The Impact of Fee Schedules

The Impact of Fee Schedules

Fee schedules play a critical role in reimbursement for every physician practice. Many physicians, however, don’t know what, exactly, a fee schedule is, and how their own is kept up-to-date.

Oftentimes, when we speak with physician practices and ask about their fee schedules, the physician acknowledges that they have a fee schedule, but that they have no idea who created it, maintains it, or even where it originated.

So, let’s start at the beginning…

A fee schedule is a complete listing of all the fees used by an insurance carrier to pay physicians and other providers of healthcare services/products. This comprehensive listing provides a maximum reimbursement that each carrier will pay to physicians for their services.

Often, many commercial/managed care carriers will base their fee schedules off of the CMS’ Physician Fee Schedule, and so CMS is frequently referenced as the leading authority for the average reimbursement for medical services. Each insurance carrier that a physician/physician group is credentialed and participating with will have their own fee schedule that is a part of their contract with physicians for reimbursement.

Fee schedules are also used internally by physician practices for both cash billing and carrier billing for services provided. These fee schedules are created and maintained by the physician and their billing

staff, and are used to ensure that the physician is collecting the maximum amount of revenue allowed by the carrier for each date of service.

Why is all of this important to physicians?

Let us provide an example…

Say you see a new patient and your internal fee schedule (what you bill the insurance company) is set at $75 for a new patient office visit CPT. The insurance carrier receives and processes the claim, and

reimburses you the entire $75. That’s great, right? Not always.

Total reimbursement by an insurance carrier for a billed amount often signals that the billed amount may be too low, and that the provider may be losing out on the maximum allowable reimbursement for that CPT; this is an indicator that the practice needs to review their billing fee schedule and perhaps increase the charged amount on certain CPT codes.

Conversely, imagine that the same patient has returned for another visit. You’ve updated your fee schedule and are confident that you will now collect the maximum you are owed for the service. Your billed amount is now set at $150 for this service. The insurance company receives and processes this new claim; however, this time only reimburses you for $25 of the billed amount. What happened? Is your fee schedule now set too high or did the insurance company reimburse too low?

Unless you have a copy of your fee schedule with that carrier, or understand what the average reimbursement for that CPT is, it will be difficult for your biller to know why the claim was reimbursed at such a low rate.

These two scenarios are good representations of what we frequently encounter when we consult with various physician practices and organizations. It is not uncommon to uncover significant lost revenue, either because the claim was billed at too low an amount, or because the biller did not have the time, information and resources (system set up) necessary to make sure each claim was being paid correctly.

It is critical that physicians and their managers recognize this crucial piece of the billing cycle, and work to make certain that it is kept up to date within their practice management system.

If you have questions or need extra help with your fee schedule and/or other areas impacting your revenue cycle, we can provide assistance.

Patient Statements: Your Secret Weapon to Improve Patient Payments

Every year, patients are paying more out of pocket for their healthcare – and given recent headlines, the situation may become worse. As a result of COVID-19 costs, one organization estimates that premiums for private plans will increase between 4 – 40% next year. In addition to monthly premiums, deductibles are on a steady rise as well. The percentage of workers with a deductible of $2,000 or more has increased from 18% to 28% over the past five years.

As a result of the shift in reimbursement from insurance payers to patients via high deductibles, patient revenue is a top source of income for many providers, following closely behind Medicare and commercial plans such as BCBS. Even before the pandemic, patient collections were a significant concern for providers, as indicated by a survey where 58% said collecting from patients was their top revenue cycle concern.1

Are organizations underestimating the impact of patient statements, and by association, patient payment options on their bottom line? Some statistics to consider:

  • 70% of consumers reported being confused by their medical bills
  • 80% said an easy-to-read statement was important for their medical bill experience
  • 65% would consider switching providers for better healthcare payments experience
  • 80% said that payment channel choices were very or somewhat important to their medical bill payment experience

Despite worries about collecting from patients, 41% of providers haven’t updated their patient statements in five years or more.1

The cost of patient statements

In addition to patient preferences driving a re-think of how you bill, statement material and labor expenses can impact your bottom line. The material costs are well over a dollar to mail a statement, and of course the labor of coordinating their generation and mailing needs to be factored in as well.  According to an MGMA Stat poll, over 46% of respondents mail three statements before a patient account is sent to collections.

