Revenue Cycle Management

AdvantEdge solutions include medical billing, certified coding, analytics,
practice management, compliance and ClientFirstTM service.

Revenue Cycle Management

AdvantEdge solutions include medical billing, certified coding, analytics, practice management, compliance and ClientFirstTM service.

Making sure your patients are given the time and attention they deserve is among the top priorities for providers in every specialty – and running an efficient in-house billing department can be a job by itself. This is one of the main reasons why outsourcing your medical billing may make sense from both logistical and financial standpoints.

Here are five other reasons why outsourcing your medical billing can optimize your practice on numerous fronts.

1. More Money Faster: It can be a challenge for your in-house billing team to have the time and expertise to audit and analyze the entire RCM process to ensure optimal financial outcomes. Dealing with a top-tier medical billing company empowers you with access to certified coders in all specialties; sophisticated and specialized technology; and a team of trained specialists who can help you solve your billing challenges. The bottom line: More money, faster!

2. Minimize Overhead Expenses: Finding dedicated team members and providing them with the necessary training can be a daunting task. It is also a costly endeavor, especially when considering potentially high turnover rates. Taking care of all the details of running an in-house medical billing department is a tall order, as well as a considerable investment. If not given the proper attention, providers could be leaving money on the table.

3. Compliance & Guideline Adherence: It’s important for everyone on your medical billing team to understand coding rules; complex insurer guidelines and various specialty rules and billing regulations. To complicate matters even further, rules and regulations are subject to change. A leading medical billing company stays on top of regulations and compliance issues – and has the resources to monitor ever-evolving industry changes.

4. Focus On What Matters Most: Keeping the focus on your patients is essential to optimizing their health. By outsourcing your medical billing needs, you are well positioned to do what you do best – help your patients lead their best possible lives. That is the foundation of what you do, so it’s important to keep the spotlight on your primary mission. Your patients will thank you for it! 

5. Details and Data: In today’s landscape, data is key. That’s why it’s essential for a billing company to have the capability to accurately extract financial data from your practice management system and proactively identify areas that may require improvement. This allows you to devise efficient and effective plans of actions, as needed. Doing so will empower your practice with the necessary data to make timely and effective business decisions moving forward. 

Get the Edge

At AdvantEdge our highly trained and experienced staff understands how precious time is for providers and recognizes that every practice has unique and specific needs in the way of medical billing. Our hands-on ClientFirst billing approach supported by our highly reliable, secure, and proprietary technology optimizes billing workflows to meet the specific needs of every one of our valued clients. 

Keep up to date on AdvantEdge and our medical billing initiatives by visiting our LinkedIn page or visit www.ahsrcm.com.

 

In our first employee spotlight of 2022, we talked with Marie Franklin on family, work-life, and what got her interested in healthcare coding.

“Coding is like a puzzle. And coders tend to be analytical. We start by looking at what needs to be done from a high-level structural perspective. We then identify what we’re coding and pull together all the clinical information with the necessary elements to code that service. Coding is super exciting because it paints a picture of what providers have done,” says Marie Franklin, MBA, CPC, CPMA National Director of Coding, Education & Audit. 

Live with Passion

Although she has always had a passion for healthcare, Marie didn’t initially set her sights on a coding career. “My mother insisted I become a nurse. She’d say: ‘You’re going toemployee spotlight - Marie Franklin become a nurse! You’re going to become a nurse!’ When I started my training, I quickly realized I was too emotional and may not have the bedside manner necessary. However, I loved healthcare. Then, I crossed paths with a coder at my job and we collaborated on some charts. I loved it and had a knack for it. The rest is history,” says Marie. 

Marie, who is the youngest of, yes, 11 children (her eldest sister is 22 years her senior), wanted to change her path through education.  Says Marie: “I’ve always wanted to change the legacy of my family to be more career oriented. For that, I knew I needed credentials on top of my work experience, so I went to school while working full-time and raising a family. It took a while, but I finally earned my MBA. Talk about blood, sweat and tears! In the end, it was a great experience – and a challenge that helped me advance in my career and in my life.”

Certified Seasoned Coders

Marie appreciates the fact that her team is comprised of devoted coders who stay the course, even when confronted with challenging cases. “Among other advantages, what makes my team unique is that we only hire seasoned, certified coders, many of whom have been coding for 25 years or more (and in many cases have been with the company for 25 years) and can code just about anything at this point. I’m a big believer in collaboration and brainstorming because it’s important to see situations from every angle – and everyone’s input counts.”

