Maximize revenue and monitor CCM program performance

Quality data drives wise decisions.

That’s never been more true than in today’s healthcare environment. Think about your practice for a moment. How would you benefit from reports, enrollment status information and other key performance indicators vital to your practice?

You’d be able to make crucial decisions needed to boost revenue and maximize returns.

In today’s interconnected world, any guru worth their salt will tell you that quality data is vital to monitoring performance and increasing revenue.

If you’ve been with us since the beginning of this blog series, you’re aware of the numerous benefits of effectively implementing a Chronic Care Management (CCM) program in your practice.

You should also be aware that we have the perfect application to help you maximize and increase revenue in addition to helping you monitor the performance of your CCM program.

ABILITY NAVIGATOR™ CCM helps you meet daily challenges head-on by providing you with built-in analytics that show key metrics including:

• Reports with patient-level and aggregate analysis on patient eligibility and enrollment status
• Realized and unrealized revenue potential
• Clinical activity performance

With powerful analytics at your fingertips, you can manage your practice more effectively so your patients will experience better outcomes.

Get to know ABILITY NAVIGATOR CCM at a complimentary webinar or speak to a CCM expert today!

We hope you’ve enjoyed this series, 5 Things You Need to Know About Implementing a Chronic Care Management Program! If you missed any posts or would like to revisit the content, click on any of the titles below:

1. Avoid Missed CCM Care and Income Opportunities
2. Increase Awareness: Introduce Your Patients to CCM
3. How to Streamline Clinical Workflow and Reduce Staff Stress
4. Prevent Uncompensated Claims in Your Chronic Care Management (CCM) Program

HICNs to MBIs for Medicare Eligibility: How to Handle the Switch

By now, you are probably aware that the Centers for Medicare & Medicaid Services (CMS) is no longer accepting SSN-based Health Insurance Claim Numbers (HICNs) for most transactions.

The HICNs have been replaced with randomly-generated Medicare Beneficiary Identifiers (MBIs), intended to improve the security of patients’ personal information and help prevent fraud.

Starting January 1, claims or eligibility transactions submitted without an MBI have been rejected. And since an estimated 65 percent of claim denials are never corrected and re-submitted for reimbursement*, this could result in a preventable and sizeable hit to your revenue cycle.

The long and tedious hunt for patient MBIs

Updated Medicare cards with the new MBIs were mailed to patients long before the deadline, so one might expect the transition to be simple.

However, it’s important to remember that patients are people. They are busy. They forget to bring their cards to appointments. Especially where hospitals are concerned, patient visits may be unexpected or emergent. Where does that leave you as a provider?

While patient cards may be the easiest way to get an MBI, it certainly isn’t the only way. It’s possible to use your Medicare Administrative Contractor’s MBI look-up tool, but this process relies heavily on precise patient or policyholder data, and checking numbers one-at-a-time is tedious at best.

You can also refer to historical remittance advice if you happened to treat the patient prior to January 1 and have access to the records.

If you’ve had to resort to these methods, you understand how cumbersome the process can be.

An easier way to turn HICNs into MBIs

Busy healthcare providers need practical procedures to keep things running smoothly. Automated tools can take the administrative burden off of your staff and allow them to move on to the next claim faster.

Unlike other revenue cycle management providers, ABILITY goes beyond basic MBI lookup to provide full-service eligibility processing. Not only does our enhanced eligibility service have a nearly 100 percent MBI match rate; when combined with ABILITY COMPLETE, it also offers batch Medicare eligibility checks, alerts to indicate other insurance coverage and more.

Discover how to perform real-time eligibility verification and collect MBIs all at once. Request a demo today.

* “Success in Proactive Denials Management and Prevention,” Glen Reiner, HFMA, Accessed Jan 20, 2020, Read more

Prevent uncompensated claims in your Chronic Care Management (CCM) program

You go above and beyond every day to provide the best possible care for your patients. Unfortunately, many of the services you provide outside of face-to-face visits require extra time and resources and don’t come with additional compensation.

