actual telemedicine visit.

3. Choose a quiet, private place. Find a place for your appointment that is quiet so you can hear your physician, and they in turn can hear you. This will reduce distractions and interruptions, making your appointment more productive.

4. Prepare your medical history. Just as in an in-person visit, having an accurate medical history available is helpful for your physician during their evaluation. This would include any personal or family history, environmental history, lifestyle, and job history. Having this information available ahead of time will make for an efficient telemedicine visit and give your physician important information to give you the best care possible. Sometimes your provider’s office may contact you in advance of the visit to obtain some of this basic information.

5. Prepare paperwork ahead of time. You may receive paperwork containing information to complete ahead of your telemedicine visit. This may include a list of medications you take, your primary physician contact, pharmacy contact, insurance information, consent for telemedicine, or payment information.

6. Obtain vital signs. If you can, it is helpful to obtain vital signs prior to your appointment. If you have an electronic blood pressure cuff, you can obtain blood pressure and heart rate. You can take your weight and temperature as well at home and report during your telemedicine visit. You can also take pictures of any rashes or conjunctivitis you have questions about. This information will be helpful as your doctor evaluates you during your telemedicine visit.

7. Be prepared for co-pays. It is important to be aware that most insurance companies consider a telemedicine visit comparable to an in-person visit and are therefore possibly subject to the same co-pays and payments.

8. Write down questions ahead of time. The stress of a new type of visit can be a distraction when trying to remember all the things you may want to ask your physician. Writing down important questions you have for your physician ahead of time will help you remember them during your visit.

9. Review your treatment plan. You should review your treatment plan with your physician during your telemedicine visit so you both understand the next steps. It is also helpful to write it down, so you do not forget the plan. Ask any questions about the plan during this time with your doctor.

10. Set up the follow-up. At the end of your telemedicine visit, set up a follow-up visit as necessary.

The Laws are the same for employees and Business Associates working from home

In the past 10 years, the number of employees working remotely in the United States has increased by 115 percent. And with the COVID-19 pandemic requiring many employees to work from home, that number is increasing at a rapid pace. Many of us are suddenly finding ourselves working from home for the first time. The pandemic does not mean we are off the hook with HIPAA privacy and security requirements. On the contrary, we are just as liable as if we were working in the office.

Create a HIPAA-Compliant Work-space

Although certain HIPAA sanctions are being waived during the current health crisis, that does not excuse us from mishandling patients’ protected health information (PHI. We must take the same physical and security measures to safeguard the PHI we are trusted with within our work.

Here are some best practices to follow:

• Ensure your home wireless router traffic is encrypted and password protected.
• Change default passwords for wireless routers.
• Encrypt and password protect personal devices you may use to access PHI such as cell phones and tablets.
• Computer programs containing patient information should be closed and logged out of when not in use. Lock your screens when walking away from your computer.
• Do not share sensitive PHI with others who shouldn’t have access, including co-workers and personal acquaintances.
• Only access a patient’s record if needed for work.
• Avoid printing PHI; however, if necessary, keep all PHI, such as patient paperwork, charts, and records, locked away and out of view.
• Never leave patient information out where unauthorized persons may see it.
• Minimize the ability for others to overhear patient information, for example, saying a patient’s whole name out loud within hearing distance of others.
• Do not allow friends, family, etc., to use your devices that contain PHI.
• Limit email transmissions of PHI to only those circumstances when the information cannot be sent another way. At a minimum, use encryption tools (most businesses provide tools to send encrypted emails).
• Never share passwords between staff or family members.
• Immediately dispose of information containing PHI when no longer needed by shredding paper files.
• Use a privacy screen on your monitor(s).

As coders, billers, auditors, compliance officers, managers, or other healthcare providers, it’s a blessing to live in an age of technology in which we can work from home. Take the time to review your organization’s HIPAA Privacy and Security policies. Work with your IT department to ensure your home office is HIPAA compliant. Be safe and live well.

Diagnostic provider leadership teams understand the importance of revenue cycle management (RCM) for maximizing reimbursement promptly. Submitting clean claims is one of the most important ways that a diagnostic organization can ensure payment in a timely manner from both private and government insurance payors. Receiving the maximum reimbursement the first time a claim is submitted is crucial to achieving desired operating margins.