Given patient perceptions, and the high cost of sending statements, taking a second look at your patient billing and payment systems may be in order.

Boost revenue with easy patient statements and payments

When updating your patient billing and payment systems, there are three critical components to bear in mind: statements, payments and past-due reminders. VOWHS can provide your practice with these features, as well as electronic statements receive payments faster.

Customized statements provide opportunities

Customized statements, especially electronic statements (e-statements), are an excellent way to decrease costs, a resourceful way to communicate with patients and useful tool to reduce billing question calls into the office. Practices that take advantage of customized messaging can communicate things such as:

  • If you think your claim is denied in error, please contact your insurance carrier to confirm coverage before calling us.
  • Question about your bill? Go to our website (insert your web address) for answers to frequently asked questions.
  • Want to speak to a billing representative? Call (insert your billing phone number). Press (X) for a callback if you don’t want to wait on hold.

Customized e-statements are also an opportunity to tell your patients what they owe in a straightforward way. Columns can be tailored into easy-to-understand language. For example, rather than calling an amount due “coinsurance,” customized statements can call it “your portion.” Rather than using the word “adjustment” at the top of a column, you can choose to call it an “insurance discount.” Small changes in wording can create a tremendous positive impact on patients. For example, a heart specialist practice was able to collect nearly $3,000 more a week with customized statements.2

The convenience of online bill pay encourages payment

It is well documented that patients are in a consumer mindset. Many see a statement as just another bill to pay and think, “If I can pay my utility bill online, why not my medical bill?” Younger patients may not even possess a checkbook! Online bill pay offers the convenience of 24/7 availability. It also makes it easy for caretakers to pay bills for their loved ones on a credit card rather than directly from a bank account. Up to 75% of patients will pay their bills online given the opportunity.2

Automated past due reminders

Most patients have every intention of paying their medical bill. However, sometimes other bills take priority, or they are distracted by life events. Rather than sending out another costly statement, automated phone calls and texts can be a quick and effective reminder that their bill is past due. If you offer online bill pay, some patients near a computer will pay as soon as they receive the alert. One practice in St. Louis used a combination of online bill pay and automated reminders to shave almost a week off their accounts receivable (A/R).2

Is it time to investigate how updating your patient billing and payment systems can improve revenue? Using the right partner for practice management software and billing makes it easy. Contact us today at (412) 424-2265 or visit our RCM page. 


1 Four ways group practices can create a better patient experience. MGMA. https://www.mgma.com/resources/revenue-cycle/four-ways-group-practices-can-create-a-better-pati.

2 POS Professional Office Services, Inc. (2020).

Moving Forward: Managing the Repercussions of COVID-19

As the country reopens from the COVID-19 shutdown, healthcare organizations are gradually emerging from the most extensive mass disruption to healthcare delivery ever known. In March, the CDC recommended postponing all elective surgeries during a nationwide lockdown. Additionally, practitioners of all specialties saw volumes drop, leading to an unprecedented plunge in revenue that resulted in 1.4 million healthcare jobs lost in April alone.

COVID-19 caused shortages of PPE, which meant that some providers were not fully equipped to protect themselves from the virus and contracted the disease. Climbing infection rates and death tolls made daily headlines. The worst may not be over; recent reports warn Americans to brace themselves for a second wave.

Where do healthcare practices go from here? There are many factors to consider, ranging from ensuring the health and safety of patients and staff, to reviewing finances to keep the practice open, to getting ready to be hit by the virus again. Here are some practical suggestions to get you started moving in the right direction.

Ensuring the health and safety of patients and staff – adjusting workflows

Although patient volume should steadily grow in the coming weeks, many patients are still reluctant to visit their healthcare provider. Healthcare organizations are aware that some members of staff may have concerns about returning to work. One answer to assure health and safety is to adjust workflows mindful of three categories: utilizing technology, maintaining social distancing, and enacting cleaning and visit protocols.

