Dealing with overpayments in your practice

“Simple it might seem, yet given the time and the resources that such monitoring and reporting eventually consumes, physician practices can find it hard to take up such intensive scrutiny amidst the overriding challenge of keeping their medical service quality benchmarked to the perennially raising medical standards. All such apprehensions point towards outsourcing medical billing management that comes with the value-addition of surveillance-check on Overpayments”.

Strange it might seem, frequency of overpayments from insurance carriers, particularly Medicare, seem to grow as the volume of health insurance claims swells with each passing day. Irrespective of the reason, whether stemming out of up-coding or lapse on the part of the payer, it is never recommended that you keep the overpayment without informing your medical insurer. As Medicare has made it mandatory for physicians to report any incident of overpayment within 60 days from the actual day of receiving such payment, failure to comply by scheduled time-frame can constitute fraud and abuse inviting penalties, such as cancellation of practice-license, monetary penalty, or imprisonment depending upon the severity of the intentional fraud and abuse. More than the material punishment, it is the credibility that you may be risking while going for unscrupulous overpayments.

Having convinced of the efficacy of reporting overpayment, now it is time to know how to report, whom to report, and how to be immune to such overpayments:

Upon finding out overpayment, the physician concerned should write a refund note to the Medicare carrier along with a brief explanation of the reason for the refund; certain extraordinary cases may need to be reported to federal and/or state criminal authorities such as the Department of Justice or the Office of Inspector General (OIG).

Further, there needs to be consistency in reporting overpayments: reporting selective or randomly may not be sufficient for building goodwill with your payer as it still opens up chance for audit exposure
Appoint your staff to specifically look into the genuineness of payment posting, and monitoring of the actual realization against the claim realization.

Simple it might seem, yet given the time and the resources that such monitoring and reporting eventually consumes, physician practices can find it hard to take up such intensive scrutiny amidst the overriding challenge of keeping their medical service quality benchmarked to the perennially raising medical standards. All such apprehensions point towards outsourcing medical billing management that comes with the value-addition of surveillance-check on Overpayments. Therefore, it becomes crucial that your prospective medical biller’s scope of Revenue Cycle Management – along with the usual patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices),

Insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), AR management (insurance and patient), financial management reporting – is inclusive enough to identify and report such odd incidents of overpayments.

Medicalbillersandcoders.com being a leading provider of such inclusive medical billing revenue cycle management, holds key to physicians’ endeavors towards honest and credible practice management.

U.S. Health Spending Projected To Grow at 5.8 Percent Annually: Pros and Cons

The recent extrapolation by the economists in the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) – which has projected all healthcare spending in the United States to be at an annual average rate of 5.8 percent for the period 2010 through 2020, and at 19.8 percent of GDP by 2020 – should be cause for celebration as well as challenge for all stakeholders: physicians, patients, insurance carriers, and professional medical billing companies.

Looking at healthcare market of $4.64 trillion by 2020, nearly half of which will be funded by the Federal Government for its popular Medicare and Medicaid programs, it is only natural that there will an unprecedented growth in medical practitioners vying for their share of the apple pie. Consequently, the medical service benchmark will get pushed up by a few notches as the patients will have options to choose from. Ultimately, with the Affordable Care Act’s Accountable Care Organization scheme coming into picture, an enormous opportunity will actually get translated into quality-driven physician services.

Going by the expansion of health insurance coverage through Medicaid and subsidized private health insurance under the Affordable Care Act, as well as Medicare reforms – which will induct more baby boomers into Federal health insurance – nearly 30 million more will come under the ambit of health insurance by 2020. Consequently, there will be a considerable reduction in the out-of-pocket spending on medical services by a majority of the underprivileged class.

Although insurance carriers can think of substantial increase in premium inflow, the prevalence of government-funded Medicare and Medicaid (nearly half of the total health insurance composition), and Federal Government’s extra vigil on controlling undesirable increase in premium, and incidental charges, will only drive them to be even more stringent on medical reimbursements.

