Month: May 2020

5 tips for Behavioral and Mental health billing

Medical billing is a useful way of managing all medical-related billings between patients, medical professionals, and insurance companies. An automated process where mental health and other medical professionals, without being involved directly in the billing process with the insurance company, can focus on their actual tasks. It is productive and beneficial when a hard-time facing medical professional gets free from these complexities, and a professional is hired for medical billing services. Medical billing service is a complex process, while mental health billing is more time and effort taking tasks than other tasks and billing services. This is the reason that behavioral and mental health billing providing professionals are hired who, not only, push the workload off of the medical professionals but also automate and manage this efficiently. So, why is that, the mental health billing is not so easy?

Complexities of Mental health Billing

Unlike all other healthcare units, medical billing for the mental health sector is a more complex process as it takes more time, efforts and energy, there are also few additional barriers in the mental health services, specifically, which makes it different and more complex. What does it take for a regular check-up? A normal checkup includes common analysis, like checking blood pressure, checking heartbeat, weight, height, and other things. However, the billing process is also very common among healthcare providers and health insurers. As a general perception medical billing for medical health services is quite complex as compared to other healthcare sectors because of the fact that mental health care contains scope, time and number of restraints that are compulsory for the treatment of medical health. In other sectors of health, a patient takes normal and average time which is standardized for all the patients.

Why we can’t standardized mental health billing process?

The services that are entertained for a mental health treatment are quite difficult and have multiple factors in terms of approach by a therapist, length of the session of location in which service has to be entertained. It also involves the age of the agreement/ willingness of a patient for the treatment. Numbers of other different factors are included as well. Because of which the treatment and a billing process cannot be standardized.

Another reason for this complexity is that services which have to be provided for mental health treatment carry lack of resources. It has been observed that a limited group of therapist practice these services plus some of them don’t possess any administrative support so it can say that the burden of the billing process is carried by the physician by themselves.

Let’s study some tips that can be useful for billing for services that are related to mental health treatment.

Checking of patient’s coverage and insurance:

The very initial step is to make ensure about the insurance plans of a patient and its benefit before making any visit. Apparently it seems very time taking process and it would take some time definitely but it makes you sure about patient’s coverage availability before providing them with any service and it will produce a larger return in the end.  For this purpose, a process can be used which is called as verification of benefits such as VOB. This process should be conducted before starting any services or treatment to the patient.

CPT codes understanding:

CPT codes stand for common procedural technology. Insurance providers use this technology of codes to calculate and determine the amount and density of reimbursement which has to be given the patient for their healthcare facilities. It is assumed and expected by each physician and therapist to understand their services and CPT codes that are associated with these services before dealing with behavioural health billing. It’s not only associated with health billing but it can be applied for all sectors of health. As a matter of fact, it’s kinda critical for a physician to understand the services they are providing and associate them with CPT. There are some services providers which provide the same code to each patient which neither legal nor recommended.

As a matter of fact, there are two kinds of CPT codes that are used specifically for behaviour and mental health sector. These codes are of E/M codes and code of psychiatric evaluation. It has been observed that E/M code has to be used for evaluating any new medical issue plus three elements of documentation have to be provided which are off the history of a patient, examination and a medical decision making. Now if we talk about codes of psychiatric evaluation, it is used for diagnostic assessment. It is considered a session of psychotherapy can include services of E/M but this time does not toward the overall timing of therapy session.

Submission of claim properly (An understanding):

A correct billing format claim and correct code to the correct insurer has to be submitted in order to receive reimbursement. The billing format can vary from one insurance company to another so, it a fundamental step that an individual should know about insurance company’s proper filling method plus the file has to be submitted within the which is allocated by insurance plan.

Updating of patient’s data regularly:

It’s a general practice that the number of patients changes their policies of insurance and just forget to inform about it to their physician which can reject the claim filed by a physician so updating the data on regular basis can avoid this conflict and can lead to the less difficult billing process.

Educating of support staff for billing process:

It is a compulsory event to educate the staff which helps the physician to carry out about all billing processes so if support staff is awake about the codes that are conducted for medical health billing them it would be kinda less complex for the physician or a therapist to process the filling.

So it is co concluded that filling a process of billing in a right way at the right time ensures all the providers that they would get paid for all the services that they have provided plus no revenue would be lost.

What is Telehealthcare?

Telemedicine and telehealth represent the exchange of medical information amongst diverse sites. Telemedicine, as well as telehealth, can be defined as the transmission of medical information like images, video consultation, patient portals, remotely controlling and monitoring of vital signs, using patient-centric applications, nursing call centers, and numerous other functions. Telehealth is a collection of means for enhancing health care for the common public and health education support by means of telecommunication technologies. Telehealth includes a broad variety of technologies and strategies to supply virtual medical services. Telehealth is not a definite service, but a collection of means to improve health care support.