Technology

Many providers are using telehealth to treat patients without seeing them in person, saving PPE and eliminating possible exposure in the office. Pre-visit COVID-screening phone calls are another useful tool to warn providers of potential cases. Some offices have chosen to ask patients suspected of having COVID remain in their cars during specimen retrieval, so the patient never enters the office. Phone or video visits can also be used by support staff for histories of present illness and health histories, so they don’t need to be done in-person, saving time (and limiting exposure) while the patient is in the office.

Social distancing

The use of ‘pod’ treatment areas is a hospital concept that can be applied to outpatient settings. Some offices are designating staff to COVID and non-COVID workstations. The idea is to keep staff and supplies completely separate, thereby lowering the risk of cross-contamination. Limiting staff and patient entrances and exits is another strategy to maintain social distancing (and screen for COVID before entering the building). Both patient and staff areas should have seating at least six feet apart and consider using partitions in places where it makes sense, such as the front desk.

Cleaning and visit protocols

Communicating to your patients about visit protocols, including enhanced cleaning and disinfection, may help patients feel more comfortable during their appointments. A bonus is that it is likely to help your staff feel more comfortable as well. Visit the CDC website for printable notices about stopping the spread of COVID-19 and educational materials to display in your office. Some offices have enacted ‘split shifts’ to accommodate new cleaning measures; for example, half a shift is dedicated to regular duties, while the second half is used for cleaning.

Review finances to prepare for future fluctuations

Unfortunately, many offices will begin operating with a diminished workforce due to lay-offs. As volume starts to increase, the need for staff will rise as well. Building financial forecasts will help organizations gauge their readiness to move toward building a ‘normal’ practice. Some financial considerations include:

  • Ensuring funding/capital is available for future needs (consider how to minimize the economic impact of a second wave or where you can go for money if needed)
  • Review the unforgivable part of the SBA 7(a) PPP loan, note reporting requirements and payment deadlines
  • Consider offering payment plans to patients that have become unemployed or uninsured; if you already provide payment plans, review payment options and limits to see if you think they are still appropriate
  • Review EOBs to look for trends indicating changes in payer mix and anticipate how changes may affect revenue moving forward
  • Consider outsourcing billing to protect your revenue flow; third-party organizations have layers of employees and systems resilient to staffing fluctuations

Also, think about revising your budget based on anticipated volume, historical collection ratios, and payback of deferments and loans. Moving forward will be much easier when you know where you stand.

Get ready for a second wave of COVID-19

Health officials warn that there will likely be a second wave of infections in late Fall of this year. Now is the time to prepare for possible PPE and drug disruptions, as well as renewed stay-at-home orders.

  • Avoid future PPE and drug shortages by analyzing consumption and supply since March
  • Build a stockpile of PPE that can carry you through the initial stages of a second wave
  • Find alternate suppliers of infection control PPE
  • Build a list of alternatives to commonly prescribed drugs at your practice
  • If you are not already using online visits, investigate platforms and consider adding them as a standard service; it will help minimize future patient care disruptions

Many lessons have already been learned since the outbreak of COVID-19, and there are undoubtedly more to come. Practices that continually assess their health and safety protocols, financial stability and preparedness for another emergency put themselves in the best position to weather upcoming challenges.

Using the right partner for practice management software and billing can help you continue operations during uncertain times. Contact us today for a no-obligation discussion at 412.424.2265 or email info@vrsmed.com.

COVID-19 Telehealth Info. to Know

Advertisements for telehealth are everywhere – insurance companies, hospitals and healthcare organizations of all sizes are encouraging patients to use virtual visits in the age of COVID-19. However, in many sectors of healthcare, the adoption of telehealth services has been slow.

