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How Healthcare Revenue Cycle Consulting Services Help Maintain Compliance

With today’s complex regulatory requirements, compliance is more important than ever for healthcare organizations.
That’s why leading healthcare organizations hire healthcare revenue cycle consulting services to help maintain compliance.
Today, we’re explaining how healthcare revenue cycle consulting services help organizations maintain compliance at every level of a healthcare organization.

What is Healthcare Compliance?

Compliance means meeting or exceeding the standards set for legal, ethical, and professional operation of healthcare organizations.
Any organization handling electronic protected health information (ePHI) is required to maintain compliance by implementing appropriate processes, policies, and procedures.

Consulting Services Help Maintain Compliance in 7 Targeted Areas

The Department of Health and Human Services (HHS) and the Office of the Inspector General (OIG) have identified seven areas where healthcare organizations should focus for compliance. By focusing on these areas today, organizations can avoid healthcare issues in the future.
An effective healthcare compliance audit program must, at the very least, address the following seven areas:
• Development, distribution, and implementation of written standards of conduct and written policies and procedures that explain the organization’s commitment to meeting and exceeding legal and ethical standards of compliance
• Designation of a chief compliance officer and other appropriate committees and individuals dedicated to maintaining compliance at every level
• Development and delivery of effective employee education programs
• Development and maintenance of effective lines of communication for reporting of compliance concerns
• Development and implementation of an effective response system or discipline system when compliance issues are identified with specific employees
• Development of internal auditing and monitoring system to observe and maintain compliance
• Creation of appropriate response system to quickly fix detected compliance issues
Consulting companies – including HMI Corp. – can help organizations develop or improve all seven of these areas.

How Healthcare Organization Compliance Assessments Work

A consulting company can perform a compliance assessment on your organization. An assessment determines where your strengths and weaknesses lie. Then, experts work to correct those weaknesses and improve those strengths.
During an assessment, experts will answer all of the following questions:
• How does the healthcare organization collect, receive, store, and transfer data?
• What does the current security system cover?
• What does the current security system not cover?
• What potential threats or vulnerabilities could disrupt the organization?
• What are the chances of a threat being carried out against the organization?
• How much would an attack cost if an attack were to occur?

Healthcare Organizations Are Required to Conduct Assessments Annually

Compliance assessments are not optional for healthcare organizations. The HIPAA Privacy Rule requires healthcare organizations to undergo assessments like the one above annually.
Healthcare organizations must collect this information, then compile a report on their findings.

Common Compliance Changes Required for Healthcare Organizations

Healthcare organizations have different compliance needs. Some of the most common areas of improvement required for healthcare organizations, however, include:
Standardizing Policies and Procedures: Healthcare organizations may have a mess of policies and procedures for different departments. This makes things difficult for staff. It’s more than just a compliance issue – it can also be an efficiency issue. Standardizing password management, PHI storage and usage, encryption, privacy, and other elements can vastly improve compliance.
Reviewing Access Control Clearance: Compliant healthcare organizations carefully limit access to sensitive files and patient data on the network. An assessment might recommend limiting access to data only to those who require data to do their jobs, for example.
Contract Coding and Medical Coding Issues: Liability issues related to coding can be significant. Coding and reimbursement are so complex and vital that healthcare organizations devote significant resources to doing it correctly. Unfortunately, many healthcare organizations still expose themselves to liability with various medical coding issues.
Claims Reviews: Many compliance issues involve problematic claims. This type of misconduct can be prosecuted civilly under the False Claims Act or under a range of criminal statutes – including healthcare fraud. Claims fraud cases are common targets for regulators and prosecutors, which is why it’s particularly important to review claims issues for compliance.

Good Compliance Saves Organizations

Compliance is crucial in any industry, but it’s particularly important in the healthcare space.
Every organization thinks they have good compliance standards until it’s too late.
Order a compliance assessment from HMI Corp today and determine exactly how and where your organization can improve all aspects of compliance.

The Best Strategies Small, Rural Hospitals Are Using to Survive

Millions of Americans depend on small, rural hospitals for healthcare. Unfortunately, due to several challenges, many of these small hospitals are struggling to survive.
Between 2010 and 2014, 47 rural hospitals across America stopped providing inpatient services, according to a report by the Rural Health Research Gateway. An additional 673 rural hospitals are at-risk for closure.
Today’s climate may seem daunting for small, rural hospitals – but it doesn’t have to be. Today, we’re highlighting some of the best strategies today’s small, rural hospitals are using to survive.

Conduct Top-to-Bottom Financial Analyses, Audits, and Assessments

Good hospital management starts with good data. One of the smartest things a small hospital can do is to conduct a 360-degree financial analysis using at least five years’ worth of data.
An objective third party – like HMI LLC or other medical consulting organizations – can pore over the data to issue concrete recommendations. You can see how your hospital compares to other organizations with a similar size and market.
Financial audits can reveal surprising problems with smaller, rural hospitals, including:
• Revenue cycle issues
• Denials management issues
• Longer lengths of stays compared to other hospitals
• Outdated systems still in use
• Medical coding and compliance issues
• Billing and purchasing problems
A top-to-bottom financial analysis can show a small, rural hospital what they’re billing and buying and how the hospital is doing it. It can identify key problems at every stage of the organization, including areas of missed revenue expectations, the best areas of potential improvement, and actionable changes the organization can implement today.

