Medical Billing a Challenge for Struggling Primary Care Practices
Medical billing is a complex process, and it’s always been a reason for primary care physicians’ struggles. In addition, their practice is often overwhelmed with constantly changing information, including protocols and billing codes, which makes the situation more challenging.
When the COVID-19 pandemic strains the U.S. healthcare system, primary care physicians are working to educate their patients, employ safety protocols, and handle significant calls. This large volume of calls is creating administrative hurdles and operational challenges. Hence, many primary care practices are changing their medical billing processes to accommodate new patient needs.
The recent release of the Medicare physician fee schedule final rule from the Centers for Medicare & Medicaid Services (CMS) contains new hope for struggling primary care physicians. You will learn about it in the following brief.
Primary care physicians often face significant challenges with dynamic medical billing rules, mainly when dealing with legacy Accounts Receivable (AR). Legacy AR refers to old, unpaid claims that accumulate over time due to changing billing regulations, coding errors, and insurance denials. This backlog can strain a practice’s financial health as outdated claims become increasingly difficult to collect. Effectively managing Legacy AR in Primary Care Billing requires staying updated on current billing rules, regularly auditing accounts, and employing robust follow-up procedures to ensure timely reimbursement and maintain cash flow.
Add-on Code G2211
The CMS needs to compensate physicians and other qualified healthcare professionals for the inherent complexity of primary care and other office visits, so it is moving forward with add-on code G2211.
You may separately list this add-on code in addition to office/outpatient (E/M) visits for new or established patients (e.g., codes 99202-99215). You can use this code even when the E/M visit is done via telehealth, as CMS permanently adds it to the Medicare telehealth list. One crucial point you must consider here is that the code’s Medicare payment allowance will be approximately $15.88 but will vary geographically.
According to CMS, code G2211 reflects the intensity, time, and practice expense required to build longitudinal relationships with patients. These codes can consistently address most patients’ healthcare needs over long periods.
In the context of primary care, CMS believes the code recognizes the resources inherent in holistic, patient-centered care that combines the treatment of illness or injury, the management of acute and chronic health conditions, and coordinating specialty care in a collaborative relationship with a clinical care team.
After learning about G2211, you should be aware of visits for which reporting code G2211 would not be appropriate.
Following are some examples that can help you to understand:
- Care furnished by a professional whose relationship with the patient is of a discrete, routine, or time-limited nature (e.g., mole removal or referral for mole removal),
- Treatment of a simple virus
- Counseling related to seasonal allergies
- Initial onset gastroesophageal reflux disease
- Treatment for a fracture
- Treatment in which comorbidities are either not present or not addressed
- Situations in which the billing professional has not taken responsibility for ongoing medical care for that patient with consistency and continuity over time or does not plan to take responsibility for subsequent, ongoing medical care for that patient with consistency and continuity over time.
Apart from Add-on code G2211, CMS also finalized proposals to increase the values of specific codes, including those for the following services:
- Maternity services,
- Transitional care management services,
- Initial preventive physical examinations and initial and subsequent annual wellness visits
- Emergency department visits.
- Some behavioral health services.
CMS has come up with changes in medical billing periodically, which is why it has become complex. If you are unsure how to handle the growing complexities of medical billing, you can outsource your billing to us. Rest assured, we are one of the best medical billing and coding companies with extensive expertise in the healthcare domain. To learn more about the benefits of outsourcing your primary care medical billing process to Medical Billers and Coders, contact us at 888-357-3226.
FAQs
1. What is legacy AR, and why is it challenging for primary care physicians?
Legacy AR, or legacy Accounts Receivable, refers to unpaid or outstanding claims accumulated over time. These aged accounts pose a significant challenge for primary care physicians because they can lead to cash flow issues, increased administrative workload, and financial instability. Dynamic medical billing rules and frequent changes in coding and insurance policies further complicate the collection process, making it harder to recover payments.
2. How do dynamic medical billing rules impact the management of legacy AR?
Dynamic medical billing rules, which frequently change, directly impact the management of legacy AR by creating a complex environment where claims are often denied or delayed due to outdated or incorrect information. Primary care physicians must continually update their knowledge and billing practices to align with current regulations. Failure to do so can result in increased unpaid claims and a growing legacy AR, which is challenging to manage and collect.
3. What strategies can primary care physicians use to reduce legacy AR?
Primary care physicians can reduce legacy AR by implementing several key strategies:
- Regular Audits: Conducting frequent audits to identify and address issues with unpaid claims.
- Staff Training: Ensuring staff are well-trained in the latest billing codes and regulations.
- Automated Follow-ups: Automated systems follow up on unpaid claims and send reminders.
- Patient Engagement: Communicating with patients about their financial responsibilities and offering flexible payment options.
- Outsourcing Billing: Partnering with professional medical billing services to efficiently handle complex and aged claims.
4. How can technology help primary care practices manage legacy AR more effectively?
Technology can be pivotal in managing legacy AR by providing tools that streamline the billing process and enhance efficiency. Examples include:
- Billing Software: Specialized software that tracks claims, highlights aged accounts, and automates follow-up procedures.
- EHR Integration: Integrating Electronic Health Records (EHR) with billing systems to ensure accurate and timely claims submission.
- Data Analytics: Utilizing analytics to identify trends in unpaid claims and optimize billing practices.
- Patient Portals: Patient portals are offered where patients can view and pay their bills online, improving payment rates and reducing outstanding balances.
5. How do medical billing experts assist primary care physicians in handling legacy AR?
Medical billing experts assist primary care physicians by bringing specialized knowledge and experience to manage legacy AR effectively. They help by:
- Accurate Coding: Ensuring accurate and up-to-date coding to minimize claim denials.
- Efficient Claims Processing: Streamlining the claims process to expedite payments and reduce backlogs.
- Regular Follow-ups: Conducting systematic follow-ups with insurance companies and patients to resolve unpaid claims.
- Financial Reporting: Providing detailed financial reports and insights to help practices understand and address revenue cycle issues.
- Training and Support: Offering training for in-house staff and ongoing support to keep up with changing billing rules and regulations.