Medical Billing Companies , which otherwise would have stood to gain in terms of additional market share, will be required to be even more competent in the wake of the ensuing ICD-10 and the HIPAA compliant 5010 standard for coding and reporting respectively – both of which demand a higher degree of competence as compared to the previous ICD-9 and HIPAA 4010 regimen.

The sum total of all these consequences will eventually reflect on physicians/hospitals’ ability to effectively and efficiently conduct medical billing, which is crucial to their sustenance and growth. But, judging by the historical experience of failed experiments with in-house medical billing practices – either in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation – it is anybody’s guess that physicians/hospitals will eventually be forced to avail competent medical billing services.

In such a scenario, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – the largest consortium of medical billing professionals, who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, compliance standards, and ride on an paralleled set of pre-qualifiers: certified by the American Association of Professional Coders (AAPC).

These proficient medical billers and coders are trained to use advanced medical billing softwares such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc., and latest coding softwares such as EncoderPro, FLashcode and CodeLink. Their expertise in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnostic codes has earned them an impressive track-record of maximizing client reimbursement of medical bills with leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid. These Medical Billing and coding specialists will be an ideal ally in complementing their clients’ cost-minimization and revenue-maximization endeavor through a proactive medical billing management.

Browse All:  Houston Medical Billing

Impact of Federal Debt Ceiling on Medicare Payments to Physicians

Debt ceiling on Federal Debt is a perennial topic for debate in the US healthcare scenario. Debt ceiling or Debt limit is the brink to which U.S. Federal Government can raise debts to fund its budgetary allocation. Although there have been instances in the past that allowed for raising debts well over the statutory limit, yet the present scenario is such that it has put a question mark over the Federal Government’s ability to borrow. Consequently, despite the talk of an additional $2.2 trillion borrowing through governmental securities, the fear of imminent debt ceiling effects across the spectrum of healthcare industry looms large.

With the national debt having approached its statutory limit of $14.29 trillion, there is an imminent set of repercussion waiting to engulf the Federal Government’s economic sectors. As the eventual debt ceiling is going to trigger off default or delay in payments to Federal Government commitments, there is a growing degree of anxiety among interest-groups: creditors, beneficiaries, vendors; military staff, social security and Medicare, and unemployed beneficiaries.

Among the many interest-groups that are likely to be impacted by the Debt ceiling, Healthcare sector – which accounts for a majority of share in the Federal Budget – is going to feel the heat more. Consequently, its stakeholders – physicians/hospitals, patients, insurance carriers, and medical billing professionals will all be forced to rethink their operational efficiency to stave off the negative impact of Debt ceiling.

Federal Government, already faced with the impending Sustainable Growth Rate (SGR) problem, will be pushed to float unprecedented radical reforms to its popular Medicare and Medicaid programs, such as

• Increase in the Medicare eligibility age and a jump in co-pays and deductibles
• Lowering benefits to low-income individuals under Medicaid
• Cuts to Medigap insurance, which would limit supplemental insurance plans for the elderly, and the implementation of a policy requiring high-earning seniors to pay higher premiums for their plans
• Reduction in spending by $1.2 trillion across a wide array of federal programs, including a 2 percent cut to Medicare provider payments starting in 2013.
• A possible threat of 29.5 percent cut to Medicare payments if the Congress doesn’t alter the Sustainable Growth Rate, in which case payments to doctors would drop so low that many would be forced to stop seeing Medicare patients.

In such a scenario, physicians – whose patient composition happens to be a majority (nearly half of their total patient composition) of Medicare and Medicaid beneficiaries – will be forced to operate at less than break-even point, which is hard to sustain.

Browse All: medical billing , Houston Medical Billing

Faced with such imminent consequences, physicians/hospitals – who are already grappling with a highly competitive healthcare market; stringent compliant environment: ICD 9CM to ICD 10 compliant coding and HIPAA compliant reporting; and failed in-house medical billing experimentation, where in either in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation – physicians/hospitals will inevitably have to look up to qualified and competent medical billing management experts, who ensure operational efficiency and revenue maximization.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billing professionals, can prove to be an ideal ally in complementing its clients’ cost-minimization and revenue-maximization endeavor through a proactive medical billing management.

