Staying On Top Of Medicare Changes in 2019

The simplest solution is usually the best one. When it comes to the tangled web of Medicare services and billing, however, staying simple isn’t always easy. Every year, the Centers for Medicare & Medicaid Services (CMS) update their policies in order to stay on top of technological advances and to streamline their processes. Less paperwork means more time to focus on what matters most. Physicians, services providers, and any staff that handles billing must take note of these updates to make sure they are compliant for the upcoming calendar year. These changes, as well as other changes in payment coding, are outlined in the annual MLN Matters, released by the CMS.

Physicians and other providers who submit claims to Medicare Administrative Contractors (MACs) for services paid under the Medicare Physician Fee Schedule (MPFS) must pay special attention to this document, as it includes many important updates.

MLN Matters Updates Include:

Summary of Policies in the Calendar Year (CY) 2019
Medicare Physician Fee Schedule (MPFS) Final Rule
Telehealth Originating Site Facility Fee Payment Amount and
Telehealth Services List
CT Modifier Reduction List
Preventive Services List

In addition to the final rule on the fee schedule for 2019 that posted on November 1, 2018, one of CMS’ primary goals for 2019 is to simplify the compliance burden on healthcare providers. This includes streamlining documentation related to home visits, office visits, and outpatient visits. It also includes changes to payments, coding, and other documentation.

The key words for 2019 are simplicity and flexibility. Reduction in duplicative paperwork results in more time saved for practitioners. Flexibility in payment processing leads to a simpler process for beneficiaries. The CMS, overall, is enacting “policies (that) will allow practitioners greater flexibility to exercise clinical judgment in documentation, so they can focus on what is clinically relevant and medically necessary for the beneficiary.” Read the full document here.

Even though these updates are intended to simplify compliance, changes of any type are a challenge to implement. Small mistakes can have a dramatic effect on reimbursements and your revenue cycle. We recommend implementing a plan for implementing the updates described in MLN Matters immediately.

Do you have questions about how 2019 CMS updates affect your practice? Schedule a consultation today to assess your readiness and ensure compliance.

The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

Sample Medicare Card with Medicare Beneficiary Identifier

The Medicare Access and CHIP Reauthorization Act of 2015, commonly known as MACRA is bringing dramatic changes for Medicare beneficiaries and the providers that serve them. MACRA is bringing big changes for anesthesiologists and CRNA’s.

Could these changes result in rejected claims and unpaid charges? The answer is YES!

We are watching this transition closely and managing the transition process for our anesthesia providers. Since we have spent so much time working on MACRA, we thought that we would share the Top 5 Things that anesthesia providers need to know about how this will affect their practice.

The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

#1: MACRA requires removal Social Security Numbers (SSNs) from all Medicare cards by April 2019.

Health Insurance Claim Number (HICN) identifiers have come under increasing scrutiny because the prominent use of Social Security Numbers creates a significant risk for beneficiary identity theft. All beneficiaries will receive a new Medicare card by April of 2019.

#2: All beneficiaries will receive a new Medicare Beneficiary Identifier (MBI).

The new Medicare cards will replace the HICN with a Medicare Beneficiary Identifier (MBI) that doesn’t incorporate the SSN. MBI’s use the same number of digits as the HICN, and it will occupy the same fields. The MBI was designed to avoid commonly mistaken letters and numbers like “0” and “O”, and it is not based on the SSN in any way. This MBI is unique to each beneficiary.

#3: Transition period begins April 2018 through December 31, 2019.

Both numbers will work during that time. Starting on January 1, 2020, HICNs will no longer be exchanged with beneficiaries, providers, plans, and other 3rd parties. The HICN will only be used for appeal requests and related forms that were accepted using an HICN.

#4: This change will lead to complex system changes.

MACRA requires complex system changes affecting the federal government, state governments, beneficiaries, providers, and plans. These groups are spending countless millions of dollars implementing system changes that may directly affect your Medicare claim filing process.

#5: Failure to comply with MACRA will prevent you from getting paid!