Implement Better Debt Management

Many of America’s small, rural hospitals are at risk because of outstanding debts. If the hospital can learn to effectively manage this debt, it can be the difference between surviving and shutting down.
Debt management strategies vary between organizations but can include all of the following:
Judicial Reorganization: Judicial reorganization is a bankruptcy handled through the court. There are pros and cons to this type of debt management. Reorganizations can trigger default on bonds, making them due immediately, for example. Bankruptcy can also lead to the loss of revenue streams from CMS and other payors. However, for some small hospitals in certain situations, it’s the best path forward.
Debt Structure Refinancing: Refinancing hospital debt may be a smart option when interest rates are low or a hospital’s credit rating improves. However, it’s not the right choice for all hospitals in all situations.
Non-Judicial Reorganization: With non-judicial reorganization, hospitals restructure their debt and payment plans with debtors outside of the court. Good reorganization can create additional time for the small hospital without resorting to bankruptcy.
Selling: Putting a hospital on the market is one option for smaller hospitals overwhelmed by debt. This option can be particularly challenging, as larger systems will naturally absorb the patient flow after a hospital closes even if they don’t buy the facility.

Identify New Revenue Streams

Generating new revenue is a great way to revitalize any business. With smaller hospitals, it’s easier said than done. However, small hospitals that want to become financially sustainable will need to develop new revenue sources – especially the hospitals that cannot cut or refinance their way to a solution.
One of the most common ways for small, rural hospitals to create new revenue is by teaming up with outpatient healthcare providers. A smaller hospital can make its facility available to the group and setup a revenue sharing program.
Many hospitals have successfully setup behavior health programs, for example, because Medicare and Medicaid now cover behavioral health services. It’s a new revenue stream that also provides a valuable service to the community.

Increase Residency Programs and Partnerships

There are approximately 80 primary care physicians (PCPs) per 100,000 people in the United States, although there are only 68 PCPs per 100,000 people in rural areas.
With that in mind, many smaller hospitals have achieved success by increasing residency programs and partnerships. It’s not just about training new doctors: it’s about keeping them long-term.
Here’s how one report explained the benefits of better rural residency programs:
“Medical residents who train in rural settings are two to three times more likely to practice in a rural area; especially those who participate in rural training tracks.”

Implement Telehealth Services

Smaller, rural hospitals may not have specialists on-site for every patient’s needs. That’s why a growing number of smaller hospitals are using telehealth to fill the gaps.
Telehealth can fill the gaps in subspecialist care, eliminating the need for patients to travel long distances to see a qualified healthcare provider.
Telepharmacy is one growing area of telehealth. Telepharmacy gives patients the convenience of remote drug therapy monitoring and authorization for prescriptions. Patients can also remotely access pharmacy counseling to maintain compliance with prescriptions.
There’s also telepsychiatry, which provides behavioral health services to patients who would otherwise have to drive hours to see a mental health provider.

Build Hospital Loyalty

Most people prefer to shop local. Just like a small business, a small hospital must build brand loyalty with the community.
By strengthening ties with consumers, physicians, and the local community, hospitals can keep their brand in the front of patient’s minds. Create a hospital-branded mobile app, for example, or sponsor local events.

Eliminate Waste and Redundancy at All Stages

Smaller, rural hospitals don’t have the resources of larger providers, so they need to compete in other ways.
An in-depth consultation or assessment can reveal surprising insight into missed revenue opportunities and inefficiencies within a hospital.
Some smaller hospitals have long wait times, which means patients are turned away and forced to visit other providers, leading to lost revenue every year.
Other hospitals have inefficient or outdated systems, increasing the number of steps taken before every treatment.
By eliminating steps in payroll processing, contract management, and other organizational systems, hospitals can save time and money, leading to lower costs and better patient care.

Final Word

Hundreds of small, rural hospitals across America are at risk of shutting down. However, even hospitals teetering on the edge of bankruptcy or closure can change their course by implementing smart solutions today.
Contact HMI LLC to discover the best options available to your small, rural hospital. Our team has combined decades of experience solving complex problems for medical providers across America.

What’s Involved in a Revenue Cycle Assessment? How Do Revenue Cycle Experts Maximize Medical Profits?

A good revenue cycle assessment will help your organization become more profitable.
But what’s involved in a revenue cycle assessment? How can revenue cycle experts maximize medical profits? What actionable steps will revenue cycle assessment experts help you implement? Today, we’re explaining everything you need to know about what’s involved in a revenue cycle assessment.

Areas of Revenue Cycle Assessments

Some organizations perform a revenue cycle assessment on their overall organization, hiring a consulting company to conduct a bottom-to-top assessment.
Other organizations request specialized revenue cycle assessments in one or more areas of the organization.
Typically, revenue cycle assessments focus on the organization’s core areas, including:
• Pre and post-system implementation
• Organizational structure
• Process flow and design
• Vendor performance
• Staff and team performance
• Denials prevention and management
• Functional office metrics
• Key performance indicators

How a Revenue Cycle Assessment Works

During a revenue cycle assessment, our experts analyze key areas of a medical organization to determine areas of improvement. Our experts use their combined decades of industry experience to solve your organization’s revenue issues.
Here’s a more detailed breakdown of how each step of our revenue cycle assessment will work:
Coding and Documentation Reviews: Good revenue management starts with good coding and documentation. Our experts will analyze your organization’s documentation and coding to ensure billed services are supported while adhering to payer mandates and guidelines.
Self-Pay Strategy: Our experts will analyze your organization’s performance for self-pay and self-pay after insurance collections. We’ll assess reporting, point of service collections, liability estimators, patient contact strategies, and third party vendor management, among other areas.
Denials Management: By analyzing your organization’s denials management, we can reduce write-offs and revenue leakage. Our team will help identify clinical and operational denials, outline identify process and workflow improvement opportunities.
Case Management & Utilization: By assessing your case management and utilization, our experts can identify process gaps that could lead to fatal level-of-care denials.
Charge Capture: Many organizations are surprised by the problems that charge capture analysis can reveal. Good revenue starts with a good chargemaster.
Patient Access: How does your organization perform for insurance eligibility, registration accuracy, centralized scheduling, prior authorization, and point of service collections? Our team will assess your patient access to identify areas of improvement.
Coding & Hierarchical Condition Categories: HMI LLC employs experienced coding consultants who assess your organization’s reimbursement risk related to coding. Every day, medical organizations across the country lose reimbursement because of coding and HCC issues.
Accounts Receivable: We can analyze your accounts receivable, then provide support and training to maximize revenue.
Job Shadowing: Revenue cycle assessment can involve employee shadowing and management training, ensuring your organization is capturing revenue from the lowest levels of the organization to the top.
Negotiations with Payers: We can negotiate with payers for increased reimbursement carve outs, enhancing organization revenue.
Dedicated, Long-Term Revenue Cycle Team: After the revenue cycle assessment is complete, we can form a revenue cycle team dedicated to tracking the revenue of your organization long-term.

