Overcoming quarantine to serve patients in a mental health crisis with telehealth

Faced with a sudden shelter-in-place order in April 2020, mental health therapist Lys Hunt needed a way to serve her patients through the pandemic. Before COVID-19 hit, Hunt had only a single patient who didn’t attend in-person sessions at her office. With this shelter-in-place order, she suddenly needed a telehealth solution for 15 patients per week.

Turning to video conferencing and telehealth tools that she’d previously used on a limited basis, it was clear to Hunt that these platforms could not accommodate a full schedule of patient appointments. Connectivity and customer support issues became apparent very quickly, and Hunt knew she needed to make a change to serve her patients through this difficult time.

With an emerging mental health crisis due to COVID-19, Hunt needed an application that made it easy for her patients to meet with her virtually. Because the therapist was already using ABILITY for billing, ABILITY’s telehealth application felt like a natural choice. With virtual scheduling and billing capabilities in one place, and a user-friendly platform, the transition has been seamless. Hunt has maintained a full case load throughout the pandemic, helping patients who otherwise could not have received desperately-needed mental health care.

While Hunt has begun reintegrating in-person appointments, she and her patients have no plans to go back to 100% in-office sessions. For some patients, who moved farther from Hunt’s practice during the pandemic, telehealth gives them the freedom to continue working with a therapist they know and trust. And vulnerable patients have the capability to continue to care for their mental health without putting their physical health at risk.

For more details on how ABILITY helped this New England therapist respond to a burgeoning mental health crisis in the face of quarantines, check out our case study.

Want to learn more about improving access to care with a telehealth application that goes the distance? Schedule a demo today.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Ten steps SNFs must take for stronger infection protection and control

Skilled nursing facilities (SNFs) face unique challenges when it comes to infection prevention and control. The close-contact nature of SNFs and an older adult population – many with underlying medical conditions – put residents at increased risk of severe illness from infectious diseases.

Due to the elevated risk of contracting infections, SNFs need to be on alert to prevent infections and ensure the facility is as safe an environment as possible. According to the CDC, “a strong infection prevention and control (IPC) program is critical to both residents and healthcare personnel.”

While federal regulations have been in place since 2016 that require facilities to have infection control and prevention programs, the COVID-19 pandemic has brought renewed attention to the oversight of these programs. For example, the Centers for Medicare & Medicaid Services  (CMS) recently instituted a rule that requires SNFs to report COVID-19 vaccination status for residents and staff.

If ever there was a time to step up your organization’s infection prevention and control to limit potential transmission routes and reduce overall risk, it’s now. Every SNF is required to have a program that investigates, controls and keeps infection from spreading.

Here are ten steps you can take to combat infectious disease, comply with regulations, and improve patient outcomes at your organization:

  1. Educate all staff on hygiene guidelines and infection protocols
  2. Monitor adherence to facility-wide infection prevention procedures
  3. Stay up to date on regulatory and reporting requirements
  4. Employ a professional infection preventionist
  5. Hold regular infection control committee meetings
  6. Designate someone to coordinate IPC program activities
  7. Incorporate infection control into your QAPI process
  8. Perform infection surveillance with ongoing analysis of the data
  9. Implement a system to streamline regulatory reporting
  10. Understand the pertinent federal tags and prepare for infection-focused surveys

Ready to take your IPC program to the next level? ABILITY can help.

Watch our on-demand webinar to learn how you can streamline and proactively manage your infection control process for better outcomes.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Is the Value-Based Purchasing program on its way out? What SNFs need to know.

The SNF Value-Based Purchasing (VBP) program is in for an overhaul. The Medicare Payment Advisory Commission (MedPAC) has been advocating to replace the current program with an alternative that is more equitable across skilled nursing providers and that builds in financial incentives to motivate quality improvement efforts more effectively.

On July 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes raising the number of quality measures in the program. Here’s what SNF organizations need to know about the upcoming modifications to the SNF VBP program.