Having an open-door policy with her team helps ensure that every AdvantEdge client gets the utmost attention. “I lean on my team, and they can take the lead because of the excellent connectivity and synergy among all of us. They understand our audience. When confronted with challenging cases, we jump on Zoom and figure it out together. Our ‘Whatever It Takes’ philosophy gets the job done.”

Marie started as an AdvantEdge Coding Manager in 2016, was promoted to Assistant Director of Coding after eight months and filled the shoes of the National Director of Coding, Education & Audit a year later. She has held the later position for nearly four years. Most AdvantEdge coders and four auditors report directly to Marie. 

Stay tuned for our next employee spotlight and other company and industry trends by visiting our LinkedIn page, or get in touch with an AdvantEdge expert now.

Medical_Billing_News

BILLING PERFORMANCE THAT MATTERS

 

2022 Healthcare Predictions

Will 2021’s big fluctuations in patient volume continue in 2022? Can we retain/hire enough staff in 2020? How will Omicron affect us? How can we deal with cost increases? We offer our predictions for these and other key questions and describe steps practice leaders can take to be successful in an uncertain, “perfect storm” 2022. Read More


Healthcare Roundup

Healthcare | 3 min read

2022 Healthcare Workforce Predictions + Essential Actions to Take

The labor shortage has been felt throughout the healthcare industry in 2021. Learn how shortages, burnout and fundamental changes will impact 2022 – and what you can do to prepare. Read More


Cybersecurity | 3 min read

2022 Healthcare Cybersecurity Predictions + 3 Steps to Take Now

Serious 2021 security breaches in healthcare remind us how important cybersecurity is. We describe what is needed in an effective 2022 cybersecurity action plan that also improves HIPAA compliance. Read More


Surprise Billing | 3 min read

2022 Surprise Billing Predictions

Our previous No Surprises article described actions all practices need to take starting Jan 1. Now we focus on how “No Surprises” has the real potential to reduce your in-network fees. Read More


Top Blog Posts | 3 min read

Top 5 Medical Billing Posts of 2021

The No Surprises Act requires action by every practice by Jan. 1! While OON billing is affected most, notice requirements and cost estimates for self-pay apply to all. Learn what “No Surprises” means for your practice. Read More


In-house vs Medical Billing Company

In a Covid/post-Covid world, does in-house billing still work for your practice. Download our white paper to compare performance, costs, and security.

 

Practice Review Kit

 

 

 

Covid-19 vaccine shot reimbursement rates have been increased by CMS.

For COVID-19 vaccines administered on or after March 15, 2021, and for additional doses of the COVID-19 vaccine administered on or after August 12, 2021, the Medicare payment rates for administering the vaccines are:
• Approximately $40 for single-dose vaccines
• For vaccines requiring multiple doses, approximately $40 for each dose in the series, including any additional doses

According to CMS, “These rates reflect updated information about the costs involved in administering the COVID-19 vaccine for different types of providers and suppliers and the additional resources you need to safely and appropriately administer the vaccine.”

For comparison, Medicare payment rates for vaccines administered before March 15 are:
• $28.39 for single-dose vaccines
• For vaccines requiring a series of 2 or more doses
o $16.94 for the initial dose(s) in the series
o $28.39 for the final dose in the series

Important note: CMS geographically adjusts the above rates based on where you administer the vaccine.

Additional payment for home-administered vaccine

Medicare’s additional payment amount for administering the COVID-19 vaccine in the home for certain Medicare patients is $35 per dose. This is in addition to the standard administration amount shown above, for a total of approximately $75.

Providers do not have to certify that the patient is homebound, but they must document in the patient’s medical record their clinical status or the barriers they face to getting the vaccine outside the home.

 

Resources
Medicare COVID-19 Vaccine Shot Payment
FDA Covid Booster Announcement

If a provider received a COVID-19 accelerated or advance payment, CMS is starting to recoup any outstanding balance from the provider’s Medicare payments.    This process began on March 30, 2021, but generally starts on the one-year anniversary of when the provider received the first accelerated or advanced payment.

CMS will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one year anniversary of issuing the first payment.   The recoupment will appear as an adjustment in the Provider-Level Balance (PLB) section of the remittance advice.

The terms for repayment are as follows:

Provider and Supplier Assistance: For questions related to the Accelerated and Advance Payment Program, CMS has established COVID-19 hotlines at each MAC that are operational Monday – Friday to assist you with accelerated or advance payment concerns. You can contact the MAC that services your geographic area. To locate your designated MAC, see this CMS Fact Sheet or visit https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.

