AMA to Host a “Check-In” Regarding the 2023 E/M Guidelines
As we all know, it has been just about 5 months since the new 2023 E/M guidelines were implemented. On Thursday, 5/25, the AMA is hosting a FREE webinar @ 11 AM CST — “REPORTING E/M SERVICES IN 2023: A CHECK-IN TO STAY INFORMED”. This meeting will hopefully answer some of the common questions we all have since the implementation of these significant guideline changes on January 1st.
The AMA speakers are Dr. Barbara Levy, Dr. Peter Hollman, and Leslie Prellwitz, the Director of CPT Content. They hosted a similar informative meeting about half-way through 2021 that addressed the significant E/M changes with the Office/Other Outpatient service codes. According to the AMA, they will address the following:
Feedback from physicians & clinical staff
Clarification to the guidelines as a result of the feedback
CPT’s consistency with the 2023 CMS Final Rule
Here’s the link to register for this highly anticipated webinar:
The Road to RevElate begins from a variety of starting points. The journey, though, regardless of the starting point, can be fraught with uncertainty, ambiguity and unknowns.
It’s hard to wrap your hands around what the future entails and knowing your gaps and pain points and having the need to have more efficient workflows to overcome those gaps and pain points is critical. Isn’t that one of the major reasons to change systems? One objective of ending the journey with RevElate is to achieve more efficient operational tools and processes to manage your accounts receivable and team member workflows.
The journey should begin with ensuring your revenue cycle teams are “operationally ready” to begin the RevElate project. You may be thinking, “where do I start?” or “how do I know if I’m ready?” There is a variety of planning, data collection, decision making, gap identification, and road mapping work that can and should be done to be optimally prepared to officially launch the project.
Check out a feature on our recently held webinar “RevElate Pre-Planning & Readiness – 5 Strategies to Successfully Prepare Your Teams Right Now” below.
Operational readiness includes a current state data analysis from a multitude of areas including workflows, reporting, and payor and health plan inventories. Gathering the data prior to the project launch will better position you and your vendor counterparts with a view of how the revenue cycle is operating in its current state.
In short, operational readiness is all about being prepped and ready for the project to start, or as Alexander Graham Bell said, “Before anything else, preparation is the key to success.”
How your org determines what their points of success will depend on what your goals and objectives are.
Success can be measured by what can be improved upon from a three-pronged approach based on people, process, and technology. For example, standard workflows and centralized processes can improve employee satisfaction. An example of provider satisfaction can be achieved with a referral process that identifies both internal and external referrals. This can lead to improved community relationships with external referring providers. More importantly, your providers are going to be able to know where their patients are, who they are being seen by, and for what.
As you plan your transition to RevElate, we must consider the significant impact that software has on people, workflows and business performance.
Join e4 on Friday, June 9th from noon to 1pm EST for a panel discussion around building a RevElate revenue cycle transformation blueprint. We’ll present a framework to create a blueprint (or roadmap) that factors in all aspects transforming a revenue cycle operation to take advantage of the new RevElate tools. The framework begins by defining the desired Future State of your Revenue Cycle and layering in transformation activities, tactics and milestones required to reach that Future State. A sample blueprint will be presented based on work completed with a partner client of e4 over the past nine months. Click here to register today.
About our experts:
Linda Waldmann, Revenue Cycle Practice Director, e4
Linda Waldmannis a healthcare revenue cycle operations professional with over 30 years of experience in the industry. Linda’s strengths in understanding the day-to-day operations of the business office has assisted her clients in achieving revenue cycle objectives that includes process redesign, accounts receivable optimization, trends analysis, resource management, project management and EHR implementations in complex, multi entity settings.
e4/Intellis and eCatalyst Healthcare Solutions have joined forces to build the leading national provider of middle revenue cycle services, including coding, auditing, clinical documentation improvement, revenue integrity, master patient index, and strategic information technology services. For decades, the companies’ combined solutions have been successfully deployed across hundreds of healthcare organizations throughout the country.
