Medisoft v24
ICD-10medical billingMedical Billing and CodingMedisoftpatient payments

New Medisoft V24 Features

New Medisoft Version 24 Features

Medisoft released version 24 with several key new features. Among the new features is Transaction Entry Alerts. With alerts, you can create rules that notify billers of potential issues before sending a claim. Another new feature is enhanced eligibility response displays, which display distinct and expandable sections on a patient’s insurance eligibility, allowing for easier comprehension of eligibility status. Additionally, eMDs enhanced Medisoft’s mobile app with more information and better scheduling features.

Let’s take a quick look at each of these items.

Transaction Entry Alerts!

Is your billing department a one-person show trying to keep track of all the rules of billing your claims correctly? Do you have billing staff taking vacations and wanting to leave pages of notes for the person filling in while they are away? Or maybe you employ multiple billers working on your data simultaneously and need to enforce billing claims rules correctly the first time? Regardless of your billing situation, Transaction Entry Alerts may be a solution to creating cleaner claims during the entry process!

This new feature to Medisoft version 24 allows you to create rules based on many different criteria. Alert messages are displayed when saving transactions while you are still in the transaction entry screen. With these alerts, staff can resolve any issues before creating claims!

Below is an example of a simple alert that could easily shorten the processing time by days or even weeks if caught early in the process. The rule states that for a specific insurance company (MED03), when a data entry person enters a specific code (in this case, 99397), an alert appears within the Transaction Entry screen, notifying the user that the code is invalid. Furthermore, the message directs the user of the appropriate codes to use for Medicare (G0439 or G0438)

So, taking a few minutes to create an alert could save your company thousands of dollars or many hours working rejected or denied claims.

 Transaction Entry Alerts are one of the latest features added to Medisoft that allows you to take more control of your claim processing by ensuring your payers are getting the right information the first time a claim is submitted.

If you have a billing service or run multiple data sets within your practices, you can copy alerts created in one practice to any other practice, saving you time. We encourage you to check out transaction entry alerts. It may be the best thing you can do for yourself and your business.

Enhanced Eligibility Response Displays

This feature requires using a clearinghouse designed to integrate with Medisoft. Sunrise Services offers this through our clearinghouse partners at Change Healthcare. We recommend bundling electronic claims, insurance remittance posting, and eligibility services together. If you are already using and happy with a different clearinghouse, it may be possible to set up eligibility only through Change Healthcare, so you can use this new feature while maintaining your existing claims clearinghouse.

Eligibility displays are more readable and useful

With version 24, eligibility displays are more readable and useful.  They include expanding sections for better access to information. Here’s a screenshot from the new eligibility response display. Notice the different data sections, and you can click on a specific section to expand it and see more details. Version 24 provides a smoother workflow for your front-office staff to manage and find deductible amounts, coverages, and more.

General information appears in the header, as seen in the graphic below. Notice the green checkmark? It indicates that the patient has an active insurance health plan coverage.

Receive more detailed information in the sections below the header. Expand or collapse each section by clicking on the little arrow left of the section’s name. If the arrow points right, toward the section name, clicking the arrow expands that section, providing more details specific to that section. Expanding the section is called “drilling down” to see more information.

If the arrow points down, then clicking it collapses the section, and the detailed information becomes hidden from view. Drilling down into only the sections from which you want information makes for a cleaner and quicker query.

The example below shows an expanded deductibles section with the status of deductibles for both the individual and family. Please note that the information you receive is limited to what the insurance company releases through the clearinghouse.

In the below graphic, the bottom section, named Other Benefits, is a repository for other information not otherwise applicable to the other sections.

You can print the screen by clicking on the printer icon at the top left of the screen. Each section prints in its expanded or collapsed form, depending on how you are viewing the screen. For example, in printing this screen, the deductibles section includes detailed information because it’s expanded. The other sections are all collapsed and show no details on the printout. If you also wanted to print out Active Coverage details, then expand that section before printing.

You can also print a specific section by Right-clicking on that section and selecting the Print option.

Medisoft Mobile App v3.2

With Mobile App 3.2, eMDs implemented both back-end development upgrades and numerous new feature capabilities.

The patient’s middle initial is now visible on the patient card view. The middle initial also appears on the following screens: charges, patient search results, and new appointments.

The case number and its description now appear on the patient card. Which case appears depends on several factors.

  • If the patient is on the appointment list AND the appointment has a case, the information from that case appears
  • If there is an appointment, but no case was selected, then no case information appears because the entry operator could have selected a case and chose not to.
  • And finally, if there is no appointment and the patient has one or more cases, information from the case appears and is based on your Program Option settings.

eMDs added new information to the Patient Card screen as well.

You can now view Secondary and Tertiary Insurance information on the patient’s case. And for all insurances, policy and diagnosis codes from the listed case now appear on the patient card. You can also see diagnosis codes from the case and the patient’s balance views.