Outcome of a Revenue Cycle Assessment

The goal of a revenue cycle assessment is to give the client actionable advice they can implement today to boost revenue. Some of the concrete deliverables created by a revenue cycle assessment include:
• A strategic roadmap for improving the client’s overall operational performance
• Identification and breakdown of current revenue cycle issues
• Identification and quantification of opportunities for improvement
• Detailed recommendations for improving key revenue cycle function areas
• Comparison of an organization’s metrics in relation to overall industry benchmarks

Schedule a Revenue Cycle Assessment with HMI Today

HMI LLC specializes in performing revenue cycle consulting for medical organizations across the United States.
Our team has a unique blend of industry, consulting, and system experience, allowing us to analyze your operations and identify ways to improve your performance.
A healthy revenue cycle is critical for organizational success. Schedule a revenue cycle assessment with HMI LLC today.

10 Benefits of Remote Revenue Cycle Management Programs

The remote revenue cycle management industry has been booming in recent years. A growing number of healthcare organizations are making the switch.
Should your organization make the switch to a remote revenue cycle management (RCM) program? These third party service providers make big promises – but do they actually live up to these promises?
Today, we’re exploring the benefits of remote revenue cycle management programs.

Fewer Denied Insurance Claims

Insurance claims may be denied because of inaccurate coding or other chargemaster issues. Good remote revenue cycle management services can reduce denied insurance claims. 90% of claim denials are preventable, and yet they still occur at every organization. Remote RCM services can mitigate the issues that lead to denied claims.

Fewer Billing Errors

Billing and coding errors increase the number of claim denials. Remote revenue cycle management services solve these bottlenecks, helping organizations capture revenue and avoid denied insurance claims.

Improved Employee Satisfaction

Cleveland Clinic claims its remote revenue cycle management program has improved employee satisfaction by enabling employees to telecommute. Employees can perform pre-registration and financial counseling remotely, helping save money and improve employee satisfaction. One executive said the work-from-home program increased productivity 113%, for example, while also reducing employee turnover and absenteeism.

Improved Quality of Information

Patients and insurers have better access to information with remote revenue cycle management services. Instead of old, manual, paper billing processes, for example, new systems use modern electronic processes to boost performance.

Better Interoperability

Aging, legacy systems can make interoperability painful. Remote revenue cycle management services can lead to better interoperability between health systems, enabling the seamless transfer of data.

Streamlined Denial Management

Remote RCM services offer streamlined denial management. Good RCM services make it easy to determine the cause of denials, mitigate the risk of future denials, and get paid faster. Common claims denial management obstacles include managing different payer rules, using manual processes, and making simple mistakes – and remote RCM systems can help avoid all of these issues.

Automation and AI Processes

Automation and AI continues to become closely integrated into the healthcare space. Remote revenue cycle management programs are increasingly using automation and AI to get ahead of the competition. The best remote revenue cycle management programs rely on AI to boost revenue and performance across organizations.

Better Regulatory Compliance

Increased government regulations in recent years have made compliance more difficult for healthcare organizations. It’s difficult for healthcare organizations to follow regulatory mandates for the adoption of electronic health and medical records, for example.Remote revenue cycle management programs improve regulatory compliance, making it easier for organizations to stay up-to-date with the latest regulations.

Better Patient Data Management

Remote revenue cycle management programs offer complete patient billing solutions. Failure to maintain necessary HIPAA and HL7 compliance and protect the patient’s data from a breach can lead to serious liability issues. Healthcare organizations are turning to remote revenue cycle management companies for better, safer patient data management.

Outsourcing Doesn’t Mean Losing Control

Remote revenue cycle management companies are aware that healthcare organizations don’t want to lose control. That’s why many make control a key issue.By choosing the right remote revenue cycle management program, companies can avoid losing control over crucial aspects of their organization. Today’s leading RCM companies emphasize a ‘win-win’ solution – and they’re increasingly living up to that promise.

Final Word:Remote RCM Continues to Grow

The market for remote revenue cycle management programs is expected to grow to $90 billion by 2022, up from $51 billion in 2017.
As more healthcare providers recognize the benefits of remote revenue cycle management programs, remote revenue cycle management isn’t expected to slow down anytime soon.

Revenue Cycle Management (RCM) Trends for 2020

Revenue cycle management has experienced ups and downs in recent years. What lies ahead for revenue cycle management?
Last year, we saw the continued rise of automation and AI. We also saw battles over price transparency.
Continuing the trend from previous years, we also saw healthcare organizations contend with patient expectations, government regulations, and a growing number of technology options.
Let’s take a look at some of the revenue cycle management (RCM) trends we’re preparing for in 2020.

Continued Battles Over Healthcare Pricing Transparency

Healthcare pricing transparency battles occurred across the country in 2019. Expect battles to continue into 2020.
A Waystar survey released in August 2019 found that lack of price transparency was the biggest factor to a negative patient experience. Governments are pushing for increased healthcare transparency, and healthcare organizations are adapting.
Last year, we saw healthcare organizations implement strategies to better manage the patient financial journey. In 2020, we expect healthcare organizations to take the next step.
Some organizations have published the chargemaster online, giving patients full transparency over how much services cost. However, because chargemaster prices are not necessarily the prices charged to the patient, these resources can be difficult for patients to interpret.
In June 2019, the Trump administration signed an executive order mandating that health systems provide out of pocket cost estimations to patients upfront.
Look for increased transparency and better patient access to prices as we move through 2020.

Higher Demand for Revenue Cycle Management RCM Outsourcing

Revenue cycle management outsourcing is becoming increasingly popular among healthcare organizations – and it’s been a trend for several years.
The trend towards revenue cycle management outsourcing is expected to continue into 2020.
Revenue cycle management companies advertise benefits like sharing the risk and reward, which creates a win-win solution for partner organizations. Healthcare organizations can create a sustainable, high-performing engine while still enjoying growing cash flow.
As revenue cycle management outsourcing companies become more competitive, outsourcing is an increasingly attractive option for healthcare organizations.

More Cybersecurity Battles and Ransomware Attacks

Cybersecurity has been a priority for healthcare organizations for over a decade, and this trend is expected to continue into 2020.
Cybersecurity attacks aren’t stopping anytime soon. Healthcare organizations need a coherent cybersecurity strategy to stay competitive.
In April 2019, the United States government reported 44 healthcare data breaches, which was the highest number of healthcare breaches reported in a single month since the government started tracking healthcare breaches in 2010. The previous record was set in April 2018, when there were 42 breaches.
Ransomware attacks are particularly common. Last year, Carbon Black released a study showing that 66% of healthcare organizations experienced a ransomware attack within the last 12 months.

Higher Volumes and Patient Revenue

Hospitals nationwide ended 2019 with an increase in hospital profitability. The increase was linked to surges in net patient revenue and service volumes. Hospitals were treating more patients – and making more money from those patients – than ever, according to a report by RevCycle Intelligence.
This profitability increased despite a slight increase in supply expenses, increases in bad debt, increases in charity care, and mixed performance on expenses.
Over 800 hospitals across the country saw particularly high volumes in adjusted discharges, emergency department (ER) visits, and operating room (OR) minutes.
It was a positive trend after a tough year. The December 2019 increase was the first year-over-year operating EBITDA margin increase in six months. Hospital operating margins also increased by 171.8 basis points compared to November 2019.
Overall, EBITDA margins rose 136.9 basis points year-over-year in December 2019. It’s possible this trend will continue into 2020.

CFOs Are Becoming More Involved

The role of the healthcare CFO has been changing in recent years. 2020 might be the year it becomes even more evident.
CFOs are expected to continue taking a leading role at every level of the healthcare organization. Modern healthcare CFOs don’t just listen: they act.
Healthcare IT Leaders Revenue Cycle Lead, Larry Todd, recently recommended that CFOs go beyond listening and start implementing:
“…any implementation will affect the revenue of the organization so it’s very important for CFOs to be involved in the implementation project and to be informed of key parts of the project that could put the organization and its revenue at risk.”
In the same article, Linda Hoff of Legacy Health described how CFOs need to take a specific interest in not just financials, but also patient satisfaction and quality. All metrics are closely intertwined:
“You have a passion for what you’re doing within your facilities, how you’re interacting with patients. You have to be as interested in patient satisfaction and quality as you are in the financials. If you don’t have that passion for all those aspects, you’re really not going to land yourself in a CFO role especially today.”

Surprise Billing Will Continue to Be Attacked

Surprise billing took a beating at the end of 2019. In December, members of Congress announced the expansion of a bipartisan investigation into supress billing practice. Because of that expansion, the investigation will now look at physician staffing companies and health insurers.
That same month, a Health Affairs study found that annual healthcare spending for patients with employer-sponsored health insurance would drop by $40 billion if specialists were not able to bill out-of-network.
A Kaiser Family Foundation report released in June, meanwhile, found that one in six Americans received a surprise medical bill in 2017 despite being covered by health insurance.
As surprise billing continues to make media headlines nationwide, surprise billing practices will continue to be attacked.
Look for these trends and more to make headlines across the revenue cycle management field in 2020.

What Role Does a Hospital Chargemaster Play in Revenue Cycle Management?

The hospital charge description master, or hospital chargemaster, communicates medical bills to payers and patients.
The hospital chargemaster plays a crucial role in revenue cycle management: it’s the heart of the healthcare revenue cycle. It’s the central point from which all billing gets sent to patients and insurers.
Organizations that fail to maintain the chargemaster face enormous problems. Poor chargemaster maintenance leads to revenue leakage. It can also lead to inaccuracies, non-competitive fees, and claim rejections.

What is the Chargemaster?

The hospital chargemaster is a list of all the billable services and items to a patient or patient’s health insurance provider.
The chargemaster lists the costs of each product and service offered by the healthcare organization, including any procedures, services, supplies, prescription drugs, and diagnostic tests provided by the hospital. The chargemaster lists the cost of everything related to that service, including any equipment fees and room charges.
When a patient receives service from a hospital, the healthcare provider documents the encounter in the medical record. Then hospital staff – like professional coders – assign the service a code for reporting and claim submission.
The codes are sent to the chargemaster. Each code is matched with a specific product or service and a fixed rate. Then, the charges are billed to the patient, creating a claim for payers – like insurance companies – to pay.

What’s Included in the Chargemaster?

Hospitals use chargemasters to keep track of the cost of all products and services offered by the organization.
Each product or service offered by the hospital – like a diagnostic test or specific surgery – gets its own entry in the chargemaster.
Each chargemaster entry includes the following:
Item Number: This number is assigned by the facility and is unique to that product or service.
CPT or HCPCS Codes: Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) codes help keep track of each product or service in a standardized way.
Item Description: Each entry has a brief text description of the product or service.
Revenue Code: A unique code based on the revenue of that item.
Charge Amount: The fee assigned to the item.
Alternative CPT or HCPCS Codes: Sometimes, codes overlap. Or, some insurers may require additional codes.
Numeric Designation for Department: A unique code describing the department where the product or service took place.
Ledger Number: A general number for organization accounting purposes.
A hospital may offer thousands of products or services. There’s a chargemaster entry for each one.

Patients Rarely Pay the Chargemaster Rate

Healthcare transparency battles raged throughout 2019. In response, some organizations are making chargemasters more transparent.
However, it’s easy for patients to get confused about chargemaster prices. The prices displayed on the chargemaster are rarely the prices paid by customers.
In fact, most patients do not see the chargemaster price from their hospital visit unless they are uninsured and must actually pay the chargemaster rate.
Why are chargemaster rates so different from real prices? It’s because of markups.
Chargemaster services are heavily marked up to make negotiations with insurance companies easier. One recent study found that the average hospital in the United States had a charge-to-cost ratio of 4.32, which means the hospital charged $432 when the service really only cost $100.
Maintaining marked up chargemaster prices also makes it difficult for patients to compare prices between organizations.
Hospitals defend this practice, claiming that markups help hospitals stay open and competitive. However, there’s been a push for transparency in recent years, and hospitals have started changing how they treat the chargemaster.

Why is Inadequate Chargemaster Maintenance a Problem?

Inadequate chargemaster maintenance is a serious issue. Even the best healthcare organizations experience chargemaster-related issues, and these issues lead to lost revenue.
Accurate chargemaster maintenance is crucial for revenue integrity. A lack of maintenance leads to revenue leakage.
Poor chargemaster maintenance can lead to overpayments or underpayments. It can also lead to claim rejections from insurance companies, poor patient experience, or compliance violations.
Many organizations are surprised to discover they have been significantly undercharging or overcharging for specific treatments because of poor chargemaster maintenance. A chargemaster audit can reveal surprising results.

Tips for Maintaining Accurate Chargemasters

Hospital chargemaster maintenance is crucial to revenue cycle management. Here are some tips to help your organization manage.
First, the American Academy of Professional Coders (AAPC) recommends maintaining chargemaster lists by following the three C’s: correct, complete, and compliant codes.
Correct Codes: Chargemaster coordinators should check that the correct codes are billed. There may be differences between what is captured in the order entry system or EHR and what is reported on the chargemaster. Someone may assign an unlisted HCPCS code when a specific code is available, for example, or the entry may be missing HCPCS codes for separately paid drugs.
Complete: Chargemaster code sets need to be complete. Hospitals need to capture the charges for all the services and items provided to patients. Failure to maintain complete code sets can lead to missed payments and revenue leakage.
Compliant: Chargemasters must also be complaint with coding standards and federal, state, and commercial payer rules. Failing to adhere to regulations can lead to significant issues, including repayments to payers, healthcare fraud, and healthcare abuse.
Ultimately, all of these issues can be solved with frequent chargemaster code reviews. Check your chargemaster code to ensure it’s correct, complete, and compliant to ensure good revenue cycle management.

Telehealth Coding and Billing During COVID-19: Tips and Guidelines

Healthcare organizations have turned to telehealth during the COVID-19 pandemic. However, some are not prepared to handle telehealth coding and billing.
Demand for contract medical coding experts is surging. Companies like HMI Corp can help your organization manage complicated COVID-19-related telehealth coding. Our coding experts have proven expertise across the United States.
Today, we’re highlighting some of the best telehealth coding and billing practices for the COVID-19 coronavirus pandemic, including changes to be aware of.

HHS Relaxes Certain Telehealth Rules During COVID-19

In response to the COVID-19 pandemic, HHS has relaxed certain telehealth coding rules. HHS allows providers to offer telehealth services while charging the same amount they would for in-person care.
Whether providing care virtually or on-site, providers can get paid the same amount for patient care because of these new HHS regulations.
Specific services covered under these regulations include:
• Telehealth visits
• Virtual check-ins
• E-visits
These rules are changing regularly.
CMS recently announced that doctors can directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. They announced similar options for nurse practitioners, occupational therapists, and hospice nurses. These changes affect critical access hospitals (CAHs), federally qualified health centers (FQHCs), rural health clinics (RHCs), skilled nursing facilities (SNFs), and home health agencies and hospices.
You can learn more about the CMS’s COVID-19 emergency declaration blanket waivers for healthcare providers and telehealth services at CMS.gov here.

CMS Releases HCPCS Codes for Telehealth Services

CMS has released a list of HCPCS codes for telehealth services and other virtual patient treatment sessions.
These codes are covered under the Physician Fee Schedule, and they will continue to be covered throughout the COVID-19 pandemic.
You can view the full list here.

AMA Releases Guidance on Telehealth Billing and CPT Codes

AMA has released information on telehealth billing and CPT codes, including telehealth visits, online digital visits, remote patient monitoring, and similar telehealth services.
AMA’s guideline was updated on May 22 and covers the implementation of telehealth in response to COVID-19, including how to code telehealth services.
The goal of the guideline is to help providers implement telemedicine and remote care services while ensuring uninterrupted care for 100 million Americans with chronic conditions.
Items covered by AMA guidelines include:
• Store and forward technologies that collect images and data for transmission and interpretation at a later date
• Real-time, audio-video communication tools that connect physicians and patients
• Remote patient monitoring tools like blood pressure monitors, wearables, Bluetooth devices, and other devices that collect biometric data for review (including mHealth apps).
• Verbal/audio-only and virtual check-ins via patient portals, messaging platforms, etc.

Using Telehealth Services for Triage

Hospitals are now using telehealth services to triage patients whenever possible, according to a recent report from the Office of the Inspector at HHS.
As demand for elective and non-urgent services declines, ambulatory organizations are following similar guidelines.
That means demand for telehealth services continues to grow – and the demand for effective telehealth coding guidelines is increasing with it.

Other Tips for COVID-19 Telehealth Coding and Billing

COVID-19 has left organizations scrambling. Some are struggling to effectively code for telehealth services. Others are struggling with COVID-19 coding.
Whatever your coding issue may be, these tips can help:
Stay up-to-date. The AMA, CDC, and CMS are releasing new guidelines regularly, and the COVID-19 pandemic is changing weekly. Spend extra time checking information from all relevant providers to help your organization stay up-to-date.
Spend extra time verifying EHRs to ensure accuracy and compliance. This is always a good tip, but it’s particularly important during an uncertain situation when coding errors are rampant.
Consider hiring contract medical coding experts for assistance. Contract medical coding experts are a guaranteed way to solve inefficiencies and reduce errors. They’re experts at medical coding, and that expertise is invaluable during a time like this.

HMI Corp’s Contract Medical Coding Experts Can Help

HMI Corp has contract medical coding experts standing by to solve medical coding issues for your healthcare organization.
Whether struggling with telehealth coding or COVID-19 coding, your organization cannot risk inaccurate or ineffective coding.
Our US-Based contract medical coding specialists are credentialed by AHIMA and/or AAPC. They have firsthand experience in Inpatient/MS-DRG, Outpatient Surgery, Physician E/M, Emergency Department E/M, Interventional Radiology, Ambulatory Surgery, GI/Endoscopy, and other fields of care. They can work with TruCode, Meditech, VISTA, 3M, McKesson, Cerner, Epic, and CHCS/CHCSII.
Contact HMI Corp for effective contract medical coding for your organization. Whether dealing with telehealth coding issues with COVID-19 or general medical coding inefficiencies, we can help.

Medical Coding Tips for Managing the COVID-19 Pandemic

Demand for medical coding companies has surged in recent months. COVID-19 has revealed medical coding inefficiencies, and firms are struggling to keep up.
Good medical coding companies work with healthcare organizations to solve inefficiencies and reduce errors. Effective medical coding tips helps a company avoid wastage, capture lost revenue, and reduce patient conflicts.
Your healthcare organization might have effective medical coding systems in place. Unfortunately, a pandemic like COVID-19 can reveal problems with any organization’s medical coding.
The CDC, CMS, and AMA have all released COVID-19 coding guidelines in recent weeks. We’ll summarize that information below to help your organization manage the COVID-19 pandemic.

What Providers Need to Know About COVID-19 Medical Coding & Billing Tips

COVID-19 has put strain on healthcare providers across the United States. Effective coding and billing helps organizations manage the infectious disease and avoid becoming overwhelmed.
The healthcare industry is adapting to COVID-19 and creating new codes for the novel coronavirus. The pandemic is bringing in new patients with unique needs, creating more coding and documentation challenges for organizations.
Below, we’ll summarize some of the guidance released by the CDC, CMS, and AMA in weeks for medical coding during COVID-19.

CDC Guidance on ICD-10-CM for Positive COVID-19 Test Results

The Centers for Disease Control released new medical coding guidance in March for COVID-19. The CDC added the new International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code from the World Health Organization.
Based on that guidance, the code for the diagnosis of COVID-19 is U07.1, 2019-nCoV acute respiratory disease.
The CDC expected to implement that code in October 2020, but they moved the implementation date to April 1 after the rapid spread of the disease.
The CDC recommends only using U07.1 to document a confirmed COVID-19 case based on a confirmed test result or a presumptive positive test result. This code also applies to asymptomatic patients who test positive for coronavirus.
U07.1.1 is a principle or first-listed diagnosis code. That means providers should sequence the code first, then use appropriate codes for associated manifestations of the illness, unless dealing with obstetric patients.
The CDC does not recommend using the U07.1 code to diagnose suspected, possible, probable, or inconclusive cases of COVID-19. Providers should only use this code for confirmed (or presumptively confirmed) test results.

Coding for Exposure to COVID-19

The CDC recommends using code Z03.818 for exposure to COVID-19. This code covers encounter for observation for suspected exposure to other biological agents ruled out and screening, according to CDC regulations.

HCPCS Codes for Diagnosing Patients and Stopping Spread

CMS created Healthcare Common Procedure Coding System (HCPCS) codes to help providers get reimbursed for diagnosing patients and stopping the spread of COVID-19.
CMS recently announced two new codes, including U0001 and U0002, which cover COVID-19 tests:
• U0001: This code is used to document and bill for tests performed at CDC laboratories.
• U0002: This code is used to document and bill for tests performed at non-CDC laboratories, including clinical laboratories outside of the CDC.
Medicare has accepted these codes since April 1, 2020, although any codes will be retroactive to February 4 to account for any tests performed since that date. Providers can expect to receive approximately $35 for U0001 coded claims and $51 for U0002 coded claims through Medicare.