“We realize the importance of staying at the forefront of this ever-changing healthcare industry”, said Matthew Zubiller, CEO of e4/Intellis. “eCatalyst is a natural fit to enhance the strength of our Team. Together, we will expand our vision to empower better health and enable our clients’ providers to more accurately tell the story of their patients, with the right data, the right technology, and the most accurate information, while ensuring their high-quality care delivery, patient safety, and timely reimbursement. By joining forces, we strive to be the premier provider of health information and coding services in the nation while enhancing our status as a Great Place To Work for all of our team members.”
Founded in 2007 by industry veteran Chris Meyers, eCatalyst provides industry leading business process outsourcing and strategic consulting services to large healthcare integrated delivery networks, specialty and children’s hospitals, small and rural healthcare facilities, clinics, and multiple specialty physician practices nationwide.
“Our newly combined organization will expand our brand promise to deliver exceptional services with unrelenting focus on client success by deploying cutting-edge solutions, innovative technologies, and industry best practices to provide value for our customers”, said Meyers. “Our collective clients can now leverage an even broader set of services while continuing to receive the highest quality support and trusted guidance that they have come to expect.”
eCatalyst will initially operate as a wholly owned subsidiary of e4/Intellis, with Chris Meyers continuing to serve as CEO of the eCatalyst team. The organizations will be fully integrated over the course of the year. By partnering with Firmament, a leading provider of structured equity capital solutions, this strategic acquisition enhances the growth of e4/Intellis and expands their portfolio of leading services and technologies to solve clients’ challenges across the middle revenue cycle.
Stay tuned for more information about this strategic combination, and please reach out to us using the contact information below.
We often hear that it is crucial for medical coders, auditors and CDI personnel to stay up to date on the latest coding changes and coding clinic information.
But why? There are a few reasons …
Accurate reimbursement. Reviewing and understanding how to apply the newest codes ensures accurate reimbursement for the healthcare organization. Using an outdated code could result in a claim being denied and/or delayed payment.
Assists with AHIMA and/or AAPC credential maintenance. Attending a ‘live’ or ‘remote’ education session on ICD-10 annual updates or Coding Clinic reviews typically include CEUs (continuing education units) which are required for credential maintenance. This is a great way to not only stay up to date on the latest in coding trends and updates, but also keep your credential current as well.
Accuracy and uniformity of medical coding. The AHA Coding Clinic provides guidance to address challenging situations that are not clearly resolved via the Official Guidelines for Coding and Reporting or ICD-10 classification itself. The AHA Coding Clinic has been published since 1984 and is a great resource for coders seeking solutions to some of the trickiest coding scenarios.
COVID-19. The guidelines and code usage for COVID-19 continue to be a fluid situation. In May of 2023, the public health emergency due to COVID-19 is supposed to be ending so look for even more coding updates related to COVID-19 to be effective in October 2023.
One easy way to stay up to date is to sign up for the Intellis IQ Center…
Here at e4 & Intellis, we offer various education sessions including everything mentioned above (bi-annual coding updates and Coding Clinic reviews every quarter). We also offer other topics such as CDI, E/M and CPT updates, Risk Adjustment Coding and various ‘hot topics’. AAPC and AHIMA CEUs are offered with ALL of our education offerings. So, whether you are an HIM manager, lead coder or CDI specialist, it is easy to take advantage of the various education opportunities that e4 & Intellis can provide for you.
2023 1Q Coding Clinic Review: The learner will review the First Quarter 2023 Coding Clinic, which includes the coding updates for April 2023. ICD-10-CM and ICD-10-PCS Q & A will also be discussed, including topics such as Neuroendocrine Tumors, Rotational Vertebral Artery Syndrome, the OPRA Device, and Maggot Therapy.
2023 April Coding Updates: Review of the ICD-10-CM and ICD-10-PCS updates for April 2023. Includes the addition of more SDOH codes and expansion of LITT therapy codes.