Medisoft features Guarantor (or family) billing. You can send one statement to an entire family that includes each member’s balance. The sum of all those balances is called the quick balance. In Medisoft, you view the quick balance by pressing F11. That balance was not previously available from the mobile app. Now, when you tap the balance on the screen, you can see the guarantor’s quick balance.

You can now select a case when creating an appointment in Medisoft Mobile. Previously, you could review existing appointments and add new appointments. Unfortunately, you could not edit, move, or delete an appointment. With version 24, you have much more control over the entire appointment entry system in Medisoft.

If you already have Medisoft version 24, you can view our online training videos at www.sunrize.com/Medisoft. Or, check the Medisoft help menu for more details. If you do not currently use version 24 and would like to upgrade, please contact our sales department 502-538-4665 option 1 or contact sales@sunrize.com.

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Cloud-Based versus Server Based EHR Comparison

Since the onset of the COVID-19 pandemic, small, independent health care practices have changed workflows to accommodate telemedicine visits with patients. Some physicians, providers, and staff may also work from home occasionally. Although a hectic time, telemedicine has helped practices cope with quarantines and social distancing requirements, while also adapting to changing patient needs. With a provider’s ability to treat patients remotely comes a necessary workflow requirement of continuing the ability to access patient health records quickly and securely. Implementing an appropriate electronic health records system for your practice delivers to your providers and staff the tools to work safely outside the confines of your practice’s walls.

Health care practices can choose from multiple technologies to access EHR remotely, although a server-based system requires an additional remote access infrastructure. The difference between a cloud-based electronic health records (EHR) system and a server-based EHR system is mostly in where the programming and data reside. Both methods are similar in that functionality and essential features attempt to accomplish the same processes. Both systems collect patient information, maintain accurate health records, organize and compile data into informative and sharable formats, and facilitate effective communication with medical providers, payers, and patients. The health care practice controls and manages all aspects of a server-based system. EHR system developers manage cloud EHRs programming and data. The cloud system eliminates the practice’s need to maintain internal servers, monitor backup procedures, or to develop redundancy and resiliency protocols that ensure continuity of service and reliable access to stored data. 


UPFRONT COSTS

Cloud systems have the advantage here. EHR is much more complicated than simple practice management or billing system. For a server-based system to work correctly and speedily requires a practice purchasing one or more servers. Keep in mind, the premise of our discussion includes your ability to work from a remote location. Don’t ask a single computer to act as an application server, data server, and remote access server, and also work well. A cloud-based system eliminates the server(s) requirement.


MONTHLY COSTS

Both types of EHR systems have ongoing monthly or annual costs for services, support, and software updates. For a cloud-based system, you’re still paying for server infrastructure hosted by the software developer, just monthly instead of upfront. You may see a more substantial monthly cost with cloud systems than server systems, especially for practices with more physicians, providers, and users.


TOTAL COST OF OWNERSHIP (TCO)

TCO is tricky. For larger practices, especially, you may experience a lower TCO over three to five years with a server-based system. But that assumes the need for only basic maintenance requirements and no major server failures during the period. Any major networking and server issues can quickly eat into the savings. Plus, what many models don’t figure in is the need to replace your server(s) after four or five years, adding a new expense. The edge for the total cost of ownership costs usually goes to server-based systems, but only barely, and not without risks.


CASH FLOW IMPLICATIONS

You may have heard the expression “cash flow is king.” Despite a possible advantage in TCO, a server-based system still requires a tremendous up-front cash outlay. Cloud systems provide the benefit of predicting and knowing your monthly cash flow needs in advance.


DATA AND SYSTEM CONTROL

A server-based system provides you complete control over your systems and data. With that control is the requirement to secure your data and protect your systems adequately. If the Internet is down, a server-based system still works in the location where the server resides. If you have people working remotely from the server, they are unable to work on the network. With a cloud-system, anyone without Internet is down, but not all locations are necessarily offline. Plus, you have backup options available in instances where Internet access is temporarily lost. 


RCM COMPANIES

Revenue cycle management companies that perform billing, coding, collection, and other services on behalf of health care practices can leverage a cloud-based EHR to accommodate a provider’s clinical record keeping needs and the RCMs billing needs. All users can access integrated clinical and billing data from various remote locations with a cloud-based EHR. Cloud-based systems give RCM companies an opportunity to continue supporting practices when the transition toward electronic health records.


The crisis facing independent health care practices is leading more practices to adopt EHR. No one solution meets the needs of every healthcare-related company. Sunrise Services can help you with figuring out the best options for your office, and the associated costs to meet your needs and goals. Reach out to Sunrise with your questions, concerns, and goals. We’ll help create a plan suitable for your practice.

accounts receivableCloud hostingHuman resourcesRevenue Cycle ManagementTelehealth

Communicating with Sunrise Services

Written by Jeffrey Stokes

We live in extraordinary times. When COVID-19 first began wreaking havoc on society and businesses, we posted an update on our website announcing our commitment and ability to maintain our support of clients using our RCM, practice management, EHR, consultant, and electronic services. With much of our staff working from home, we have maintained our support levels.