Why is the SNF VBP program changing?

The SNF VBP program is supposed to reward SNFs with incentive payments that reflect the quality of care provided to Medicare beneficiaries. However, in a mandated assessment, MedPAC concluded that there were “fundamental design flaws” in the current SNF VBP program and recommended it be “replaced as soon as possible.”

According to the Commission, shortcomings of the program include:

  • Use of only a single outcome measure – hospital readmissions – to assess performance
  • A reward system that does not motivate all providers to improve quality
  • Failures to address social risk factor variations across patient populations
  • Not distributing all withheld funds

What changes are expected?

The FY 2022 SNF Prospective Payment System (PPS) Final Rule lays out the following the provisions that will impact the SNF VBP:

  • The Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) will be suppressed for FY 2022 due to COVID-19
  • All participating SNFs will be assigned a performance score of zero to address possible distortion of performance scores and incentive payment multipliers
  • The federal per diem rate for each SNF will be reduced by 2%, and 60% of the withhold will be awarded back, resulting in a 1.2% payback to those facilities that meet their targets
  • Up to nine additional measures may be applied to the SNF VBP program beginning in FY 2024

What’s next and how can SNFs prepare?

The expanded SNF VBP will undoubtedly incorporate multiple performance measures, focus on patient outcomes and resource use for scoring and account for social risk factors.

While any new changes are limited to functional status, patient safety, care coordination or patient experience, new measures will still need to go through the rulemaking process. Currently, CMS is considering measures that are already required for long-term care facilities (LTCFs) in addition to input provided by stakeholders.

The best way for SNFs to prepare is to ensure their quality programs include technology to track quality metrics and provide analytics to improve performance.

This can be achieved with ABILITY CAREWATCH, a proven application that helps organizations simplify quality management, monitor their incentive multiplier, stay current with regulatory changes and optimize incentive payments under SNF VBP.

 

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.

Using telehealth to expand care and protect vulnerable patients

When the COVID-19 pandemic hit, therapist Janet Dyer had to quickly find a way to serve all her patients – without compromising their health or her own. As an immunocompromised person herself, Dyer needed to protect her own health so that she could continue to serve the 20 patients per week who depended on her for mental health care.

Despite being physically vulnerable, Dyer didn’t even consider closing her doors. Instead, she turned to telehealth services.

Dyer was not a complete stranger to remote mental health therapy. Prior to the pandemic, she had offered limited telehealth services to a few patients. She never considered expanding those services, though, as scheduling and connectivity obstacles made it too challenging to work at scale.

Faced with the need to provide a safe means to treat all of her patients, Dyer turned to ABILITY for a HIPAA-compliant telehealth application that offered easier scheduling, reliable connectivity and features like group appointments and screen sharing.

Her patients immediately embraced the convenience of the app, enjoying easy access directly on their phones or from their email. The app’s integration with their calendars and the automated appointment reminders made it easier for many patients to get the help they needed.

Discussing the improved efficiency and ease for her patients, Dyer said, “My patients don’t have to do a lot of planning and work for their appointments. They can wake up at 7:55 for an 8:00 appointment on a Saturday morning.” Unsurprisingly, many patients have indicated that they want to continue seeing Dyer via telehealth instead of returning to the office.

While patients enjoy increased convenience – and the freedom to conduct their therapy session in their car, home or even a local park – Dyer appreciates the efficiency of a single source for all her telehealth-related tasks. The application has saved her time and helped her streamline non-patient-focused tasks – so she can spend more time where it counts: with her patients.

For more details on how ABILITY helped Dyer serve her patients safely through a global pandemic, check out our case study.

Want to learn more about expanding care with a telehealth application that goes the distance for you and your patients? Schedule a demo today.

Easy claims management: how a billing consultant keeps it simple

When you think of healthcare claims, “effortless” is not usually the word that comes to mind. Quite the opposite, in fact. But that’s how one billing consultant described her experience using ABILITY’s claims management application.

