Author: PractiSynergy

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PractiSynergy Updates

Lyme Disease: Protect Yourself for the Rest of the Season

As summer comes to a close, it’s essential to remain aware of potential health risks we may have come into contact with, even amidst the joys of the season. One such concern is Lyme disease, a tick-borne illness that has been linked to the summer months. At PractiSynergy, your partner in medical billing, coding, credentialing, and practice management consulting, we believe in not only optimizing healthcare practices but also in promoting awareness and education. 

Understanding Lyme Disease

Lyme disease is caused by the bacterium Borrelia burgdorferi and is primarily transmitted through the bite of infected black-legged ticks, also known as deer ticks. These ticks are most active during the warmer months, making summer a time when the risk of contracting Lyme disease is heightened. While the disease can affect various systems of the body, including the skin, joints, heart, and nervous system, early diagnosis and treatment are key to preventing complications.

The prevalence of Lyme disease during the summer is influenced by several factors, including the increased outdoor activities that come with the warm weather. Hiking, camping, picnicking, and other outdoor adventures place individuals in closer proximity to tick habitats, such as wooded areas, tall grasses, and shrubbery. Ticks are more likely to latch onto exposed skin when people are wearing shorts, t-shirts, and sandals, making skin-to-tick contact more likely.

Furthermore, the summer sun encourages people to spend extended periods outdoors, increasing the likelihood of tick exposure. Ticks thrive in humid environments, and the combination of warm weather and moist conditions creates an ideal breeding ground for these tiny parasites. As a result, individuals who venture into tick-prone areas without proper protective measures are at a higher risk of encountering infected ticks.

Prevention and Awareness

At PractiSynergy, we understand the importance of proactive healthcare management. To minimize the risk of Lyme disease during the summer months, consider the following preventative measures:

Protective Clothing: Wear long-sleeved shirts, pants, and closed-toe shoes to reduce 

the amount of exposed skin. Tucking pants into socks and using insect repellent on 

clothing can also deter ticks.

Tick Checks: After spending time outdoors, perform thorough tick checks on yourself, 

your family members, and even your pets. Pay close attention to hidden areas like the 

scalp, behind the ears, and the groin.

Tick Removal: If you find a tick attached to your skin, use fine-tipped tweezers to grasp 

it as close to the surface as possible. Gently pull upward with steady, even pressure. 

Clean the area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

Landscaping: Keep your lawn well-maintained and free from tall grasses, leaf litter, and 

overgrown shrubs, as these can provide hiding places for ticks.

By staying informed, adopting preventative measures, and seeking medical attention if symptoms arise, you can enjoy the rest of the season while safeguarding your well-being. At PractiSynergy, we’re not only dedicated to your practice but also to promoting the health and wellness of both patients and healthcare providers. Stay connected to our blog for more insightful articles on healthcare topics that matter. Your well-being is our priority.

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Medical Coding Guide

Veterans & Mental Health: What We Can Do

After commemorating our veterans earlier this month with Purple Heart Day, it’s important to remember that vets not only sacrificed their physical well being, but their mental health as well–something that has historically been overlooked and underestimated. The journey to mental well-being for our veterans is a shared responsibility that involves comprehensive support, understanding, and appropriate interventions. Veterans often confront unique mental health challenges stemming from their service experiences. What can we do about it?

Understanding Veterans’ Mental Health Needs:

Service-related experiences can lead to a range of mental health issues among veterans, including but not limited to post-traumatic stress disorder (PTSD), depression, anxiety, and substance abuse. These challenges highlight the need for specialized care and support that acknowledges the complexities of their situations.

Addressing Mental Health Needs Effectively:

The key to supporting veterans’ mental health lies in a multi-faceted approach that goes beyond medical treatments. While professional help is vital, holistic care considers various aspects:

Community Understanding: 

Fostering awareness about veterans’ mental health challenges helps remove stigma, making it easier for veterans to seek help without fear of judgment.

