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Watch the First of Our COVID-19 Webinar Series

By | Blog, Webinar

As the COVID-19 pandemic continues to affect practices, we’re doing what we can to help practices adapt to the challenges. In case you missed it, we recently kicked off the first of our CareOptimize COVID-19 Webinar Series.

The first edition was held this past Wednesday and focused on the recent trends and innovations in the healthcare industry such as regulatory billing and optimum practices to improve revenue. We also took a close look at CMS regulatory program submission changes and several of the differences between Telemedicine and Telehealth.

You can still watch the COVID-19 Webinar Series by visiting the following link: https://www.youtube.com/watch?v=kPuf4vX8nEo&feature=youtu.be. Make sure to bookmark our YouTube page and be sure to subscribe to stay updated on future webinars.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, MIPS consulting, and more. For more information, please call 855.937.8475.

Join Us for the COVID-19 Initiatives Webinar

By | Webinar

As the COVID-19 pandemic continues to spread, some practices may be overwhelmed while others may be forced to close. In response to the pandemic, CareOptimize will be hosting weekly online webinars talking about what practices should be doing during these difficult times.

Each CareOptimize webinar will be centered around the latest updates and developments in the healthcare industry, including regulatory billing and best practices to maximize revenue during this challenging period. The first of these weekly webinars will be held this Thursday, March 26 at 2 PM Eastern time. Other topics will include:

  • The latest updates on CMS regulatory program submission changes
  • Telemedicine versus Telehealth, including documentation and system requirements
  • Chronic Care Management (CCM) requirements, revenue, and how specialists can take the initiative and get involvedWe will also showcase real-world examples of distinct provider models and how each is handling the challenges faced by their practices during the pandemic.

To join or view this week’s COVID-19 The CareOptimize Response webinar, please visit or bookmark the following link

Streamline Your Revenue Cycle Management With a Basic Approach

By | Blog

Per a recent HFMA survey, nearly 70% of leaders in healthcare revenue cycle are putting funds toward technology capable of improving the integrity of revenue, getting rid of human error, and boosting efficiency. Yet a major and largely unexplored opportunity for many companies to boost performance comes down to a familiar word: data.

Healthcare organizations still have a long way to go in areas like addressing out-of-pocket cost concerns with consumers, reducing collection costs, and cutting down on the rise of initial denial rates. A back to basics approach could be a viable solution even as digital automation becomes prevalent.

By performing some analysis, revenue cycle leaders can take a look at potential breakdowns during the revenue cycle process before they become a major issue. For example, an organization dealing with an unusually high discharged-not-final-billed (DNFB) rate can do analysis to figure which types of claims are stalling the claims submission process.

Data analysis provides revenue cycle leaders with a roadmap of where traditional claim processing failures originate and the forms of claim rejections and denials most commonly encountered. These may include additional documentation, failing to acquire prior authorization, or not filing on time.

To read more about the HFMA survey, visit https://guidehouse.com/insights/healthcare/2019/hfma-rcm-survey.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, MIPS consulting, and more. For more information, please call 855.937.8475.

Medicare Reimbursement Information for COVID-19 Tests Has Been Released

By | Blog

Following closely on the recent billing codes released by the Centers for Medicare & Medicaid Services (CMS), the federal agency is now allowing clinical laboratories to know what Medicare reimbursement they will receive for performing COVID-19 tests on patients. The amounts are typically $36 and $51 for CDC and non-CDC test kits, respectively. However, these numbers could vary.

CMS released new Healthcare Common Procedure Coding System (HCPCS) codes on March 5 and February 13 for healthcare providers and labs to check patients for COVID-19. HCPCS code (U0001) is intended to acquire diagnostic research carried out by accredited laboratories using CDC tests. The other code (U0002) will be used to bill COVID-19 for all non-CDC laboratory tests, including those produced in-house under the most recent FDA guidelines.

