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.

Beginning on August 1st, providers are expected to start repaying accelerated Medicare loans received for COVID-19 relief. To ensure payments are recouped, providers won’t receive Medicare reimbursement from their claims until the amount of the loan received is reduced to zero. With more than $100 billion in loans given to providers, we outlined what to expect going forward.

Congress has been negotiating loan forgiveness or looser repayment structures in the next round of the COVID-19 relief bill. To stay updated, subscribe to our newsletters

Sources: CMS

CMS released an updated COVID-19 FAQ on Medicare fee-for-service billing for COVID-19 related services. The policies in the article are effective for the duration of the PHE unless superseded by future legislation. With 41 sections and over 200 questions and answers, we highlighted key information below.

Physician Services

Question: What does the IFC change for physician and practitioner billing?

Question: What are the changes to supervision?

Question: When do the changes on supervision take effect, and for how long?

Question: Can medical groups contracted to provide care at local hospitals bill Medicare for covered professional services at temporary expansion sites.

General Billing Questions

Question: Regarding the use of the condition code “DR” and modifier “CR,” should these codes be used for all billing situations relating to COVID-19 waivers?

For the full list of FAQs on Medicare fee-for-service billing, please click here: CMS COVID-19 FAQ on Medicare fee-for-service billing

Source: CMS

How is AdvantEdge Healthcare Solutions currently positioned?

First off, I would like to mention that although AdvantEdge Healthcare Solutions has not been spared from the economic uncertainty, we are grateful to be in a position with limited exposure.

Having multiple locations and a history of operating with remote employees allowed us to execute swiftly and thoughtfully during these unprecedented times. With continuous adjustments and refinement of our processes, business model, and technology, we have been able to deliver for our clients with the quality and performance they know and deserve. Allowing AdvantEdge not only to address the challenges of the COVID-19 crisis but also to identify opportunities throughout.

With 85%+ of your employees working from home, how has the experience been for AdvantEdge?

The work from home experience has been great, and what made this such a unique experience was our readiness to transition. We have always had 15% – 20% of our workforce remote, and have been using video conferencing as a normal part of our business for many years, making the “COVID” transition much less intrusive and disruptive than it likely is for most of our competitors.

The heavy-lift was increasing our remote workforce from 20% to 85%, which also has implications on how business may be conducted in the future. We are discovering several functions traditionally done in the office that can transition to a remote environment more easily than expected. We do not subscribe to the general theory that productivity decreases when working from home and have proven that to be incorrect. I believe we will see new and unique business models going forward, across many industries.

With AdvantEdge having global operations, what is the situation like for other countries?

Our visibility into the global environment mainly comes from our 2 locations in India. Much of India has implemented and eased restrictions in manners similar to the United States. In India, like the United States, we have seen protocols around office capacity, facemasks and other PPE, social distancing, and the concept of “essential business.”

The mood has been quite positive; through constant contact with our global team, we discuss techniques to handle workloads and how to properly distribute work based on the ebbs and flows of domestic and international COVID based restrictions, allowing us to provide the best service and solution to our clients. Having our own global operations and not relying on outsourcing to third-party BPOs overseas, who have been incredibly affected by this crisis, has helped us tremendously during this time and will continue to do so.

Do you have any tips for navigating these times?

Have an open line of communication with your team, up and down, environmentally and legislatively, to understand how business is being effected from all aspects.

Stay informed, stay engaged, and continue to do what is right. Actionable data, as opposed to anecdotal information, should be a considerable driver of your decisions.  We believe in asking questions early and often and accepting real data, even if it is not what we want to hear. If your team is constructed of amazing individuals, like ours is, you shouldn’t be afraid to lean on them.

You also need to be truthful with yourself relative to the economic effects of this crisis. The healthcare industry felt the financial impact of COVID-19 greatly, and it’s essential to acknowledge and address the reality on the ground, even though it necessitates more difficult [and often unpleasant] decisions and harder work. Build your plan based on financial realities and follow that blueprint to recovery.

What have you learned from this experience?

When the going gets tough, the tough really do get going. I don’t mean this as a self-reflection but a reflection of my team. I am honored to see first-hand how my team responded when faced with this adversity, and I can proudly say their character is unbelievable.

“People are always stronger than you think, and if you have trust in your team, you will be rewarded.”

Throughout all of this, our mission has not changed; improve healthcare outcomes for all people by enabling our clients to have a razor-sharp focus on delivering clinical care within their communities.  Eliminate their distractions by making them our competencies. Be a resource and communicate, communicate, communicate.  It has been a privilege to be on a team so dedicated and focused.