Even before COVID-19, Sunrise Services began a process to enhance the tools we use to communicate with your practice. Our new phone system is entirely cloud-based, allowing staff to work from multiple remote locations and still communicate with other team members in real-time. You have additional options for reaching out for sales, support, and RCM questions.

The easiest method for opening a service ticket is to email support@sunrize.com. Provide us with your

  • Practice name
  • Contact name and telephone number
  • Description of the issue or service request

Upon receiving the email, we validate you have a current support agreement. If so, we create the ticket and route it to the correct technician. If you have no ongoing support agreement, we still assign a ticket, then place it on hold, send you an updated support contract, and release the hold upon completion of the contract.

Sunrise uses a customer relationship management (CRM) system named ConnectWise for managing support tickets, service requests, and sales processes. Like how an EHR includes a patient portal for a provider to patient communication and data exchange, our ConnectWise Support Portal allows you to create new ticket requests, view updates on current tickets, and review previous support occurrences.

The support portal provides an excellent means for managing your overall support requirements. Contact our support department if you’d like to include the portal as one of your support tools.

Through our Support Portal, you have access to a new and expanding knowledgebase. Information within our knowledgebase is growing each month. Join the support portal and check it out. You may find information that alleviates the need for additional support.

Our website URL is https://sunrize.com. Along with the typical selections on Services, Support, and Products, you will also find a section specific to COVID-19 resources. You can review past newsletter articles and essential blog posts.

Sunrise has a robust social media presence. You will find our Facebook page at https://www.facebook.com/SunriseServicesLLC/. Follow us and Like us on Facebook. Our Twitter handle is @SunriseServices. Follow us on Twitter to receive occasional updates and newsworthy items.

And, of course, you can always contact us by phone. Our main telephone line is still (502) 538-4665. When calling, we present you with three options:

  • Option 1: Sales
    • Generally, option 1 is for new customers. If you have an established relationship with a staff member, please feel free to reach out to them if you want additional services or support. If you’re not sure who to contact, then option 1 is an excellent place to start.
  • Option 2: Support
    • If you need technical support on MDsuite, Medisoft, Medisoft Clinical, or our WAN hosting services, use option 2
  • Option 3: RCM
    • Our Revenue Cycle Management customers with questions or issues related to their billing should use option 3.
    • We provide a different contact number on statements for any patients with billing questions. If you are an RCM client and a patient calls your office with billing questions, please direct them to call the number provided to your office.
  • Option 9: Dial by Name
    • Want to speak to someone specific, but do not know their extension? Press 9, and you can enter in part of their name.

We are working hard to provide many options for requesting and receiving help and advice. If you believe we can do better, or if you have suggestions, please email Jeff Stokes at jstokes@sunrize.com, or call (502) 538-4807.

Navigating eRx in Medisoft Clinical
MedisoftElectronic Medical RecordsEMREHRelectronic patient record

Navigating eRx in Medisoft Clinical v11.2.1

Sunrise Services recently concluded Medisoft Clinical upgrades to version 11.2.1. The latest version incorporates a new ePrescribing module based on an enterprise service. One tremendous advantage of the enterprise version is the elimination of downloading, installing, and managing insurance formularies and drug interactions. Instead, Medisoft Clinical incorporates these features into the service!

NOTE:  This article is for Version 11.2.1 only. If you have not updated to version 11.2.1, please contact us so we can guide you on any requirements to upgrade

As the lead Medisoft Clinical support technician for Sunrise Services, I’ve experienced with you, first-hand, how any change in a feature can affect your workflow. Therefore, I’ve compiled some of the most common questions, issues, and confusions clients experience with the new eRx service:

When you look under the ‘RX/Medication’ tab in a patient chart, you may notice several different status codes.  You must look at the entire picture to get an understanding of what the status is for the selected prescription.

Pending – The prescription has not yet left the system. No action required unless the status changes to ‘Error’,

Queued – The order is in the system and queued up to send to Surescripts and the pharmacy.  If the RX remains queued for more than 10 minutes, contact support to investigate.

Verified – The pharmacy received the prescription and confirmed receipt with a message sent through Surescripts.

Error – The prescription did not make it to the pharmacy, resulting in an error message received from Surescripts or the pharmacy. If the error message appears to be one you can remedy, correct it yourself. Otherwise, or if in doubt, call Sunrise for support.

Completed – The Rx was put in the system for a different provider and is complete. Completed prescriptions occur when you perform a ‘Medicine Reconciliation.’ Remember to remove the medicine when it is no longer active.  Just highlight the medication and move to ‘Historical.’

Sent – You’ve received no additional information from Surescripts or the pharmacy after sending the prescription.