To encourage both patient and provider utilization to help people comply with stay-at-home orders (as well as to protect healthcare workers from possible infection exposure) the Office for Civil Rights (OCR) and the U.S. Department of Health and Human Services (HHS) have eased regulations for telehealth during the COVID-19 emergency. There are three main points to know:

  1. Everyday video/audio communications are permitted (you don’t need to use a specialized platform – although there are distinct advantages for doing so)
  2. HIPAA regulations have been relaxed
  3. There are new, expanded options for billable telehealth visits


A closer look at COVID-19 telehealth

It’s okay to use Skype, Apple Facetime, Google Hangouts or similar technology – but proceed with caution

According to the OCR and HHS announcement concerning the new regulations, as long as the visit can be one-on-one, everyday applications like Skype are permitted. Platforms such as Twitter, Facebook Live and chat rooms are not allowed because they are not ‘private.’ Providers do not need a Business Associate Agreement from the technology platform to use video conferencing during the emergency.

As a short-term solution, using regular commercial platforms will help patient flow. However, from a business perspective it may not be a viable solution for long. Billing for virtual visits that are in no way linked to your organization’s practice management or EHR system will require additional administrative time that will inflate labor costs, as well as raise material costs-to-collect. Organizations that use an integrated solution, such as ezTelemedicine, an athenaPractice™ (formerly Centricity™ Practice Solution) integrated solution, will not only avoid the headaches of manual claim input and after-visit payment collection, but will also have the security and convenience of their normal medical management software. Providers that choose to use ezTelemedicine can be up-and-running in as little as seven days.

Make reasonable efforts to protect patient privacy during visits

HIPAA regulations have not been completely dismissed. As long as providers are making an effort to protect patient privacy as much as possible, the OCR and HHS will not penalize for HIPAA breaches (such as a hack into a visit). What types of efforts are considered reasonable for healthcare organizations? Some examples include:

  • Using permitted technology
  • Conducting visits in as much privacy as possible
  • Continuing to abide by the minimal disclosure rule
  • If working from home, using a secure network and protecting patient information from household members


There are more ways to use telehealth during COVID-19

CMS published an expanded list of telehealth services to give both inpatient and outpatient providers more options to see patients. CMS is encouraging providers to use telehealth to minimize in-office patient visits as much as possible – which means the appointments don’t necessarily need to involve COVID-19 cases and suspected cases.

For example, group psychotherapy can be held via teleconference technology (CPT® 90853). Physical and occupational therapists can perform evaluation visits, physical performance tests and self-care management training. Inpatient providers can utilize telehealth for emergency department visits and observation. In-home visits by providers are also covered and can now be done via telemedicine, if appropriate. Visits eligible for telehealth before the pandemic remain on the list (new and established patient E/Ms, behavioral health visits, etc.) Billers will still need to use Modifier 95 to indicate a telehealth visit.

Keep an eye out for changing rules and regulations

The expanded telehealth codes have been valid for use on claims since March 1. As of now, there are no end dates for the new (but temporary) codes. Although most major insurance companies will likely accept telehealth billing, it is always wise to check before sending out claims.

As the response to the pandemic evolves, compliant billing and coding will change as well. Stay on the lookout for updates from CMS and payers to avoid problems with payment in the future.

Do you have questions about integrating telemedicine into your practice? Contact us today at (412) 424-2265 or visit our RCM site.

Are you working harder, not smarter?

Examining your gross and net collections ratios will tell you.

Have you been in this scenario?

You’ve gone through your financial reports, again and again, trying to figure out why your practice is making less money. The problem is everything looks the same. There is no increase in denials, chargebacks or write-offs. Your patient visits have remained steady. Where do you go to find answers?

According to Alyse Danley, Revenue Account Manager at Virtual Revenue Solutions, a sister company and partne of Virtual OfficeWare Healthcare Solutions, there are two ratios you should check: your gross collections ratio (GCR) and your net collections ratio (NCR). “Understanding these numbers can help you gauge your performance and forecast future earnings,” said Danley. “When you look at these numbers in conjunction with your fee schedule, you can understand adjustments you may need to make to put your practice back on track.”