Regina Burnham is a billing and account management consultant who works with behavioral health providers. To provide the best service to her clients, she needs to manage multiple claims with multiple payers – while maintaining efficiency and accuracy.

Burnham began using ABILITY CHOICE All-Payer Claims to automate her manual claims process. Now, several years later, she still counts on the application to simplify her billing. She explained, “I stayed with it because of the ease of submitting the claims.”

Even Medicare claims don’t slow her down. “ABILITY takes the pain out of getting Medicare claims set up so they can be submitted efficiently,” she said. “And they’re clean claims when they go out.”

Burnham submits her claims with confidence knowing she doesn’t have to choose between speed and accuracy.

View her story to learn more about her experience and how her claims management has transformed for the better.

 

ABILITY and design®, ABILITY® and ABILITY CHOICE® are trademarks of ABILITY Network, Inc.

5 ways to maximize revenue on every claim

Hospitals and health systems have long struggled with creating, growing and maintaining healthy revenue cycles.

The pandemic introduced new challenges when many facilities were forced to cancel elective procedures, dealing a hefty blow to balance sheets across the country. As your organization regains its footing, what are some of the most impactful strategies for recovery?

First, find your revenue

Let’s start with a number that’s hard to ignore: $660 billion. That’s how much hospitals have lost to uncompensated care since 2000.1

This means care was provided, revenue was earned, and it wasn’t collected. Ouch.

Adding insult to injury, nearly half of hospitals have experienced an increase in uncompensated care and bad debt resulting from the pandemic.1

Now, the good news.

There are simple steps you can take to drastically reduce the odds of self-pay accounts resulting in uncompensated care or underpayments. In many cases, you can side-step the risk of self-pay altogether.

Identify all available coverage

When you have a full view of all active insurance coverage, you can be reimbursed directly from payers instead of patients. It’s easier than you think.

ABILITY offers a superior insurance discovery tool that can help providers find up to 20% more billable coverage for unpaid accounts.2

Submit claims with renewed confidence knowing that you can avoid downstream denials and rejections by identifying all coverage information from the point of initial patient access.

ABILITY Insurance Discovery delivers the following key advantages to providers:

  1. Demographic information verification – Verify nine key elements in real time, note missing data and obtain complete, accurate info for each patient and claim.
  2. Active coverage identification – Numerous database searches identify unique primary, secondary and tertiary coverage, rank that coverage, and reveal managed care and advantage replacement plans.
  3. Expanded payer search – Run an average of 13 transactions per patient and find up to double the number of payers compared to other services.
  4. Geographic payer search – Conduct national searches and query the most relevant payers using proprietary matching algorithms.
  5. Customizable workflow capability – Create custom exclusions to eliminate false coverage and establish rules based on facility, patient, state and payer.

What kind of impact is this having on collection rates? Read the story of how an ABILITY customer in Florida experienced double-digit increases in insurance collections for hospitals and other providers.

It’s time to find out how much uncompensated care is costing you, and learn more about how ABILITY can help.

 

Sources:

1 “Hospital Uncompensated Care Costs Grew to $41.61B in 2019,” Jacqueline LaPointe, RevCycle Intelligence, January 26, 2021, https://revcycleintelligence.com/news/hospital-uncompensated-care-costs-grew-to-41.61b-in-2019

2 ABILITY internal reporting, July 2021. Individual results may vary.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

How an insurance discovery app drove double-digit increases for a collections agency

How do you improve your collection efforts when you’re faced with limited access to both data and insurance carriers?

Every collection agency has its challenges, but Marie St. James, Chief Operating Officer at Gulf Coast Collection Bureau, was dealing with limited data and delays that significantly impacted collection rates. So, not only did she need to find a way to make improvements, but she also needed to find a partner that could deliver on its promises.

“The biggest challenge with other vendors,” mentioned St. James, “was that they didn’t have the option for bigger carriers such as Blue Cross Blue Shield.”

