Austin, TX, January 18, 2024: EqualizeRCM, a leader in helping healthcare providers maximize performance through its suite of Revenue Cycle Management (RCM) solutions, is pleased to announce it has invested in TrilogyRCS, a leader in consulting and management services for community-based healthcare providers’ revenue cycle systems. 

TrilogyRCS has a team of experienced revenue cycle professionals that improve and optimize every aspect of the revenue cycle, from scheduling and registration to final claims resolution. The scope of Trilogy’s revenue cycle engagements is tailored to fit the needs of each client and maximize their opportunities. Chad Feldman, CEO of TrilogyRCS says, “We are thrilled to have EqualizeRCM as investors but more importantly as partners in our company and look forward to providing even better service to our clients and expanding our reach in the US.” 

According to Michael A. Hill, President of EqualizeRCM, “EqualizeRCM aspires to be the leading provider of RCM services to Critical Access and rural PPS hospitals. It’s rare to find a business, a leadership team, and a CEO like Trilogy’s Chad Feldman that perfectly match our aspirations. Overnight, we have significantly increased our combined ability to serve rural healthcare providers across the United States.” 

EqualizeRCM provides RCM services to CAHs, FQHCs, RHCs, physicians, labs, and other healthcare providers across the United States. EqualizeRCM and TrilogyRCS both deliver hospital solutions tailored to the unique needs of CAHs–providing critical healthcare services to rural communities. Together, the two firms will serve CAHs and rural PPS hospitals in Texas, Oklahoma, Kansas, Georgia, Alabama, Mississippi, and North Dakota, among others, with the ability to serve clients nationwide. 

According to Nagi Rao, Executive Chairman of EqualizeRCM, “We are excited to add TrilogyRCS, Chad and his team. Our strategy of growing organically while selectively investing in companies to expand our geographic reach and client capabilities is proving a success.” 

To learn more, please visit, TrilogyRCS.com

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1. Review of Workflow and Processes
   Consider a refresher training of the system and workflows for your team. It might be surprising how many team members are missing a step in the appropriate workflow. These missteps can lead to rework by registration, coding, and billing leading to delays in claim submission and subsequently cash collections. Refresher trainings to ensure all team members understand and are actively
   following the workflow will help to minimize claims errors and denials. This review will also help in identifying any redundancies or missing steps that need to be addressed.
2. Timely-filing, Timely-appeals and Prior Authorization Grid
   Prior Authorization information could include which payors require authorizations, web-links to current requirements, required timeframes, and how to request an authorization. For example, request via fax versus request via web portal. In addition to Patient Access and clinic staff, don’t forget to include Utilization Management. Back to the Basics MS Chapter of HFMA · Mississippi Headlines · Aug/Sept 2022
   A Timely-filing and Timely-appeals for all payors. This should include information such as timely filing
   guidelines for primary claims, secondary claims, corrected claims, and appeals listed in an easy-to-read reference grid. While many providers have these grids, it’s not uncommon for these grids to be outdated due to payors frequently changing their policies and procedures.
3. Insurance Card
   A review of sample claims to see if insurance card copies are being captured at each visit. The accounts
   should also be reviewed to see if the patients are then being correctly registered in the correct insurance / plan code. This would also include whether the insurance is correctly identified as primary or secondary. This review can often surface training issues or a clean-up of the insurance / plan codes. This includes deleting redundant or unused insurance / plan codes and ensuring the descriptions seen by front-end staff match the current insurance cards.
4. Eligibility Return Review
   A review of sample eligibility verifications to see if staff are reading the Eligibility Return correctly. This
   would include identifying the managed Medicare plans correctly and not as Original Medicare. This would
   also include identifying products correctly as primary versus secondary.
5. Provider Manuals and Payor Updates
   A routine review of provider manuals for updates and changes and to reinforce payor policy and procedures with staff is crucial to the revenue cycle. Payors update their policies regularly and often these updates are not discovered until denials are received. Having a designated review period and a process to ensure these updates are pushed out to the relevant revenue cycle teams and departments will decrease denials, reduce cost to collect and shorten the cash cycle. Back to the Basics MS Chapter of HFMA · Mississippi Headlines · Aug/Sept 2022
6. Denial Review Against Front-End Edits
   Avoiding denials is any revenue cycle team’s top priority; however, having zero denials is inevitable. A systematic review of historical denials to identify opportunities to increase the clean claims rate helps identify process improvements that may have been overlooked. One way is to compare your Electronic Health Record and/or Clearing House front edits against denials. This can help identify front-end edits that are misfiring or the need for new front-end edits to prevent denials. As providers, we place a large focus on automating processes using technology and data analytics. However, given the complexity and ever-changing rules in our industry, people will always be a key part of a successful revenue cycle system. Given such, it’s always good to incorporate a routine review into your processes. If you don’t already have a systematic review of your processes, scheduling at least an annual review of getting Back to the Basics will help validate your processes are working as intended.