Our medical billing experts – who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – have been preferred choice of a majority of physicians/hospitals groups across the U.S. Proficient in using advanced medical billing and coding softwares and an impressive track-record of efficient reimbursement with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well – our medical billing professionals carry an extra edge in the industry.

Optimizing Revenue By PQRS Participation

PQRS, the Medicare program paid out over 234 million US dollars in 2009 to medical professionals who subscribed to the program. However, a large segment of professionals failed to qualify, were just not aware, or lacked the inclination to take part. Out of over one million medical professionals deemed eligible to take part in the PQRS, only 210,000 subscribed in 2009. Out of the 210,000 that participated, 120,000 earned bonuses averaging 2000 US dollars each. This number could have been significantly higher had the professionals been aware of the program and its incentives.

PQRS is an initiative to make it possible for physicians to report patient records qualitatively and aims to encourage preventive care on the basis of relevant data collected from physicians’ practices. PQRS will be mandatory by 2015 and non-participating professionals will be penalized as well.

Presently, the PQRS, popularly known as the ‘pay-for-reporting system,’ is optional and attracts cash rewards, By early PQRS participation, medical professionals will get a head start by getting certification from medical authorities as well as gaining recognition and credibility in the community and medical fraternity as thorough professionals who provide conscientious and quality service to their patients leading to greater demand from patients. Also, the physicians will have set up a system that will be quite costly when participation becomes mandatory as well as avoid penalties.

Browse All:  Houston Medical Billing

The amount physicians invest in setting up the PQRS is recovered twice over in the first year alone, through the incentive program. Most physicians are considering opting in while they can earn incentives, instead of having to install the system at their own cost, without any incentive.

Once the physicians opt to go in for PQRS participation, they have to decide on the PQRS measures for patient care relevant to their practice as well as ensure that their staff too is well versed with these reporting requirements and have put procedures in place to incorporate this data on claims (50% of applicable claims are required to include PQRS data).

The healthcare providers who are not able to support these initiatives through lack of time, resources, or trained staff should think of getting expert help from outside for implementing and integrating the PQRS initiatives.

Medical Billing and coding companies can support physicians in implementing and streamlining the PQRS processes in their facility by seamlessly incorporating these initiatives into their claims submission workflow with minimum hiccups during the transition period. They have certified and trained staff to document the relevant quality measures on the billing form.

By hiring the services of professionals from Medicalbillersandcoders.com not only will one be rid of the hassles of sourcing and training necessary staff, but also the entire process of installing and learning the PQRS system will be streamlined. Added to that, while the incentives last, the physician will not only recover the investment as well as gain increased Medicare reimbursement but will also ensure that their staff establishes procedures for identifying and integrating PQRS data as a routine part of the claims submission flow before the mandatory phase sets in.

Finally, the good standing a physician will acquire among his colleagues and community will result in optimizing revenue for the health care provider or facility since it enhances levels of a doctor’s efficiency when standard administrative responsibilities like PQRS reporting are handled by trained and expert staff.

It’s a win-win situation to get in touch with a quality service provider at the earliest.

To get more information on setting up a quality reporting system as well as other related measures through our RCM and Consultancy services, please visit www.medicalbillersandcoders.com, Birmingham Medical Billing, Boston Medical Billing

Medicalbillersandcoders.com Ensure Viable Practice for Pediatric Practitioners in High Density Areas

Wilmington, 12th September, 2011 : At $183,000 a year, the pediatricians earn the lowest pay of all physicians except Primary Care physicians, according to the medical search and consulting firm Merritt Hawkins & Associates’ 2011 Review of Physician Recruiting Incentives.

The nationally low reimbursement rates for the pediatric specialty have been further aggravated by the rising malpractice rates even when there is no outstanding claim, as well as the cost of living.

With a large number of pediatric patients covered under a single payer, Medicaid, and with close to 60% overheads and far fewer billable diagnoses and procedures, pediatrics reimbursement has remained much lower compared to other specialties. This has led to the pediatric specialty physicians refusing to provide care or even writing off cases. Many more do not participate in plans at all.