Let’s take a closer look at the ‘Sent’ status:

If you created a paper Rx, then it is ok to have a ‘Sent’ status. On a printed prescription, the system has no way to validate whether the pharmacy received the order, so the system marks it as “sent” to indicate completeness. 

If you made an Electronic Prescription, or eRx, and the status is stuck on ‘Sent,’ then you must investigate further. The ‘Sent’ status indicates the prescription did not make it to the pharmacy, or the pharmacy sent back a denial.  You’ll see this status typically when a refill request is filled and is older than 14 days.  When you have a refill request present on the eRx Worklist, it’s in your best interest to address it as soon as possible.

If the eRx status has a sent Status, usually after about 10 minutes, you can see any associated errors by doing the following:

  • Click on Maintenance > Setup > Prescriber Management.  The Prescriber Management window will open. 
  • Click on Message History (Bottom Right).  Insert the patient’s last name and click on Search. 
  • If the status is ‘Error,’ click on the eye icon on the right to open the raw message where you can find the denial reason. 
  • If you see no reason provided, it is more than likely that the refill request is out of the date scope for the pharmacy.  To rectify, remove the eRx from the medication list and make a new one.  You should have a new status in under 5 minutes. 

NOTICE: Any eRx refill request received in the Worklist that does not have a corresponding Medication in the current medications list will result in a pop-up box. To rectify the problem, you can match the refill request from the medication on the left to a medication in the drop-down list, OR you may deny the request and select the Proceed button. The pharmacy will receive a denial request. You may also deny the eRx now and submit a new medication.

If, after you perform these steps, you require further assistance, please call Sunrise Services Support line @ 502-538-4665.

Medisoft Clinical’s latest upgrade includes several other advancements to help in your staffs’ daily workflow.

A new Prior Auth button is available in the eRx Worklist: Click the ‘Prior Auth’ button to access the CoverMyMeds ePA Dashboard.  For more information on enrollment, contact Sunrise Services support.

When you discontinue medication and select either Adverse reaction or Allergic reaction as the discontinue reason, a new section expands to enter details about the reaction. Select the severity from the drop-down options and type or select the reaction description.

A CCDA based on selections clicked in the clinical summaries is now sent to Updox (Patient Portal). Make your selections within the Special Features section of the Configuration drop-down.

The most significant changes in the new RX process are behind the scenes.  No longer is Medisoft Clinical using the PMSI application, but rather the more stable PMSI Interoperability service. This change frees up memory and allows the program to operate at a premium level.

For additional information on Medisoft Clinical’s new features and how to incorporate them into your workflow, give Sunrise Service’s support team a call at (502) 538-4665.

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Data Backups- Are You Sure They Are Being Done?

backup

Are you CERTAIN you are backing up your data?


Here are four examples of why you should care.

HARD DRIVES FAIL – A small pediatrician’s office asked for help with analyzing some data. The best way to assist them was to back up their database to an external drive and take it back to the office since this was before affordable remote access technology.

The office staff diligently backed up their database daily to an external drive. Except they didn’t! At some point in time, the backup location had reverted to the hard drive of the computer, the very same computer on which they store their database. A failed drive and they lose both the database files and the backup too.

A few days later, their computer’s hard drive failed. When staff went to restore their backup data, much to their surprise, the CD was empty. Fortunately for them, I still had the database backup used to help them with reports.

With no backup, an office might expect to pay thousands of dollars to a specialist to retrieve data. Upwards of 60% of businesses shut down within six months after losing data. Coincidence saved this office from much worse alternatives and scenarios.

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CYBER ATTACK – A practice with electronic health records software experienced a ransomware attack in 2017. Their IT company determined an employee likely accessed a website masquerading as an ICD-10 search tool. The employee called in a panic as she witnessed files changing names and systems no longer working. The immediate action was to shut off all computers and network devices and disconnect from the Internet. The malware successfully encrypted some files on the infected computer and a shared network folder of their server.

Fortunately, they had a disaster recovery plan in place. Within minutes, the system was shut down. Their IT company wiped clean the infected computer, reinstalled the operating system, and reset the network. We reinstalled the software. The practice had both onsite and offsite backups of the server and critical files.

It took two full days to complete the process, but with everything restored to the original state, the practice resumed normal operations on the third day. Imagine if no backup existed or was outdated.

VENDOR MISCOMMUNICATION – A colleague’s client faces the worst-case scenario in our first example. The billing company’s server crashed. They thought their IT company was backing up their multiple databases; however, they were not. Instead, the IT company thought the billing company was backing up their data. Nobody was monitoring the backups.

Regardless of who’s at fault, the billing company and all their clients are scrambling to find a solution. Even if you think your office has backups under control, communicate with whoever oversees them, and verify their completion regularly.

Maybe you have scheduled daily backups on your computer. Technology can fail or change unexpectedly. An unverified scheduled backup may turn out to be no backup at all. Verify your backups regularly.