With the account data the agency received already sitting at 90 to 120 days, timely filing was a constant and critical concern. Combine that with a vendor platform that was not user-friendly, and they found that their collection rate suffered. The organization needed a simple application with improved functionality that didn’t require constant communication with an IT team.

ABILITY Insurance Discovery provided the carrier access and straightforward functionality that strengthened collection efforts across the board.

By switching to ABILITY, the organization can focus more on the collection process instead of simply trying to access data in a readable format. Now, they have improved efficiencies, agents can more easily capture necessary information, and they have increased collections by 10%, according to a recent case study.

Ready to see how this innovative application can help you find more billable coverage? Schedule a demo today to see ABILITY Insurance Discovery in action.

New law eliminates access to FL Medicaid claims portal

New changes to the Agency for Health Care Administration (AHCA) in Florida could impact your practice’s claims submission and remit processes. CS/HB 1057, signed into law in June, eliminates parts of the AHCA’s requirements for Medicaid reporting. As part of those changes, Florida providers will no longer have access to CMS’ free Medicaid reporting portal.1

The changes included in the bill come with some good news and some challenges, as some providers will need to adjust in order to make reports and submit claims through clearinghouses, rather than directly through the Medicaid portal. Let’s take a look at what’s changing and how you can prepare for the measure, which took effect July 1.1

What’s in the new law?

The good news is that it eliminates some reporting requirements that have been in effect for several years. Providers will no longer need to report on:

  • Medicaid Managed Care Transition
  • Pharmaceutical Expense Assistance Program
  • Medicaid Drug Spending Control Program

The first of these requirements, Medicaid Managed Care Transition Report, was implemented in the transition from traditional Medicaid programs to the new Medicaid Managed Care program. Since this transition has been complete for the last seven years, this report is now redundant and can be ended.1

The Pharmaceutical Expense Assistance Program Report only applies to Medicaid recipients who have been eligible since 2006 or earlier. There are now only 14 patients still eligible for this assistance in Florida, and while they will continue to enjoy eligibility, reporting on this program is no longer necessary.

Finally, the Medicaid Drug Spending Control Program is another legacy reporting requirement that was implemented in the transition from Medicaid Fee-for-Service (FFS) to the new model. Because much of the eligible population for this program has dual eligibility with Medicare and may also be receiving medications through skilled nursing facilities, the data collected from this report may not be an accurate reflection of medication spending trends for the Medicaid population.

What does the law mean for your healthcare organization?

While Florida providers are now no longer responsible for these reporting requirements, the bill also eliminates access to the free portal for Medicaid claims submissions. Instead, providers must send those claims through a clearinghouse connecting them indirectly to federal payers.

Fortunately, ABILITY works with organizations in Florida and across the country to simplify claims submission and remit processes – bringing all submissions together through a single, centralized portal for all payers.

To learn more about how ABILITY can help you automate claims submissions, decrease denials and streamline remits, request a demo today.

 

1.“New bill revises AHCA Medicaid practices,” Nicole Pasia, State of Reform, June 22, 2021. https://stateofreform.com/news/florida/2021/06/new-bill-revises-ahca-medicaid-practices/

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

How a family medicine practice protected revenue and served more patients with telehealth

How can practices protect revenue while serving more patients and improving outcomes? During the COVID-19 pandemic, Southwest Family Medicine was faced with a serious challenge: how to reach patients and provide outstanding care when in-person appointments weren’t an option. Thanks to the right telehealth technology, the practice was able to see more patients and maintain cash flow. “Instead of losing revenue during a time when everyone was experiencing a downturn, we’ve stayed busy,” said office manager Shanna Hammond.

In her time at Southwest Family Medicine, Shanna has seen it all: patients arriving with common colds, broken bones and chronic conditions. What she hadn’t seen before 2020 was a once-in-a-lifetime, pandemic-driven shutdown that left her office deserted. With patients unable to attend in-person appointments, Southwest Family Medicine turned to other options to treat patients virtually.

