3 Essential Billing Benchmarks of a Healthy Practice
It is essential as healthcare practice owners that you are monitoring your billing goals to ensure that your practice is healthy and thriving.
Here are three billing benchmarks that LRS recommends being aware of at all times:
Denial/First Pass Payment Rates
How many denials are you receiving and how many claims are paid on the first try? Many factors go into these metrics including how accurate your insurance verifications are, how clean your claims are, and how timely your claims are submitted. A very efficient practice will have a denial rate under 5% and a first pass claim rate higher than 95%.
Percentage of Receivables over 120 Days
How quickly are you collecting the money you are owed? You should be aiming for less than 10% in this aging bucket. There are always going to be issues with specific claims but a healthy practice has at least 75% of their AR in under 60-days outstanding.
Payer Mix/Expected Revenue per Payer per Visit
Who are your top 5-10 payers? What are they paying you per visit? Your reimbursement rate is only as good as the payer mix of patients that you see.Maybe it is time to try to renegotiate contracts or consider going out-of-network with some insurances. LRS also recommends knowing what you are being paid per CPT code per payer per visit.
These are only a few of the KPI metrics you should be reviewing on a monthly basis. Do you see room for improvement in your practice? Contact us today at inquiries@lincolnrs.com to see how we can help you improve these essential benchmarks.
Thing You Should Know This Week
Proposed 9% Cut to PT and OT and 7% Cut to ST:
The Centers for Medicare and Medicaid Services (CMS) released the 2021 Proposed Rule for services paid under the Medicare Fee Schedule. This includes all outpatient PT, OT, and ST services provided under Part B benefits.
The biggest challenge for our industry that has been looming overhead was the original 8% proposed cut to reimbursement. The 2021 proposed rule has taken this a step further with a proposed 9% payment cut in 2021 to PT and OT services and 7% cut to ST services. This greatly undervalues therapists and the tremendous service that is provided to the Medicare population.
Now is the time to take action and let your voice be heard. All comments to CMS are due by October 5th. We will be in touch in the coming weeks with ways you can easily comment to CMS on this and the other issues in the proposed rule.
Telehealth Coverage Updates
A potential positive proposed 2021 rule is that telehealth coverage could be here to stay! The rule would make permanent telehealth and workforce flexibilities provided during the COVID-19 Public Health Emergency while also improving healthcare for Americans in Rural Areas.
Learn more details of the 2021 Proposed Rule on the CMS Fact Sheet.
Be Prepared!
Due to the Public Health Emergency, CMS could release the final rule as late as December 1 and still have policies effective January 1, 2021. There could be little time to prepare your bottom line for the coming changes if the proposed payment cut takes effect. Contact us to learn more about the changes you can make today to improve your reimbursement.
Credentialing Best Practices
Much like the way the engine is the most necessary part for a car to drive down the street - credentialing is the most necessary piece for your practice to get paid for the claims you submit to insurance. Without effective and efficient credentialing, your practice’s bank account is going to stall shortly after it rolls out of the parking lot. It is that pivotal to your success!
So what can you do to ensure your credentialing is in working order?
1. Ensure accurate effective dates:
Knowing the effective date of a contract or a provider’s participation date is a critical piece of the credentialing process. This will ensure your claims are paid and avoid unnecessary denials.
Do not bill a new payer contract until you have confirmed the effective date. If you bill claims with dates of service prior to receiving your fully executed contract, you will surely receive denials that won’t uphold appeals.
Be sure to inquire with the payer about backdating of effective dates. If you know an effective date will be backdated to today’s date (or potentially earlier), you can treat patients in the meantime and hold the claims while waiting for the credentialing approval.
2. Ensure proper time frame for credentialing:
Familiarize yourself with the time frames it takes to receive approval for credentialing and re-credentialing. These time frames vary widely payer to payer.
Ask for confirmation of receipt when submitting an application. Follow up every 2 days until confirmation is received.
After you’ve received confirmation of receipt, follow up every 2 weeks until approval is received.
Keep a spreadsheet to organize progress, follow up intervals, and responses.