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According to an article on People Scout at https://www.peoplescout.com/insights/engage-and-retain-healthcareworkers/, a healthy healthcare organization has happy and well engaged employees. The article references a survey conducted by Leaders for Today that included 852 participants of clinical and non-clinical employees. The survey results showed that 43% of respondents were with their current organization for less than 2 years and 65.7% stated that they were with their hospital less than 5 years. More than one-third of the survey respondents had planned to leave within 2 years and 68.6% were planning to leave in 5 years. Additionally, there is the high financial cost of employee turnover.

The best way to retain employees and achieve sustainable business growth is by aligning the goals of employees with those of their directors and leaders and providing a world class employee experience. Since COVID 19, it is no longer business as usual in how we engage with employees to align their experience with the organization’s purpose, brand and culture. One of the primary questions we must address is how to retain good people remaining committed to do their jobs during a time of uncertainty?

Outlined below are some strategies to consider in retaining your employees and providing that world class employee experience:

1. Evaluate compensation rates and incentive options to remain competitive in what is now a global market
   for recruiting and retaining top talent.
2. Establish clearly defined goals and performance standards with options for professional development and performance-based incentives.
3. Evaluate onboarding process to ensure new employees experience organization’s values and
   culture during the onboarding process and are affirmed in their decisions to work for you.
4. Provide ongoing training for staff development and provide clear path for career progression.
5. Remain intentional in staying connected to all team members to have a personal touch in building relationships and morale. Consider options for leaders to connect with team members to let them know they are cared for, appreciated and valued perhaps with a handwritten card, virtual lunch to celebrate wins, water cooler chat within Microsoft Teams and/or spontaneous check-in to ask how team members are doing personally.
6. Keep teams connected with frequent team huddles.
7. Allow an alternate work schedule to enhance work life balance while continuing to meet the needs of the
   business and ensure adequate coverage.
8. Conduct monthly meetings to share vital information to keep everyone abreast of new issues or areas of
   concern.
9. Have door prizes that employees can win to show appreciation. Employees enjoy winning prizes, and they feel appreciated.
10. Provide lunch once a quarter to show appreciation for the employees with messages of appreciation for all they do.
11. Provide timely feedback on employees’ progress and continued opportunities to learn and grow.
12. Provide timely recognition and praise for doing good work.
13. Ensure employees have frequent opportunities to provide feedback and suggestions through virtual suggestion box, formal employee engagement surveys and exit interviews and ensure leaders provide timely feedback to address opportunities identified. Employees are any organization’s most important assets. Organizations must be consistently assessing employees’ needs and develop talent carefully to keep employees engaged and committed to their jobs.
    
    
    References: Dyson, E. (2022, March) Medical Staffing: How to Engage and Retain Healthcare Workers PeopleScout
    https://www.peoplescout.com/insights/engage-and-retain-healthcare-workers/

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Examples of population health billable revenue streams are programs such as Chronic Care Management, Behavioral Health Integration and Remote Patient Monitoring. The Chronic Care Management program is focused on patient outreach for those that have at least one chronic diagnosis. The eligibility for these services has expanded over the past couple of years, which is creating more opportunity for these types of programs. Behavioral Health Integration is a similar program focused on those with a mental health diagnosis that uses a psychiatric collaborative care model approach with a primary care provider, psychiatric consultant, and care manager working directly with the patient. Another component of these types of reimbursable services is Remote Patient Monitoring. This is a monthly billable service to Medicare for both the monitoring and the Care Management services. All these programs require a Care Management team approach to managing chronic conditions in collaboration with the provider network at the facility or clinic level. By instituting these services, the facility is providing a service that can support revenue growth for 2021 and beyond. By frequently contacting patients, this impacts the overall care and allows for the patient to stay connected to the facility.