Like many practices, Southwest Family Medicine did not previously offer telehealth services. So, when faced with a pandemic and the need to see patients from afar, they turned to existing virtual appointment apps.

These off-the-shelf appointment applications were not only clunky and difficult for patients and providers to use – they also presented HIPAA compliance issues. Worse yet, patients ran into compatibility issues with their mobile devices and desktops, creating a nightmare for scheduling and keeping appointments.

“We started out using systems that were the quickest and most familiar to our patients,” Shanna said, “but we realized that we were fighting an uphill battle with apps that weren’t designed for healthcare settings.”

To address compliance and accessibility issues, the team at Southwest Family Medicine turned to ABILITY Virtual Care, a secure and user-friendly platform that was much easier for patients and staff to use. For details on their success, check out our case study now.

 

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Hospice providers now may submit claims to Medicare Advantage Organizations

More Medicare beneficiaries may enter hospice care with complementary Medicare Advantage (MA) plans as the Centers for Medicare & Medicaid Services (CMS) rolls out health plan innovations under the Medicare Advantage Value-Based Insurance Design (VBID) Model. The innovative plans are meant to reduce costs and improve care for Medicare beneficiaries.

Once hospice providers have registered with CMS to participate in the program, they can begin identifying eligible patients and can bill the appropriate Medicare Advantage Organization (MAO) by first submitting a notice of election (NOE).

Identifying hospice patients with MA coverage

To take advantage of VBID coverage, hospice providers first must determine if patients with Medicare coverage also are beneficiaries of an eligible MA program. Patients who present a Medicare card with a Medicare Beneficiary Identifier can check eligibility using their normal processes or by utilizing the MAC Portal, the MAC Interactive Voice Response System, the Health Insurance Portability and Accountability Act Eligibility Transaction System (HETS), billing agencies, clearinghouses or software vendors.

The same resources can be used for beneficiaries whose cards do not list a Medicare Beneficiary Identifier by using the MA contract number and plan benefit package identification information on the MA enrollment card.1

Submitting claims to participating MAOs

To be paid at original Medicare rates for eligible patients, hospice providers that are not contracted with participating MAOs first must submit original Medicare claims for the covered hospice care.

To begin a bill for an eligible patient, provider must confirm that the hospice start date was on or after Jan. 1, 2021, and file a NOE with the provider’s MAC and the participating MAO. Next, claims should be submitted to MAC following normal procedures. Those claims will be returned with the following message:

  • Claim Adjustment Reason Code (CARC) 96: Non-covered charge(s)
  • Remittance Advice Remark Code (RARC) MA73: Information remittance associated with a Medicare demonstration. No payment issued under Fee-for-Service Medicare as patient has elected managed care
  • Group Code Contractual Obligation (CO): MAOs participating in the VBID Model’s hospice benefit component will be responsible for coverage of the above services

The claim also must be submitted to the MAO. Hospice providers that already are contracted with the participating MAO should follow the contractual billing and claims-processing guidelines. Providers that are not in the MAO’s network can use the same forms they use to submit claims to their MAC. Once the patient is discharged from hospice, or the benefit is revoked, the provider needs to file a Notice of Termination or Revocation with the provider’s MAC and the patient’s MAO.

Hospice providers who use ABILITY EASE All-Payer will not see a change in claims submissions, as a MAO is treated similarly to a secondary payer. ABILITY EASE All-Payer users already are able to submit NOEs to MAOs.

To register or to get more information on the VBID program, visit the CMS website. If you have any questions about how to submit VBID claims within your claims system, reach out to an ABILITY expert for guidance.

1. “VBID Model Hospice Benefit Component Billing & Payment: CMS Innovation Center.” Innovation Center. Centers for Medicare & Medicaid Services, October 28, 2020. https://innovation.cms.gov/innovation-models/vbid-hospice-benefit-billing-payment.

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.