Tag: practisynergy blog

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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. 

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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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Uncategorized

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.

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Medical Billing Guide

Am I being Scammed? – The Truth Behind Virtual Credit Cards

Did you get a piece of paper in the mail with what appears to be an outline of a credit card with numbers and a whole bit? What are these and are they legit? 

It’s no secret the internet is slowly taking over. Everything is becoming ‘optimized & automated’. After COVID, the virtual world skyrocketed as we know it. It’s no surprise credit card companies have wanted an in. These virtual credit cards advertise as a streamlined way to make purchases and keep up with payments. Much like everything else, virtuality has its pitfalls. Not everything is meant to be optimized. Have you ever been on the phone with a large company, needing assistance, but find it takes an endless amount of time to reach an actual person? Virtual robots can’t assist you the way human interaction can. 

Providers are getting buried in a sea of virtual credit cards coming from all different insurance companies – companies as large as UnitedHealthcare to small private union insurance funds. The appeal behind these virtual cards can be rooted within streamlining the process. Insurers are trying to reduce costs by outsourcing payment processing. Printing checks requires supply costs as well as people to print and handle these checks. The downfall of checks include getting lost mail. The advantage of virtual credit cards means it’s easier to track. Since the credit card isn’t tangible, the balance can’t get lost. 

Each insurer has different needs. Providers must figure out what is the best option for them – virtual credit cards, physical checks or direct deposits. All fees need to be examined as well as the time it may take if checks get lost. Some corporations find it beneficial to outsource to virtual assistance – saving them time to get back to their main job duties. The right virtual credit card can also help protect personal information and privacy. Virtual cards generate new card numbers, so that individual account numbers can stay confidential. 

Providers get dinged with fees since they have to run the cards through a merchant service provider (credit card servicer) that will deposit the funds into their bank account. If you decide a virtual credit card is not your jam. You must initial the “opt-out” of these cards and select check or direct deposit. Keep in mind some of the direct deposit options through these outsourced vendors also charge a fee.

All in all, there’s a give and take between payment options. Each individual requires different needs. And it’s important to seek counsel when choosing the best option. At PractiSynergy, we work closely with clients to give them the best option for their unique needs. To get informed about our medical coding and billing services, reach out to Katie Fergus. Call 515.412.2800 or email  katie@practisynergy.com.

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Medical Claim Adjustments Medical Coding Guide

Deductible Season For All Medical Insurances

Doctor with health insurance healthcare graphic.

It’s here. Deductible Season. The time of year when most insurance plans re-set deductibles back to $0.

So, what exactly does that mean to your practice? Its not all doom and gloom, its not too late to make a few changes to help you maintain your cash flow.

1. Eligibility Check

Always check insurance eligibility. This includes MEDICARE! Medicare beneficiaries had open enrollment late fall allowing them to choose Medicare advantage plans as well as supplemental
plans. What do you want to look for when checking eligibility and verifying benefits?

a. Does the patient have an active policy? What is the effective date of that policy?

b. Does the patient have a co-pay, deductible, coinsurance, or an out-of-pocket maximum?

c. Does the service you provide require a prior authorization or a referral?

d. Does the patient have any secondary insurance?

2. Payment Collection

Collect payments from patients at the time of service. Unless an insurer bars you from billing a patient (such as Medicaid), it is wise to collect money up front. Always collect a co-pay at the time of service. If a patient has a deductible or co-insurance that applies to your service, collect a set amount of money at the time of service. Depending on your patient population and service provided anywhere between $50-$150 might be appropriate for your practice.

3. Don’t Make It Difficult To Pay For Patients

Always take a payment if a patient offers, and do not make it difficult for your patients to pay.

Technology is spanning all the generations. Patients regardless of age expect the ability to pay their bills online. Identity theft has increase and few patients want to send a check or credit card through the mail for fear it will be stolen. Secure email and text is a great way to remind your patients they still have a bill outstanding.

Finally, remind patients (verbally, in writing, or both) of their financial responsibility. Whether it is keeping insurance updated, patient contact information updated, and a friendly reminder that most insurers require the patient to pay the provider some portion of their bill – even Medicare (Medicare’s deductible for 2022 is $233).

These strategies will help medical practices keep a better cash flow during this deductible season. PractiSynergy can help providers set up these processes. Please contact Katie Fergus, call 515.412.2800 or email  katie@practisynergy.com.