All we can say is … ouch. But what if you could get paid for that time and care?

Medicare’s CCM program was created to help you more effectively manage the complex care of patients with multiple chronic conditions, resulting in better patient outcomes and provide reimbursement for these essential non face-to-face activities.

We’ve heard from many of our healthcare provider partners that in most cases, the work is already being done but without compensation. Why should you go unpaid when you’re providing world-class care for your patients? A Chronic Care Management (CCM) program can change that by ensuring you’re compensated for the services you provide.

You’ve done your part, now you rely on your billing team to submit claims for the work you’ve done and collect payment. What checks and balances do you have in place to guarantee all CCM claims get paid? Manual processes can be time consuming and inefficient. Wouldn’t it be nice to see with the click of a button which claims have been billed, paid or need your attention?

ABILITY NAVIGATOR™ CCM empowers your billers with the tools they need to ensure you’re compensated for the care coordination activities you’ve delivered. With a comprehensive view, you’ll have the capability to filter by claim status to see which patients need claims submitted, which have been billed and which have been paid. We’ll also alert your staff of claims that need attention so that no claim slips through the cracks.

You and your staff are doing too much work not to get compensated.

Discover how ABILITY can help you streamline and optimize your CCM billing!

Coming soon! Don’t miss our fifth and final blog in this series! We’ll discuss how to monitor your CCM program performance, determine program potential and track clinical activity performance.

How to streamline clinical workflow and reduce staff stress

Did you know that over 40 million Medicare beneficiaries have multiple chronic conditions? Did you also know that people with chronic conditions account for over 75% of hospital stays, office visits, home health care, and prescription drugs?

There’s a high probability many of your patients qualify for Medicare’s Chronic Care Management (CCM) program. That said, manually managing a CCM program can put a significant strain on your staff, potentially leading to burnout.

If only there were a way to streamline your Chronic Care Management program, allowing you to enjoy the numerous benefits of CCM without unnecessarily burdening your staff…

That’s where we factor into the equation.

ABILITY NAVIGATOR™ CCM addresses many of the common concerns you face in your medical practice:

Patient enrollment: Our application helps you identify eligible patients at or before the point of service. We’ve even created a patient-education flyer you can share with patients.
Unfulfilled CCM activities: The application includes a streamlined workflow for you and your staff to see which patients still require care for the month.
Burned out staff: This application helps your staff track, document and bill for CCM activities. Streamlining the workflow reduces stress for your team.
Potential compliance issues: CCM activity records can be exported for ingestion by most EHR systems.

ABILITY NAVIGATOR CCM is a time-saving, easy-to-use application that fits into current workflows and eliminates manual CCM program management and time tracking.

It’s time you took a well-deserved break! Let ABILITY NAVIGATOR CCM do the heavy lifting so that you can avoid burning out your staff without missing out on unfulfilled CCM activities.

We’d love to show you how all the bells and whistles work!

In our last post, we talked about increasing patient awareness about CCM benefits. If you missed it, you can read it here.

Don’t miss our next blog! We’ll share how you can avoid uncompensated care and maintain a healthy bottom line.

Increase awareness: Introduce your patients to CCM

They say ignorance is bliss. While that may be true for some things in life, it certainly doesn’t apply to healthcare. And for patients with chronic conditions, being informed about care options is critical.

Fortunately, Medicare’s Chronic Care Management (CCM) program helps patients get the coordinated care they need.

Wouldn’t it be fantastic if you had a feature rich application filled to the brim with resources designed to educate your patients about CCM?

What effect would that have on your practice? How many patients would sign up for your Chronic Care Management program if they were well informed?