More details are available in the CMS ACCELERATED AND ADVANCE PAYMENT REPAYMENT & RECOVERY FREQUENTLY ASKED QUESTIONS.

 

Repayment and Reconciliation Terminology:

Extended Repayment Schedule (ERS) is a statutorily authorized debt installment payment schedule, which allows a provider or supplier experiencing financial hardship to pay debts over the course of three years. This can be extended to as many as five years, where certain extreme hardship criteria are met. Providers and suppliers are able to request ERSs after demand letters are issued. Providers and suppliers should contact their MAC for information on how to request an ERS.

Recoupment means the recovery by Medicare of any outstanding Medicare debt by reducing present or future Medicare payments and applying the amount withheld to the indebtedness (42 CFR 405.370). For the purposes of recovering accelerated and advance payments, recoupment means the recovery by Medicare of any outstanding Medicare accelerated and advance payment loans by reducing present or future Medicare payments and applying the amount withheld to the outstanding loan balance.

If a provider received a COVID-19 accelerated or advance payment, CMS is starting to recoup any outstanding balance from the provider’s Medicare payments. This process began on March 30, 2021, but generally starts on the one-year anniversary of when the provider received the first accelerated or advanced payment.

CMS will show the recoupment on the remittance advices issued for Medicare Part A and B claims processed after the one year anniversary of issuing the first payment. The recoupment will appear as an adjustment in the Provider-Level Balance (PLB) section of the remittance advice.

The terms for repayment are as follows:

Provider and Supplier Assistance: For questions related to the Accelerated and Advance Payment Program, CMS has established COVID-19 hotlines at each MAC that are operational Monday – Friday to assist you with accelerated or advance payment concerns. You can contact the MAC that services your geographic area. To locate your designated MAC, see this CMS Fact Sheet or visit https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.

More details are available in the CMS ACCELERATED AND ADVANCE PAYMENT REPAYMENT & RECOVERY
FREQUENTLY ASKED QUESTIONS.

Repayment and Reconciliation Terminology:
Extended Repayment Schedule (ERS) is a statutorily authorized debt installment payment schedule, which allows a provider or supplier experiencing financial hardship to pay debts over the course of three years. This can be extended to as many as five years, where certain extreme hardship criteria are met. Providers and suppliers are able to request ERSs after demand letters are issued. Providers and suppliers should contact their MAC for information on how to request an ERS.

Recoupment means the recovery by Medicare of any outstanding Medicare debt by reducing present or future Medicare payments and applying the amount withheld to the indebtedness (42 CFR 405.370). For the purposes of recovering accelerated and advance payments, recoupment means the recovery by Medicare of any outstanding Medicare accelerated and advance payment loans by reducing present or future Medicare payments and applying the amount withheld to the outstanding loan balance.

Since the decision was finalized to re-open special enrollment, the United States and President Biden have seen over 200,000 people sign up. With the coronavirus response bill being passed, financial assistance for premiums will become considerably more generous, allowing more middle-class households to qualify. It is predicted to see a spike in additional signups.

With only 36 states served by the federal Healthcare.go insurance market, it is estimated to see another spike in enrollment once states running their insurance website are factored in. As applications run through May 15 and a $50 million advertising budget to promote signup, President Biden hopes to see significant progress by mid-April.

The importance of continue growth in special enrollment is the drive towards a new form of Healthcare in the United States. It will be vital to look closely at what is to come after May 15 to Healthcare as a whole.

As vaccines become more and more available, CMS has released a payment allowance and effective dates cheat sheet to assist providers, states and insurers prepare to administer COVID-19 vaccines swiftly. Below is a quick overview of the CMS cheat sheet.

CPT Code – 91300

CPT Code – 0001A

CPT Code – 0002A

CPT Code – 91301

CPT Code – 0011A

CPT Code – 0012A

CPT Code – 91302

CPT Code – 0021A

CPT Code – 0022A

CPT Code – 91303

CPT Code – 0031A

For a full breakdown provided by CMS please visit cms.gov page here: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

 

Sources: CMS

As of March 15, 2021, CMS has updated the Medicare payment rates for COVID-19 vaccine administration. The new Medicare payment rate for administering a COVID-19 vaccine will be approximately $40 to administer each vaccine dose.

For any COVID-19 vaccine administration services furnished before March 15, 2021, the Medicare payment rate for a single-dose vaccine or the final dose in a series is $28.39. ($16.94 for the first dose and $28.39 for the final dose)

To stay updated on billing codes, payment allowances, and effective dates, use CMS free resource here: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies. 