The financial issue has led to the overall shortage of pediatric subspecialists in the US as well as their concentration in a few areas such as Massachusetts with 165 pediatricians per 100,000 children is closely followed by other northern states including New York (154), Connecticut (127), Maryland, the District of Columbia (160), and New Jersey (131) – whereas the plains and western states such as Montana (43), South Dakota (41), Wyoming (35) and Idaho (28) registered lowest concentrations.


This situation calls for optimization of pediatric practice in areas with lower concentration of pediatricians as well as providing professional support to physician clinics and hospitals in high concentration areas on effective and efficient management of their practice.

Browse All: Medical Billing (http://www.medicalbillersandcoders.com/)

MBC, a leading medical billing and coding consortium views this situation both as an opportunity and challenge as it offers a huge workforce of established pediatric medical billers and coders who can effortlessly realize the clients’ requirements amidst a stringent insurance environment. With expert pediatric medical billers and coders for high concentration areas such as Massachusetts, New York, Maryland, Washington, Connecticut, and New Jersey, medicalbillersandcoders.com can ensure compliant standards on their clients’ behalf.

Apart from these, MBC also has a fair presence in South Dakota, Montana, and Idaho with our Idaho and South Dakota medical billing professionals – which together with others make up for the majority of pediatric medical care market.

MBC is a well entrenched association of highly experienced billers and coders with a competent set of pre-qualifications in congruence with the prevailing standards for medical reimbursement ( ICD-9 and HIPAA 4010 coding and reporting compliance ). With a track record of denial-free multispecialty billing and coding services, and a proactive out-look to the ensuing ICD-1O and HIPAA 5010 coding and reporting compliance, our pediatric billing services promise to be indispensable ally to pediatric practitioners spread across urban and suburban areas of these highly competitive states.


About Medicalbillersandcoders.com

Medicalbillersandcoders.com is the largest 'Consortium of Medical Billers and Coders,' across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US ( Houston medical billing (http://www.medicalbillersandcoders.com/city/houston-texas-medical-billing-specialist.html), Dallas medical billing (http://www.medicalbillersandcoders.com/city/dallas-texas-medical-billing-specialist.html), Florida medical billing, Pennsylvania medical billing, Las vegas medical billing, Miami medical billing, Phoenix medical billing), with the most prominent being Pediatrics medical billing and General Practice.

Contact:
Prerna Gupta, Media Relations
108 West, 13th street,
Wilmington, DE 19801
Tel : +1-888-357-3226
Email : info@medicalbillersandcoders.com
http://www.medicalbillersandcoders.com/

US Physicians’ Administration Costs Four Times Higher Than Single-payer Healthcare Providers

Going by a recent survey by the researchers with Cornell University and University of Toronto – which has unearthed alarming fact about relatively higher administrative costs in the United States: physician practices incurring nearly $83,000 in administrative costs per physician each year, nearly four times the amount spent by their Canadian counterparts – it is quite imaginable the extent of its implication on physicians’ fees, and patients’ medicals bills ultimately. The fact that the survey has treated Canadian medical quality on par with that of United States, ranked highest globally, further endorses the need for immediate insurance-related administrative reforms that can drastically:

• Bring down the per-capita physician administrative cost to as low as $22,205
• Reduce time spent by nurses and medical assistants on administrative tasks related to health plans to as low as 2.5 hours per physician per week, which is what prevailing in Canada, and
• Achieve an annual savings of $27.6 billion on insurance related administrative costs

Easier said than done, the reform measures should effectively address multiple issues that have been responsible for this undesirable scenario. While running a thorough analysis on reasons responsible, the researchers have identified the following areas that require reformatory action:

• Multiple-payer health care system: The prevalence of multiple-payer health care system has been both complex with different sets of regulations, procedures and forms mandated by each health insurance plan or payer, as well resource-consuming. Ideally, multiple-payer health care system needs to be simplified into either two-payer system – one each for private and Federal insurance plans – or, if possible, single-payer system that Canadian physicians follow.
• Failed Experimentation with in-house medical billing: Experimentation with in-house medical billing practice has not been encouraging either – either in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation. Consequently, physicians – with no avail but to practice medical billing somehow – have to bear the brunt of excessive operational costs.
• Unscrupulous Medical Billing companies: There have been instances where in solution-seeking physicians/hospitals have run into some unscrupulous medical billing company or medical billing agency, who contrary to ensuring cost optimization and revenue maximization, have further compounded their clients’ woes by sending out wrong bills in an incorrect format.