A recognized leader in the HIM field, Kim has more than 30 years of coding, auditing and management experience in both university and community hospital settings. She has been the project manager for a large scale risk-adjustment federal audit for the past seven years. Kim was previously the President of SePHIMA and is the PHIMA 2023 Distinguished Member Award Winner. She has presented at various local, state and national association meetings. She has had adjunct faculty roles at Temple University, Thomas Jefferson University, Gynedd-Mercy College, Anne Arundel Community College and Study Mentor at Western Governors University.
The transition to RevElate – especially for Oracle Cerner customers who are not familiar with Soarian Financials – is a significant change event. And it may be tempting to down-play the significance of this change.
A better approach to managing the change is to embrace it and enter into the process with an understanding of where those changes will impact your staff and your way of working. Of course, it isn’t possible to anticipate every way the changes will make an impact, but there are considerations and concepts that can be explored and understood early to help ease the transition and ensure a more successful outcome. Even though each customer may be starting from a different place, a different mix of revenue cycle and clinical solutions, there are some common themes that will help prepare your organization for this transition.
Common language is fundamental to communication and understanding. Even though the RevElate patient accounting solution is an Oracle Cerner product, it is different from the Millennium CPA and has its own unique nomenclature. Establishing the foundation of terminology at the onset of your transition will help your teams understand the new concepts they will be learning.
Check out a feature on our recently held webinar “Meaningful Differences Between the Foundational Applications: Soarian Financials and Millennium CPA” below.
Traditional business office setup tends to be reactionary when it comes to issue management. Issues are identified and managed when the patient account makes its way to billing. RevElate provides the opportunity to systematically identify and address issues earlier in the patient account lifecycle. This requires changes to how we think, how we work, and even how we design our delivery of care. It will be necessary to make adjustments to workflows and staffing models to take advantage of these benefits. This philosophy also translates to overall system design including front-end patient access and clinicals. It promotes a design approach that considers all aspects of the patient life-cycle to ensure successful and streamlined billing.
“Everyone hates change,” some say. “Change is good!” other say. Either way, expect that this change will cause some measure of disruption to your current state, plan for it, and be intentional with how you manage it.
Whether your RevElate journey starts in a few months or in two years, there are 5 preparedness initiatives organizations can consider employing to assist with operational readiness. Join us this Friday, March 31 from noon to 1pm EST for a panel discussion that outlines objectives to accomplish to ensure successful operational readiness. Click here to register today.
About our experts:
Tim Brennan, PMP
Tim Brennan is a PMP certified project manager with over 28 years of experience in health care. Tim started his career with a major payer supporting electronic claim submission and benefit inquiry. He spent 15 years as an implementation project manager for two software vendors – one focused on HIM solutions, the other on bed-side patient safety solutions for nursing. Most recently, Tim has been a Practice Director at e4 Services where he is responsible for a team of 16 project and program managers. During that time, Tim has also managed multiple projects and programs including ICD 10, finance and supply chain conversions, and Cerner revenue cycle implementations – both CPA and Soarian Financials.
e4 and Intellis have combined to form the nation’s premier eMPI remediation solutions provider. Todd Goughnour, RHIA, MBA, VP of HIM and Robin Gates, RHIA, Sr. Director, Sales and Business Development share how a new model of identity management is helping organizations define a more effective enterprise-wide identity management strategy.
The old model of identity management: The common and traditional Identity Management model at many healthcare organizations tends to be reactive. First and foremost, the concentration is remediating a duplicate medical record when it appears. Some duplicates need urgent attention, some are potentially a duplicate, and others may not ever be resolved and/or false duplicates, but the efforts of the organization are mainly focused on after the potential duplicate has been triggered. From there, downstream systems are rarely kept ‘up to date’ and even more so not reconciled and rarely does the organization understand the full system interface schematic and how patient merges are handled automatically. Additionally, there is lack of ownership within the organization on who ‘owns’ the unique identity of these patients, and in most cases, the duplicates are caused by one department (Patient Access) and the ‘clean-up’ efforts completed by another department (HIM). Seldom is there much collaboration between the two departments to revise the issue, and rarely is HIM included in any IT efforts on MPI decisions.