Chronic Care Management can transform the quality of care offered by your staff, and provide a wealth of benefits for your patients. These include:

A healthcare team to coordinate, monitor and follow up on tests and treatment
Reduced risk of adverse health events
Access to care 24/7, including holidays and weekends
Medication management to avoid adverse reactions
Periodic check-ins from clinical providers

If your patients remain in the dark about CCM, they’re missing out on a major opportunity to receive the enhanced care they need. And since Medicare pays your practice for every qualified patient who signs up for your CCM program and receives the required care coordination each month, there’s no reason NOT to inform your patients at every opportunity.

ABILITY NAVIGATOR CCM can help by providing patient education resources and reporting for staff to identify potential participants within your practice.

Interested in what our application can do for your practice? Reach out to an ABILITY CCM expert to learn more today!

Stick around for the next blog in our series, where we’ll show you how to streamline your CCM program to help you reduce employee burnout.

Missed our last blog? Read it now!

Avoid missed care coordination and income opportunities

So, you’re thinking about starting a chronic care management (CCM) program, but not sure where to begin? If your objective is to avoid missed care opportunities AND increase your revenue…

You’ve come to the right place!

First things first. How do you go about identifying CCM-eligible patients?

CMS requires participants who are under your care to have two or more chronic conditions, and we’ve heard from many practices that this is a manual process done when patients are in the office for face-to-face visits. If you’re concerned about missing eligible patients, that’s where we can help.

ABILITY NAVIGATOR™ CCM features a patient panel that identifies which individuals have two or more chronic conditions and are eligible under CCM program guidelines. How much time would this save you and your staff? How many more patients would benefit from an automated identification process? Think about the positive impact this could have on your patient outcomes!

Now that you’ve identified your eligible CCM patients, you’re one step closer to unlocking a new stream of revenue and avoiding missed care opportunities for your patients in between face-to-face visits. As you and your clinical staff are managing care, ABILITY NAVIGATOR CCM enables you to streamline the workflow, not only for your clinical staff, but also your billing staff so no claim goes unbilled. ABILITY NAVIGATOR CCM does this by helping you:
Track time on care coordinated activities to meet CMS billing guidelines
• Alert clinical staff of patients that still require care for the month
• Notify your billers when care has been fulfilled and claims are ready to go

Have we piqued your interest? Reach out to an ABILITY CCM expert today!
Stay tuned for our next blog and we’ll share how to jump-start your CCM program or take it to the next level by increasing patient awareness and enrollment.

What the HETS transition means to you

Ready or not, a change is coming to your Medicare eligibility check process.

The Centers for Medicare & Medicaid Services (CMS) has officially announced the deadline for hospital, home healthcare, hospice and skilled nursing (Part A) eligibility inquiries to transition to a new platform.

On February 1, you must bid farewell to the Common Working File (CWF) and embrace the HIPAA Eligibility Transaction System (HETS) for eligibility verification.

The future for CWF and HETS

Though all eligibility inquiries will transition to HETS, CWF will still exist for claims management functions (entry/status/summary) and other transactions.

For eligibility purposes, the main difference users will notice is that HETS requires slightly different input information and returns more targeted results than CWF. Other differences include once-daily information updates and a limit of 30 eligibility requests per day.

Next steps

The most important thing to do prior to the deadline is prepare. If you’re already using HETS, there’s nothing you need to do. If you’re currently using both systems, you should start using HETS exclusively.

ABILITY® customers who currently use an application for eligibility verification can expect a seamless transition with no disruption to business as usual. All of our applications with integrated eligibility components are currently HETS-ready/connected. What that means for you is that February 1 will bring no changes or surprises.

To learn more about how ABILITY can provide a stress-free switch, request a demo today.

For additional information about the transition to HETS, visit the CMS announcement page.

Disrupting the status quo: staffing based on evidence

“Meaningful and sustainable change to traditional staffing models is a moral imperative that requires urgent collaborative action.”

That call to action from the American Association of Critical-Care Nurses reminds us all that when it comes to staffing in healthcare, the status quo is no longer okay. We now have decades of research and first-hand experience that confirms we can have a positive impact on patient and workforce outcomes by changing the way we think about, model, design, fund and implement staffing policies and practices.