MONITORED BACKUPS REVEALED A BIG ISSUE – Monitoring your computer systems, including backups, can alleviate the likelihood of more significant issues down the road. One client, who uses our cloud-based, HIPAA-compliant backup system, also backs up their electronic health records onsite to an external hard drive. After receiving reports with errors for their cloud-based backup, I checked their server for possible issues. The backup would run but wouldn’t complete successfully without errors. A reviewed of Windows logs showed errors as well. It appeared something was wrong with their hard drive or file structure.

I immediately contacted their IT company. They determined the hard drives were failing along with their RAID system, requiring a complete reconfiguration and restore. If they hadn’t had a monitored backup, they might not have found out about the failing hardware until it was too late, and the backups may have been incomplete as well.
Hardware failures, malicious cyber-attacks, and general miscommunication each demonstrate a need to monitor and verify your backup regimen. Add natural disasters, theft, vandalism, and other occurrences, and a verified back is critical.

HIPAA regulations (§164.308) require the protection of ePHI data through the implementation of “policies and procedures for responding to an emergency or other occurrence” (7)(i) and to ”establish and implement procedures to create and maintain retrievable exact copies of electronic protected health information.” (7)(ii)(A).

Sunrise Services offers offsite backup systems to help you maintain HIPAA compliance and create a proper disaster recovery plan. Call us for details. Whether you plan your backup strategies, seek help from your IT department, or ask us for help, make sure you develop a verification policy as well.

accountingaccounts receivableICD-10medical billingMedical Billing and Coding

Medisoft V24 A/R Tracker

Are you on version 23 or 24 of Medisoft Advanced or Network Professional? Have you looked at the new AR Tracker yet? If you answered “No” to either question, keep reading.

A new feature added in version 22, the “AR Tracker” module deserves an award. It is a very flexible tool that can save you time and much money by getting better control over your Accounts Receivable. It doesn’t matter if it’s just you or a staff of 20. The AR Tracker can help keep your AR efforts under control and more focused.


Do I have your attention yet? Many of you have a system of reports, notes, Final Draft messages, and color codes to help in your efforts already. You don’t have to change the way you do everything! However, you may find many of your AR efforts obsolete in a matter of minutes!

Accessible from the Activities drop-down menu, the AR Tracker pulls much of the critical information you need into one location, tying together AR management into one cohesive workflow, with advanced filtering to track and collect Insurance and patient balances.

Find and sort claims and statements in ways you didn’t know to wish for! Search results filter down by the provider, then insurance, the patient, and finally the claim number, where you can see any transaction color-coding, aging information, and so much more. From those results, you can create a task for a Medisoft user and track the outcomes.

“As an administrator, you can make sure that tasks are getting worked on and completed by their assigned follow-up dates.”

A simple right-click on a claim or statement will open the door to many of the tools you need to assist your AR process.

  • Add or view notes that are date stamped (so you can keep track of what has been done by you or others in your office)
  • Assign Status and Task codes then assign them to another staff member or yourself with a follow-up date (which a user can then use in the tracker to find his or her tasks to target the AR before it is lost)
  • Open and edit the insurance, patient, or claim and return right back to the AR Tracker list. Go straight to the patient’s transaction entry screen or to their case. Even check eligibility if you’re a Change Healthcare user.

If you have created a task for a Medisoft user, you can then create a filter template specifying the user and, or task code. The user then quickly opens the AR tracker and selects their templet to immediately target claims and statements they need to work on and enter follow up notes.

As an administrator, you can make sure that tasks are getting worked on and completed by their assigned follow-up dates.

Medisoft version 24 further enhances the module with a new field in the insurance carrier screen to enter the timely filling days. While editing an insurance, in the Address tab you’ll find the new Timely Filing Days field. Enter the number of days this insurance allows for a claim to successfully adjudicate. Back in the AR Tracker, you will notice a new column in the Details grid for claims: Days to File Pri. This column shows you the number of days before this claim reaches the timely filing deadline for that insurance carrier when it is the Primary insurance.

And it’s not just your billers that will benefit from the AR Tracker. Your front desk person using office hours can benefit from seeing Patient AR Status codes while scheduling or checking in patients. Data entry persons can get Pop-up messages when entering charges based on the same codes.

MDSuiteMedisoftRevenue Cycle ManagementValue Based Care

Vaping: How Are We Supposed to Code This?

Vaping

At the time this article was written, eight people had lost their lives due to severe respiratory illness from the use of e-cigarettes, also known as “vaping.”  That number is expected by healthcare professionals to rise as this trendy alternative to cigarettes becomes more and more popular, especially in the younger population. According to the Center for Disease Control and Prevention (CDC), as of early September, there are over 450 possible cases of e-cigarette related lung illness. With this recrudescence spreading and becoming a common issue, the fact that there is no specific ICD-10 code for this diagnosis is problematic.