Understanding your gross collections ratio (GCR)

Total payments/charges

One question this ratio answers is how close you are to your payers’ rates. Monitor your top codes to confirm that you are in line with your practice’s established fee schedule ratio (typically around 150% of Medicare allowable amount or above). If your top code fee ratios are smaller than your set ratio, it may be time to renegotiate your rates with payers. Outdated reimbursement rates are often a problem with older practices because operational costs have gone up, but payment rates are stuck in the year the payment contract was signed.

If your GCR is inching-up every month, then it’s time to review your fee schedule and consider raising your rates. There’s a possibility that your fees may be lower than some of your payers’ allowable amounts. Low fees happen more frequently than many realize. Yearly reviews of your fee schedule against payer reimbursement will help avoid this issue.

According to Danley, your GCR is best used for internal measurement. It’s good to be aware of your number every month, but looking at a rolling six-month analysis allows for variances due to seasonality (such as deductibles at the beginning of the year, holiday slow-downs or times of the year when you get particularly busy).

Understanding your net collections ratio (NCR)

Payments – adjustments/ charges

Your NCR measures how well your practice is collecting the money it is owed. Ideally, NCR ratios should be at 95% or above – meaning you have collected 95% or more of possible revenue. This ratio is dependent on many factors, both operational and payer-related, including your mix of carriers, the types of procedures you perform and how quickly A/R is resolved.

If your NCR needs to be improved, or you are seeing large month-to-month fluctuations, there are several questions you should be asking. The answers will help you pinpoint weaknesses and set goals for improvement. They include:

  • Are you carrying A/R past 60 days?
  • Is there an issue with receiving payments?
  • Are payments posted promptly?
  • Do you have a consistent mix of appointments (new patients, sick visits, follow-ups, etc.)
  • Are you performing more or less of your top procedures?
  • Has reimbursement for your top procedures changed?
  • Is there a problem with sending out secondary claims or patient statements?
  • Are there payers having unusual delays in payments?

A change in payer mix may account for variations in your NCR as well, so Danley recommends performing a payer mix review on at least a yearly basis. Isolate your top payers and pull reports showing charges, payments and adjustments for the last twelve months. It may be that payers that reimburse less are a more substantial part of your patient population than a year before. She also recommends periodic reviews of longer data periods (three to five years) to identify macro trends that are hitting your bottom line.

Another useful aspect of knowing your NCR is that it is an excellent metric to use to compare your practice to others. Resources to find comparable data include the MGMA, HFMA and other medical associations. In many instances, you will pay for the reports, but the value of having realistic benchmarks to work toward and simply knowing how your practice is performing against others can make the cost worthwhile.

Do you have questions about your GCR or NCR ratios, or concerns about your practice’s overall performance? Contact us today at (412) 424-2265 or visit our RCM page. 

ICD-10 Codes for the Holidays.

ICD-10

Cut your High Rate of Unspecified Coding Denials

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Although ICD-10 has been in use for several years, problems with unspecified coding and the subsequent denials they trigger persist. Fortunately, unspecified coding denials can be easy to remedy for coders when they are given the complete picture of the encounter. Unfortunately, clinicians often don’t understand how poor documentation can leave coders with no other choice but to use an unspecified code.

It is essential to understand what unspecified codes say to insurance companies in order to fully understand why they so often trigger denials.

What unspecified codes really mean

In a nutshell, anytime an unspecified code is recorded on a claim, it is telling the payer that the case is so exceptional, it cannot be defined. According to The American Health Information Management Association (AHIMA), documentation must reflect the full extent of clinical knowledge. Therefore, these codes are saying that there is something about the condition that is unknown.

Sometimes unspecified codes are appropriate

There are times when unspecified codes are applicable – for instance, in cases of poisoning when the agent can’t be determined or with certain diseases and viruses. Overall, most providers that are practicing day-in-and-day-out medicine should be using unspecified codes as an exception rather than the rule.

The financial consequence of unspecified coding

Unspecified codes can trigger outright denials that need to be resubmitted and additional documentation requests (ADRs) that are time-consuming to resolve – resulting in increased labor costs. Another costly danger of unspecified claims is the risk of timely filing write-offs when responses to ADRs are delayed.