 

Sources: CMS

The Centers for Medicare & Medicaid released new information on how to bill for COVID-19 vaccine shots. Below is a breakdown of how to make sure you are billing correctly.

Billing for COVID-19
How to Submit Institutional Claims

Five shots must be administered simultaneously to use institutional claims unless the institution is an inpatient center. Below are valid types of bills for roster billing.

When it is time to submit a paper claim, first CMS-1450 (UB-04) and then submit roster form for patients (Contact your MAC for this form).

How to submit professional claim

For electronic claims, use PC ACE billing software to submit directly to your MAC. 

First, for paper claims, fill out the health insurance claim form and then submit the roster form for patients (Contact your MAC for this form).

How to submit a centralized bill

For individuals enrolls as a centralized biller, you can submit a professional claim to Novitas, not dependent on who administrated the shots, although you must operate in at least 3 MAC jurisdictions.

Sources: CMS

While COVID-19 vaccines are reportedly becoming more widely available to the general public, there’s no denying that the effects of the virus we’ve been dealing with for more than a year will continue to be felt across every industry, especially within healthcare. Calling for physicians, hospitals, and medical billing groups to fundamentally pivot their operations to deal with COVID-19. 

2021 is looking to be a year of much-needed recovery, but the full impact from COVID-19 will continue to evolve. To provide some guidance and direction on the healthcare industry for the remainder of 2021, we talked to the executive leadership team at AdvantEdge to provide insight into the impact of COVID-19 and what it means going forward. Based on thoughts provided by David Langsam, President & CEO, and Director of AdvantEdge Healthcare Solutions, below are the top 3 trends to watch out for:

1. Payer Mix

With unemployment rates skyrocketing, so did providers’ 2020 payer mix. As more payment responsibility falls to patients who went from insured to uninsured, we need to reflect and evaluate how we approach collections and patient satisfaction; it’s important to treat patients with the same client-first approach as companies do with their clients.

“The medical billing industry will need to treat patients with compassion, empathy, and a solution-based approach that enables them to meet their financial responsibility with dignity and satisfaction…When evaluating current operations to ensure the patient experience achieves these objectives, it’s important to take an in-depth look at your existing processes, vendors, and partnerships.

2. Encounter Volume

As the world continues to slowly get back to normal, look for encounter volumes to gradually increase. Even with telehealth services, almost 70% of physicians still provided fewer total visits (in-person and telehealth). It won’t be until restrictions ease, and social normalcy begins that these volumes will return to normal. If you are reassessing the capabilities and performance of your medical billing departments or vendors,

“…take a close look at billing performance from May through November, when elective surgeries were made available again, and encounter volumes were on the rise. This will help you validate that your operations or current billing partner are up to the task.” 

3. Telehealth 

Telehealth services exploded in 2020 due to advancements in technology, such as Zoom and other video conferencing platforms, and the need to continue interacting with healthcare professionals. Similar to remote work capabilities, expect telehealth services to continue to grow as patients and healthcare professionals witnessed the value of this offering. Many appointments that don’t require direct interaction, such as follow-up visits and initial consults, will continue to be leveraged by video conferencing platforms.

“As telehealth services grow, it will be more important that your staff or billing partner understand the nuances of telehealth coding and billing. Continue to have discussions with your billing department or medical billing partner on ongoing changes in telehealth, making sure you (or their) process and procedures are current.”

To learn more about medical billing and healthcare trends in 2021, we invite you to download our recent report on the state of healthcare, which provides more details on the top 3 trends and dives into topics such as remote staff, physician revenue loss, and regulations and compliance. To learn more, download our complimentary report: “Evaluating the Pandemic Impact on Medical Billing.

As COVID-19 starts to slow down, the congressional focus has shifted to permanently expanding telehealth access, with the discussion starting around payment, timing, and which flexibilities should be retained after the COVID-19 public health emergency expires. As conversations continue, we highlighted key information to help predict telehealth in 2021.

The main focus on Capitol Hill is the COVID-19 relief package, but with the temporary fee-for-service Medicare set to expire in April, we should expect more traction in late March.

The Department of Health and Human Services (HHS) has delayed the February 15th reporting deadline for Provide Relief Funding (PRF), with a new deadline to be decided. With many questions left unanswered, we outlined key information HHS has released to date.

Why is the reporting deadline delayed?
Is there anything PRF recipients need to do?
Does this affect the deadline for the second report due on July 31?
When can you expect an update?

As the $1.9 trillion COVID-19 relief package makes its way to the Senate for voting, AdvantEdge Healthcare Solutions highlighted key sections of the bill that will directly impact the healthcare industry.

