Author Archives: Greety Gladia

What’s New with CCM? Medicare Reimbursement 2020 Code Changes Explained!

First, let’s have a quick look at what were the codes in 2019.

Beginning January 1, 2019, the CCM codes were as below

CPT 99490 (Non-complex)

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

CPT 99491

Chronic care management services, provided personally by a physician or nurse practitioner for at least 30 minutes, per calendar month to high-risk patients. Codes 99490 and 99491 cannot be billed in the same month for the same patient so practices will need to decide if this new code is a good use of their doctors’ time and which patients would benefit from it.

CPT 99487 (Complex)

 Complex chronic care management services, with at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 (Add-on for CPT 99487)

Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure).

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes in addition to the first 60 minutes of complex CCM services during a calendar month.

The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both. Do not report 99491 in the same calendar month as 99487, 99489, 99490.

What’s New?

On Nov 15, 2019, Centers for Medicare and Medicaid Services (CMS) finalized the CY 2020 Medicare Fee Schedule (MFS). It has revised the current chronic care management reimbursement program and has created a new care management reimbursement program.

Here’s a quick look at 2020 Medicare Reimbursement Codes for Chronic Care Management:

99487, 99489*, 99490, G2058*, 99491

CMS has created an add-on code, HCPCS Code G2058 for non-complex CCM effective Jan 01, 2020.

G2058 Specifications:

A medical practitioner can bill CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM activities (educating the patient or caregiver about the patient’s condition, care plan, and prognosis, etc.) in a given calendar month and can charge HCPCS code G2058 for the second and third 20-minute additions (additional staff time respectively). Use G2058 in conjunction with 99490. Do not report 99490, G2058 in the same calendar month as 99487, 99489, 99491. These CPT codes are tailored toward primary care physicians but can be billed by any physician or by any skilled healthcare professional and get the reimbursement by fulfilling the code requirements.

Payment or reimbursement for the CPT code 99490 is $42.23 while the add-on code G2058 (up to two) pays $37.89. Therefore, total reimbursement for an hour or more of non-complex CCM services is $118.01.  

** Add-on codes are bundled and cannot be billed separately from their base code.

CCM Patient Eligibility

Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services.

How does the scope for CCM look like in 2020?

Qualified healthcare professionals have been billing Medicare for providing CCM services like maintaining care plans, handling care transitions between providers to Medicare patients with two or more chronic conditions. Even today CCM continues to be underused.

The epidemic of chronic disease continues to grow and has reached global epidemic proportions. This condition is exerting considerable demand for health systems to adopt an IT solution to provide better care for their chronic patients. This increased demand has become a major concern today. Adapting new technology or operating models is vital for the health systems to provide care differently, more efficiently, and with better patient outcomes.

HealthViewX CCM platform helps individual physicians, practices, billing companies, etc. to provide CCM services seamlessly to their enrolled Medicare patients. The simplified and automated process makes it easy to meet the criteria for CMS billing and reimbursement.

Power your entire system – simplify your workflow, create patient-specific care plans, automate documentation, generate detailed reports, and improve overall efficiency. Hosted in cloud servers, HealthViewX CCM solution is extremely scalable to meet requirements of any operative size and our pricing model keeps overhead cost minimal and manageable.

Schedule a demo and talk to our solution experts today!

 

Ref: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf

https://hcpcs.codes/g-codes/G2058/

 

It’s time to stop faxing referrals – Why are we still faxing patient referrals?

One out of every three patients is referred to a specialist each year. These referrals are sent to specialists, imaging centers, etc., through multiple channels like phone calls, fax, emails, website forms, etc., and fax is the most commonly used channel. Despite the array of digital patient referral management software available in the market, health systems are still following the old school model of referring patients through fax machines and paper-based letters.  Ironically, there could be multiple barriers like the reasons listed below for not using the electronic referral communication software

  • Traditional workplace culture
  • Not having the right technology in place
  • Not understanding the software usage
  • Peers not using eReferrals 

Healthcare professionals need to understand the usability, security, and interoperability of the solutions available in the health IT market. Health systems need to adapt to more secure means to send and receive referrals. With that being said, Referral Management Solution is progressively vital for better patient experience and care coordination. Today, in most health systems referral workflows are poorly documented, insecurely sent and are not effective in providing quality care for patients.

Knowing the security consequences of maintaining paper-based systems and physical paper letters is critical – as they could be easily misplaced and accessed by unauthorized people. Some health systems still depend on their EMR to manage their referral process but they need to understand that EMR’s are not equipped enough to handle the end-to-end referral process. Health systems should understand the need of having a good patient referral solution.

Why do health systems need a good patient referral solution?

The healthcare industry is constantly scrutinized for inefficiencies in processes, systems, operations, etc. As a result, health systems are under more pressure to do more with fewer amenities. Inefficient referral processes lead to long lead times and are inconvenient to both patients and providers. A referral solution can streamline communication between the referring provider, receiving provider, patient and other healthcare providers, save time, enhance care quality and a lot more for both patients and providers.