How diagnostic providers define a clean claim varies significantly. Some consider claims clean even when they have no apparent errors on the front end even though they may ultimately result in denials in the back end. Allowing claims to be labeled as “clean” when they contain errors means that an organization will never have the analytical insights necessary to improve the quality of the claim information they receive. In its simplest form, a clean claim should be defined as one that has no errors or omissions and can be processed without additional information or verification of information by a human, third-party service, or automation.  A clean claim contains all of the following correct information:

• Each procedure code has a supporting diagnosis code that is not expired or a deleted code
• There are no potential issues or questions regarding medical necessity
• The patient’s coverage was in effect on the date of service
• The patient’s insurance covers the service provided
• The claim submission includes all the required patient information such as full name, mailing address, and date of birth
• The claim identifies the payer, including the correct payer identification number, group number, and mailing address
• All required claim information is in the correct field
• The claim is submitted within the timely filing window

To measure how a diagnostic organization is performing when it comes to RCM, an important metric to track over time is the “clean claim rate.” This measure quantifies the rate at which insurance claims have been successfully processed and reimbursed the first time they were submitted. This means it contained no errors, rejection, or need for manual input of additional information. To achieve a high clean claim rate, organizations have traditionally had to work claims manually to:

• Retrieve missing patient information
• Correct errors or information in the wrong fields
• Validate insurance eligibility
• Follow up with physician offices for supporting information.

Submitting clean claims means the claim spends less time in accounts receivable, less time at the payer, and the laboratory or other diagnostic provider gets paid faster. Experts across the industry agree that a clean claim rate should exceed 90 percent. However, based on an analysis performed by XIFIN, specific to laboratory claims, approximately 35 percent of all diagnostic procedures have errors that need correction before they can be reimbursed. This translates to upwards of $20 billion per year in either delayed or permanently lost reimbursement in the US alone. XIFIN also found that 12 percent to 20 percent of all requisitions lack a payer-specific ICD-10 or other information resulting in partial or full claim denial. Many organizations choose to write off these uncollected claims rather than incur the labor costs associated with achieving a clean claim. In contrast, leading organizations are maximizing their clean claim rates and reducing their bad debt without an increase in labor costs by leveraging automation. Real-time connectivity and error correction, integrated patient demographic and insurance discovery, automated supporting document attachment, and portal-enabled patient and client communications all improve clean claim rates without human intervention.

Above and beyond clean claim rates, laboratory and other diagnostic provider leadership teams will find it exceedingly valuable to have analytical insights that:

• Indicate the most significant financial impact or anomalies (either negative or positive) based on a month over month change in allowed amounts by payer and volume
• Demonstrate the number of claims being processed without human intervention as compared to the claims that had errors that required manual intervention
• Identify which team members are performing or (underperforming) on specific actionable error codes and how the fixes are impacting reimbursement rates
• Highlight which physicians and ordering clients are causing the most issues in the billing process due to missing or invalid information that was needed for the claim

Another critical measure of a diagnostic organization’s revenue cycle performance is its “write-off rate.” Write-offs happen when the amount collected for a claim is lower than the contracted pay rate. Under current accounting rules, the amount of those discrepancies should be recorded as bad debt, thus reducing revenue by the unpaid amount. Many legacy billing systems, however, incorrectly attributed the discrepancies to contractual allowance. Consequently, these organizations saw a falsely low bad debt rate and failed to identify potentially recoverable revenue. Relegating under- and non-payments to contractual allowance is not only against current accounting rules but also erases the opportunity to attempt recovery. So while no organization enjoys a higher bad debt rate, the good news here is that correctly identifying these amounts as (potentially recoverable) bad debt, rather than the contractual allowance, enables a laboratory to take steps to recover this otherwise lost revenue.

It is clear that a low level of clean claims directly contributes to higher write-off rates and, thus, lower revenue, profit, and margin. It is a challenge for labs and other diagnostic providers to be promptly reimbursed if they lack accurate patient data. Too often, labs write off balances if they don’t have all of the information needed to get the claim paid, especially if it is a low-value claim. This can be particularly impactful for laboratories associated with hospitals and health systems. More laboratory claims tend to be written off in these cases because the average value of each claim is quite low when compared to other hospital- or health system-related claims.

To ensure that claims are getting handled correctly to maximize timely cash collection, billing and finance leaders can start by asking their revenue cycle management team, the following key questions about write-offs:

• What percentage and dollar amount of my claims end up written off (i.e., what is our write-off rate)?
• Are our claims subject to automated write-offs based on a dollar amount threshold set in the system?
• Are automated write-offs of our claims categorized as bad debt, since no effort to collect has been attempted?

Finally comes the question: Are we using the best RCM system to maximize our clean claims, minimize write-offs, and thus optimize our revenue, profit, and margin? Here are a few questions to ask on that front:

• Does our RCM system automate the correction and completion of patient demographic data?
• Does our RCM system has automated insurance discovery that corrects and completes insurance information?
• Does our RCM system allow the automatic attachment of supporting documentation to minimize denials?

Only by maximizing the clean claims rate and minimizing the write-off rate can a laboratory or other diagnostic provider maximize revenue. A goal of zero percent write-offs is not practical, however. For some very small claims or unpaid balances, the effort to reclaim the reimbursement outweighs the value of the outstanding balance. But an optimized RCM solution with proper automation will help laboratories and other diagnostic providers cost-effectively maximize clean claims and minimize write-offs. This is one of the very best ways to thrive in today’s challenging healthcare landscape.