In March of 2017, and again in September of 2018, the American Thoracic Society (ATS) requested specific ICD-10 codes for e-cigarettes. They stated:

The development and marketing of e-cigarettes, e-cigars and other electronic nicotine delivery devices poses significant challenges to health care providers, researchers, patients, public health officials and for ICD-10-CM coding. Currently, there is no effective way for health care providers to specifically code patients who use ENDS [electronic nicotine delivery systems] products. Given the growth in its usage, both domestically and internationally, the lack of a unique code set for these products will pose a barrier for the effective use of ICD-10-CM for health surveillance and research purposes. (1)

United States. Center for Disease Control and Prevention. Coordination and Maintenance Committee. “ICD-10 Coordination and Maintenance Committee Meeting.” Cdc.gov. Page 31. National Center for Health Statistics. March 2017. Web. 30 September 2019.

No one in the healthcare community doubts the harm that vaping can cause, especially in young people. However, when documenting a patient’s diagnosis, the available ICD-10 codes do not cover e-cigarettes specifically. The ICD-10 codes one would use are F17.200 – F17.291, which indicates nicotine dependence, either unspecified, cigarettes, chewing tobacco, or other tobacco product (like snuff), and either uncomplicated or in remission. None of these would accurately describe e-cigarettes as these vaping products affect the respiratory system in a different way than cigarettes, chewing tobacco, and other tobacco products.

E-cigarettes deliver a vaporized dose of nicotine, along with various chemicals, including, but not limited to, glycerin, propylene glycol, and flavorings. When someone vapes, they inhale vapor instead of smoke. No long-term studies exist to back up claims that inhaling vapor is less harmful than traditional smoke. Cancer takes years to develop, so it’s unclear if a product causes or increases the risk of cancer until that product has been out for at least 15-20 years. We know little about the long-term health effects of vaping.

The FDA Commissioner announced in the fall of 2018 that middle and high school students using e-cigarettes and vaping had reached epidemic proportions. This issue has only grown since then, but the codes for nicotine dependence haven’t changed since they were new codes in 2015. The new ICD-10 codes for 2020, which set for release by the time this article runs, do not include any alterations to the nicotine dependence codes, specifying e-cigarettes, nor are there new codes for this wide-spread, still growing health issue. It seems like we will be waiting another year to accurately document and survey the prevalence of developing respiratory issues caused by this possibly deadly trend.

If you need more information or assistance from trained coders and billers, contact us to purchase an “Ask Us Anything” support contract, and we will be happy to help.

https://www.cdc.gov/nchs/data/icd/topic-packet_03_07_17.pdf
Human resourcesMDSuiteMedical Billing and CodingRevenue Cycle Management

The Importance of Soft-Skills in Healthcare

The landscape of healthcare organizations has changed dramatically over the past few decades. The concept of “healthcare consumerism” has gained significant traction with health systems, hospitals, and medical practices. Healthcare consumerism is a movement that advocates patients’ involvement in their healthcare decisions-moving away from the mindset of “do what the doctor says” to a model of a working partnership between the doctor and patient. Previously passive patients have become empowered consumers due to the extreme financial burden placed on their personal paychecks. This shift towards value-based care impacts how patients are cared for and how physicians and hospitals are paid. The rise in consumerism in healthcare is pervasive and has created a workplace that is more demanding, more complex, and more collaborative than ever before.

Healthcare organizations will need to hire and train healthcare employees with the right professional skill sets to provide well-coordinated, high quality, patient-centered care. Finding healthcare workers who will contribute to the value-based care environment means hiring staff with the right balance of hard and soft skills.

While hard skills are related to technical knowledge and training, soft skills are personality traits. Candidates should possess exceptional skills in communication, teamwork, critical thinking, and adaptability. Soft skills were often overlooked in the past but should be considered a core criterion for hiring today. 

According to SkillSurvey Inc., 2019 soft skills are a collection of personal, positive attributes and competencies that enhance their relationships, job performance, and add value to the market. In today’s workforce, soft skills should be considered essential to managing and working with people, customer satisfaction, and forming a positive work environment. When patients encounter rude behavior from medical staff, there is an increased likelihood of labeling future interactions as rude and as such patients are more apt to be rude in turn. Patient care suffers because people are afraid to speak up, and the level of ambient rudeness goes up. 


Here are five tips to help leaders find the best candidates for their organization (National Association of Colleges and Employers (NACE) 2015; Parker 2011; Skill Survey Inc 2019)

  1. Make soft-skills part of your organizational culture.

  2. Identify soft skills that matter to the position you are hiring

  3. Design job descriptions to communicate required soft skills

  4. Conduct a detailed assessment prior to extending an employment offer

  5. Make soft-skills part of your organizational learning and development programs.

Mastering soft skills is an on-going process and should continue throughout a person’s professional career. Proper use of soft-skills can not only create valuable healthcare team members but also creates an environment to provide the best patient care.