Staying connected and increasing capture of all needed services through the facility will also increase pull through revenue at a system level. These types of population health revenue streams have the potential for not only bringing in additional revenue but also for positively impacting the quality outcomes. Quality outcomes are becoming more important with additional payors expanding into basing portions of reimbursement on outcomes. It is important to review the potential for your facility to ensure you are not leaving revenue on the table. Having a team dedicated on executing your population health strategy is the key to success. If you are not currently maximizing your opportunity for these types of billable services, you can contact Trilogy Population Health for a complimentary evaluation of your revenue potential.

Brandy Hoell, MSN, RN, CCM
Partner, Population Health
Trilogy Health
brandy@trilogy-health.com
318-773-2948

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A common misconception among front line staff is that worker’s compensation provides full medical benefits for all medical services rendered to an injured worker. Many hospital and healthcare providers believe an injured employee covered under an employer sponsored Worker’s Compensation claim can see as many providers as needed to receive essential care. Though it is true according to the Mississippi Worker’s Compensation Commission “an injured worker is entitled to whatever reasonable and necessary medical services are required to treat the injury and achieve maximum cure. These include but are not limited to doctor and hospital services, nursing services, medication, physical therapy, crutches and any other apparatus or medical service which is necessary.” However, it is important to remember that:

• Worker’s compensation benefits only cover one referral from the patient’s originating servicing provider to another servicing provider
• All additional referrals must be approved by either the employer’s worker’s compensation insurance carrier or the Workers Compensation Commission.

Therefore, if not captured and tracked appropriately, these additional patient referrals have the potential to cause significant denials for noncovered services with no authorization. That is why it is imperative that we utilize effective and efficient scripting when registering or scheduling a patient for work related injuries. Best practice industry standards suggest that:

• If an injured individual(s) arrives for services without an employer sponsored accident-related report or approved worker’s compensation claim form, the patient’s medical insurance is to be entered as Primary with the patient listed as the guarantor; this is true for both urgent and non-emergent scenarios
• If an injured individual(s) arrives for services with an employer sponsored accident-related report or approved worker’s compensation claim form, this information is to be entered as Primary and the patient’s medical insurance as Secondary listing the “employer” as the guarantor

If you are concerned about potential reimbursement associated with worker’s compensation claims for services rendered at your hospital or healthcare servicing provider, you may want to revisit your front-end revenue cycle process and strategy. Here is a helpful link to CMS for additional information WCFacts2013.pdf (ms.gov) or you may contact Trilogy Revenue Cycle Solutions.

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How Often is ICD-10-CM Updated?
The ICD-10-CM Coordination and Maintenance Committee (C&M) meets biyearly, typically in March and September to review new code proposals. This Committee is comprised of representatives from Centers for Disease Control and Prevention (CDC), National Center for Health Statics (NCHS) and Centers for Medicare and Medicaid Services (CMS). There is an opportunity for the public to submit clinical presentations on disease processes for consideration of new code creations at these meetings. Committee meetings minutes and presentations are made available for public comments before implementation of new codes and guidelines. October 1st each year is the golden date for most coding updates to ICD-10-CM. However, as seen with the Pandemic, decisions to implement new diagnosis codes to capture more information can be made as needed.
For example, additional code specifications were added for COVID-19 on January 1, 2021.

In May of each year the ICD-10 C&M Committee closes the public comment period on all proposed codes that have been presented at the March meeting. The CMS website continually provides ICD-10-CM updates and links to activities of the C&M Committee. This is good time to review the proposed codes and begin the analysis of impacts to your organization.

Timeline Considerations for ICD-10-CM Updates
Enlist a Certified Coder to stay abreast of new code guidance from the CMS and CDC on a routine basis and share within the organization. Maintain open communication with EHR and IT vendors to assure all new code sets are uploaded by the effective dates. Prepare for Coder and Provider education of new codes.

Angie Buckley, RHIT, CCS, CPC
Coding Manager, Trilogy Revenue Cycle Solutions

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