Telehealth uses the data and communication technologies to deliver the best health care when patients and health care providers are not in the same location. Doctors can have sessions to evaluate the patients, diseases can be diagnosed and treatment can be provided through secure video conferences and other virtual means.

 For patients, this means getting medical help in the comfort and safety of your own home with faster access to good care with very less waiting, greater control over scheduling, and a better connection amongst specialists and primary care.

The three main areas of telehealth

  • Telemedicine is video conferencing with your health care professional
  • Telemonitoring is the health care professional remotely collecting and sending patient data
  • Mobile health is using mobile communication devices like smartphones, tablets, and computers to send health information or support lifestyle plans.

There are a number of different types of consultations that can take place by means of telehealth.

  • Live video specialist Telehealth Visits
  • Follow-up appointments
  • Multidisciplinary team meetings
  • Virtual Check-Ins
  • Ward rounds
  • Emergency assessments
  • Therapy and treatment appointments
  • E-Visits

[1]

Telehealth visiting is and should be available for both new and regular patients. Different payers require different Place of Service (POS) designations for telemedicine. Prior to coding a telemedicine appointment, check the carrier services website for POS updates to ensure the claim is not precluded. The organization and first-hand patients can schedule a virtual check-in with the practitioner like an introductory appointment.  The patient can submit a video or image for clarification before or after the appointment or they can share this information during the session, both will be accepted and classified accordingly while billing.

Physicians, assistants, or nurse practitioners can conduct appointments such as E-visits and code them based on practicing status. E-visits require time-based coding in 10-minute augmentations and should be submitted within a collective seven-day time period.

During the COVID-19 public health emergency, telehealth is crucial to those who seek medical help from the safety of their home. Not only does this way of health care protects the patients from exposure to the virus it protects the health care providers as much as possible from getting infected by the at-risk patients. Healthcare professionals are fighting COVID-19 on the front lines for us, either by visiting hospitals in need to provide support in emergencies or taking care of those who need daily routine care.

Telehealth Billing

In order to preserve financial stability during the current healthcare crisis, it is vital to have the resources for proper billing and coding for virtual visits. Service providers and insurance providers make sure to help with updates and resources on the corporate part of health care, to make sure that healthcare providers can focus on patients.

Medical billing is the process of submitting and following up on dues with health insurance companies in order to receive payment for services performed by the healthcare provider. A necessity for medical billing in telehealth services in the form of practitioners who can perform their health care duties and be reimbursed for the covered telehealth services, including, physicians, nurse practitioners, physician assistants, and more.

There are no geographic restrictions for telehealth services and billing. Telehealth services are usually available for people in rural and urban areas. There are no longer restrictions for the types of providers; they simply need to be AHCCCS registered providers. [2]

A facility fee is basically an amount paid to the local healthcare facility that handles the patient during a telemedicine visit. In the current Medicare telemedicine model, a patient has to come into a qualified originating site for the telemedicine visit with the healthcare provider at a distant site. That originating site can then charge a facility fee to cover the costs of hosting the telehealth visit.

The Centers for Medicare and Medicaid Services (CMS) issued a second Interim Final Rule, COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, in retort to the coronavirus pandemic. This rule changes and adds many of the current telehealth coverage developments with waivers of the requirements previously defined by CMS, due to the public health emergency. With the arrival of the COVID-19 pandemic, telehealth has become a necessary way of providing care to the patients.

ACCC recently hosted a webcast in which Teri Bedard, BA, RT(R) (T), CPC—the Director of Client Services at Revenue Cycle Coding Strategies LLC, discussed the rapid changes in the coverage of and billing for telehealth services amid the COVID-19 public health emergency. Since this national emergency declaration, the Centers for Medicare & Medicaid Services (CMS) has issued a series of waivers relaxing restrictions regarding telehealth. During the public health emergency, it has been decided by the service providers to relax the classifications of the codes that allow services to be performed only for the established patients and instead has decided to expand them to include new patients as well.[3]

During the pandemic, the importance of telehealthcare and billing is undeniable. Not only does this make basic health requirements easier and safer for the patients it helps the health care providers perform their duties through this difficult time without compromising their own health, time, and business.


References

[1] “About Telehealth – Telehealth,” accessed May 20, 2020, https://www.telehealth.org.nz/telehealth-forum/what-is-telehealth/.

[2] “Telehealth Services and Billing Guidelines FFS Presentation,” 2019.