Set reminders to ensure no follow ups are missed!
3. Ensure billing and credentialing departments are communicating:
Your billing and credentialing departments should have a solid process in place for communicating credentialing status’ and how that directly affects the submission of claims.
It’s essential that your credentialing department shares all crucial information, including: pending, approved, and terminated credentialing status’; claims that need to be held and when those claims are okay to be submitted; and contract intricacies to ensure that the EMR and claims reflect the contract details.
Do you think your credentialing could use some fine tuning? Don’t let a bad mechanic operate on your credentialing engine! Contact LRS today to see how we can improve your processes and cash flow!
8 Minute Rule - AMA V. CMS
8 Minute Rule - AMA v. CMS
Unfortunately, very few therapists understand the core differences between billing for insurances that follow AMA guidelines and insurances that follow CMS guidelines. Within your EMR, you should be able to set up and customize the billing and payer settings to ensure you are billing accurately and getting reimbursed properly for the services you have rendered.
Please note: It is important for you or your billing team to verify with each insurance carrier to determine which guidelines they follow.
Here are some side by side examples to ensure understanding. Please see our previous post here if you would like a more detailed breakdown.
Example 1
Example 2
Increasing Your Revenue Per Visit
“Give me six hours to chop down a tree and I will spend the first four hours sharpening the axe. - Abraham Lincoln”
At LRS, we pride ourselves on efficiency and process improvement. Our company is named after Abraham Lincoln - we focus on ways to make your practice more efficient and in turn, collect every penny of what you are owed.
Since we started our company six years ago, we have been sharpening our axes.
Join us on June 23rd at 12:00pm EST to learn three ways physical therapy practices can sharpen their best practices and increase their revenue per visit.
Redundant v. Progressive Coding
Moving from basic to advanced activities - purpose, progression and compliance.
CMS v. AMA 8-Minute Rule
How each work and what they mean for you, your billing and your reimbursement.
59 Modifier Denials and Adjustments
Payers we see this with, adjustments v. denials, and how to approach these.
Join us next Tuesday, June 23rd at 12pm EST to learn more about each of these topics and the steps you can take to increase your revenue per visit immediately!
You’re Invited: Increasing Your Revenue Per Visit
INCREASING YOUR REVENUE PER VISIT
Contract re-negotiation was more than challenging in normal times, let alone now when insurance companies are looking to cut costs even further - but re-negotiating isn't the only way to increase your practice's revenue/visit.
Join Lincoln Reimbursement Solutions CEO, Bryanne Johnson, President, Danielle Pantalone, and DPT Ashley Geer, for an interactive webinar where they discuss how you can increase your revenue through better coding practices, maximizing the 8-minute rule and appealing 59-modifier denials. These are all measures you can take TODAY to improve on your bottom-line!
Things You Should Know This Week
Tricare No Longer Covers TENS Treatment:
Effective June 1, 2020, Tricare will no longer cover TENS treatment for beneficiaries for acute, sub-acute and chronic low back pain. Dry needling also remains a non-covered benefit when it is the sole purpose for the visit.
Telehealth Updates:
Humana will now cover telehealth for outpatient physical, occupational and speech therapy and will follow CMS guidelines and/or state specific guidelines where applicable.
Aetna Extendeds Telehealth Coverage: Due to COVID-19, Aetna has announced that they will cover outpatient physical, occupational, and speech therapy via telehealth until August 4, 2020.
United HealthCare also extended their outpatient physical, occupational and speech therapy coverage for telehealth until September 30, 2020 for their Medicare Advantage plans and until July 24, 2020 for Individual and fully insured Group Market health plans. UHC Community Medicaid plans remain unter state-specific regulations
Paycheck Protection Program Flexibility Act of 2020 (H.R. 7010)
This was signed into law on June 5th. It will:
Allow forgiveness for expenses beyond the 8-week covered period to 24 weeks;
Increase the current limitation on non-payroll expenses (such as rent, utility payments and mortgage interest) for loan forgiveness from 25 to 40 percent (in other words, the eligible recipient is required to use at least 60% of the loan amount for payroll costs, down from 75%);
Extend the program from June 30 to December 31;
Extend loan terms from two to five years;
Ensure access to payroll tax deferment for businesses that take PPP loans.