Accessible Resources: Ensuring veterans have access to a variety of resources, from 

counseling services to peer support groups, creates a safety net of support that acknowledges their unique struggles.

Tailored Interventions: Recognizing that each veteran’s experience is different, individualized treatment plans that consider their background, triggers, and preferences can significantly improve outcomes.

Our Role as Medical Professionals:

Medical professionals play a vital role in veterans’ mental health support. We can make a drastic difference in veterans’ quality of life if we address these patients and their unique needs effectively. 

Compassionate Care: A patient, empathetic approach helps create a safe space for veterans to open up about their experiences and challenges.

Accurate Diagnosis: Clinicians trained in veterans’ mental health concerns can provide accurate diagnoses that lay the foundation for appropriate treatment.

Collaborative Efforts: Collaborating with mental health specialists, community organizations, and veterans themselves ensures a comprehensive support system.

Additionally, in PractiSynergy’s role in assisting these medical professionals in keeping their practices productive so that they can continue to treat their patients effectively, we recognize that this can also present challenges in the medical billing and coding side of things. With complex diagnoses and societal stigma, accurately coding and documenting can be daunting. That’s what we’re here for. With successful and accurate coding, veterans can reap more benefits from their mental health care:

 Timely Access to Care: Accurate coding allows veterans to access mental health services promptly, reducing wait times and ensuring that their needs are met in a timely manner.

Comprehensive Treatment: Proper coding ensures that veterans receive comprehensive mental health treatment tailored to their specific conditions. This can include therapy, medication, and other interventions that contribute to their overall well-being.

Reduced Financial Burden: For veterans, mental health care costs can be a significant concern. Accurate coding helps veterans maximize their insurance benefits, reducing out-of-pocket expenses and easing the financial burden associated with seeking help.

Data Analysis and Improvement: Accurate coding generates reliable data that can be analyzed to understand veterans’ mental health trends and needs. This information is invaluable for healthcare providers and policymakers to improve services and allocate resources effectively.

Veterans have served our country, sacrificing their health and safety for the good of the nation and it’s citizens. The least we can do in return is recognize their unique struggles and treat their mental health as a matter of utmost importance, which requires a collective effort from society, medical professionals, and our community. While we are only a small part of that effort, PractiSynergy is proud to do our part by assisting fantastic medical practices with their medical billing and coding so that they can focus on their patients rather than payments. By understanding their unique challenges and providing holistic support that goes beyond medical interventions, we can create a compassionate environment where veterans feel heard, valued, and empowered on their path to mental well-being. 

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Medical Coding Guide

How to Make Wellness Screening Codes Work for You

Did you know that you can earn additional revenue for your healthcare practice by utilizing wellness screening codes? Medicare and various insurance companies provide coverage for preventive services beyond the annual wellness visit in a primary care setting. By taking advantage of specific wellness screening codes, you can bill and get reimbursed for services like alcohol misuse screening, depression screening, and counseling for tobacco cessation. Here’s how PractiSynergy can help your practice identify and maximize billing opportunities.

 

Alcohol Misuse Screening & Counseling:

Alcohol dependence is a prevalent issue that affects many individuals. Medicare and other payers cover an annual screening for alcohol dependence. This screening is defined by certain criteria, including tolerance, withdrawal symptoms, impaired control, and preoccupation with alcohol use. If a patient meets the criteria, your practice can bill for this service once per year. Additionally, for those who screen positive for alcohol dependence, brief face-to-face behavioral counseling can be provided. Behavioral counseling interventions should follow the 5 A’s approach: Assess risk factors, Advise on behavior change, Agree on treatment goals, Assist with behavior change techniques, and Arrange follow-up or other treatment. This counseling service can be billed up to four times per year.