Vaccines and Testing
Medicaid

As President Biden continues to reform the United States’ healthcare, Chiquita Brooks-LaSure looks to be a part of the plan. The Biden administration officially nominated Chiquita Brooks-LaSure as CMS Administrator Friday, February 19, 2021.

Chiquita Brooks-LaSure experience includes over 20 years in health policy, heading operations, such as guiding the ACA through passage and implementation. Brooks-LaSure also carries extensive knowledge and experience from her time on the Obama administration.

Brooks-LaSure will have a lot on her plate; from her past work and current positions, here is what we can expect if she received the position.

2021 CPT Medical Coding Updates:

Source: AMA

With Joe Biden set to become the 46th President of the United States, Wednesday, January 20th, the proposed $1.9 Trillion stimulus bill, The American Rescue Plan, will be a top priority for Biden and his team to finalize. We highlighted key information below.

Vaccination
Stimulus Checks
Unemployment
Small Business
Renters
Child Care Providers
Child Tax Credit
Frontline Workers
Minimum Wage

The Trump Administration has finalized their Phase 3 Provider Relief Funding (PRF) amounts that are a total of $24.5 billion, up from the original $20 billion amount, to over 70,000 providers, through the Human Resources and Services Administration (HRSA). 90% of each applicant’s reported lost revenues and net change in expenses in the first half of the 2020 year, according to HHS Secretary Alex Azar. The payment period of the funding will be from December 2020 through January 2021.

“With the Provider Relief Fund, we’ve been able to support providers hardest hit by COVID-19, including safety-net hospitals, rural providers, and nursing homes, helping ensure they can continue serving their communities during and beyond the pandemic,” states Azar.

HHS implemented versatility within the PRF program to accommodate the constantly changing landscape of the pandemic. For example, applicants that have not been given a baseline payment of 2% of yearly revenue from patient care were now eligible to do so. Also, funding was not just limited to new applicants of the program, those that were already eligible for original program funding amounts were invited to apply for additional funding for this round. Nursing home providers will be receiving an additional $1.10 billion in funding while ambulance providers will be receiving $1.48 billion.

The additional $4 billion added to the updated total of $24.5 billion in funding was added after the HHS quickly realized that the original $20 million budget would not satisfy the applicants’ submissions of lost revenues and net changes in expenses for Phase 3 of the program. The additional funding will distribute up to 88% of providers’ total reported losses. However, 35,000+ applicants will not receive additional payments because they have already received funds that are or are above this 88% or have not experienced a change in revenue or net expenses due to the pandemic.

Going forward, the PRF program will be still prioritizing ways to equip providers’ employees with PPE and expanding capacity to continually fight against Covid-19.

Customer service is an integral part of a customers’ experience and lasting reputation with the company’s brand. One does not only have to consider the one customer you are speaking with at the time, but also the next five people that will hear about his or her review afterward through word-of-mouth or an online review written about your company. That is why it is essential that customer service is considered and trained accordingly. 

It is particularly important to uphold quality customer service within the healthcare industry considering the confusing and frustrating path that is navigating their hospital bill. At AdvantEdge Healthcare Solutions, we carefully consider this through empathy and our “First Call Resolution” method. To get a deeper look into AdvantEdge’s approach to customer service, we asked some of our leading team members what their thoughts are regarding the subject: 

Barbara Lewis – Director, People Services at AdvantEdge Healthcare Solutions

Lyne Green – VP of Operations at AdvantEdge Healthcare Solutions

Laurie Krachenfels – Regional Director of Operations at AdvantEdge Healthcare Solutions

What makes AdvantEdge’s Customer Service Department work well?  What is unique about customer service departments in medical billing?

Can you provide more detail?

How do you measure and celebrate excellence?

On December 28, 2020, Congress passed a new spending bill, The Consolidated Appropriations Act of 2021, signed by President Trump, to reduce the cuts imposed by the Medicare Physicians Fee Schedule for 2021. The Act also provides new information on the temporary suspension of Medicare sequestration, surprise billing, and three-year delay of HCPCS add-on code G2211. 

Increase in Conversion Factor and Delay of Payment for HCPCS add-on code G2211  

Extension of Temporary Suspension of Medicare Sequestration

No Surprises Act

Key note: If the facility is participating and the provider is OoN, and the provider is not hospital-based, and the service is not an emergency; the OoN provider can balance bill the patient if the following notice and consent requirements are met:

[1] David Vaughn, Esq., Vaughn and Associates, LLC, Baton Rouge, LA

AdvantEdge
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