The commonplace of the industry in general is to merge, acquire, consolidate, and increase the size of the hospital organization/network, so influxes of ‘new’ patients / MPI’s is more prevalent than ever. Organizations and HIM Departments are having an increasingly harder time keeping up with the varying ‘one-time shock’ increase of potential duplicate medical records. Then, just as in any profession in the industry and even elsewhere, it is increasingly difficult to retain staff, fill open positions, and find qualified candidates to support the workloads at hand.
The new model of identity management: Healthcare organizations should be focusing their identity management efforts to be more proactive. Instead of mainly focusing on remediating potential duplicate medical records when they appear, organizations should be more so focused on how to prevent those duplicates from being created in the first place. The need to do the manual remediation will not disappear, but the time spent remediating duplicates can be greatly reduced.
Healthcare organizations should be focusing on defining an enterprise-wide identity management strategy, including initiatives to define an enterprise-wide identity team that is centralized, defining clear ownership of the enterprise unique identifier, and implementing a scalable duplicate resolution team that can fluctuate the same as the future of increasing acquisitions and patient loads. Collaboration efforts between HIM, Patient Access, and IT should be at the forefront of discussions and major efforts should be made on identifying the root cause locations of where higher amounts of duplicate records and their source/reasonings.
Furthermore, healthcare organizations should heavily consider the idea of outsourcing duplicate resolution to support their enterprise-wide strategy. Securing a reputable partner for these efforts not only brings expertise into the organization that can support defining a strategy and fully understanding the big picture, but also has the vast resources to support fluctuations in volumes of duplicates vs. having more (or less) staff than needed hired directly by the hospital – and more importantly on the hospital’s payroll. This will eliminate any problems with staffing (unexpected time off, extended time off, vacant positions, productivity/quality issues, etc.) and will ensure that the organizations overall goals of the identity management strategy is being met and not limited because of staffing constraints.
e4 and Intellis have combined to form the nation’s premier eMPI remediation solutions provider. With the largest team of identity experts in the nation, e4 and Intellis have reviewed more than 7 million duplicate medical records in the last 2 years alone.
Todd Goughnour, RHIA, MBA is a proven HIM and Health IT executive with more than 10+ years of leadership experience in system installation, on-time delivery, and under-budget results. As Practice Director of the Health Information Management Practice at e4, Todd has managed numerous system installations, operational designs, and some of the most successful eMPI cleanup initiatives in the industry. Todd has helped design, install, and optimize e4sight®, e4’s remote worker productivity software, which is being used at numerous health systems across the US.
Robin Gates, RHIA, Sr. Director, Sales and Business Development
Robin Gates is an accomplished sales leader with proven track record of exceeding sales, revenue, and client retention goals over a 25+ year career. Robin’s background in sales management, business development, and account management skills help her deliver outstanding customer experiences. Robin is a respected and trusted adviser to the C-Suite, departmental directors, colleagues, and channel partners.
Whether your RevElate journey starts in a few months or in two years, there are 5 preparedness initiatives organizations can consider employing to assist with operational readiness.
The first webinar in our “Road to RevElate” educational webinar series helped organizations better understand the differences between foundational applications. Missed the session? Check out a clip from the webinar below, and click here to request the presentation.
Our next webinar will highlight 5 preparedness initiatives organizations can consider employing right now to assist with operational readiness.
Attendees will learn how to successfully prepare your Revenue Cycle teams for operational readiness to implement Cerner RevElate, what components should be included in an operational pre-planning readiness checklist, and how to define a Revenue Cycle Future State Blueprint.
Linda Waldmann is a healthcare revenue cycle operations professional with over 25 years’ experience in the industry. Linda’s extensive business office operations management includes technical and professional fee services for a variety of clinical settings including acute, ambulatory, and post-acute care. Linda’s background of leadership and strong analytical and problem-solving skills enables her to partner and guide clients in assessing current state operations with future state optimization objectives in mind. Linda’s strengths in understanding the day-to-day operations of the business office has assisted her clients in achieving revenue cycle objectives that includes process redesign, accounts receivable optimization, trends analysis, resource management, project management and EHR implementations in complex, multi entity settings.
Every health system transitioning to Cerner RevElate is following a unique path. No matter what path you are on, proper planning can help you can avoid unnecessary challenges during your implementation.
Join e4 on Friday, February 24 from 12pm to 1pm EST for a free educational webinar session that highlights meaningful differences between RevElate and Millennium CPA. From nomenclature to approaches to error management, we will explore concepts to help you better prepare and adapt for the changes ahead.
Attendees will learn the importance of addressing terminology differences at the initiation of your project, how RevElate’s design for error management compares to Millennium impacts operational resources and workflow design, and what the conceptual differences between RevElate and Millennium are that must be managed for a successful outcome.
Tim Brennan is a PMP certified project manager with over 28 years of experience in health care. Tim started his career with a major payer supporting electronic claim submission and benefit inquiry. He spent 15 years as an implementation project manager for two software vendors – one focused on HIM solutions, the other on bed-side patient safety solutions for nursing. Most recently, Tim has been a Practice Director at e4 Services where he is responsible for a team of 16 project and program managers. During that time, Tim has also managed multiple projects and programs including ICD 10, finance and supply chain conversions, and Cerner revenue cycle implementations – both CPA and Soarian Financials.
Significant E/M changes went into effect on January 1st! We have the E/M resources you need to be prepared! Our E/M MDM Tables and Tip Sheets are now available! What’s included?
MDM Tables (8 total)
There is an individual MDM (Medical Decision Making) table for ALL the 2023 categories that now utilize the new method of determining the level of service:
OV/Other Outpatient Services
Emergency Department
Nursing Facility – Initial
Nursing Facility – Subsequent
Hospital Inpatient/Observation – Initial
Hospital Inpatient/Observation – Subsequent
Consults – Inpatient & Outpatient
Home/Residence – New & Established Patients
Additional Tip Sheets include (12 total)
There are 3 key elements used in MDM (Problems Addressed, Data and Risk – double sided tip sheets for each). Also, tip sheets on Time and the categories in E/M that use Time (two double sided) and Prolonged Time (double sided):
Problems Addressed – definitions and key takeaways (one double sided tip sheet)
Data – definitions and key takeaways (one double sided tip sheet)
Risk — definitions and key takeaways (one double sided tip sheet)
Time – Office Visits and Prolonged Time [99417 – commercial vs G2212 – CMS] (one double sided tip sheet)
Time – all remaining categories (Inpatient/Obs, Nursing Facility, Consults, Home/Residence and key takeaways from Time) (one double sided tip sheet)
Prolonged Services & time thresholds for G codes from CMS (one double sided tip sheet)
To access this bundle, please visit this link for more information, or click the image below!
Intellis Partner and Executive Chairman, David Van Doren, RHIA, CCS
Intellis has been named as one of the top 100 fastest-growing companies owned or led by Florida State University alumni. Intellis Founder and current FSU Law student, David Van Doren, RHIA, CCS, will be in attendance as Intellis is honored at the 6th annual Seminole 100 Celebration on Saturday, February 25. This event recognizes and honors FSU’s entrepreneurs and allows them to share valuable business insights with each other.
Intellis has grown to become one of the most trusted providers of healthcare information services and solutions in the market. By combining forces with e4 earlier this year, the collective e4 and Intellis team now represents the nation’s premier provider of Coding, HIM, and Healthcare IT solutions.
Congratulations to Intellis on this stellar achievement!