Starting on January 1, 2020, your claims will not be paid unless they are filed appropriately using the new MBI. Any claim submitted with the HICN will not be processed, resulting in significant delays in getting paid.

Anesthesia Providers and MACRA

Medical Business Management works with CRNA’s and Anesthesiologists to ensure that their claims are submitted accurately and paid in a timely manner. We navigate the complicated transition process and manage your revenue cycle so that you can focus on what you do best: serve your patients.

If you would you like to find out more about MACRA; Contact us today about how these changes will impact your revenue cycle.

$68 Billion in Medical Billing Errors Creates High-Risk Situation for Providers

medical billing errors

When it comes to medical billing errors, the numbers are staggering: as many as 80% of all medical claims submitted to insurance carriers contain errors costing approximately $68 billion. Additionally, the incorrect coding of about 55% of evaluation and management (E/M) claims has resulted in roughly $6.7 billion worth of erroneous Medicare payments.  

Physicians who are hoping to dodge the consequences of such errors – namely, lost revenue and other grim penalties – have begun to require more training for their staff, and seeking out employees who have obtained a specialized training and certification program.

A Sharper Eye

Because of the multitude of medical billing errors, there are more watchdog agencies enforcing the rules than ever before – and more penalties, too. This has created a high-risk situation for providers, 17,000 of whom have lost their license to bill Medicare due to tougher screening measures.

Even when a staff member handles claims and coding, the physician is ultimately responsible for every claim that’s billed under their unique provider number – and it’s literally the physician’s signature on those claims that verifies its accuracy and legitimacy. So if there’s a mistake, the doctor’s name is very much on the line.

All of this ramped-up scrutiny has prompted many providers to require their staff to become certified in medical billing, and any staff member who knowingly submits a fraudulent claim for payment can be held liable for that error.

Keeping the Physician’s Focus on Patient Care

Most physicians are more concerned with providing an excellent patient care experience than they are overseeing the medical billing process. For that reason, they tend to have a less thorough understanding of medical claims management than someone who’s been specifically trained in that area.

Today’s doctors prioritize the hiring of a billing and coding staff who will stay up-to-date on Medicare and other third party guidelines – but now, they’re looking for more than just experience. They’re looking for official certification.

Avoid Medical Billing Errors – Contact MBM Today

If you want to ensure that your medical billing and coding is done properly, and you want to avoid costly errors that could jeopardize your entire practice, Medical Business Management is ready to help. We specialize in anesthesia and pain management billing, and we can help physicians stay focused on their patients instead of worrying about possible errors on insurance claims.  

Interested in learning more? Take a look at some of the services we can offer your clinic.

The ABCs of Qualifying Circumstances

qualifying circumstances

Modifier codes are sometimes used to signal abnormal circumstances related to anesthesia care. These 5-digit qualifying circumstances codes are recognized as modifiers when they are billed as separate line items in order to report services that were provided under unusually difficult circumstances (i.e. unique operative conditions, extenuating issues with the patient’s condition, etc.).

Read on to learn what these codes are and how to properly use them as modifiers.

Qualifying Circumstances Modifiers for Anesthesia Risk

The following codes are recognized as anesthesia modifiers when reported properly.

99100 – Unit value = 1

Administration of anesthesia to a patient who is younger than age 1 or older than age 70.

99116 – Unit value = 5

Administration of anesthesia complicated by utilization of total-body hypothermia.

99135 – Unit value = 5

Administration of anesthesia complicated by utilization of controlled hypotension.

99140 – Unit value = 2

Administration of anesthesia complicated by emergency conditions only. An “emergency” is defined as delay in treatment of the patient that would lead to a significantly heightened increase in the threat to life or body part.

One thing of note is that if multiple anesthesia risk modifiers are billed, payment will be made as far up as the highest unit value modifier. When billed in conjunction with a Physical Status Modifier of equal unit value, no payment is allowed to the Qualifying Circumstances Modifier.

How to Document

For CPT codes 99116 and 99135, anesthesia records should be submitted. For CPT code 99140, the indications for performing the service should be recorded directly on the CMS 1500 claim form. Block 19 may be used to record risk indications, and EMC providers can enter indications in the Comments field.