Considering the root causes of unspecified coding, most claim problems are avoidable.

Documentation omissions often result in unspecified codes

ICD-10 expanded diagnosis codes from the prior ICD-9 set of approximately 13,000 to around 68,000. That means the new codes contain a level of specificity that didn’t exist before the update, and the only way to code to that level of specificity is to have the information documented in the patient record. Generally, some broad categories help define specificity. They include:

  • Laterality
  • Specific body sites
  • Prior history
  • Circumstances (intentional or accidental)
  • Initial or subsequent encounter

Including information about the general categories will often give coders the information they need to code to the highest level of specificity.

Coders need to dig a little deeper

Of course, there are instances when documentation that defines specificity is contained in the patient record, but overlooked by coders. For example, a patient encounter only states shoulder pain, but a radiology report tied to the visit finds a hairline fracture of the right scapula. Therefore, the fracture should be the diagnosis rather than the pain in the shoulder.

In addition to looking through documentation to find answers, it can be helpful for coders to have more than one resource to help code.

Coding resources can help define specificity

There are many resources available to help coders capture the correct ICD-10 code. Free resources to aid coders are available from CMS at https://www.cms.gov/Medicare/Coding/ICD10/ICD-10Resources. However, many practices use coding software for its convenience, accuracy and efficiency.

For example, Centricity® offers a function that uses an easy-to-understand stoplight system to help providers determine if there is an acceptable level of specificity on the claim. A click of the mouse accesses the full list of ICD-10 codes to search. The codes can then be refined further to enhance specificity and can account for clinical attributes such as anatomical site, causative agent, specific episode of care, laterality, etc. A green light appears when billable specificity levels are achieved.

Get to the bottom of your unspecified coding issues

There are some simple, but effective steps you can take to minimize the use of unspecified codes:

1.  Audit denials

Regularly run denial reports to pinpoint problem coding. Plan on tackling the codes with the largest percentages of denials first.

2.  Review documentation

Pull patient records for the selected denied codes to confirm the encounter notes contain all required information for coding to the highest degree of specificity. If critical information is missing from the record, provide training to providers to ensure awareness of the information needed for correct coding. Retrain coders that are missing vital information contained in the patient notes to avoid unspecified codes in the future.

3.  Continually monitor

Coding definitions change and many practices have staff turnover. Continual monitoring of denials and documentation allows corrective action to be taken immediately – keeping labor costs low and revenue flowing.

Want to learn more about how VOWHS can help you avoid unspecified code denials? Contact us today at (412) 424-2260 or visit us at www.vowhs.com.

Raleigh Neurology Associates discovers the VOWHS service difference

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When Amy Roberts began working two and a half years ago as Director of Health Information Systems at Raleigh Neurology Associates (RNA) in NC, she was a bit concerned about working with a value-added reseller (VAR) of Centricity®.

“I’ve worked in the Centricity space for 15 years,” said Roberts. “When working for an orthopedic practice several years ago, it just so happened that my first day was also the first day of go-live for Centricity. Later, I worked for a third-party portal company and implemented the portal for Centricity practices. Given my familiarity with the system, I wasn’t sure if a VAR would benefit me.”

However, Roberts realized the value of Virtual OfficeWare Healthcare Solutions (VOWHS) with the submission of her first service ticket.

“It’s inevitable that service issues will arise. I was blown away that we were able to resolve our ticket so quickly,” recounted Roberts. “Before working with VOWHS, I usually had to wait for weeks or even months for a ticket to be resolved, which was very frustrating and had a direct impact on productivity. VOWHS had the problem solved in no time.”

According to Roberts, “Collaborating with VOWHS has made a significant productivity difference and moved the needle for our practice.” She cited three reasons why she believes VOWHS has had such a tremendous impact on operations:

1. VOWHS is an advocate

“There is no doubt I was skeptical of having a middle-man between me and the software vendor. But, VOWHS is completely invested in our business and goes the extra mile,” reflected Roberts. “They completely understand our needs and issues and have effectively advocated for us to Centricity when we needed it. They understand both sides.”