Amidst such complex problems, the ensuing Affordable Care Organization (ACO) floated by Patient Protection and Affordable Care Act of 2010 (PPACA), scheduled to be officially launched in January 2012, promises to bring down spiraling health expenditure through

• Incentive linked payment system, initially for Medicare physicians, and subsequently for private practitioners also.
• Controlling premium and incidental charges of insurance carriers

While these reformatory measures are greatly welcome, physicians/hospitals should inevitably carry on seeking professional help of expert medical billing specialists that are competent enough to tackle spiraling administration costs, and ensure operational efficiency and revenue maximization.

Medicalbillersandcoders.com, the largest consortium of medical billing professionals, brings certified medical billers and coders from all 50 states under one roof. With the average experience of billers in this consortium to be 7 years, you can find well trained in-house billers and well equipped medical billing agencies in your city.

These billing professionals are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards, riding on unparalleled set of pre-qualifiers – certified by the American Association of Professional Coders (AAPC).

Expert at applying standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis; and an impressive track-record of maximum and efficient reimbursement of medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group and Government sponsored Medicare and Medicaid as well – is uniquely poised to complement physician cost-minimization and revenue-maximization endeavors.

• Albuquerque,NM Medical Billing
• Atlanta,GA Medical Billing
• Austin,TX Medical Billing
• Baltimore,MD Medical Billing
• Birmingham,AL Medical Billing
• Boston,MA Medical Billing
• Bridgeport,CT Medical Billing
• Charlotte,NC Medical Billing
• Chicago,IL Medical Billing
• Cleveland,OH Medical Billing

Level of Preparedness for Smooth Transition to ICD-10

US Federal Government, which has earmarked October 1, 2013 as the deadline, has sought to replace the 30-year-old ICD-9 with the radical ICD-10 – believed to be harbinger of sweeping changes across all facets of healthcare organizations: providers, staff, processes, insurance carriers, and systems and technology.

But, given the experience in other countries – UK, France, Australia, Germany, and Canada, which prior to adopting ICD-10 in 1995, 1996, 1998, 2000, and 2001 respectively, had to wait as long as 5 years for achieving successful implementation of ICD-10 – it is only expected that the incubatory period from 2010 to 2013 is going to be spent on implementation alone across the length and breadth of the U.S. healthcare system.

Further, transition involving multiple constituents – ICD-10 CM, used in both inpatient and outpatient settings, replacing ICD-9-CM volumes 1 and 2; ICD-10-PCS replacing ICD-9-CM volume 3 for use in inpatient settings only; and, more importantly, the implementation of the HIPAA compliant 5010 standard, a prerequisite to ICD-10 since the current HIPAA 4010 standard does not support ICD-10 codes – is sure going to make it excruciation for all covered entities, including health plans, healthcare clearinghouses and most healthcare providers.

Fortunately, experiences historically in other nations should both be an indicator of challenges that lie on the way, as well as guidelines for realizing smooth transition by the deadline of October 1, 2013. Combining these experiences with the following implementation guidelines should not only make the transition less excruciating but also enable an early interoperable health data exchange in the US, and improve the ability to measure medical processes and outcomes:

Analyzing the chasm between the current system and the demands of ICD-10 system

One of the important tasks prior to implementing the ICD-10 is to analyze the gap between the current system – both technical as well as human – and the projected demand of ICD-10 system. Fundamentally the areas that require a re-look are technology, including interface and interoperability requirements; education and Training; workflow and organizational processes, including clinical documentation, health Information management (HIM) department, clinical service areas and back-office administrative and billing functions and processes, coding productivity and workflow, data quality, data and information reporting – internal and external, and revenue cycle processes and workflow.