 

HHS announced Friday, July 17, it will deliver an additional $10 billion in federal release dollars to hospitals in new COVID-19 hot spots.

Overview

The American Hospital Association informed HHS that more funding is needed as it does not consider areas in the country experiencing the current surge. To stay up-to-date on HHS Funding and COVID-19 news, subscribe to our newsletter here: AdvantEdge Healthcare Solutions Newsletter

Sources: HHS Gov

If you received PPP funds or HHS Relief Funds in excess of $150,000 (per TIN), you are required to file a quarterly report to HHS. The initial quarterly reports would have been due by July 10, 2020. However, HHS delayed the quarterly reporting requirement.

HHS stated it is still working on a report containing all the necessary information required to comply with the reporting requirements. HHS will notify providers that attested to the funds of due dates and reports needed in a few weeks.

As a reminder, information is changing daily, and we do our best to keep articles current. We encourage everyone to subscribe to our newsletters for updates.

Overview
Where and how to submit the report
What information is needed

The information requested is likely to change once HHS releases its updated guidance.

Going forward

Sources: HHS Gov

President Trump signed the bipartisan Paycheck Protection Flexibility Act (the “Act”), Friday, June 5, 2020. The Act significantly changes the Paycheck Protection Program (“PPP”). Below is a list of the most significant changes made by the Act.

Forgiveness Period
Payroll Requirement
Restore Workforce Level and Wages

New Exceptions to Restoring Workforce
Loan Maturity
Forgiveness Application
The Breakdown

Sources: SBA Government

What if the Paycheck Protection Loan isn’t enough?

Read Now: 5 Questions You Should Be Asking Your Billing Company as a Result of COVID-19

About the Application:

The PPP application contains the following components.

All Borrowers must submit (1) and (2) to their Lender.

Information Needed:

Access the Application Here:

https://home.treasury.gov/system/files/136/3245-0407-SBA-Form-3508-PPP-Forgiveness-Application.pdf

On May 12, 2020, the House proposed a new $3 trillion COVID-19 relief bill. The critical aspects of the bill are outlined below.

The House could vote on the bill as early as Friday, May  15, 2020. Although it is not expected to receive any Republican support, elements of the bill could be included in a compromised, bipartisan relief bill that could emerge over the coming weeks.

1. Go to HRSA Provider Relief Fund Website

https://data.cdc.gov/Administrative/HRSA-Provider-Relief-Fund-General-Allocation/kh8y-3es6

2. Review the Dataset

3. Click “View Data”

One deadline that hasn’t changed due to COVID-19 is the Pre-Publication Open Payments Review and Dispute, set for May 15, 2020. The national disclosure program promotes transparency and accountability regarding financial relationships between providers and healthcare manufactures and group purchasing organizations (GPOs). The information is available to the public through the Open Payments Search Tool (https://openpaymentsdata.cms.gov/.)

The Open Payments Search Tool is used to search payments made by drug and medical device companies to physicians and teaching hospitals, according to CMS. Under the law, CMS must report payments from these companies to physicians in the prior year by June 30.

Practice representative will be required to log in to the CMS Enterprise Portal (https://portal.cms.gov/wps/portal/unauthportal/home/) to review and dispute Open Payments Dataset and access 60+ other CMS healthcare-based applications. For security purposes, CMS locks accounts that have not been accessed for 60 days and deactivates accounts not accessed in 6 months, so the physician may be required to re-register if the physician’s ID and password have expired. Additional instruction is available on the CMS.gov/openpayments portal.

On April 30th, 2020, CMS finalized an expansion of telehealth services allowing a wider range of care to Medicare beneficiaries in their homes. 

  1. Expansion of providers that can conduct telehealth services
    • Physical therapists, occupational therapists, and speech-language pathologists.
  2. Increase Payment of telehealth visits
    • Payments will see an increase from a range of about $14-$41 to about $46-$110 for telephone codes 99441-99443.
    • CMS is broadening the list of services that Medicare would pay for, no including much behavioral health and patient education services.
  3. CMS is waiving the video requirement for certain telephone evaluation and management services. As a result, Medicare beneficiaries will be able to us an audio-only telephone to get these services.
    • 5-10 minute telephone call with no video component, you would bill 99441, and Medicare would pay you the same as 99212.
    • 11-20 minute telephone call, with no video component, you would bill 99213, and Medicare will pay you the equivalent of 99213.
    • 21-30 minute telephone call with no video component, you would bill 99443, and Medicare will you pay you the equivalent of 99214
  4. CMS will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible.
  5. CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics.