Filing a Claim

When using an anesthesia risk modifier, the anesthesiologist may use Block 19 for provide indications or supporting information. Anesthesia risk modifiers may be reported in Block 24D of the CMS 1500 claim form. Enter the applicable anesthesia CPT code on the first line, followed by modifier codes. Then, report the charge for the service on the same line in box 24F, and put the time units in box 24G.

For situations that require the use of an anesthesia risk modifier, enter the 5-digit risk modifier code on the second line and report the charge for the modifier on the same line in box 24F.

MBM Can Handle Your Claims

If you’d rather focus on your practice and your patients than CPT codes, contact Medical Business Management to see how we can help. We specialize in anesthesia and pain billing, and we’re ready to take coding and billing off your plate. Contact us today!

Preventing Misunderstood Acronyms from Leading to HIPAA Mistakes

healthcare acronyms

Healthcare acronyms are everywhere – MACRA, EMR, PHI, HIPAA. They can be confusing, and it’s easy to get them mixed up – but using the wrong acronym could lead to HIPAA mistakes. Your providers and staff may use health-related acronyms regularly, but that doesn’t necessarily mean they are all on the same page – or that any of them are using the acronyms correctly. Read on.

The Danger of Similar Acronyms

Often, you’ll hear people in healthcare using the acronyms EMR and EHR interchangeably; however, they actually mean different things. This is also true of ePHI and PHI — while they are similar, they refer to unique areas of concern under HIPAA.

Below, you’ll find the true definitions for five often mixed-up acronyms.

  •      EMR – Electronic Medical Record. This is the electronic version of a patient’s paper chart, which maintains the patient’s medical and treatment history at that practice only.
  •     EHR – Electronic Health Record. This is also a record of a patient’s health and treatment history, but as opposed to EMR, it extends beyond an individual practice to include all providers and care that a patient has had: hospital visits, lab work, imaging, and more. Clinicians can share an EHR in order to coordinate care.
  •      PHR – Personal Health Record. This tracks a similar batch of information to EMRs and EHRs, but it’s managed by the patient, and usually includes family history and care.
  •      PHI – Protected Health Information. This refers to patient information a provider collects during health interactions in which the patient is personally identified. PHI was originally detailed in the HIPAA Privacy Rule, and it is currently protected under it.
  •      ePHI – Electronic Protected Health Information. This includes all of an individual’s identifiable health information that a healthcare provider creates, receives, maintains, or transmits in electronic form. It is protected under the HIPAA security rule.

Ready to Simplify Your Practice?

Here at Medical Business Management, we understand that clinicians already have their hands full with patients, staff, and of course, acronyms. There’s no need to dedicate even more time and energy to things like coding and billing, which is where we come in. Let us handle these aspects of your clinic so that you can focus on your practice! Contact us today for more information.

The 3 Medical Billing Reports You Should Run Consistently

medical billing reports

Medical billing reports can tell you a lot about the health of your practice. For example, they can show you how your practice is doing on revenue cycle metrics, whether claims are being paid on time, and how well (or how poorly) insurance carriers are paying you. But which reports are the best ones to run?

Take a look at the 3 key medical billing reports below.

#1: Accounts Receivable Aging Report

This report is a great way to determine your practice’s overall health. Someone with experience in billing can look at this report and know how well the practice’s billing department is doing its job. To get more details and supplement this key report, you can also run the Insurance Payment Trend Report and the Insurance Collection Report.

The A/R aging report basically breaks down all of your practice’s claims based on the number of days they’ve gone unpaid (in other words, how many days they’ve spent in your receivables). Most claims are paid in an average timeframe of one month.

The bottom line on this report is that it gives you a bird’s eye view of your practice’s billing health, while the supplemental reports mentioned above offer more details.

#2: Key Performance Indicators Report

This is arguably the most useful report because it gives you a great idea of how your practice’s revenue cycle management process is doing. This allows billers to spot trends, see changes, and identify potential problem areas. Additionally, it helps you identify the CPT codes and encounters that are most profitable for your practice.