The World Health Organization has officially deemed COVID-19 a pandemic and it is putting tremendous strain on the healthcare system, particularly here in the United States. Industry leaders have expressed fears that resources are not adequate to handle a large influx of people that may be infected with the virus.

Diagnostic testing will likely play a critical role in monitoring virus spread and maintaining hospital capacity as the number of COVID-19 cases grow. To read more, https://revcycleintelligence.com/news/cms-releases-medicare-reimbursement-details-for-covid-19-tests.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, MIPS consulting, and more. For more information, please call 855.937.8475.

COVID-19 and Its Effect on the Healthcare Revenue Cycle

By | Blog

As nations are ramping up their efforts to deal with COVID-19, healthcare providers are being proactive in their response to the coronavirus outbreak. These efforts may have a considerable effect on the revenue cycle for health care and the budgets of the providers.

Coronavirus has been a major concern for health care providers on the frontline of tracking and treating infected people. The impact COVID-19 will have on the health-care revenue cycle and financial operations is among their concerns.

Maintaining the billing office in optimum operation during an epidemic is key to keeping hospitals and clinics open to people who are sick and need treatment. But this can be a challenge to respond to COVID-19 demands, particularly for smaller organizations with a limited amount of funds available.

The COVID-19 outbreak also illustrates issues relating to the financial responsibility of patients. Accounts have surfaced of patients left with medical bills of thousands of dollars after seeking care for suspected symptoms of coronavirus. Healthcare providers in the age of high deductible health plans and other cost-sharing programs are struggling to build collection strategies.

Payers recognize the efforts arising from financial responsibility for patients and many are taking steps to ease the process for patients to seek care and for providers to simplify the financial encounter.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, MIPS consulting, and more. For more information, please call 855.937.8475.

Coronavirus Billing Codes Have Arrived

By | Blog

With the country on edge because of COVID-19 (better known to the masses as the coronavirus), the Centers for Medicare & Medicaid Services (CMS) have revealed new billing codes for testing the virus in labs. With these new billing codes, providers and clinical laboratories can be reimbursed for assisting patients with the virus while keeping a close eye on new cases and conducting tests. The codes have already been adopted by the Healthcare Common Procedure Coding System (HCPCS) which is utilized by insurers as well as Medicare for claims processing.

U0001 is the first billing code, released last month and aimed squarely at SARS-CoV-2 diagnostic tests done at CDC research laboratories. The second billing code (U0002) published earlier this week will allow laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV, or simply, COVID-19.

Per the most recent World Health Organization figures, there are more than 95,000 cases of coronavirus around the world. Of those cases, close to 100 of them are in the United States.

In light of the coronavirus, CMS has also given a call for action to health care providers. The agency recently urged providers to make sure that they are enforcing proper infection control protocols.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, MIPS consulting, and more. For more information, please call 855.937.8475.

CMS Moves Forward With ET3

By | Blog

The Centers for Medicare & Medicaid Services (CMS) recently found the applicants that will become part of its Emergency Triage, Treat, and Transport (ET3) Model initiative. The five-year payment model will provide increased flexibility for ambulance response services following a 911 call to meet the emergency healthcare of necessities of Medicare Fee-for-Service beneficiaries. The participating applicants are comprised of ambulance providers and service suppliers in more than thirty states, all of which are Medicare-enrolled.

CMS revealed last February the ET3 model is aimed at establishing a new range of opportunities for emergency transportation and care, ensuring that patients receive convenient, effective treatment in the environment they feel is appropriate for them.

The goal was to promote more efficient use of facilities, ensuring that patients are handled expeditiously and fairly by Medicare-enrolled providers and suppliers. The model could result in Medicare savings of more than $500 million a year by sending patients to doctor’s offices versus the emergency room.

Currently, Medicare will only provide payment for emergency ground ambulance services should a patient be taken to certain facilities, usually a hospital emergency room. With ET3, Medicare will pay participating ambulance providers to transport a patient to an alternate destination, such as an urgent care clinic, for example.