[3] “UPDATED 5/7/20: Telehealth Billing & Coding During COVID-19,” accessed May 20, 2020, https://www.accc-cancer.org/acccbuzz/blog-post-template/accc-buzz/2020/04/20/telehealth-billing-coding-during-covid-19.

Revenue cycle in the healthcare sector

What is the Revenue Cycle?

A revenue cycle is a general term that is used in business and accounting which expresses or presents the journey of a service or a product to its sale from its humble beginning. So we can say that a revenue process starts when any provider delivers a product or a service and it gets paid for the given service or product. The revenue cycle covers all functions of the clinic or administrative which contributes to management, capture, or revenue collected by patient service. In this article, a complete study of revenue cycle, RCM, and all terms that are related to it are discussed. This article explores the idea of billing in terms of the revenue cycle in the healthcare sector.  

Let’s discuss some fundamental steps of the revenue cycle which involves in all healthcare centers and hospitals. A revenue cycle involves the following mentioned steps.

The capture of charge:

 It renders medical services into charges that are billable.

Submission of claim: 

It contains a claim which is submitted to the insurance company for the billing process

Coding

It’s about CPT codes and procedures

Pre-registration 

It’s about collecting data on patient’s coverage and insurance

Registration

 It’s about collecting data to establish a medical record about a patient and to collect information about clinical and financial requirements.

Process of remittance 

It’s a process by which a payment can apply or rejected.

Follow up by the third party 

It’s about payment collection from Insurers of the third party.

Reviewing

Study and examination of medical services that are necessary.

Revenue cycle management

Revenue cycle management which is commonly known as RCM is a financial process that actually utilizes the software of medical billing. This software is used to facilitate the healthcare sector in terms of registrations, appointments, visits, and final payment. As a matter of fact, RCM simplifies the clinical and business sides of a healthcare sector by combining data of administration which is of the patient’s name, name of the company which is providing insurance, and some other information which is related to patient treatment and healthcare.

One of the key components of RCM is to communicate with health insurance. So, it’s a general practice that whenever any patient schedule a visit or an appointment then the staff of the hospital properly check and observe the insurance coverage reported by the patient before the visit. After this step, the next step is to study the nature of treatment provided by service providers, and then the healthcare center categorize it as per ICD-10 code. Health care staff sends the summary of whole treatment which is given to the patient to the patient insurance company along with ICD and ICP codes. This process is done to check how many portions of care would be covered up by a policy of insurance plus it’s a kind of remainder with the patient’s billing process.

Value-based care along with RCM

It is a perception of some experts that systems of RCM provide help in the transition of payment over the industry. It has diverted the concept of fee for service to reimbursement that is of value-based. RCM overlooks the patient population and it allows providers and payers to oversee the details of each other. It helps to see the provider about the portion of patients who are suffering from chronic diseases plus it also allows them to monitor and observe the aimed data and to mention any abnormalities.

Revenue cycle and healthcare

As a matter of fact, each healthcare and hospital is concerned about the best outcomes for the patient. To gain this goal one thing is to be considered which is an operational solidity of the business side of provider systems. It indicates about a clear and vivid focus on the revenue cycle like from start to finish plus the continuum of patient care. For the healthcare sector, revenue cycle is about everything. Its starts from the moment when a patient creates his/her account to the care package or surgery. In order to make the revenue cycle to work, it should be predictable. It means that the overall process of a patient should be executed precisely. A small error at any stage can cause lots of confusion and conflict which may slow down the billing process and may impact some negative action.

Revenue drivers

The financial performance is determined by the medical practices on billing operations. One of the most important decisions is to determine the gatekeeper for the billing process so we can say that revenue drivers play a vital role for creating well revenue and to maintain the revenue cycle.  A revenue cycle contains all steps that include from patient’s appointment to a billing process.  Front office task is to make a schedule about appointments, learn about insurance availability of a patient, eligibility verification and all those tasks which are related to clinical care. Back office tasks are to submit claims, posting of payment, processing of statement and managing all denied claims. So the point is as perfect as you tackle these tasks as soon as you get your full amount for the services.

Internal revenue drivers are of front task designers that examine the capacity of the provider, volume of patient and payment for the services. Generally, all healthcare centres easily tackle internal revenue drivers. But when it comes to external revenue drivers then a less efficient system can be observed in all sectors.

A key component for a revenue cycle in healthcare is an education

A complete awareness about revenue cycle and its benefits should be circulated into hospital staff by live sessions, online learning and by webinars. It will ensure that all staff of hospitals such as nurses, doctors, coders and support staff have learned the importance of the revenue cycle. A general perception is that a revenue collection and billing are considered as necessary evils. A well run system helps it very well. Its allows the providers to focus on their tasks that are to take care of the patient while support staff manages all collection of revenue cycle and billing process.