2. VOWHS knows who we are

Roberts said that VOWHS’s knowledge of the system and workflows has had a considerable impact on issue resolution speed. There is no need to start from scratch with each ticket. And, when you open a ticket, you work with the same group of people, so you develop a comfort level that doesn’t exist when you are dealing directly with a large corporation.

Another benefit of the relationship is that VOWHS makes adjustments to meet Roberts’ specific workflow needs. “They not only give us technical support but workflow advice as well. Communication between the practice and VOWHS is ongoing and has a partnership feel,” said Roberts.

3. VOWHS is hands-on

If there is a critical workflow or technical issue, tickets are quickly triaged and escalated. According to Roberts, “The VOWHS staff will stay on the phone with you and work with you until the issue is resolved.”

Roberts cited another example of VOWHS’s hands-on approach.  RNA recently implemented a product developed by VOWHS that allows multiple documents to be faxed in one batch out of the system. “It has become a huge time-saver for my medical records team,” she commented. Roberts said that there was a smooth roll-out of the new product because VOWHS was hands-on and ensured a successful implementation. When it’s time for a substantial upgrade, VOWHS works with her internal IT department to ensure everything runs smoothly.

VOWHS has helped RNA improve patient care

When Roberts was asked what she would recommend to organizations that were exploring a Centricity VAR, she had this to say: “Working with VOWHS has helped us in so many ways. We have direct contact with the expertise we need to resolve issues promptly. We’ve been able to make workflow adjustments to meet our needs because of their insight. Our practice has improved tremendously, and it’s satisfying to see the positive impact on our staff and our patients.”

Want to learn more about what VOWHS can do for your organization? Contact us today at (412) 424-2260 or visit us at www.vowhs.com.

How to Solve Report and Form Workflow Issues

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A leading behavioral health center saves time and improves care with EHR functionalities.

Like many other behavioral health organizations, Coastal Horizons Center, Inc. (Coastal Horizons) located in Wilmington, NC, realized the paperwork required for patient treatment was causing labor overruns and taking clinician time away from patient care.

Caitlin Garner, assistant program director and Substance Abuse Intensive Outpatient Program (SAIOP) coordinator of Coastal Horizons, explained how behavioral health paperwork affects providers’ day-to-day patient care. “There is a lot of unavoidable paperwork to get clients the care they need. There are authorization forms for care, initial intake processes, re-authorizations, and reporting that needs to be regularly updated.”

Coastal Horizons turned to Virtual OfficeWare Healthcare Solutions (VOWHS) to help solve their workflow issues with two goals:

-Create electronic workflows for forms and reports with the ability to pull information from previous forms (so each one did not need to be started from scratch)

-Integrate layout formatting into the system so completed forms look exactly like the original

“VOWHS listened to us closely and helped us transfer everything into electronic formats that help us provide more efficient and effective care,” said Garner. Garner described two examples of expedited workflows developed with VOWHS:

Comprehensive Clinical Assessments (CCAs) – Previously, these reports were time-consuming because of the laborious process of re-recording patient histories. Now, information is pulled into the forms from previous years (so there is no re-keying of data) and new developments and treatment plans are quickly entered. Garner also pointed out that patients can be poor historians and often provide incomplete information about their past care. The new workflow gives a more comprehensive conceptualization of client needs and an accurate record of prior treatments, so time is not wasted trying treatments that have failed in the past.

Treatment Authorization Requests (TARs) – Gathering, processing and submitting information on paper was tedious and difficult to track. Today, the EHR aggregates information and organizes it into an electronic form that is submitted for authorization. The new process saves time and is easy to track.  Further requests for information have been drastically reduced because the information is laid out in a logical and organized way.

Garner also said there are some EHR features that providers find particularly useful:

Records organized by date – Records organized by date saves a lot of time compared to searching through paper records (and inserting records into paper files). Plus, paperwork from other providers is easily uploaded and accessible throughout the system.