Thing You Should Know This Week
Medicare Allows Institutional Providers to Bill Telehealth
Medicare FINALLY announced that they will be allowing institutional providers to perform telehealth services. This announcement includes: Rehabilitation Agencies, Skilled Nursing Facilities doing Part B, Comprehensive Outpatient Rehabilitation Facilities, Hospital Outpatient Therapy Departments (including Critical Access Hospitals) and Home Health Agencies providing outpatient therapy in the home.
Denials and Adjustments You Should Be Appealing
Are you missing appealable denials? Anthem BCBS, Aetna and Humana all have been denying providers who bill 97530 as mutually exclusive. Their EOBs sometimes read as a contractual adjustment and not a denial and therefore, you might be missing out on significant reimbursement! Make sure your billing team is reviewing these EOBs thoroughly and are submitting appeals for this issue.
Telehealth Billing Regulations
Has your staff been trained on telehealth billing and current regulations? These rules have changed multiple times over the last few weeks and months. Now is a good time to review with your team on the do’s and dont’s of telehealth compliance. Here are a few great resources:
The LRS Customer Service Difference
6 Ways to Provide Patients with Exceptional Customer Service
At LRS, we pride ourselves on our exceptional customer service. We think of ourselves as an extension of your practice and want your patients to know how much you care about them.
We wanted to share some of our customer service secrets with you to see if there are tips you can implement in your own practice.
Effective Listening: Patients are calling for a reason and they want someone to assist them with solving an issue or to get answers to their questions.When you really listen to patients, you can learn what the patient truly needs assistance with rather than assuming. By doing this, it shows the patient that you truly care about them and their concerns.
Courtesy: Not sure if people get super excited to call their medical office to pay a bill or talk about insurance but at least we can make it as painless as possible! Answering the phone with a greeting and a person smiling through the other end of the phone just sounds warm and comforting rather than “What do you want?” A welcoming greeting to someone is just a better way to start off a conversation. You can also personalize the experience by asking for the patient's name and using it through the entire phone call. Even being polite can go a long way - remember your please and thank yous! Treat patients like your guests.
Efficiency: Gathering information can take some time. Strive to find accurate information in a timely fashion. Following up quickly and having all the information the patient requested makes a patient feel important. Giving a deadline to your patients also helps so they can expect a call back rather than feel forgotten.
Resolving Issues: Take a problem and find a solution! Whether that’s thinking outside the box or asking more questions. We want to explain and communicate to our best ability so that the patient understands what is going on. “I don’t know” will NEVER be in our vocabulary. We make our explanations as simple as possible so that everyone can understand the medical billing world.
One Team, One Dream: We are an extension of your medical office but the patients do not need to know that. We work together as a team so the patient can’t see where the line is between the clinic and the billing department.
Thank You: We cannot thank our patients enough for allowing us to help them with their billing needs, trusting us in helping them find a solution to their concerns, and giving us time out of their busy schedules to talk to us. A simple “thank you!” at the end of a conversation leaves a positive, memorable impression.
These 6 strategies are things that we do every day at Lincoln Reimbursement Solutions that makes us different from the other medical billing companies. We call it the LRS Difference. Our patients are very important to us and we strive to provide the most exceptional customer service! We hope that we can share our exceptional service and our medical billing solutions with you when you join our LRS Family!
ICYMI: Updates to NCCI Edits Big Win for PTs
CMS National Correct Coding Initiative edits, known as NCCI edits, provide guidelines for what codes can be billed with evaluation codes and which modifiers may be required. As you can imagine, these rules can greatly impact reimbursement.
In January, CMS implemented strict changes about what could and could not be billed with an evaluation code. Since then, CMS has rescinded many of their changes in order to alleviate the significant burden that the update to the edits placed on providers during COVID-19.
PTS in both private practice and rehab agencies can pair many codes without adding the 59 or applicable X modifier. These changes are retroactive to January 1, 2020.