American Medical Association Reveals COVID-19 Coding & Guidance

On May 20, AMA released new coding and guidance for the Medical Coding Tips COVID-19 coronavirus.
AMA’s new Current Procedural Terminology (CPT) codes were created to streamline the novel coronavirus testing available across the United States.
Key points from the AMA’s CPT codes include:
• The AMA accepted the addition of code 87635 to report infectious agent detection by nucleic acid (DNA or RNA) for COVID-19 by amplified probe technique. The code is effective from March 13 onward.
• The AMA accepted the revision of code 86318 to report immunoassay for infectious agent antibodies and to be a parent to 86328.
• The AMA accepted the addition of code 86328 to report single step antibody testing for COVID-19. They also accepted the addition of child code 86769 to report multiple-step antibody testing for COVID-19. These new codes and revisions were effective from April 10 onward.
• The AMA accepted the addition of PLA code 020U to report the BioFire Respiratory Panel 2.1 (RP2.1) test, with the new code effective from May 20 onward.
You can view full details of the AMA’s expanded COVID-19 medical coding additions and revisions here.

Telehealth Coding for COVID-19

More healthcare providers are using telehealth for patient care. Telehealth can introduce new coding challenges beyond COVID-19.
HHS has relaxed certain rules during the COVID-19 pandemic, allowing providers to use telehealth while getting paid the same amount for patient care – even though care is provided virtually instead of on-site.
CMS has released a list of HCPCS codes to document telehealth services and other virtual patient visits. These codes will be covered under the Physician Fee Schedule throughout the COVID-19 pandemic.
AMA has released its own guidance on telehealth billing with CPT codes. The AMA’s guidance covers telehealth visits, online digital visits, remote patient monitoring, and similar telehealth services.

Other Medical Coding Tips COVID-19

COVID-19 medical coding can be complicated. By following these tips, you can minimize disruption and maximize patient care during the pandemic:
• Check the latest information from the CDC, CMS, AMA, and other official organizations frequently. The situation is changing constantly, and these organizations regularly release new coding guidelines.
• Assess documentation guidelines in EHRs to ensure providers are accurately documenting services.
• Take extra care to provide complete, precise, accurate documentation that reflects all related conditions during this pandemic. Researchers will use this data to assess this pandemic and the response, and high-quality data will be more valuable for preventing future pandemics.

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6 Ways COVID-19 Has Impacted Healthcare Revenue Cycles in America

The COVID-19 pandemic has wreaked havoc on healthcare organizations across the United States.
But as some organizations are failing, others are thriving. By capitalizing on changes, and by training staff, organizations can optimize healthcare revenue cycles throughout the coronavirus pandemic.
Today, we’re highlighting five ways COVID-19 has impacted healthcare revenue cycles for organizations across the United States – and how organizations are thriving in the face of change.

Telehealth Appointments & Coding Challenges

Obviously, telehealth has surged in recent months. Many outpatient facilities have switched to telehealth appointments, giving patients the same quality of care via a safer, remote environment.
Telehealth appointments are also introducing coding and billing challenges. Some healthcare plans have updated policies for telehealth, while others have not. Medicare has introduced telehealth-related changes, for example, while other insurers are struggling to manage.
Meanwhile, some staff have inadequate training for telehealth billing. They bill patients when they should be billing healthcare plans, for example, or they’re charging inaccurate out-of-pocket payments and co-pays to providers. Some organizations have improper coding in place, complicating things further.

Remote Work

It’s not just patients accessing care remotely: staff are working remotely. Many organizations have requested billing and other support staff to work remotely throughout the pandemic.
Hennepin Healthcare in Minneapolis, for example, recently shifted nearly all support staff to remote positions, including coders, coding educators, coding auditors, coding support specialists, coding coordinators, and transcriptionists, as explained in an interview with HealthLeaders.
Remote work has introduced new challenges. Remote employees need to access company infrastructure to work, for example. Remote employees also need to consider HIPAA, taking extra care when managing patient data in an unfamiliar setting.
With employees using their own equipment, it introduces new challenges. IT departments across the country are struggling to keep up.

Billing & Coding Updates

There have been multiple billing and coding changes as a result of COVID-19. Good healthcare organizations are staying up-to-date on changes, while other healthcare organizations are lagging behind.
In April, the American Medical Association (AMA) announced it was fast-tracking the development of a unique Current Procedural Terminology (CPT) code for coronavirus testing.
CMS also released guidance on billing and reimbursement for treating COVID-19. CMS had previously released two Healthcare Common Procedure Coding System (HCPCS) codes, allowing labs to bill for certain COVID-19 diagnostic tests.
These changes can seem confusing, but good coding is the backbone of healthcare revenue cycle management.

Long-term Medicare Changes

As part of an $8.3 billion emergency funding measure passed earlier this year, Medicare now covers telehealth services. Healthcare organizations can receive payment from Medicare for telehealth appointments. Medicare covers video visits and similar telehealth appointments.
It’s possible this change is permanent: some experts suggest it will forever change the way we deliver healthcare.
When patients can access care without leaving their home, and when specialists can provide treatment from a remote setting, it changes the face of healthcare.

Postponed Elective Surgeries

Many patients have postponed elective surgeries due to concerns about coronavirus transmission in hospitals. Revenue cycle experts have also encouraged patients who can’t afford out-of-pocket costs to postpone elective procedures until they have a payment plan in place.
In April, CMS recommended that “all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.”
Prior to that press release, organizations had already announced their own elective surgery policies.
Organizations across the country postponed elective surgeries to free up resources in preparation for a surge in cases.
All of these shifts have a significant impact on revenue cycles.