This update is provided by CareOptimize. We provide healthcare management consulting services and products and we’ve helped numerous healthcare organizations succeed for more than a decade. We provide managed care solutions as well as products like coding modules, next-generation EHR utilities, and more. For more information, please call 855.937.8475.

CareOptimize State of the Practice Report

By | Uncategorized

There are so many moving parts in healthcare’s regulatory arena it can be difficult to keep up. With the CareOptimize State of the Practice Report, you can ferret out issues in your practice that may be affecting efficiency, productivity, and your bottom line.

In 30 minutes, the complimentary CareOptimize State of the Practice Report gives you a comprehensive summary of Key Performance Indicators across your operation. Having all this information in one place will allow for informed decisions on many levels. Reports include:

Active Contracts – Lists all contracts inside your system, when they are effective and when they expire, to see that all contracts are there
BBP Jobs List – Makes sure all the jobs set to run nightly are, in fact, doing so
Licensed Providers – Lists all licensed providers within your system and the licensing types they have
A/R Aging  – Shows any accounts receivable outstanding receivable by plan, with 30, 60, and 90-day listings
Bill Lag Time – Average time elapsed between encounter date of service and first bill date for the last 30 days
Charge Entry Lag Time – How long it is taking each provider to get charge entries in for the last 30 days
Denial Rate – Breaks down denials throughout the system and shows you why you are getting those denials
Top 20 Payers – Total amount of transactions from your 20 highest payers and what percentage is coming in from each payer
Unapplied Credits – Where you have credits at encounter and account levels
Avg. Appointment per Day by Provider – A productivity report showing total appointments for each provider, number of no-shows, and the average overall for the last 30 days
First Third Appointment by Resource – Shows profitability and the amount of load for each provider by accessing the appointment book, finding the third open time slot, and the lag time between those
PM Tasks Not Completed –  Oldest date of task and listing of assignees for each
Kept Appointment With No Charges – Broken down by resource and event, this catches those appointments that may have fallen through the cracks and have not yet been billed
MIPS Quality – Gives a broad overview of all the measures configured for CQM
MIPS Risk Assessment – Shows your potential maximum surplus from MIPS and potential reductions
EHR Task Over 7 Days Old – Shows the oldest date of any open tasks to help move tasks and tracking
Users With More Than 20 Outstanding Tasks – Helps with tracking possible inefficiencies
Provider Approval Queue – Shows open EHR tasks by user (documents, notes, HIE documents, etc.)
Open Referrals – Referrals not in a complete status and overall number (no patient details)
Rosetta Status – Shows anything stuck in Rosetta holding tank for more than 24 hours
Unmatched Refills – Listed by provider, gives an overview to ensure medications are being matched to the correct patients
Versions – Good for system administrators, this lists versions of software in your system
Templates Usage – Lists all templates used in the past 2 months, providing information for upgrades, customizations, efficient workflows, etc.
Average Days to Complete Documentation – Shows amount of time from encounter date to actual note being finalized
Chronic Care Management – Tracks CCM codes being billed and their associated diagnosis codes Relevant for practices with CCM programs
Unspecified New Codes – Shows every code used by providers for last 60 days – compared with denial rate to help alleviate inaccurate coding to lower denial rates

 

 

Insights19 State of the Practice Report

By | Uncategorized | No Comments
The CareOptimize State of the Practice Report is a comprehensive summary of Key Performance Indicators across your operation. This webinar gives an extensive review of the SOP Report and how it can benefit your practice.
Highlights include:
– Provider productivity and availability
– Billing efficiencies, bottlenecks, and opportunities
– Payer strategy
– Untapped revenue streams
– System configuration

CareOptimize Free Utilities – Three Favorites

By | Blog

Many CareOptimize utilities, free and paid, are initially developed to help solve client issues. Others come about based on gaps in the market. As these products are released, they are placed on the website www.ehrutilities.com. The Insights webinar in April dealt with three of the free offerings.