Corona Virus and Mental Health

The recent worldwide pandemic commonly known as Corona Virus or COVID-19 was first noticed in late 2019, when an unusual and rare illness was reported in Wuhan, China. Coronaviruses are a large family of viruses that may affect animals and/or humans.  In humans, quite a few coronaviruses are known to cause respiratory infections, from just the common cold to more severe diseases such as Severe Acute Respiratory Syndrome (SARS). The official name of this virus is “severe acute respiratory syndrome coronavirus 2” or SARS-CoV-2 due to its relation with the virus that caused the SARS outbreak in 2003.

COVID-19 can be spread from an infected person to anyone who he has been in contact with. The disease spreads mostly through small droplets from the nose or mouth, released when an infected person coughs, sneezes, or speaks. People can catch COVID-19 if they breathe in these droplets. The idea of social distancing to contain the virus is so important because these droplets are too dense to travel far enough, explaining why it is important to stay at least 1 meter away from each other. If the infected person has been in contact with any surfaces, it is possible for the virus to travel from one person to another through the surface in contact. The possibility of the virus infecting you can be increased by touching your eyes, nose, or mouth, particularly after being in contact with people or uncleaned objects.  Constant hand washing and sanitizing is an essential way of making sure your hands are sanitary and not disease-ridden. 

Whenever you leave the house, wear a mask, and keep at least 1-meter distance from other people. If possible wear gloves or continuously sanitize your hands after touching any surfaces to avoid any germs. If you have been in close contact with or shared an object with someone who was diagnosed with COVID-19 there is a high chance you may be infected.

The initial symptoms of COVID-19 are similar to that of the flu, which may cause confusion amongst the infected causing a delay in their checkup. It is important that you do not ignore any symptoms and seek medical help as soon as possible. If you show, any symptoms, even if you believe to not have been in contact with anyone infected, make sure to self-isolate and monitor yourself. If you have been in contact with someone infected but do not show any symptoms, it is still crucial to self-quarantine for at least 14 days.  Self-isolation in such cases is important to avoid any further spread since you are more likely to infect others in the early stages of the disease. If you were tested and diagnosed with COVID-19 and have successfully recovered, self-quarantine is still a necessary step to take.

Mental Health is Important too

Making sure you are well informed and physically healthy is very important, but it is equally important to keep a check on your mental health. Living in isolation and away from the outside world for so long can have a very damaging effect on our mental health. During this difficult time, it is important to make sure you are not suffering. It is a blessing that we live in a time where even quarantined we can connect with people around the world. It is extremely important to reach out for help and have a healthy conversation about your feelings. Take a break from the pandemic and focus on yourself for a while. The constant anxiety of the pandemic is something we are all experiencing, and so it is essential we support each other in any way we can. From time to time, take a mental break from the constant updates and information you are being bombarded with everywhere. Find ways to enjoy, laugh, have a good time, and appreciate life indoors. Isolation can make a person lose their mind, connecting with people, talking to them, and sharing experiences that will make you feel that you are not alone in this fight. 

It is not much you can do about the pandemic except make sure you and people around you are safe and taking the necessary precautions to avoid spreading the virus. However, there are some simple ways you can stay healthy and help yourself deal with the anxiety of the pandemic. 

  • Keep up with your normal daily routine as much as possible or make new ones accordingly.  
  • Make time to do things you enjoy. 
  • Try to reduce how much you watch, read or listen to news that makes you feel
  • anxious or distressed.
  • Stay in contact with people by cell phone and/ or through online networks.
  • Be conscious of how much time you spend in front of a screen. Make sure to take regular breaks from on-screen activities.
  • Use your social media accounts to share and promote positive and hopeful content. 
  • Help people in your community as much as you can.
  • Be thankful for what you have.
  • Thank your country’s health-care workers and all those working to respond to COVID-19 through the various channels you have.
  • Be kind and generous. 
  • Do not discriminate against people who you think may have coronavirus.
  • If you require a mental health specialist, make sure you continue your sessions through virtual methods. 
  • Do not avoid any mental distress symptoms and make sure to get help as soon as you can.  

If you or your closed ones have been infected, it is extremely important to make sure you are keeping your mind calm and healthy. The health care workers and doctors are trying their best to make sure the people infected recover as soon as possible. Trusting your doctors and health care workers is the best option for your sanity and health. In this rough time, we all require your cooperation and support as a community. Regardless of what country you belong to, this is the kind of hardship every human in the world is facing, and helping each other is how we shall come out of this pandemic. 

REFERENCES

 “Q&A on Coronaviruses (COVID-19),” accessed May 19, 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses.