Avery Hurt

The front desk staff is essential for checking in patients, collecting copays, and verifying insurance. But there’s more to the story, and out of sight doesn’t mean out of mind. Much of the heavy lifting for billing and collections is done in the back office, so it’s even more important to have a deep bench of talent, says Tammie Olson, manager and coding and compliance strategist at Management Resource Group.

In this two-part series, Olson, who works at the Ocean Springs, Miss., firm, offers financial management and support services for the healthcare community. She shares six ways to get your back office team to bring their best game to your billing and collections efforts.

Six back office billing strategies

Be sure to check out part one of this series for

tips on improving your front office billing strategy!

Slideshows

Expert advice for turning your back office staff into billing and collections all-stars.

If you want your billing and collections to be as smooth and effective as possible, you need to make sure everybody on your team is doing their part.

Sometimes small tasks can fall through the cracks, and large ones can seem like more trouble than they’re worth. But when everyone on the team is focused on the goal, small tasks get done quickly and large ones seem easier. And when everyone is on top of their game, work runs more smoothly and your bottom-line will be healthier for it, says Tammie Olson, manager and coding and compliance strategist at Management Resource Group.

Olson, who works at the Mississippi-based firm, offers financial management and support services for the healthcare community. She offers four suggestions to jump-start your billing and collections process, starting with your front office staff.

Four front office billing tips

tips on improving your back office billing!

Advice to help your front office staff start the billing process off right.

Pre-authorizations are never going to be fun, but if you make these few small tweaks they might not create quite so many headaches.

Making prior authorizations less burdensome

There’s no doubt prior authorizations are a major time suck. Here are five ways to make them a little less onerous.

Money isn’t everything. When it comes to motivating employees, money may be not be nearly enough. Psychologists are increasingly discovering that money is not the best motivator.

Sure, people have to make enough money to pay their bills. But when it comes to getting them to go the extra mile for the team, it takes more than a good paycheck.

Fortunately, for practice managers, often the best motivators are relatively easy, inexpensive, and often a whole lot of fun. Try a few of these ideas at your practice, and see if your team is more willing to go the extra mile.

Six ways to motivate your team for free

Money talks; it’s true. But people are far more motivated to do their best work when they love their jobs, have fun at work, and know that the leadership notices and appreciates what they do. It’s not that hard to give them that.

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Getting the best employees requires offering an attractive salary and benefits package. Getting the best work from those employees requires something more.

The COVID-19 pandemic has totally upended the practice of medicine. Physicians are having to learn how to manage patients via telemedicine, how to deal with a totally new infection, and how to keep a practice afloat during a time of shuttered waiting rooms and social distancing. Many of these new routines-from telemedicine to navigating decisions relating to COVID-19 itself-pose a variety of potential pitfalls. One particular concern is a possible increase in malpractice claims. Malpractice, however, is likely much less of a threat than it seems at first glance. 

12 ways medical practice staff can help prevent a patient lawsuit

Practicing telemedicine is not, in and of itself, likely to increase your risk of a malpractice suit. According to 

, a physician-owned medical malpractice insurer, telemedicine poses a relatively low risk of malpractice. For the period from 2007 to 2018, their data shows 27,559 closed malpractice claims of which only 38 involved telemedicine. The number of telemedicine claims has increased over the years as use has increased. However, the total number of cases is still low. 

, CMPE, assistant director of association content with the 

 (MGMA), does point out one risk of telemedicine in this particular crisis. “There are two main ways malpractice can occur,” he says, “misdiagnosis and failure to treat. If you think it may be COVID, be sure to look for other things as well.” You don’t want to miss another respiratory condition because you’re too focused on COVID-19. 

In general, malpractice claims increase during economic crises, says Hajde. But there are reasons to think that won’t be the case this time. In fact, 

, MD, JD, professor emeritus of family medicine at the University of Wisconsin-Madison, predicts that there will be a 

One reason, he says, is that visits are down. “People are afraid; they don’t want to enter the health care system.” According to an April poll by the MGMA, 97 percent of member practices have seen a drop in patient volume; for 71 percent of members, that decrease was 50 percent or more. In addition, while emergency departments and ICUs are overwhelmed with COVID-19 patients, admissions are down for other illnesses. 

But perhaps the biggest reason we might see fewer claims is the nature of the crisis itself. It’s difficult to treat COVID-19 because we know so little about it. And that may be the what protects physicians. “A key component of a malpractice claim,” Roberts explains, “is that the provider didn’t provide standard of care. What is the standard of care with COVID-19? We haven’t figured that out yet.” 

There may be some increased liability, once this is all said and done. But Roberts expects that it will be borne mostly by federal and local governments. Meanwhile, the 

 (Coronavirus Aid, Relief, and Economic Security Act) expands Good Samaritan protections for health-care workers who are volunteering to help with the crisis. The 

 (Public Readiness and Emergency Preparedness Act) offers some immunity for physicians using certain medications or therapies to treat, diagnose, or mitigate the spread of COVID-19. 

 claims during this pandemic is the same way you protect yourself during normal times. Make sure you’re there for your patients, one way or another. If you can’t see them in person, make sure you have a reliable way to do televisits. Follow the CDC protocol for COVID-19, and check regularly for updates. This virus is a fast-moving target and the guidelines are changing quickly. And beware treatments not authorized by the FDA. 

Most importantly, says Roberts, “Do the best you can. In the end, the question will be, ‘Did you act responsibly?’ Just practice good medicine and you’ll be fine.”

https://www.thedoctors.com/articles/covid-19-telehealth-resource-center/

https://www.mgma.com/landing-pages/covid-19-resource-center/financial-assistance-and-guidance-for-practices/staying-afloat-as-patient-volumes-and-revenues-dec

https://www.ama-assn.org/practice-management/sustainability/liability-protections-health-care-professionals-during-covid-19

Practicing medicine is more challenging now than ever, but malpractice claims are probably not a major risk.

Avoiding malpractice claims during the pandemic

It seems like yesterday that tech enthusiasts were complaining that too few physicians were embracing telemedicine, and doctors who did use telemedicine were complaining about how hard it was to get paid for it. That’s just one more thing coronavirus changed in an instant. According to a recent survey by the physician recruiting firm Merritt Hawkins, almost half of all physicians are now treating patients via telemedicine. That’s up from 18 percent in 2018. Meanwhile, CMS is relaxing the rules about what they will pay for. 

If you’re new to practicing virtually, here are some tips for making telemedicine work for you-and getting paid for it. 

The first decision you face once you’ve decided to practice telemedicine is which platform to use. And as it has done with almost every other aspect of life, the coronavirus has changed this, too. The Office for Civil Rights has relaxed some of the HIPAA requirements for telehealth. However, that doesn’t mean anything goes. “CMS is still guarded about platforms to use,” says 

, CPC, CPMA, Senior Industry Advisor with the Medical Group Management Association (MGMA). “You can use Facetime and Facebook Messenger, but you can’t use Tik Tok or Facebook Live. Basically any kind of public facing program is 

Other aspects of HIPAA regulations remain in place. “Even though the use of non-HIPAA compliant platforms has been loosened, HIPAA rules should be followed as closely as possible,” advises Carol Self, coding and compliance strategist with the American Academy of Family Physicians (AAFP). “Medical conversations should take place in a private space, and communication should be patient authorized and patient initiated.” 

It’s also important to keep in mind that these relaxed guidelines are temporary. “You’ll need to use a service that’s HIPAA compliant once the public emergency is over,” says Bradley.

The AAFP does not recommend or endorse any particular platform, but products their members use include 

, eVisit, SimpleVisit, VSee, MEND, and Spruce Health. Both Zoom and Google now have health care platforms as well. The AAFP suggests helpful features to look for when choosing a telemedicine vendor are out-of-office messaging, the ability to schedule appointments, and the ability to queue up patients. Bradley also recommends choosing a platform that can be integrated with your electronic health records system. 

Once you’re up and running with a telemedicine platform, whether it’s an ad hoc solution or something more permanent, you need to make sure you 

. Fortunately, CMS is also loosening restrictions about how much they will pay and what they will pay for. “Medicare previously paid telehealth services at parity, but it was at the lower facility rate,” says Self. “As part of the flexibilities granted during the public health emergency, Medicare will pay telehealth visits at parity using the non-facility rate.”

In addition, CMS is not enforcing the established relationship rule, and services can be provided to Medicare beneficiaries by phone (even without video capability) during this time. 

But in order to get paid at all, you must be sure to use the proper codes. “If you don’t bill with the correct POS [Place of Service], you may not be paid at the same rate as a face-to-face visit,” says 

, Commercial Insurance Strategist with the AAFP.  The codes for these services are typically evaluation and management codes, along with a Place of Service code and any necessary modifiers. 

Getting the codes right is equally important with private payers. “If you use a CPT code a payer doesn’t recognize, you’ll get a denial,” says Cantrell. Despite recent changes, billing for telehealth isn’t that much trickier than billing for any other service as long as you pay attention. “The only likely hiccups,” says 

, CMPE, Assistant Director of Association Content, MGMA, “would be not using the proper modifier or service code and confusing telephone with video visits. Both are allowed now, but they have two different codes.” 

Private payers are generally falling in line with CMS, but there are some variations. The MGMA has a site with links to the major payers’ coronavirus billing policies. You can also check the website 

, an industry trade group, for policies of specific insurers. If your payers aren’t included on these sites, be sure to contact them directly, and stay on top of emails from payers with policy updates. Things are changing quickly these days. 

Coronavirus has pushed the medical community over the cliff into telemedicine, but the fall is not that steep, and CMS is helping to make it a soft landing. 

Telemedicine survey:
	https://www.merritthawkins.com/news-and-insights/media-room/press/-Physician-Practice-Patterns-Changing-as-a-Result-of-COVID-19/

OCR statement re: HIPAA regulations:
	https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
	https://www.hhs.gov/coronavirus/telehealth/index.html

MGMA payer site:
	https://www.mgma.com/landing-pages/covid-19-resource-center/financial-assistance-and-guidance-for-practices

Relaxed regulations make it easier to practice-and get paid for-telemedicine.