Depression Screening:

Depression is a common mental health condition that often goes undiagnosed. Medicare and other payers offer coverage for annual depression screenings lasting up to 15 minutes. To ensure accurate diagnosis, effective treatment, and follow-up, staff-assisted depression care supports, such as nurses or physician assistants, should be in place. Your practice can bill for this service once per year, allowing you to provide crucial mental health support to your patients while receiving reimbursement.

Counseling to Avert Tobacco Use:

Smoking and tobacco use cessation counseling is an essential service for patients using tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related diseases. Medicare Part B and other payers cover up to eight counseling sessions per year. By offering counseling to help patients quit tobacco, you not only improve their overall health but also increase your practice’s revenue through reimbursable services.

 

Utilizing PractiSynergy:

Identifying and maximizing billing opportunities for wellness screening codes can be a complex process. This is where PractiSynergy can assist your practice. PractiSynergy is a comprehensive healthcare management solution that helps practices optimize their revenue cycle management. With its advanced features and tools, PractiSynergy can identify the services you’re already providing that qualify for reimbursement and ensure proper billing. By leveraging PractiSynergy, you can streamline your billing processes and focus on delivering quality care to your patients while maximizing revenue.

 

Take advantage of the wellness screening codes offered by Medicare and other insurance companies to increase revenue for your healthcare practice. By billing and getting reimbursed for services like alcohol misuse screening, depression screening, and counseling for tobacco cessation, you not only provide essential preventive care but also optimize your practice’s financial performance. With PractiSynergy’s assistance, you can easily identify these billing opportunities and streamline your revenue cycle management. Start leveraging these reimbursement options today and see the positive impact on your practice’s bottom line!

Contact us today!

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Medical Coding Guide

Increasing Payments When Rates Are Decreasing

PractiSynergy understands the challenges faced by healthcare providers in maximizing revenue. With governments tightening their budgets and insurance companies implementing complex reimbursement processes, it is crucial for medical practices to employ strategies that increase cash flow without overwhelming their staff. In this blog post, we will focus on one such strategy: Chronic Care Management (CCM).

 

What is Chronic Care Management (CCM)?

Chronic Care Management, as defined by the Centers for Medicare & Medicaid Services (CMS), refers to the coordination of care services provided outside of regular office visits for patients with two or more chronic conditions expected to last at least 12 months or until the patient’s death. CCM aims to address the needs of patients at significant risk of death, acute exacerbation/decompensation, or functional decline.

 

Reimbursable Opportunities for Providers:

Physicians, along with other healthcare professionals such as physician assistants, clinical nurse specialists, nurse practitioners, and certified nurse midwives, have the opportunity to bill for CCM services. However, it’s important to note that only one practitioner can be paid for CCM services per patient within a given calendar month. We recommend that only the provider responsible for the primary care of the patient bill for CCM services.

 

Understanding the Reimbursement Process:

CCM services are payable for a minimum of 20 minutes spent by clinical staff. Certain healthcare providers may also bill additional codes for extra time spent with patients. At PractiSynergy, we help medical practices determine which patients are eligible for these services and assist in creating a comprehensive plan to ensure all requirements for reimbursement are met.

 

Unlocking Additional Funds with CCM:

By documenting a few extra items in addition to the regular care provided to patients, medical practices can potentially qualify for additional funds through CCM reimbursement. PractiSynergy encourages healthcare providers to reach out and determine if they are eligible to leverage this opportunity.

 

How PractiSynergy Can Help:

At PractiSynergy, we understand the complexities involved in maximizing revenue and navigating the reimbursement landscape. Our team of experts will assist your practice in identifying eligible patients for CCM services and guide you through the process of implementing a reimbursable event. By partnering with us, you can streamline your billing and coding processes, allowing you to focus on providing quality care to your patients while optimizing revenue.

Contact us today!

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The End of the Public Health Emergency: Part 3 – Medicaid DIS-Enrollments

The Consolidated Appropriations Act of 2023, signed by President Biden on December 29, 2022, ends the continuous health coverage requirement for Medicaid members during the public health emergency. While this requirement was in place, Medicaid members did not have to go through the usual annual redetermination of their eligibility for benefits. However, now that this requirement has ended, Medicaid members will receive renewal letters with requests for information. If they do not respond or respond late, they could lose their Medicaid coverage.