This report keeps up with total encounters, total number of procedures, total charges and collections, outstanding accounts receivable, and total adjustments. Billers can compile data across months and identify trends with ease.

#3: Top Carrier / Insurance Analysis Report

This report may be the most useful when it comes to saving time and money. It tracks revenue cycle metrics and offers a quick view of how the practice is doing.

If you want to know the charges, payments, and collections of the top 10 carriers in your practice, this report will be very helpful to you. Not only does it track payments and collections, it also keeps up with CPT codes and units, which allows your practice to dig deep into the charges, payments, and collections for a specific CPT code.

Need Help with Your Billings?

If the billings process is just too much for your practice to handle, contact Medical Business Management right away. We’re here to handle the coding and billing so you don’t have to! Keep your focus on your practice and your patients; let us handle the insurance companies and A/R for your pain management or anesthesia billing needs!

A Great New Year’s Change for Clinicians: Hire a Medical Billing Company

medical billing

We all know that 2017 is slated to be a year of great change, both politically and medically. With MACRA’s implementation this year, there’s a significant learning curve for everyone in the medical field – which means there’s no better time to make a change that will simplify your practice’s daily operations.

Not only does hiring a medical billing company streamline your clinic’s processes – it also gives you great peace of mind. Read on!

Reorienting Your Focus

One of the best reasons to hire a medical billing company in 2017 is that it takes so many things off your plate. Billing and coding take up a lot of your staff’s time and energy, which means they’re not fully focused on providing excellent care to your patients. This is through no fault of their own; it’s simply a flaw in the system. Their focus is on paperwork because it has to be – or does it?

When you hire a medical billing company to handle your billing and coding, you and your staff are freed from the burden of tedious, time-consuming paperwork, which enables you to focus on the people who come to your practice for care. And when you and your staff can focus on patients, those patients feel seen and valued, and they’ll come back again.

Ditching the Constant Change

Medical rules are always changing, and the constant shifts can become exhausting. Just when you think you understand one new policy, you get hit with another one that replaces it. And just when you get the hang of one method of coding, here’s a totally different method that you’re supposed to start using.

Do you have time to keep up with all that? Probably not – and you shouldn’t have to worry about it, either.

When you’ve got a medical billing company working with you on your coding and billing, the constant change isn’t a factor anymore because that company stays on top of it for you. Like we said before, your focus can be exactly where you want it to be – on the patients you serve.

Giving You Peace of Mind

Your patients deserve all your attention, and as a physician, that’s what you want to give them. But paperwork, changing policies, and insurance issues can all get in the way.

That’s why hiring a medical billing company like Medical Business Management is such a great option for medical practices. With the burden of billing and coding lifted, you and your staff will enjoy peace of mind like never before – and that can only mean good things for your practice.

2017 is a great time to make this change. Contact us today for more information!

How Value-Based Care Affects CRNAs

value-based care

As the value-based care trend continues, Certified Registered Nurse Anesthetists (CRNAs) will face a variety of challenges. But what do these challenges look like, and how will value-based care affect the future for CRNAs? Read on to learn more.

Proper Valuation

Currently, the trend is to move away from fee based service and toward bundled care, also known as value-based care. Because of this, CRNAs want to make sure that their anesthesia services are properly valued.

Supporters of value-based care have suggested that it will result in higher accountability standards for health care spending by ensuring that any care given to patients is actually necessary. This, they say, will lead to better care coordination.

Those who oppose the move to value-based care argue that this method will result in contention between provider groups when it comes to reimbursement, because there is no proof that bundled care will actually decrease costs.

The Impact of Value-Based Care on Anesthesia Providers

For CRNAs and anesthesiologists, the result of all this will likely be lower reimbursement and a more demanding workload. If we look down the road a bit further, there are other unintentional consequences of this shift to value-based care:

  •      Nursing and medical students with a decreased interest in anesthesia
  •      An increase in CRNAs and anesthesiologists leaving their profession early
  •      A continued shortage of anesthesia providers

What Does the Future Hold?