The Clinical Operations Manager is used to manage a practice on an enterprise-wide level. It was designed to view data across the entire practice and can be filtered by type, user, and location, depending on the relevancy to any particular item. Tasks can also be reassigned. The template is easily installed; you do not have to be a developer. It easily opens from a system practice template and gives administrators a high-level view of any assigned or outstanding tasks and inefficiencies including:

  • Clinical Tasks
  • Patient Portal Messages
  • PAQ Items
  • Open Orders
  • Unmatched Refills
  • Undocumented Encounters
  • Unbilled Encounters
  • Rosetta Holding Tank Items

Our most popular free utility is the Document Management/Care Guidelines Auto Complete Utility. Upon scanning an image into Document Management, the Care Guidelines or Open Orders for any particular item automatically complete, removing the need to manually go into Order Management or Care Guidelines section, saving time and increasing productivity. It comes in separate packages; you can install either one. Installation does require a bit of development knowledge. Instructions on how to set up triggers are included and can be used by your team developer. (If you don’t have a team developer, please contact us at info@careoptimize.com.) NOTE: If you have NextGen v. 5.9/8.4, we suggest you work with this utility in a test environment, since this latest version, developed to run with that update, is still in a beta state. If you have an earlier system, the utility will run fine.

Our State of the Practice Report is a proprietary report allowing you to evaluate your practice in more than 25 metric types created with data culled from many different parts of your system. Practices need to get in touch with CareOptimize to setup a webinar to run the SOP. Once the report has been installed and run, a follow-up meeting will be scheduled to go over metrics and make suggestions on any deficiencies. Both the running of the report and the consultation are free. This is a great way to identify ways to improve your practice. NOTE: To avoid slowing down your system, it is recommended this be run after hours. Metrics of the report include:

  • Active Contracts – all currently active contracts
  • BBP Jobs List – all jobs in BBP, last time they ran, and last time they were successful
  • Licensed Providers (pulls from file maintenance) – all your providers and licensing types
  • A/R Aging – outstanding accounts receivable by plan for 30, 60, and 90+ days
  • Bill Lag Time – average amount of time elapsed since DOS and first bill (last 30 days)
  • Charge Entry Lag Time – average time by provider for charges to get in
  • Denial Rate – breaks these down as to what caused denial
  • Top 20 Payers – total transactions and amounts from each payer
  • Unapplied Credits – total amount at encounter or account level
  • Average Appointment per day by Provider – how many appointments, no shows, and the average
  • First Third Appt. by Resource – looks at appointment book and finds the third open time slot and lag time between that and the current date – monitors provider load
  • PM Tasks Not Completed – total PM tasks outstanding and oldest outstanding date (Clinical Operations Manager will clean this up)
  • Kept Appointment with No Charges – breaks down by resource and event
  • MIPS Quality – if you CQM check, this shows measures it’s configured for
  • MIPS Risk Assessment – potential maximum surplus from your MIPS payment
  • EHR Tasks Over 7 Days – open EHR tasks assigned by user (Clinical Operations Manager will clean this up)
  • EHR Tasks – users with more than 20 tasks outstanding (Clinical Operations Manager will clean this up)
  • Provider Approval Queue – breaks down into different PAQ activities, oldest date, deficiencies
  • Open Referrals – referrals not in a complete status (works well with Document Auto-complete)
  • Rosetta Status – shows anything stuck in Rosetta for more than 24 hours
  • Unmatched Refills – by provider
  • Versions – identifies different template versions being used – useful for system administrators
  • Templates Usage – shows all templates used in the last two months to discover focus areas for upgrades
  • Average Days to Complete Documentation – shows previous month, difference between encounter date and last generated note (can also prevent legal liability)
  • Unspecified and New Codes – every code used in the last 60 days by provider

Please visit www.ehrutilities.com to see the complete line of utilities CareOptimize offers.