States could start this process as early as February 2023, and disenrollment may start on April 1, 2023. This means that some Medicaid members may lose their coverage starting in May 2023. However, many states have opted for an “unwinding” period over the course of twelve months. During this period, Medicaid members who do not respond to renewal letters or requests for information may lose their benefits.

The potential for Medicaid members to lose their coverage could have a significant impact on providers with a high concentration of Medicaid members. Providers may see a negative impact on their cash flow and need to have conversations with patients to encourage compliance with requests for information to avoid disenrollment. Additionally, contingency plans should be in place to ensure payment for future visits. This could include setting a cash-pay or sliding fee policy, providing assistance or information about the plans available on the Marketplace, completing any paperwork required for patients during the redetermination phase, and being available to support an appeal if necessary.

To avoid surprises and non-payment, providers should verify eligibility on all patients. According to the Kaiser Family Foundation, between 5 million and 10 million people will lose their Medicaid coverage as states re-start the redetermination phase. Providers should be prepared for a potential increase in uninsured patients and have plans in place to ensure they are still able to provide quality care to those in need.

The end of the public health emergency marks a new phase in the healthcare landscape. With the end of the continuous health coverage requirement for Medicaid members, providers must be proactive in ensuring their patients have the necessary information to maintain their coverage. This includes having conversations with patients, verifying eligibility, and having contingency plans in place to ensure payment for future visits. By doing so, providers can continue to provide quality care to all patients, regardless of their insurance status.

With our deep expertise in healthcare policy, reimbursement, and regulatory compliance, PractiSynergy has been guiding our clients through the complex and dynamic changes that have arisen with the conclusion of the PHE.  Contact PractiSynergy to learn how to protect your cash flow through these upcoming changes.

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End of Public Health Emergency – Part 2

As the end of the public health emergency (PHE) approaches, it’s important for medical billing and coding businesses like PractiSynergy to stay up-to-date on the latest developments in telehealth services. During the PHE, the US Department of Health and Human Services made significant changes to the requirements for patients to access and for medical professionals to provide telehealth services.

Thanks to the Centers for Medicare and Medicaid Services (CMS) enacting waivers, providers were given greater flexibility in using telehealth services for their patients. But what happens when the PHE ends? In December 2022, President Biden signed the Consolidated Appropriations Act which extended the telehealth waivers through December 31, 2024. This means that the following temporary benefits will still be in effect:

  • No geographic restrictions on telehealth originating sites, including in a patient’s home
  • Telehealth visits may be delivered using audio/video or audio-only platforms
  • In-patient visits will not be required within a certain timeframe of a telehealth visit for mental/behavioral health
  • Physical and Occupational Therapists, Speech Language Pathologists, and audiologists may offer telehealth services
  • Services may be rendered outside of a provider’s state of enrollment
  • Federally Qualified Health Center (FQHC)/Rural Health Clinic (RHC) can serve as a distant site provider for non-behavioral/mental telehealth services.

However, it’s important to note that one element of the PHE telehealth service will end with the end of the PHE. Providers will now be required to use HIPAA-secure means of communication platforms while providing services. This means CMS will no longer allow chat applications such as FaceTime, Google Hangouts, WhatsApp video chat, etc. as a method to communicate with patients.

It’s essential to stay current on these changes to telehealth services. By doing so, providers can continue to offer high-quality care to their patients in a way that’s safe, secure, and compliant with all applicable regulations. At PractiSynergy, we’re committed to helping our clients navigate these changes and stay ahead of the curve when it comes to telehealth services.

Contact us today!

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Medical Billing Guide

End of Public Health Emergency – Part 1 COVID Services

It’s the end of the Public Health Emergency (PHE) as we know it! Under the PHE, private and government health insurers could not apply any cost-share amounts (co-pays, co-insurance, deductibles, etc) for COVID testing, COVID vaccines, certain treatments, or anti-viral drugs such as Paxlovid. Starting May 11, 2023, however, some of these COVID-related services will be changing. 

So what do you need to be aware of?

At the end of the PHE, Medicare Beneficiaries Cost Share will be reinstated. Meaning, COVID testing (at home and otherwise, except when being treated by a doctor to rule out COVID) and COVID treatments except for oral anti-viral drugs such as Paxlovid will now be able to be applied with cost-share amounts. 

For Medicaid and CHIP, no cost share will be applied to COVID vaccines or the administration of COVID vaccines for adults and children. Additionally, until the last day of the first calendar quarter one year after the end of PHE (September 30, 2024), no cost-share amounts can be applied. 

Finally, Private Health Insurance may reinstate patient cost share and may require prior authorization to cover COVID testing and testing-related services, as well as patient cost share for vaccines and vaccine administration. Private Health Insurance will also no longer be required to reimburse out-of-network providers for COVID tests, testing-related services, vaccines, or vaccine administration. 

As we celebrate coming to the end of this Public Health Emergency brought on by the COVID-19 pandemic, we also need to remain aware of the changes that will come with it. But with PractiSynergy, you don’t need to spend your time being vigilant over these changes or focusing on getting every detail right. We handle all things medical-billing and coding so that you can spend your time on what matters most, your practice and your patients. 

Contact us today!

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Medical Billing Guide

Should You Outsource Your Small Practice’s Billing?

We know that you and your practice have a lot on your plate. There’s lots to get done, and you can’t do everything! The revenue cycle is a time-consuming, complicated process, so should you outsource your billing? 

While it’s understandably tempting to want to have your part in all aspects of your practice, you’ll have to ask yourself if it’s worth sacrificing time and energy for the billing process. Will internally learning, understanding, and doing all functions of the revenue cycle contribute to a better understanding of the practice’s financial position? Here’s why you should consider letting an external company like Practisynergy take the weight of billing off of your shoulders. 

The revenue cycle is dense and complicated, and running your practice is a big task already. It would be nearly impossible for one person to be an expert on each part of the revenue cycle; verifying insurance eligibility and benefits, medical billing and coding, managing claims, denials, and accounts receivable, answering questions about medical bills, and more; taking care of each of these would be extremely difficult, especially on top of other duties. 

The cycle is also time-consuming, taking valuable time and energy from your patients. You would need to find the time to appeal claim denials, make sure your billing and patient statements are accurate, manage insurance credentialing and contracts, et cetera. With all that time dedicated, you may also need to bring on more employees to pick up the slack, especially in case of vacation or illness to keep claims going out the door.

This is a heavy burden for any one person to bear. As you’re running your practice, don’t add this weight to your load. While you stay focused on your patients, let PractiSynergy take care of your medical billing and coding. With our smooth process to transition a practice from in-house billing to us, and a model that fits your needs and increases revenue, you won’t regret switching to PractiSynergy. 

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Medical Billing Guide

When to Switch Billing Companies

How do you know it’s time to start thinking about switching your billing company? When it is time, how do you know where to start? With so many questions surrounding such an important part of your practice, we’re here to lend a hand and make sure you have all the information you need to take the best steps for you, your patients, and your practice. 

How do you know it’s time to switch?

Are payments coming in slower?

Are your payments coming in at lower amounts?

Has there been an increase in patient complaints about billing?

Are claim denials and rejections increasing?

Are your Accounts Receivable creeping up?

If you’re answering yes to one or more of these questions, you may want to consider making a switch in billing companies. 

 

So you’ve decided to move forward in finding a new billing company:

Here are the key things that you’ll want to look for in a company that will be the best for your practice: 

Good references: Do other practices have good things to say about their experience?