Other Key Benefits of referral solution include

  • Reduced wait times for patients
  • Better referral tracking
  • Improved referral quality
  • Cost reduction
  • Enhanced operational efficiency
  • Secure transfer of patient information
  • Reduced referral leakage

Referral management solution is important for better patient experience, care coordination and to arrest patient leakage. Health systems lose millions of dollars due to referral leakage as every patient seeking care outside the network is lost revenue. Minimizing leakage is an increasingly key focus for many health systems. Health systems need to make substantial improvements in processing referrals efficiently, improve processes and invest in technologies. It is high time for health systems to stop receiving and sending unsafe fax referral and have a streamlined end-to-end referral solution in place.

A streamlined referral management solution has the potential to standardize the referral process, maximize efficiency in the referral process, and improve workflow through technology. Talk to our experts today and schedule a demo to understand more about our Patient Referral Management Solution.

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

          Referring physicians refer patients to out-of-network providers

          Patients move out of the care network due to poor care coordination

          Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective.  Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

  • Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.

  • Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.

  • Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.

  • Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.

  • Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.  

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

 

 

Transform Your Care Practice With A Streamlined Patient Referral Process

 

It is imperative to transform your care practice to deliver value-based care. Promoting and exploring technologies for streamlining various processes is the way forward for improved care quality and care coordination. One such process that requires a transformation in care practices is the patient referral process which is still a tedious, fragmented, and time-consuming task for referral coordinators in many health systems. The conventional patient referral process (both inbound and outbound) results in more stress for the referral coordinators and poor patient satisfaction. This inefficiency in the patient referral process leads to frustrated referral coordinators, physicians, specialists, patients and health systems as a whole. Patients not showing up for scheduled appointments are revenue loss for health systems that are trying to keep their patients within the network for better outcomes.

Today’s patient referral process makes it hard for patients to get the care they need, and healthcare facilities the visibility they need in the process. Additional challenges like lack of communication amongst providers, appointment delays, no-show rates, incorrect referral, etc. all have far-reaching consequences. Ineffective communication between clinical teams leads to poor health outcomes of patients and lost revenue for health systems. It is not a surprising fact, that more than half of the PCPs and Specialists are dissatisfied with the information they receive during a referral.

How to eliminate these challenges in the referral process?

A technological referral solution that offers end-to-end automation and is convenient for patients and providers is required to actively manage referrals and improve efficiency.

Healthcare providers need to adapt to an advanced technological solution that

–          is patient experience focused, process-driven, and easy to use

–          improves PCP, specialist experiences

–          has end-to-end referral workflow automation

–         intuitive dashboards with data insights and analytics

HealthViewX Patient Referral Management Solution is designed to help providers to focus on delivering high-quality coordinated care by keeping track of their patients throughout the care continuum. The solution makes the referral process efficient and simple with no burden on practice staff. It helps improve patient experience, reduces the burden on staff, improves operational efficiency, and overall benefits the health system in processing referrals.

Streamlining the patient referral process can help with

–          better care for individuals and the community as a whole

–          lowered cost and improved operational efficiency

–          reduced paperwork for referrals

–          awareness of in-network and out-of-network providers

–          improved patient experience and value-based care drive

–          better care coordination among providers

–          visibility into real-time data to understand referral patterns, referral staff performance, patient status tracking, and gaps in care.

HealthViewX Patient Referral Management Solution helps solve challenges in all stages of the referral workflow to meet the needs of the patients, healthcare providers, and payers, and also integrates seamlessly with all EMR systems. An intelligent end-to-end automated solution is essential for better provider connectivity, reducing network leakages, improving quality care, and better health outcomes.

Schedule a demo today with our experts to understand how our solution seamlessly solves challenges in the patient referral process.

 

The Role of Referral Management in Value-Based Health Care

What is Value-Based Care?

Value-Based Care is a care delivery model in which healthcare providers are paid based on the health outcomes of the patient. Value-based is a quality-based care model that drives “better health for all” and benefits the community, providers, and payers as a whole. Value-based care helps healthcare providers by helping patients improve their health and reduce the prevalence of chronic illness. This care model is a potential swap for fee-for-service reimbursement based on quality. The providers are paid based on the health outcomes of the patients and are rewarded for helping patients’ improve their health. The ultimate goal of value-based care is to optimize the care for the patient population.

What are the benefits of Value-Based Care?

For Patients – Reduced cost and better health outcomes

For Providers – Better patient satisfaction and improved care efficiencies

For Payers – Stronger control on costs and lowered risk

For Community – Reduced spend on healthcare and improved overall wellbeing

What is a Patient Referral Management Solution?

Patient Referral Management Solution is a patient referral tracking tool for end-to-end referral communication and management. The solution is designed for healthcare organizations to enable them to provide better care with a well-orchestrated customizable workflow. Its primary goal is to enhance and streamline interaction among all care providers involved in patient care for better patient outcomes.  

