As a healthcare provider, you know that America’s healthcare system is in flux. Medical billing has become more complex and time-consuming for providers in private practices.
While you need to attend to your patients, you also have to oversee (or take care of) clerical tasks, including billing insurance carriers and your patients. This requires you to be on top of changes in state and federal laws that impact coding and billing practices, which was not something that you covered in medical school.
Lost Revenue
Doctors in the United States leave approximately $125 billion on the table each year due to poor billing practices. Yikes! Are you worried that you might be among them, and that you may have lost a substantial amount of revenue? What’s going on?
There are two big culprits. The first is that an estimated 80% of medical bills contain errors. Some of the most common are:
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A patient’s name is misspelled
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A duplicate bill is created
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Other patent information is inaccurate
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The date of service is incorrect
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Diagnosis (ICD-10) and treatment (CPT) codes are mismatched
All of these errors are easy to fix if spotted as soon as they are made or before a bill is sent, but they are also easy to make and can create bigger problems once the bill is submitted to an insurance carrier: The carrier denies payment on the incorrect bill. A doctor then needs to correct the information, resubmit the bill and wait even longer for payment.
The second culprit is a provider’s failure to stay up-to-date on medical billing rules and regulations. This is an understandable problem: If you run a small practice alone or with a handful of colleagues, you’re (rightly!) focused on giving your patients the best possible care. It can be nearly impossible for you or your office staff to devote the time necessary to stay on top of changing rules and regulations. Training takes up time (and money); updated software and the computer systems required to run it also cost money.
At the same time, you may also be experiencing an influx of new patients who have recently acquired health insurance. Having more patients is, of course, wonderful, but more office visits mean more bills to fill out and submit, which means more opportunities to make innocent mistakes that can later cause headaches.
2019 Medical Coding Changes
On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that went into effect on January 1, 2019. It includes provisions to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS). You can read the entire rule on CMS’s website, but we wanted to draw your attention to four of the provisions that specifically address coding (or will in the near future).
Streamlining Evaluation and Management Payment and Reducing Clinician Burden
CMS is finalizing a number of documentation, coding, and payment changes over several years that will reduce the administrative burden on providers while also improving payment accuracy for office/outpatient evaluation and management (E/M) visits.
For the calendar years (CY) 2019 and 2020, CMS is implementing several documentation policies to alleviate the administrative burden on providers. The current coding and payment structure for E/M office/outpatient visits for these two years will remain unchanged. Practitioners should continue to use either the 1995 or 1997 E/M documentation guidelines to document E/M office/outpatient visits billed to Medicare.
Beginning January 1, 2021, payment, coding, and other documentation changes will be implemented with the aim of further reducing the burden on providers. Payment for E/M office/outpatient visits will be simplified and payment would vary primarily based on attributes that do not require separate, complex documentation.
Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services
Patients are interacting with their providers remotely via remote communication. Are you offering remote services? In an effort to streamline the billing process for these services, CMS is finalizing proposals to pay separately for two newly defined physicians’ services:
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Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012) and
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Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)
CMS is also finalizing policies to pay separately for new coding describing chronic care remote physiologic monitoring (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).
Providers could be paid separately for the brief communication technology-based service when the patient checks in via telephone or other telecommunications device to decide whether an office visit or other service is needed. This would increase efficiency for practitioners and convenience for beneficiaries. The service of remote evaluation of recorded video and/or images submitted by an established patient would allow practitioners to be paid separately for reviewing patient-transmitted photo or video information conducted via pre-recorded “store and forward” video or image technology to assess whether a visit is needed.
Medicare Telehealth Services
For CY 2019, CMS is finalizing its proposals to add the following codes to the list of telehealth services:
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HCPCS codes G0513 and G0514 (Prolonged preventive service(s))
Recognizing Communication Technology-Based and Remote Evaluation Services for Rural Health Clinics and Federally Qualified Health Centers
For CY 2019, CMS finalized payment for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for communication technology-based services and remote evaluation services that are furnished by an RHC or FQHC practitioner when there is no associated billable visit. These services will be payable for medical discussions or remote evaluations of conditions not related to an RHC or FQHC service provided within the previous 7 days or within the next 24 hours or at the soonest available appointment.
RHCs and FQHCs will be able to bill for these services using a newly created RHC/FQHC Virtual Communication Service HCPCS code, G0071, with payment set at the average of the PFS national non-facility payment rates for communication technology-based services and remote evaluation services.
You became a physician because you wanted to help patients, not spend your time caught up in the complex, changing world of medical billing. For nearly 20 years, Heartland Medical Billing & Consulting has been helping providers like you get the payments you are owed from insurance carriers. Contact us today for a free, no-obligation consultation and quote to find out how we can help you!