Despite relentless efforts to curb the growth in denied healthcare claims, physician practices see between 5 to 10% of claims continue to be rejected by commercial and public payers each year. Each claim costs to rework, it pays to get them right the first time. For health systems, physician groups, and billing companies in claims management not only erode revenue and crush staff productivity but also represent a source of major worry for providers. Yet below are the places to focus to avoid those rejections. Claims are commonly denied on the basis of:

• Missing, incorrect, or duplicate information
• Incorrect codes
• Inclusion of service, drug, or charge that isn’t covered by the patient’s plan
• Missing pre-certifications or authorizations
• Missed filing deadline

With the right strategies and tools, providers can optimize their revenue cycle to make sure claims are right the first time.

A three-part strategy to eradicate avoidable claim denials

1. Dive into the data to find and fix the leaks

To reduce denials, providers should start by analyzing denial and audit data to pinpoint where the errors are creeping in. Tracking denials by volume, type, payer, and reason allows providers to understand the most frequent root causes. Business intelligence tools can then use these insights to help providers discover whether the vulnerabilities are attributable to people, workflows, technology, or data.

For example, is there a department or service line that seems particularly exposed to denials? Or has there been a surge in rejected claims following a change in payer policy? The goal of both retrospective audits and ongoing monitoring of claims processes is to identify those trigger points, resolve problems quickly, and prioritize solutions to prevent future denials from occurring. If one gets answers to these, they no longer have to wait 30 to 45 days to review denials. They can review them on the day of submitting if they choose.

This real-time monitoring helps connect front- and back-office staff for a more efficient overall system. Immediate feedback on what happened and how it might be prevented in the future helps both ends.

2. Assign the right work to the right specialist

The processes and criteria for submitting claims are complicated. Payer rules are changing, and as payers rely more and more on sophisticated algorithms to check for errors, they’re becoming more efficient at rooting out inaccuracies and rejecting claims. With increasingly complicated criteria and varying requirements in payer contracts, it’s becoming more challenging for providers to submit accurate claims the first time around.

To meet this challenge, providers need to ensure their own processes are similarly efficient. From patient access to patient accounting, automated workflows can help improve patient matching, reduce billing errors and free up staff to make the best use of their time.

Crucially, that means assigning the right person to the job. Some providers also segment claims staff by care setting or payer, which allows them to become extremely familiar with the nuances of specific types of claims. Again, data analytics can help providers determine the appropriate level of specialization.

3. Improve communication with payers

High volumes of denials are a burden for payers, too. When the same errors appear repeatedly, payers must dedicate extra administrative resources to reprocess corrections and appeals. Effective contract management with payers can help providers stay up to date with each payer’s specific requirements and formatting preferences to avoid such errors as well as monitor payer performance to check for patterns in denials.

To achieve this, providers need to look at everything from improving patient matching to understanding exactly what payers are asking for in claims submissions. A good claims management strategy will take a holistic view of the revenue cycle to see where improvements need to happen, and implement the right processes, tools, and technology to drive down denials.

Primary care practices are at serious risk of closing as patient volume and Revenue continue to decline during the Covid 19 Pandemic.

Primary care practices are facing significant financial challenges as a result of the COVID-19 pandemic, leaving 20% of practices without the resources they need to remain open beyond the next four weeks.

Close to 46% of the over 2,600 primary care physicians, nurse practitioners, and physician assistants surveyed were unsure if their practice will have enough cash to keep their practices open for the next four weeks. About 42% also reported concerns about layoffs and furloughed staff, with an overwhelming majority 85% noticing sharp decreases in patient volume.

Primary care practices are hoping to receive external financing support to keep their businesses open. Practice is likely to apply for a Small Business Administration loan in the next four weeks.

The Small Business Administration also reported that it is no longer able to accept new applications for the Payroll Protection Program. The program was a key effort from the federal government to keep small businesses operating during the COVID-19 pandemic.

Policymakers are currently devising a fourth coronavirus stimulus package, which could include $450 billion for small businesses and hospitals hurt by COVID-19, national news sources reported earlier this week.

However, primary care practices also need help with virtual care in order to survive the economic hit from COVID-19, the survey showed.

In the survey, 65% of respondents reported having patients who cannot use virtual health because they lack a computer or internet access.

Additionally, full-scale use of virtual platforms is still limited, with just 34% relying on the majority use of video, 15% on e-visits, and 19% on patient portal use. In comparison, 48% of primary care clinicians conduct the majority of visits by phone, the survey found.

Overall, 22% of practices reported no use of video visits, 42% reported no use of e-visits, and 28% does not use patient portals.

But even practices leveraging virtual care to alleviate patient volume challenges during the pandemic are unsure they will get paid for the services, they were uncertain they will receive reimbursement for virtual care.

About 44% of respondents were also unsure if their practice would get reimbursed for conducting visits over the phone.

Medicare has lifted restrictions related to virtual visits for physicians during a national emergency. But Medicare’s decision to reimburse practices for virtual care for beneficiaries does not guarantee reimbursement among private payers.