Integrated Cloud Based SolutionsMDSuiteRevenue Cycle Management

A Billers Perspective of MDsuite

I’ve used different billing software as a biller over the past years, and MDsuite is one of my favorites for processing a practice’s entire revenue cycle management (RCM). This article will highlight a few reasons why.  


Ask almost any biller, and they will tell you, entering patient demographics is boring. It may very well be the biller’s most crucial task. If entered incorrectly, you run the risk of insurance denials, thus delaying payments. A simple mistake, at this initial stage, could bring the entire billing process to a quick halt, causing delays and extra time for finding and fixing the error. 

“The scanner automatically populates a patient’s address, date of birth, and photo from the driver’s license, as well as pertinent insurance information from scanned insurance cards.”

MDsuite includes many features that aid in avoiding such mistakes. One option consists of a card scanner that allows you to scan a patient’s license and insurance cards with a click of a button. As an integrated option within the system, the scanner automatically populates a patient’s address, date of birth, and photo from the driver’s license, as well as pertinent insurance information from scanned insurance cards. You will decrease your entry time, and, more importantly, improve data entry accuracy. Plus, you now benefit from copies of the patient’s photo, license, and all insurance cards at your fingertips. Even without the scanner, as you enter patient demographics, you can check the billing zip code with the click of a button. The beautiful thing about that is if the patient’s address is wrong, it takes you to the USPS website to verify and correct. 

After entering insurance information -when linked with an integrated clearinghouse- as soon as you click ‘Save’ in the insurance tab, it checks the patient’s eligibility. I use the Imspro clearinghouse, and one of the benefits of Imspro is that I can see the patient’s address along with their insurance benefits, leaving little room for denial for eligibility. If a patient is returning or needs an up-to-date eligibility check, you can go into the insurance tab and check eligibility at any time. The process then timestamps the updated eligibility inside the patient’s chart automatically. Your information is up-to-date, accurate, and completed quickly.

MDsuite has a separate section inside the patient’s chart to add documents. I use it to store the patient intake form, authorizations, and credit card authorizations. You are no longer trying to find files or documents in multiple locations. You’ve uploaded them all into the patient’s chart, and they’re all accessible in one area.

As a biller, you want to enter charges as quickly and accurately as possible, but it can be time-consuming moving from screen to screen. In MDsuite, you never have to leave the posting screen, saving considerable time. You can post several dates of service, use multiple providers, and add or change prior authorizations and hospitalizations while posting; all while never leaving the posting screen. Do you ever need to look up a patient or insurance while posting charges? All you need to do is open it in a new tab, without exiting the posting screen. You can have multiple tabs open simultaneously, making data verification easy while cutting the time it takes to post charges in half.

MDsuite includes an EDI manager, which is your hub for sending claims and statements and receiving insurance remittances. The EDI manager looks like your email. It even has an inbox, outbox, and several different folders to sort files. When you’re posting a remittance, and there is something that you need to work through, you don’t need to stop the process to save or print your work. Instead, you move it into a folder for rejections or working. The manager keeps an activity log for your practices, and you can quickly move from folder to folder with a simple right-click. The EDI Manager is the inbox of the system regarding claims, statements, and remittances.

No matter who or what you bill for, you need reports. MDsuite has an entire library of reports from which to choose. How many times have you had to run a report that you filtered to your specifications, and it works perfectly, but then you come back to rerun it, and it’s not the same, or you forget the filters? Well, in MDsuite, when you find a report you like, you can save it and use it repeatedly. For example, I have a practice that is a group, but the providers report separately. When running the A/R reports, I have them filtered and saved separately by primary insurance, secondary insurance, patient, and provider. This way, I can pick which report I need from a dropdown, without the need to recreate the filter each time. 

Timesavers group together tasks and run them in a batch instead of one at a time. It utilizes the Windows Task scheduler to perform the Timesaver even if you log out of the system or are out of office. Timesavers are another way to help save time, and I use them for reporting. I have it set to run each report I need for each provider every Friday afternoon. No more waiting for a report to process and then save. I set it and forget it. Then on Friday afternoon, I pull the reports from the timesaver folder. It takes some time to set the tasks up, but it is well worth it and is a substantial “timesaver.”These are but a few of my favorite aspects of MDsuite. As with any software, you will have likes and dislikes, but, in my opinion, MDsuite streamlines a biller’s RCM workflow and helps with time management. If you want to learn more about billing or MDsuite, please give us a call. We are happy to answer your questions

EHRmedical billingMedical Billing and CodingRevenue Cycle ManagementTelehealth

Understand How To Code Telehealth, Telemedicine

Hint: The terms aren’t interchangeable.

Providers are increasing patients’ access to healthcare services through virtual communications. If providing services to patients without an in-person, face-to-face interaction makes sense for your practice, it’s important for you to know how to code the services correctly.

TelehealthWhile you may hear telehealth and telemedicine used interchangeably, from a coding perspective, the words refer to different services and situations.