Increased Focus on Emergency Preparedness

Good healthcare organizations were prepared for this pandemic. They had emergency preparedness plans in place. They had previously established business continuity plans. Other organizations were less prepared: they were prepared for smaller emergencies or short-term surges, but they were not prepared for a months-long pandemic.
Revenue cycle management consultants can establish emergency preparedness plans for organizations. They can create business continuity guidance, helping firms navigate a complex, uncertain future while maintaining quality patient care and compliance.

Consider Hiring a Revenue Cycle Management Consultant

Revenue cycle management consultants are in high demand. Organizations across the United States are struggling to deal with the coronavirus pandemic – but some are thriving.
The difference between good and bad healthcare organizations is effective revenue cycle management. At HMI Corp, we specialize in revenue cycle management consulting. We highlight inefficiencies in your organization, then fix them.

Schedule a consultation with HMI Corp today. Discover effective revenue cycle management services that deliver a proven return on investment. We have 30+ years of experience helping small, medium, and large organizations optimize revenue cycles.

Healthcare Revenue Cycle Management and COVID-19: Coronavirus Impact & Management Strategies

97% of America’s healthcare organizations have experienced some disruption due to COVID-19.
As states re-open, healthcare organizations continue to navigate healthcare revenue cycle management. Some organizations are managing more effectively than others.
COVID-19 has introduced billing and coding challenges, patient financial responsibility issues, and other problems for healthcare organizations.
Today, we’re explaining strategies firms are using to manage revenue cycles during the COVID-19 pandemic – including how your organization can stay ahead.

Medical Coding Challenges

Many organizations have faced billing and coding challenges during the COVID-19 pandemic.
To navigate the pandemic, your organization needs to know what is covered by health plans for both inpatient and outpatient care.
Rules are changing constantly. That means staff require frequent training and regular updates to avoid billing and coding problems.
Many outpatient facilities are scheduling telehealth appointments, for example. Some insurance companies treat telehealth appointments the same way as in-person appointments. Others treat them differently. Check if the insurance company pays the same full rate for telehealth appointments. Check if the insurer needs further documentation or approvals.

Billing Challenges

Many healthcare organizations have shifted their billing office to work remotely. With some preparation, organizations can handle billing responsibilities from home.
To setup remote billing, an organization may need to give employees remote access. Employees may need to access certain systems and equipment to remain productive.
Employees also need to adhere to regulations – including privacy and data security. Working from home introduces new challenges with HIPAA, and your organization needs to address these challenges before compliance issues occur.

Business Continuity Issues

COVID-19 has made some healthcare organizations starkly aware of business continuity issues. Some organizations have strong emergency preparedness plans. Others do not.
Every healthcare organization has some type of emergency plan – but few healthcare organizations were prepared for a multi-month pandemic-related shutdown.
You may think it’s too late to address emergency preparedness for the coronavirus pandemic. However, nobody knows what happens next: a second wave later this year could be worse than the first wave. There’s no such thing as too much preparation.

Changes to Medicare

Several Medicare changes were introduced in recent weeks. Healthcare organizations need to review these changes and stay up-to-date on other upcoming changes.
Some of the biggest changes involve billable services, including services that can and cannot be billed under Medicare. Medicare allows billing for the treatment of uninsured patients with COVID-19, for example, or providing telehealth care.
Another big change is with Medicare cash flow: organizations can receive accelerated or advance payments from Medicare in certain situations, increasing cash flow at a time when needed most. By taking advantage of these cash flow changes, organizations can minimize COVID-19 disruptions.

Collecting from Patients

Patients are facing higher financial responsibilities during the coronavirus pandemic. Some patients are facing financial difficulties because their health plan lacks coverage for coronavirus-related bills.
Today is a great time to evaluate your organization’s collection and credit system. Each organization should evaluate its credit and collection policies. Pay close attention to changes in:
Copays and Deductibles: Some of America’s largest insurers have changed copay and deductible policies, including out-of-pocket responsibilities for patients.
Standard Referral Requirements: Consider standard referral requirements, as this can move payment obligations from the patient to the insurer.
By keeping staff trained and up-to-date on patient financial responsibility changes, healthcare organizations can optimize revenue cycles during the pandemic.

Other Things to Consider

Healthcare organizations are dealing with countless challenges during the coronavirus pandemic. Other things to consider with revenue cycle management include:
Capacity Assessment: Hospitals in many states are facing a surge in patients, including surges that overwhelm capacity. Your healthcare organization needs to develop proactive revenue cycle strategies to ensure you continue to meet patient needs when nearing capacity.
Staff Management: Your staff are on the front line of patient care. Has your organization created proactive plans for hours of operation, staffing and documentation requirements, telehealth accommodations, and other unique situations created by the coronavirus?

Hire a Consultant

There’s never been a better time to hire a revenue cycle management consultant. A good revenue cycle management consultant spots inefficiencies that impact revenue.
By implementing a consultant’s recommendations, your organization can thrive during the pandemic, surpassing revenue management cycle obligations and goals.
Revenue cycle management consulting is an investment. A good consultant firm provides a return on that investment, providing actionable recommendations that impact your firm’s revenue immediately.
At HMI Corp, we have offered revenue cycle management services since 1989. As a diversified healthcare company, we provide a spectrum of revenue cycle management services, including charge capture, chargemaster reviews, medical bill audits, and claims reviews.
Our clients include physician groups, large teaching hospitals, and organizations of all sizes in between. Contact us today to discover how we can help optimize revenue cycles for your organization. Our goal is to help you meet revenue goals while maintaining quality and compliance standards.

Final Word

The COVID-19 pandemic has introduced many challenges for healthcare organizations.
The situation is fluid, and it’s uncertain what happens next. However, organizations must continue to meet obligations and missions throughout the pandemic.
Using the strategies above, healthcare organizations can manage and thrive during the coronavirus pandemic, ensuring they meet revenue cycle goals.