One sure tactic for doing so is adopting new technology, and specifically staffing software and applications, that can dramatically improve how we schedule staff.

For example, modern scheduling tools can enable:

  • Better decision making. Staffing managers have at their fingertips the data they need to make quick, accurate decisions when it comes to filling shifts. Leading solutions offer intuitive dashboards that offer full visibility and real-time insights so you can act fast.
  • Access from anywhere. Cloud technology and well-designed mobile apps enable managers and staff to access, manage and communicate about shifts from their mobile phones.
  • A more collaborative culture. Managers and staff work together to fill open shifts. As a result, manager/staff relationships improve, staff satisfaction rises, and turnover falls.
  • Less wasted time. Managers spend less time stressing over, completing and managing the schedule, and more time focused on making improvements that truly impact patient and workforce outcomes — and the bottom line.

All that isn’t to say that we are ignoring the realities of the healthcare industry. Administrators and managers are under intense pressure to control costs, while addressing insurers, changes in payer rules, unions, legislation, labor shortages, rising labor costs and more.

Still, with staffing being such a complex issue, it’s wise to look at solutions that can ease that complexity, while also helping organizations to heed the AACN’s call to action and drive better outcomes through simplified scheduling and improved collaboration.


About the Author:

Award-winning nurse leader Kathy Douglas, RN, MPH, has been in healthcare workforce strategy for over 20 years. She has authored dozens of published articles and presented on all aspects of staffing in healthcare. Kathy is also a filmmaker and directed the internationally distributed film, NURSES: If Florence Could See Us Now.

3 patient billing workflow areas that are costing you money!

Is your healthcare organization losing money to inefficient patient billing workflows?

You’re likely all too familiar with the losses that you can incur from write-offs and denials, but you may be surprised at the hidden costs that come with a few very common workflow issues. Read more

5 hidden remittance problems that are holding you back — and how to fix them

How much are your remittances costing you? You may have hidden inefficiencies draining your time, labor and revenue. If any of the following issues sound familiar, you could benefit from a centralized approach.

  1. Wasted time pulling from different places

How many different sources are you using to pull your remits? If your organization is like most, you probably have to access clearinghouses for some, payer websites or PaySpan for others, and some even come on paper.

Just pulling your remits takes time away from your billing staff that they could use in more productive ways.

  1. Scanning, downloading and printing

Staff often have to scan in remits or save them to downloaded files for research and follow-up later on. These tasks are time-consuming and tedious, and they create a lot of inefficiencies in your billing processes.

  1. Inefficient posting processes

How much time do you devote each week to posting remits? When billing staff are forced to retrieve remits from different places, posting takes more time than it needs to.

  1. Challenges keeping up with multiple tax IDs

If your organization handles multiple National Provider Identifiers (NPIs) and tax IDs, your billing staff may have to split remits to post electronic remittance advices (ERAs) back into different electronic health record (EHR) and electronic medical record (EMR) systems. This is just one more way that disparate systems result in wasted time and increased A/R days.

  1. Cumbersome methods for remit searches

Does your platform let you filter and search remits by different criteria — such as adjustment codes, reason or remark codes? If not, billing staff are forced to get creative and scour through potentially hundreds of remits to find what they need.

A centralized approach to remittance management

How can you take these inefficiencies and challenges out of your remittance management workflows? A centralized approach can save your organization significant time and money.

With the right technology, you could bring back all available ERAs into a single portal, eliminating multiple sources and workflows that your staff have been dealing with.

In one centralized location, you could easily download remittances for autoposting. If your organization handles multiple tax IDs, you could split the remits for posting into different systems. And, you could eliminate all scanning, saving and storing of remits. Instead, you would have a digital filing cabinet for all ERAs for printing and research.

Want to learn more about how you can simplify your revenue cycle with a central source for all your claims management needs? Read about ABILITY EASE® All-Payer here.