Definitions:  A good place to start is by outlining the difference between telehealth (defined as any health service provided by telecommunications) and telemedicine (defined as any clinical service provided by telecommunications). Additionally, you’ll want to consider the array of nuanced guidelines and constantly changing code sets.

Have a look at three key areas to cover some of your most pressing telemedicine and telehealth services’ coding needs:

 

  1. Keep an Eye on Changes

“One of the greatest challenges facing telemedicine coding is that changes in technology typically occur faster than changes in coding,” says Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians.

“CPT® code change proposals are often generated and acted upon more than a year before the changes/new codes appear in CPT®, and CPT®itself is only published once a year. So, it’s easy to see how technology moves faster, leaving coders to wonder if a new telemedicine service fits an existing code or needs to be reported using an unlisted code,” Moore adds.

As an example of this rapid change, theCenters for Medicare and Medicaid Services(CMS) introduced two new HCPCS codes for 2019: G2012 (Brief communication technology-based service, e.g. virtual check-in…) and G2010 (Remote evaluation of recorded video and/or images submitted by an established patient…), which you can use when a provider is evaluating information to determine if a patient needs to be seen in the office.

Additionally, CMS added two prolonged service codes, G0513 (Prolonged preventive service(s) … first 30 minutes…) and G0514 (…each additional 30 minutes…), to the telehealth services’ list.

One means of staying current with telemedicine codes is consulting Appendix P in your CPT® manual. Documenting any service listed there when provided via telemedicine is as easy as appending modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system). You will also need to add place of service (POS) code 02 (Telehealth) to your claim to indicate that the provider is at the distant site (as opposed to the originating site where the patient is located).

GT no longer needed: Unless you are billing claims from a critical access hospital (CAH) under method II for institutional claims, you no longer need to apply modifier GT (Via interactive audio and video telecommunication systems) to a Medicare telehealth claim. But modifier GQ (Via asynchronous telecommunications system) is still required for asynchronous communication when appropriate, says Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

2. Know What Qualifies as Telemedicine

While telemedicine can involve the use of telephone communication, two groups of telephone evaluation and management (E/M) codes are not regarded as telemedicine.

Codes 99441 through 99443 (Telephone evaluation and management service by a physician or other qualified healthcare professional … provided to an established patient, parent, or guardian …) and 98966 through 98968 (Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian …) are not regarded as telemedicine because CPT®does not regard them as being “face-to-face” services.

Medicare Advantage Now Features Telehealth Expansion

In the past, telehealth was only an option offered through Medicare Advantage beneficiaries’ supplemental benefits, but the Centers for Medicare and Medicaid Services (CMS) wants to change that.

Now: Bolstered by provisions outlined in the Bipartisan Budget Act of 2018 (BBA 2018), CMS updated telehealth services for Medicare Advantage (MA) plans starting in the contract year 2020, notes a two-part final rule, published in the Federal Register last month.

“Under this final rule, MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility,” CMS advises. “MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.”

The final rule allows MA plans the option to offer telehealth benefits to MA patients beyond their supplemental benefits in both rural and urban environments, aligning with BBA 2018 legislation, indicate attorneys Matthew M. Shatzkes and Susan Ingargiola of the national law firm Sheppard, Mullin, Richter & Hampton LLP, in the Sheppard Mullin Healthcare Law Blog.

However, “MA Plans will continue to be able to offer MA supplemental benefits (that is, benefits not covered by fee-for-service Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for coverage under fee-for-service Medicare or the requirements for MA additional telehealth benefits (such as the requirement of being covered by Medicare Part B when provided in-person),” Shatzkes and Ingargiola explain.

The same is true for 99444 (Online evaluation and management service provided by a physician or other qualified healthcare professional … using the Internet or similar electronic communications network), which is also regarded as non-face-to-face and would also not be defined as telemedicine by virtue of its asynchronous nature.

3. Don’t Forget Difference Between State and Federal Rules

Depending on the nature of the telehealth service and the clinical care administered telemedically, CMS may not cover the outcomes.

“The key to compliance with Medicare rules is to evaluate the Medicare billing requirements for a bona fide telehealth encounter with the proposed arrangement from the telehealth company,” says John E. Morrone, a partner at Frier Levitt Attorneys at Law in New York City. “It is very common for healthcare services to comport with applicable state law but not be reimbursable by Medicare.”

He adds, “A telehealth encounter may be perfectly acceptable under state law, and even billable to commercial carriers, but not be billable to Medicare.”

Resource: For a more in-depth look at CMS’s telehealth services, visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf?utm_campaign=2a178f351b-EMAIL_CAMPAIGN_2019_04_19_08_59&utm_term=0_ae00b0e89a-2a178f351b-353229765&utm_content=90024810&utm_medium=social&utm_source=facebook&hss_channel=fbp-372451882894317.

 

Originally published Published on Thu Jun 06, 2019, TCI