Role of Patient Referral Management Solution in Value-Based Care

Right from small to large, healthcare providers face a lot of challenges in their referral process. Poor communication and referral workflow among providers lead to diminished care quality and patient experience. Lack of timeliness of the information and inadequate patient information or reports all contribute to poor care continuity, patient dissatisfaction, and poor health outcomes.

A well-orchestrated and automated patient referral solution has the potential to transform referral workflows and help providers improve their patient health outcomes. It helps provide value-based care through better care coordination throughout the care journey. A referral management solution can help improve efficiency, reduce time spent on redundant tasks, cut down on overhead costs, reduce referral processing time thus helps both providers and patients. Streamlined workflows lead to better patient outcomes.  The prime objective of the solution is to improve patient-physician interaction and provide value-based care for better patient outcomes.

Why is Referral Management crucial for Healthcare Providers? 

Referral Management is very crucial for healthcare providers to track and manage referrals, and ensure better patient outcomes. Referral management is essential when

  • referring and receiving providers have different EMRs/EHRs
  • healthcare providers are coordinating between in-network and out-of-network providers
  • health systems are looking to improve patient health outcomes and reduce no-show rates
  • providers want to increase revenue and reduce operational cost
  • health systems want to focus on quality care by using value-based care models 

A major challenge in the current referral process is that most EMRs are not equipped enough to handle the end-to-end referral process. A referral management solution helps healthcare providers to track and manage their end-to-end referral process with complete transparency. The solution helps streamline workflow, reduce clinical errors/delays, cut down the processing time by automating multiple touchpoints, and obtain strategic data/facts for informed decision-making. The prime objective of the solution is to enhance communication among healthcare providers involved in patient care.

By leveraging technology the healthcare industry can provide value-based care for their patients and better patient experience. An end-to-end patient referral tracking ensures timely care, improves care coordination and better outcomes. HealthViewX referral management solution is designed to suit any practice, customized to meet user requirements, and enables data-driven decision support, and provides real-time insights of patient-reported data to promote better care delivery. Schedule a demo today to understand more about our HIPAA Compliant SaaS-based referral solution from our experts. 

Advantages FQHCs Gain From A Patient Referral Management Solution

What is a Federally Qualified Health Center?

 A federally qualified health center (FQHC) is a community-based healthcare organization that provides high-quality primary care and preventive care for people of all ages, regardless of their ability to pay or health insurance status, providing health, oral and mental health/substance abuse programs. Federally qualified health centers are also called Community Health Centers (CHC), 330 funded clinics or Migrant Health Centers (MHC).  FQHCs were originally intended to provide the medically underserved population with quality care to minimize patient load in hospital emergency rooms. FQHC provides access to high quality and preventive medical health care to the underserved, underinsured and uninsured people. 

FQHCs embody community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They additionally embody outpatient health programs or facilities run by a tribe or tribal organization or by an urban Indian association. FQHCs are paid in compliance with FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner. Their mission has modified since their founding. Their mission now is to reinforce primary care services in underserved urban and rural communities.   

Community health centers or federally qualified health centers provide critical primary care services to tens of millions of people each and every year. Their role in healthcare makes them necessary access points for patients coming into the vaster healthcare system. Let us see how these organizations use patient referral management systems to leverage their role as a crucial source of patient referrals and enhance the care they can provide for their populations.   

1. Making a more combined provider network:

Right from small to large, FQHCs are moving towards providing value-based care for their patients. Many FQHCs have discovered that requests for better care coordination with specialists go unheard until there is a change in the current referral process. FQHCs have realized technology alone can provide them with the ability to differentiate themselves from their competitors, and help them deliver quality care to their patients, and close referral loops efficiently.  A referral management solution will help them organize, quantify and ultimately shape their referral stream and improve care coordination.

2. Improved patient support and access to care:

Insurance prior authorization is one of the major challenges in the patient referral process. Finding the right specialist, insurance prior authorization, ensuring the patient visits the specialist, getting the information back and updating the information back to the EMR is all crucial in patient care. A referral management solution helps FQHCs to automate end-to-end referral process and helps them close referral loops with ease. This improves patient experience and increases their access to quality care.

3. Improved referral workflows:

Many FQHCs lack care coordination in their current referral process. Manual processes are time-consuming and tedious. Making the referral workflow simple will not only help referral coordinators and patients but will also help the FQHC performance as a whole.

4. Better care coordination and patient outcomes:

In an efficient referral process, patients get the care they need. Right from referring the patient to the right provider, to insurance prior authorization, scheduling appointments, sending reminders, updating the patient information back into the EHR, etc. all contribute to better care coordination and patient outcomes.

5. Increased referral loop closures and MU Credits:

Receiving a report from the provider to whom the patient was referred to and updating that information back into the EHR is critical for FQHCs. Referral loop closure is essential for better care coordination and will help FQHCs improve patient experience and outcomes. A referral solution that is MU stage 3 certified can help the practice with MU credits, as referral transferred using the platform can be counted for MU credits.