Like all medical professionals, CRNAs already encounter a variety of challenges in the health care world. But for those looking to start (or continue) a career in anesthesia, the future seems to include uncertain reimbursement, a focus on safety and quality, and a demand for evidence of value – which will end up driving both policy and practice.

Regardless of where the health care industry goes, one thing’s for sure: Medical Business Management will always be up-to-date on the latest policies, laws, and trends. We’re here to relieve the burden of coding and claims so your focus stays right where it should – on your patients. Contact us today for more information!

Why Is Medical Billing So Hard for My Practice?

medical billing

For any practice, medical billing is a time-consuming, often confusing process with ample room for error and rules that change regularly. Here, we’ll look at three reasons medical billing is so difficult to keep up with.

Reason #1: Ever-Changing Rules

One of the main frustrations of medical billing is that the rules always seem to be changing. New coding systems and updated compliance regulations come out every so often, and if your practice doesn’t keep up with the latest development, you’ll suffer a deluge of problems, setbacks, and rejected claims – all of which can result in major payment delays.

Reason #2: Insufficient Staff

Keeping a dedicated billing specialist on your staff is great – if you can afford to do it. If you can’t afford it, then your regular staff will have to handle the billing on top of all their other duties, which will likely result in poor morale and a higher turnover rate. And if you can’t keep your staff on board, that means you’ll spend a lot of extra time training new employees, only to watch them walk out the door six months later because the workload is completely unmanageable.

Reason #3: Too Much Problem-Solving

Rejected claims. Late payments. No payments. Improper coding. The list of potential problems your practice will spend time solving includes all these things, plus other issues like software malfunctions. When your already overworked staff is having to figure out billing problems and pursue past-due accounts, then a bad situation has just become much, much worse – and this kind of heavy, scattered workflow just isn’t sustainable.

So What’s the Solution for Medical Billing Difficulties?

The medical billing process isn’t likely to get simpler anytime soon, so what’s a practice to do? Outsourcing your medical billing is a great option because it takes the whole thing off your plate. Instead of correcting a bunch of inaccurate codes or calling patients to collect overdue payments, your staff can put their focus where it should have been all along – on the patients they serve.

Improve your workflow and revenue cycle. Boost staff morale. Call Medical Business Management today, and let us handle all your medical billing needs!

Tips for Increasing Your MIPS Score

increasing MIPS score

Beginning in 2017, MIPS (Merit-based Incentive Payment System) will make up an important part of a provider’s payment from CMS.

A higher MIPS score can lead to more revenue for a practice – and a lower MIPS score can lead to penalties that will decrease revenue from CMS. Each year, CMS will set a threshold for performance. If your practice beats that threshold, your Medicare Part B payments won’t be impacted. However, should your practice drop below that threshold, penalties could be applied.

2017 is a lot closer than we all would like to think, so it’s imperative to start learning how to increase a MIPS score now.

There are four essential components to the MIPS score that we’ll go through.

The Meaningful Use (MU) Component

MU can refer to a lot of different things, but for the purposes of MIPS in 2017, it primarily means making use of electronic health records (EHR). This is key, since MU will comprise 25 percent of your overall MIPS score.

Ideally, your practice started the Medicare or Medicaid programs in 2014, which was the last year to join the Medicare program and take advantage of its incentives. If not, it’s likely that your practice has been vulnerable to penalties each year. Starting to fully embrace certified EHRs now can greatly improve your MU portion of your MIPS score.

There are four benefits practices receive from EHR implementation anyway, so it’s a good best practice to follow regardless of MIPS.

The PQRS and VBM Component

The Physician Quality Reporting System (PQRS), along with the Value-Based Modifier (VBM), are both integral to your practice’s score and will account for half – 50 percent – of your score. Thus, increasing compliance with these two areas will have the single largest impact on increasing a MIPS score.