The Coding Changes
PTs are now able to pair the following code combinations without the use of 59 or X modifiers:
97530 with 97116
97161 with 97140
97162 with 97140
97163 with 97140
99281-99285 with 97161-97168
97110 with 97164
97112 with 97164
97113 with 97164
97116 with 97164
97140 with 97164
97150 with 97110
97150 with 97112
97150 with 97116
97150 with 97164
There are additional edit changes as well that can be viewed on the CMS links below.
Which Payers These NCCI Edit Changes Apply to:
Medicare and Medicaid follow CMS’ NCCI edits. Commercial payers also typically follow the edit guidelines but may not have updated yet based on the recent news. It is important to check with your insurance companies if you have denials come back for the previous edit guidelines.
Links to Learn More:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes
LRS Webinar
Join Lincoln Reimbursement Solutions CEO, Bryanne Johnson, and President, Danielle Pantalone, for an interactive webinar on an in depth discussion of the Top 7 Billing Best Practices.
Now, more than ever, it is essential that you are collecting every penny that you are owed.
On the webinar, Bryanne and Danielle will walk you through the questions you should be asking your billing team on a quarterly basis to ensure your key metrics are being met and your bottom line isn't suffering unnecessarily.
Billing Best Practices
Below are some items you should be asking your billing team on a quarterly basis. These are your key performance indicators that directly affect your bottom line. If answers to these questions are drastically different quarter to quarter you will likely notice a difference in your cash flow.
What do my AR buckets look like?
• Is the 120+ less than 15% of the total AR?
What is my first pass payment percentage?
What is my Daily Sales Outstanding (DSO)?
What is my current payer mix?
What is my denial rate?
• What are my top 5 denial reasons?
• How many claims were written off in the last 90 days and what were the reasons for needing to write off?
What is the average reimbursement per visit for my top 5 insurance payers?
What are major insurance changes that I should be aware of?
• Who are my flat rate payers?
• Are any new insurances requiring authorization?
We are happy to talk through the answers you receive to these questions, review your contracts, and provide you with a strategic revenue analysis.
Save the Date For Our Billing Best Practices Webinar. Register here!
May 19th, 2020 @ 12:00pm EST
BREAKING NEWS: CMS Allows Therapy Providers to Deliver Telehealth
The moment we have been waiting for - CMS announced today that physical, occupational and speech therapy providers may deliver care via telemedicine for the duration of the COVID-19 pandemic.
This will allow clinicians to protect their most vulnerable patients and reduce the risk of spreading the virus. PTs, OTs and SLP can provide services to new or current Medicare patients.
Medicare will allow Physical and Occupational Therapy and SLP to provide the following services via telehealth. CPT codes 97161- 97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507. Please note that not all PT, OT and SLP CPT codes are currently allowed. See here for a comprehensive list.
As always, contact us with any questions. We will continue to monitor and share updates from CMS and other major commercial payers as they develop around telehealth.
Stay well!
Things You Should Know This Week
United Healthcare - New Guidance Sent Out This Week
To help you manage the claim submission and reimbursement process with UnitedHealthcare, as well as access the CARES ACT funding available to health care professionals, here’s a summary of resources to address your most common questions and concerns. Use this list of quick links as an easy reference to save you time.
Telehealth Coding Scenarios: This guide has helpful examples of how UnitedHealthcare might reimburse for telehealth services during the national emergency. UHC also released additional coding and reimbursement guidance available on their website.
Expanded Telehealth Access: Policies around telehealth have been expanded across all of our health plans.
Timely Filing: Claims with a date of service on or after Jan. 1, 2020 will not be denied for timely filing deadlines if submitted by June 30, 2020.
Videos to Help Guide Billing: Two videos are available for easy visual instruction on billing for COVID-19-related office visits and laboratory tests.
Prior Authorization Requirements: Many requirements have been suspended or eased during the national emergency period. Review specific details and dates here.