Electronic signatures – This feature speeds document generation. There is no need to wait for a record to be physically transferred to the provider for a signature and then returned.

Templates prompt required next steps and documentation – When additional diagnoses need to be entered into the patient record, the system now automatically prompts the necessary codes for billing. There is no need to look up codes in the Diagnostic and Statistical Manual of Mental Health Disorder.

What is Garner’s advice to other organizations that are trying to create efficiencies in their workflows? “The biggest factor is saving time. Not only time entering data after a patient visit, but also time when a patient is sitting in front of you. When what you need is at your fingertips, treatment is more efficient and effective. Paperwork is necessary, but redundant. Optimizing workflows allows more time for clinical work, rather than paperwork.”

Want to learn more about what VOWHS can do for your organization? Contact us today at (412) 424-2260 or email us at info@vowhs.com.

Use Your Payer Mix to Boost Revenue

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Ever feel like you are working more and getting paid less? You might be if you haven’t taken a close look at your payer mix lately.

Your payer mix may shift over time even if you haven’t changed the insurances you accept. That’s because there are two elements to your payer mix: the fee schedules of the payers you accept and the number of patients you get from each payer. It is the interplay of the two factors that comprise your payer mix.

Managing your payer mix

The first step to maximizing revenue is understanding your current payer situation. The best way to assess where you stand is by examining:

-The payers you accept

-Your contracted rates with each payer

-Your most common CPTs

-How many patients you see from each payer

Let’s take a closer look at each category

Payers you accept – Hopefully, there is a reference list posted in your office of your in-network payers (if not, consider making one). Don’t forget to include patients as a payer group.

Most common CPTs – Examine claims and determine your most common 10 – 20 CPTs. These should make up most of your reimbursement and will give you a more accurate read of the actual situation than analyzing every single CPT.

Payers’ contracted rates – In many cases, this is more difficult than it sounds. Reimbursement rates should be included in your payer contracts. Some payers detail each CPT code, while others give you a percentage of Medicare or Workers’ Compensation. Percentage calculations can get complicated because some payers use base rates from the year of the contract, while others pay current year rates. Calculate your reimbursement accordingly for each CPT. It is not uncommon for contracts to be lost. If you can’t hunt one down, contact your payer to get your fee schedule. Use your self-pay fee schedule for patient payments.

The number of patients you see from each payer – Having this count will reveal the weight of each payer in your payer mix. Remember, self-pay patients should be included as a patient population.

Analyze your information

Create a spreadsheet to compare reimbursement for each of your common CPTs from every payer – this will tell you who pays most (and least). After determining which payers have the best (and worst) reimbursement, look at the number of patients you see from each payer. The combination of compensation and patient payer ratio is your payer mix.

Remember that your payer mix can vary from day-to-day, month-to-month, and year-to-year. This variance explains why you might get paid less for doing the same amount of work. One week may have more patients from a good payer come through your doors, while another week might see more patients from a payer with lower reimbursement.

Improve Your Revenue

Your lower payers are most of your patient population. If this is the case, it may be time to renegotiate your contracted rates. Investigate if you are one of only a few providers in the area that is in-network because that can be an advantage in negotiations. Conversely, if you are curious about the larger insurance companies in your area, find a helpful resource here.

You don’t have many patients from your highest payers. Find out which employers in your area offer your high payers and market to their employees. If you take referrals, find the providers that are in-network with your top payers. Reach out to those practices and confirm they have your office’s contact details for appointments.

Some payers have meager reimbursement rates. These payers might not pay what your time is worth, so, it may make business sense to drop them. Renegotiating fee schedules with other payers will improve revenue; actively marketing to employees of companies with better payment rates will fill appointment slots. It’s a hard decision to drop a payer, but sometimes it must be done to keep your practice in business.

The critical thing to remember about your payer mix is that it can, and will, change. Periodic audits and adjustments will keep your practice on track and ensure you’re maximizing your reimbursement opportunities.

If you would like to learn more about creating an effective payer mix, contact us at 412-424-2260 or email info@vowhs.com.