Read more: https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

Sources: Center for Medicare & Medicaid Services

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

How much money is available?

Who is administering the program?

What services are eligible for reimbursement?

Healthcare providers who provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursements through the program and will be reimbursed at Medicare rates, subject to available funding.

How do eligible providers receive funding?

To receive funding, providers must attest to the following:

What is the timeline for requesting and receiving reimbursement?

All claims submissions and claims reimbursements must be submitted and remitted electronically.

How are the reimbursement rates determined?

Sources: Health Resources & Services Administration

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

The Centers for Medicare & Medicaid Services (CMS) announced that it is suspending its Accelerated and Advance Payment Program (AAP) to Part B suppliers. With the successful payment of over $100 billion to healthcare providers and suppliers, CMS has started constructing guidelines for repayment along with additional funding.

Sources: Centers for Medicare & Medicaid Services 

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

The Department of Health and Human Services (HHS) updated how it will distribute the remaining $70 billion of the Provider Relief Fund. The framework consists of 6 sections, general allocation, COVID-19 high impact areas, treatment of the uninsured, rural providers, Indian Health Service, and additional allocations.

General Allocation ($50 Billion)

HHS will supplement the initial $30 billion it distributed from the Provider Relief Fund with an additional $20 billion

COVID-19 High Impact Areas ($10 Billion)

$10 Billion will be distributed to hospitals in areas that are highly impacted by the coronavirus. Hospitals can apply for funding by providing four (4) pieces of information via an authentication portal before midnight PT, Thursday, April 23. The portal is live, and hospitals have already been contacted directly to provide the following information:

Treatment of the Uninsured

Although no specific amount is listed, healthcare Providers who provided treatment for uninsured COVID-19 patients on or after February 4, 2020, can request claims reimbursements through the program and will be reimbursed at Medicare rates, subject to available funding.

Rural Providers ($10 Billion)

$10 Billion will be distributed to rural hospitals and rural health clinics (RHC).

Indian Health Service ($400 Million)

$400 million will be allocated for the Indian Health Service facilities, distributed on the basis of operation expenses

Additional Allocations

There are some providers who will receive further, separate funding as followed:

For more information on the Provider Relief Fund please visit HHS website CARES Act Provider Relief Fund

After a couple of weeks of negotiations, the House & Senate reached a deal on a $484 billion COVID-19 relief package, adding funding and enhancing programs from the CARES Act. The agreement segments into four (4) sections: $320 billion for small businesses, $75 billion for hospitals, $60 billion for the SBA disaster loan program, and $25 billion for disease testing.

$320 billion for small businesses (66%)

The SBA stopped accepting new applications under the Paycheck Protection Program until funds were replenished. Banks anticipate that funding will run out in less than two (2) days. If you still need to apply for your Paycheck Protection Program Loan utilize our free resource to get started: Paycheck Protection Program – CARES Act

$75 billion for hospitals and healthcare providers (15%)
$60 billion for the SBA Disaster Loans Program (12%)
$25 billion for disease testing (5%)

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

As states and localities begin to stabilize, CMS recognizes the importance to restart care that is currently being postponed, such as surgeries and procedures, chronic disease care, and preventive care. As states and regions pass the Gating Criteria (symptoms, cases, and hospitals) and proceed to Phase 1, CMS created recommendations aimed to give healthcare facilities some flexibility in providing essential non-COVID-19 care to patients without symptoms of COVID-19 in regions with a low incidence.

General Considerations

Personal Protective Equipment

Workforce Availability

Facility Considerations

Sanitation Protocols

Supplies

Test Capacity

Sources: Centers for Medicare & Medicaid Services (CMS)

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

With the announcement on April 10, 2020, that $30 billion has been distributed to eligible providers throughout the healthcare system, the focus of physician practices shifted from receiving the funds to the signing the attestation within the next 30 days.

The attestation should be signed whether you plan to accept or reject the funds. If you are still deciding on your decision, we encourage you to utilize our free resources HHS Provides Guidance on Relief Funds and CARES Act Provider Relief Fund as restrictions and reporting requirements are required.

CARES Act Provider Relief Fund Payment Attestation Portal

Below are 5 critical questions you should be asking your billing company, as the answers will help you determine the financial viability of your organization during this crisis and potentially beyond.