CARES Act Training: UnitedHealth Group has been selected to facilitate delivery of CARES Act Provider Relief funding through the U.S. Department of Health and Human Services (HHS). This user guide will help you navigate the HHS provider portal, and this quick tutorial outlines what you need to know to request or confirm additional relief funding.
Medicare
CMS announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments.
For more information on the CARES Act Provider Relief Fund and how to apply, visit here.
For an updated fact sheet on the Accelerated and Advance Payment Programs, visit here.
States Resuming Elective Surgeries
Becker’s Healthcare is keeping a running list of states as they announce plans to resume elective surgeries. Is your state on here? Bookmark the list here.
Paycheck Protection Program Updates
An SBA loan that helps businesses keep their workforce employed during the Coronavirus crisis has resumed as of April 27, 2020. The SBA has started accepting Paycheck Program applications from participating lenders. If you're a small business, look into applying here or contact your local bank.
Sharpen Your Axe with LRS!
Sharpen Your Axe with LRS!
““Give me six hours to chop down a tree and I will spend the first four hours sharpening the axe.” - Abraham Lincoln”
At LRS, we pride ourselves on implementation and improvement. Our company is named after Abraham Lincoln - we focus on ways to make your practice more efficient and in turn, collect every penny of what you are owed.
Since we started our company six years ago, we have been sharpening our axes. Here are several of the ways we can help you:
LRS works as a clearinghouse to reduce the administrative burden that is placed on the medical practice and instead allows you to focus on providing quality care to your patients.
Now, more than ever, it is essential that you collect on every claim you have outstanding. Let us help you attack your AR and clean up any outstanding debts you have.
Insurance Verifications & Authorizations
We understand that you may be working with a lean staff right now. We can take over verifications and authorizations for you to ensure the patients that you are seeing are going to be covered for service.
Now is a great time to make a switch for your full revenue cycle management. We will guide you through the process every step of the way and hit the ground running submitting your claims, working your denials and AR, and collecting every penny you are owed.
Things You Should Know This Week
Accelerated Payments
CMS released information on the expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat the 2019 Novel Coronavirus (COVID-19).
A Medicare provider/supplier who submits a request to the appropriate Medicare Administrative Contractor (MAC) and meets the required qualifications will be able to request up to 100% of the Medicare payment amount for a three-month period. Review of the accelerated/advanced payments are handled by the providers and suppliers’ MAC. Electronic submission is preferred and MACs are supposed to review the submission within seven calendar days of the request. The provider/supplier can continue to submit claims as usual after the issuance of the accelerated or advance payment; however, recoupment will not begin for 120 days.
Learn more on the CMS fact sheet here.
Also, CMS isn’t the only insurance provider who is offering accelerated payments. Check with your billing team to see if your other major payers have this as an option.
Telehealth Relief Application
The COVID-19 Telehealth Program will provide $200 million in funding, appropriated by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, to help health care providers provide connected care services to patients at their homes or mobile locations in response to the novel Coronavirus 2019 disease (COVID-19) pandemic.
On April 2, 2020, the Commission released an order establishing the COVID-19 Telehealth Program. The COVID-19 Telehealth Program will provide immediate support to eligible health care providers responding to the COVID-19 pandemic by fully funding their telecommunications services, information services, and devices necessary to provide critical connected care services until the program’s funds have been expended or the COVID-19 pandemic has ended.
Stimulus Relief Fund Payment
Approximately $30 billion in payments was distributed to Medicare Part B providers in proportion to their overall share of Medicare Fee for Services payments that were made to the participant during 2019. Providers were distributed a portion of the $30 billion based on their share of total Medicare FFS reimbursements in 2019.
However, there are strings attached to these CARES Act Provider Relief Funds. Please see here for the applicable payment terms to consider before using any of the funds.
THANK YOU!
We wanted to take a moment to thank all of you health heroes. In the wake of our new reality of ‘flatten the curve,’ where social distancing and face masks are the new norm and quarantine measures are widely practiced, you all are still showing up every day for your patients. So many of you have stepped up in incredible ways - transitioning to telehealth models quite literally overnight, ensuring your clients (and clinicians) safety in your offices, and continuing to provide the highest levels of care to the communities and vulnerable patients you serve.