If you haven’t already, start monitoring PQRS measures and report them on a regular basis. Additionally, either register through the Group Practice Reporting Option (GPRO) – which is available if you have two or more professionals who are eligible and are billing under Medicare and have the same TIN – or report at least half of your groups eligible professionals on an ongoing basis.

It’s crucial to choose and follow at least one of the measures for VBM. Additionally, make sure you’re fully participating with PQRS. Many practices aren’t, and that will punish them in 2017.

The VBM Cost Measures Component

The third component also involves VBM – specifically, the cost measures. This will account for 10 percent of your MIPS score. CMS calculates these cost measures on your behalf based on your Part B claims that you submit. On one hand, there is less work for you to do; on the other hand, improving this component is more difficult than with others.

The Clinical Practice Improvement Component

Finally, Clinical Practice Improvement (CPI) will comprise the remaining 15 percent of your MIPS score starting in 2017. CPI involves using a rigorous analytical framework to assess every process in the delivery of health care, and measuring the inputs and outputs in the form of patient outcomes. This is probably the most unfamiliar concept for practices because, unlike the other three components, this is a new concept from CMS that doesn’t incorporate or replace any pre-existing program.

CPI activities are broken up into six subcategories, and each activity is weighted according to its importance, from medium to high. An example of a high-weighted activity is beneficiary engagement, which includes collecting data on patient experience and satisfaction.

Reaching a perfect score of 100 percent requires a provider to reach 60 points broken out by high and medium (worth 20 points and 10 points, respectively). Becoming approved as a Patient Centered Medical Home (PCMH) results in an automatic 100 percent rating, as is being certified as a “comparable specialty practice.”

Increasing Your MIPS Score

Improving your MIPS score needs to be a major priority between now and 2017. One recommendation is to focus on the largest areas, which would be MU and PQRS/VBM components. Adopting EHR is very important and is one single step that can result in an immediate improvement (although it does take time).

Consult with a third-party consultant to learn more about how you can improve MIPS.

The Top 5 Things Anesthesia Providers Need to Know About Medicare Beneficiary Identifiers

The Medicare Access and CHIP Reauthorization Act of 2015, commonly known as MACRA is bringing dramatic changes for Medicare beneficiaries and the providers that serve them. MACRA is bringing big changes for anesthesiologists and CRNA’s. Could these changes result in rejected claims and unpaid charges? The answer is YES! We are watching this transition closely […]

$68 Billion in Medical Billing Errors Creates High-Risk Situation for Providers

When it comes to medical billing errors, the numbers are staggering: as many as 80% of all medical claims submitted to insurance carriers contain errors costing approximately $68 billion. Additionally, the incorrect coding of about 55% of evaluation and management (E/M) claims has resulted in roughly $6.7 billion worth of erroneous Medicare payments.   Physicians […]

The ABCs of Qualifying Circumstances

Modifier codes are sometimes used to signal abnormal circumstances related to anesthesia care. These 5-digit qualifying circumstances codes are recognized as modifiers when they are billed as separate line items in order to report services that were provided under unusually difficult circumstances (i.e. unique operative conditions, extenuating issues with the patient’s condition, etc.). Read on […]

How Value-Based Care Affects CRNAs

As the value-based care trend continues, Certified Registered Nurse Anesthetists (CRNAs) will face a variety of challenges. But what do these challenges look like, and how will value-based care affect the future for CRNAs? Read on to learn more. Proper Valuation Currently, the trend is to move away from fee based service and toward bundled […]

Why Is Medical Billing So Hard for My Practice?

For any practice, medical billing is a time-consuming, often confusing process with ample room for error and rules that change regularly. Here, we’ll look at three reasons medical billing is so difficult to keep up with. Reason #1: Ever-Changing Rules One of the main frustrations of medical billing is that the rules always seem to […]

Tips for Increasing Your MIPS Score

Beginning in 2017, MIPS (Merit-based Incentive Payment System) will make up an important part of a provider’s payment from CMS. A higher MIPS score can lead to more revenue for a practice – and a lower MIPS score can lead to penalties that will decrease revenue from CMS. Each year, CMS will set a threshold […]