Contact: You should be able to have a single contact person with a backup person for emergencies

Availability: Does the availability of those contact individuals match yours? Are they available during your hours of operation?

Billing options: Do they offer on-shore or off-shore billing? Your payment percent will be higher when an on-shore/local billing team is used because they are more comfortable and knowledgeable about state-specific billing guidelines

Training: You want your team to stay up to date on new developments so you don’t have to. Do they offer training opportunities to stay current?

Reports: What types of reports will you receive and how frequent will you receive them?

There are lots of different aspects that will factor into your choice of switching billing companies and which company to switch to. Whether you’re just starting this process or ready to make the change, Practisynergy is here to help with all of your medical billing and coding needs.

 

Need more advice?

Check out our “12 Questions to Ask Before Hiring a Billing Service” worksheet.

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What You Need to Know About Medicare Open Enrollment

For those who are Medicare-eligible, now through December 15th is the time to look into open enrollment options. Today we’ll look at the two main options available–Medicare Part B and Medicare Advantage plans–and weigh the differences and costs. In the past, providers only needed to participate in Medicare to see Medicare beneficiaries. With the addition of Medicare Advantage Plans, providers need contracts with several insurance companies to see patients they have already been seeing for years in order to get paid. It’s important to know what this means for your practice and your patients.

Medicare Part B

What does it cover? How is it different?

Administration

  • Medicare Part B is administered through the Social Security Administration.

Services

  • Outpatient services: annual well-patient visits, some vaccines, physical rehabilitation, etc.
  • Non-hospital medical services like physical therapy, occupational therapy, and office visits
  • Ambulance services
  • Mental health services

Equipment

  • Durable medical equipment
What are the costs?
  • Monthly premium depending on income
  • $226 deductible for ALL Medicare Part B beneficiaries in 2023
  • 20% co-insurance applies to each covered service with no maximum out of pocket
  • Physician referral may be required for payment of services
  • No-cost annual physicals, certain vaccines, and certain lab services
  • Does not cover prescription drugs (for this coverage, patient must also enroll in Medicare Part D)
  • Many patients add supplemental Medicare coverage (secondary insurance) to ease patient responsibilities, but also require additional monthly premiums
  • Medicare sets the allowable fee schedule used by many carriers

Medicare Advantage

Advantage Plans replace the patient’s Medicare Policy and add complexity to the care of patients.

What does it cover? How is it different?

Administration

  • Medicare Advantage is administered through private insurance companies abiding by Medicare coverage policies
  • Medicare Advantage plans can provide expanded coverage by combining Medicare Part A and Part B in one plan
  • May require prior authorizations for payment of service (Medicare Part B does not require prior authorizations)
  • Providers must be contracted with Advantage Plans for coverage and payment of service

Services:

  • Some plans offer additional benefits such as dental, vision, hearing, wellness benefits, and others
  • Includes prescription drug coverage
  • Limited network of contracted providers
  • Any services covered by Medicare are covered by Advantage plans
  • Advantage Plans may limit frequencies of service (physical therapy, in-network referrals, etc.)

What are the costs?

  • Monthly premium–differs based on plan options, benefits, and income
  • Deductible varies by plan
  • Co-pays and co-insurance–these vary depending on type of medical service
  • Limitations on out-of-pocket expenses–deductible, co-insurance, and copays
  • Providers bear the burden of collecting out of pocket expense–supplemental plans can not be used to pay Medicare Advantage copays, deductibles, or premiums

For the good of your patients and your practice, it’s crucial to communicate with patients and let them know who you are contracted with. Most insurance companies take many months to get providers added to networks, so don’t let your patients be left behind. You can relieve the burden of your administrative staff and ensure a satisfactory patient experience by working with PractiSynergy to handle your medical credentialing and billing.

For more information, get in touch with us today!

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Telehealth Success Guide

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ROI of Outsourcing Your Billing

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New Practice Start-up Checklist

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Billing Rejections Checklist

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12 Questions to Ask Your Billing Services

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