A quote from Theodore Rubin has resonated with us during this time:
Happiness does not come from doing easy work, but from the afterglow of satisfaction that comes after the achievement of a difficult task that demanded our best.
The pandemic has demanded our best. We will get through it together.
Thank you for all you do.
With admiration,
Bryanne and Danielle
Using This Time to Clean-Up Your A/R
Using This Time to Clean-Up Your A/R
In the midst of this chaos (and most likely as you are seeing less patients), it is more important than ever to collect every penny you are owed.
The best way to do this is to start a complete A/R overhaul.
At LRS, we are A/R clean-up professionals!
A few details on how we attack your outstanding claims and get you paid faster:
We review each and every individual claim that is aged out over 90 days.
We handle all the rebilling, recommendation of write offs, correcting of claims, appealing of denials, and anything else that may need to be done to bring the claim to a resolution.
We provide you with a spreadsheet with each of these claims with the reason they are outstanding and what the anticipated outcome is for each claim so you know exactly how much money you can expect to be coming in the door.
As always, through this A/R process and through everything we do at LRS, we really pride ourselves on our communication with your entire team.
Do you want to learn more about how we could help? Contact bjohnson@lincolnrs.com to set up a time to talk.
Insurance Updates to Implement This Week
Several announcements have been made regarding policies during COVID-19.
CMS has temporarily halted sequestration under Medicare. Starting on May 1, 2020 and extending through December 31st, 2020, CMS will no longer sequester 2% from allowable Medicare payments.
UnitedHealthcare has approved telehealth for therapy providers. This is subject to state laws and regulations around telehealth, but, if permissible, this enables physical therapists, occupational therapists, and speech therapists to provide true telehealth services. Eligible codes will be reimbursed by UHC with a place-of-service code 02 and the 95 modifier.
CIGNA has created telehealth policies for therapy providers. These measures allow for reimbursement of PT services that include codes 97161 (evaluation, low complexity, 20 minutes, telephone or virtual), 97162 (evaluation, moderate complexity, 30 minutes, virtual), and 97110 (therapeutic exercises, two unit limit). Codes must be appended with a GQ modifier and billed with a standard place-of-service code.
Each payer is providing different guidance on how to bill for telehealth services so it is important that they are set up correctly in your EMR system.
If you have any questions about billing for telehealth services (or getting set up to provide it), please don’t hesitate to contact us. We are here to help.
COVID-19 and Industry Updates
We hope you are staying well during this time. We wanted to highlight a few news updates both COVID-19 related and industry news related.
As a reminder, Contact your legislators today and ask them to pass The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (HR 4932/S. 2741). This is bipartisan legislation that would expand the use of telehealth services and ease restrictions on telehealth coverage under the Medicare program. Click here to send a letter directly to your Congressional Members.
In other news, TRICARE has issued the final rule to add PTAs and OTAs as TRICARE authorized providers for PT or OT services under the supervision of a TRICARE-authorized PT or OT in accordance with Medicare’s rules for supervision and qualification. General supervision requires the PT or OT to be available if needed by the PTA or OTA but does not require the PT or OT to be in the office suite or on the premises. Tricare may still implement CQ and CO modifiers. This will be effective April 16, 2020. Read more about the final rule from the GAO.
As a reminder, AIM auths are scheduled to go-live on 04/01/2020 for the following plans:
Anthem Medicaid IN, NY, WI
Anthem Commercial CO, NV
Anthem Medicare CA, CO, CT, GA, IN, KY, ME, MO, NH, NM, NY, OH, TN, TX, VA, WA, WI.
For services that are scheduled on or after 04/01/2020, providers must use AIM to obtain authorization for outpatient rehabilitation services. The online portal can be used 24/7 to place authorization requests, and many times, the determination is made at the time of submission! Visit here to register today!
As always, we are here to help. Be well.
Click here to read how we’ve taken our security more seriously in this article with our President and Co-Founder, Danielle Pantalone and Paobox!