  1. Is my billing company communicating with me regularly and updating me on their status?
    • Silence or lack of regular communication during this crisis is a signal for concern.
    • If they are not reaching out to you with answers to these and other questions they may either be overwhelmed or not comfortable sharing information on their status.
    • In either case, if they are not proactively communicating with you, you should be reaching out to them.
  2. Is my billing company specialty specific?
    • Certain specialties have been hit excessively hard and reduction in volume will continue for several months
      • Most specialties heavily dependent on elective procedures (i.e. Anesthesia, Surgery, Plastics, and ASCs) have experienced a significant reduction in volume.
      • If your billing company specializes in a specific specialty or healthcare sector, now is the time to proactively communicate with them about how they are reacting to this dramatic reduction in cash flow – Are they financially positioned to continue to be “open for business”?
  1. Is their staff still working (in the office or remotely)?
    • Notwithstanding the reduction in volume, some of your old A/R will now be a source of interim cash-flow while your practice activity is reduced. You still need to make sure the billing company is “open for business”
    • If they have laid off staff, how do they intend to ensure that as volume begins to increase, they will be able to ramp back up to meet those needs? Don’t forget; they will need to hire back and pay employees before they generate payments on your behalf and cash flow for their company.  Are they financially positioned to achieve this?
    • If they have staff working remotely, what security provisions have been implemented to ensure they are operating in a HIPAA compliant environment?
  2. Is the processing done in a geographically distributed model?
    • Billing companies with multiple locations may be in a better position to redistribute work to unaffected (or less affected) offices if one or more becomes a COVID-19 “hot spot.
    • Some states with Shelter at home mandates will “open” before others. Therefore, having multiple locations increases the likelihood that your work can be processed in a normal state sooner and reduces the risk of the prolonged impact of the virus on your cash-flow prolonged shutdowns will lead to gaps in claims processing resulting in delayed payments and significant cash-flow issues.
    • What is your billing company’s disaster recovery or business continuity plan?
  3. Does my billing company outsource work to a 3rd party?
    • If so, what controls (and visibility) do you/they have over the 3rd party to which they outsource your claims processing?
    • How would that third party answer the questions above and how much influence over their actions/plans does your billing company have?
    • Shutdowns are in place in many countries where these 3rd parties operate. You should know whether this is happening and how your vendor is responding.

If you find your current in-house process or billing company may be vulnerable in any one of these areas, it may be time to look for alternatives or a least a contingency plan (Plan B).   Having a Plan B doesn’t mean you’ve given up; it means you’re strategic and realistic about current events and their potential impact on the viability and success of your organization.

Adapting to change, such as major healthcare disruptions by COVID-19, is essential.  Groups and healthcare organizations need to continue to monitor the situation, identify acute threats and modify current processes and business relationships to address areas of their business that are susceptible and could be negatively impacted by acute and potentially chronic threats to their business.

If AdvantEdge can be of resource to your organization, feel free to contact us at [email protected]

 

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

The Department of Health & Human Services (HHS) has provided clarification regarding the Terms and Conditions when retaining the Relief Fund payments under the CARES Act. In the update below, HHS highlights two key guidelines focused on the concern that the provider must be currently treating actual or possible COVID-19 patients.

  1. HHS now states, “care does not have to be specific to treating CVOID-19. HHS broadly views every patient as a possible case of COVID-19.” In other words, if you treated any patient, you treated a possible case of COVID-19, and you can breathe a sigh of relief knowing that you treated actual of possible COVID-19 patients.
  2. HHS removed the requirement that you must be “currently” treating possible COVID-19 patients, such that if you “ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds.”

Sources: The Department of Health & Human Services: CARES Act Provider Relief Fund

 

Who is AdvantEdge Healthcare Solutions?

AdvantEdge Healthcare Solutions is a national, top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical practices for over 50 years.

On March 27, 2020, the President of the United States signed the CARES Act that included $100 billion in relief funds to hospitals and healthcare providers, leading the COVID-19 response. The funding will be used to support healthcare-related expenses or lost revenue attribution to COVID-19 and ensure uninsured Americans can get testing and treatment.

With the announcement that $30 billion will be distributed April 10, 2020, to eligible providers throughout the healthcare system, the question is asked, who is eligible, what action is needed from eligible providers, how is payment distribution determined, how does this affect different types of providers?

Key Note: These are payments, not loans, and will not need to be repaid.

Eligibility

Process for an Eligible Provider

Payment Distribution

Different Type of Providers

Please visit https://www.hhs.gov/provider-relief/index.html for more information about the CARES Act Provider Relief Fund.

Sources: The Department of Health & Human Services: CARES Act Provider Relief Fund

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