Having analyzed the gap with respect to the above parameter above, there comes the need to align the requisites in line with the ICD-10 demands

Education and Training

Having analyzed the areas to be upgraded in line with the demands, the next step is to educate and train the human resources that actually are going to be impacted. Primarily, the following sections of manpower are going to be in need of the education and training in line with the ICD-10:

• Health Information Management (HIM) professionals (regardless of departmental affiliation or the presence of centralized or decentralized coding practices)
• Administrative and front office staff such as Registration or Scheduling departments
• Clinical staff – physicians and all other allied health professionals who may document the patient health record
• Revenue Cycle and Business office support staff, including contract managers, documentation reviewers and corporate compliance officers
• Finance Department staff
• Departmental and other management staff including quality and utilization management, performance improvement and other key areas that may use or report ICD codes
• Clinical Documentation Improvement

Educating and training your staff alone is not going to make any difference unless there is considerable improvement in clinical documentation, which, along with successful compliance with HIPAA norms, enables best coding practices as per ICD-10. Hence, the resources spent on education and training should reflect on the quality of clinical documentation.

Tactful Management of Revenue Cycle

ICD-10, being exhaustive and stringent, has the potential to negatively impact your revenue cycle, with the billing reimbursement taking far more time to realize, or frequent reports of denials. A better proactive processing system that can tactfully solve ICD-10 intricacies will be indispensable.

Upgrading Information Management and Technology

Successful implementation requires a matching deployment of technology application and system in congruence with ICD-10 demands. Therefore, healthcare organizations should look installing advanced systems, and at integrating them across all functional points within the organization.

Post Implementation Review

Implementing alone will not yield the desirable objectives; there will be regular review and audit of the implementation, which will not only ensure revenue optimization, but also and quality data dissemination for research and archiving.

With such an arduous task ahead, physicians or hospitals can safely resort to availing services of medical billers who are proactive and prepared with material-requisites for ICD-10.

MedicalBillersandcoders.com (www.medicalbillersandcoders.com), with a long-standing reputation of being the largest consortium of medical billers in the U.S., is a preferable catalyst in smooth transition to ICD-10.

• Columbus,OH Medical Billing
• Dallas,TX Medical Billing
• Denver,CO Medical Billing
• Detroit,MI Medical Billing
• ElPaso,TX Medical Billing
• FortWorth,TX Medical Billing
• Houston,TX Medical Billing
• Indianapolis,IN Medical Billing
• Jacksonville,FL Medical Billing
• Kansas City,MO Medical Billing

The Need for a Long-Term Solution to the Perennial SGR Problem

The decade old uncertainty over fixing a permanent solution to Sustainable Growth Rate (SGR) is set to continue with the House deciding not to set off the accumulated deficit (25% for 2011) against primary care physicians till the end of this year. Although a temporary relief for doctors, the absence of a permanent solution will always keep doctors apprehensive every year. What is more, the accumulating deficit is destined to move upwards.

Primarily brought into force by the Balanced Budget Act of 1997 to amend Section 1848(f) of the Social Security Act for controlling costs related to spending on Medicare expenditure by the Centers for Medicare and Medicaid Services(CMS), Medicare Sustainable Growth Rate (SGR) happens to be an overriding improvement over the earlier method, the Medicare Volume Performance Standard (MVPS).

As the SGP advocates equating Medicare expenditure for each beneficiary proportionate to the growth in the GDP, physicians are driven to render quality service under the GDP sealing. Despite Medicare Payment Advisory Commission’s close watch – advisory to the U.S. Congress on the previous year’s total expenditures as against the target expenditures, and conversion factor that modifies the payments for physician services for the next year in congruence with the target SGR – the Medicare Sustainable Growth Rate has never been able to witness the Medicare expenditure in congruence with the GDP.

Although the CMS may place partial blame on physicians for overshooting the SGR every year, yet, amidst ever-rising cost of medical practice, physicians have been finding it hard to sustain the SGR. The estimated SGR for 2010, which is a negative 10.30%, and the conversion factor for the physician fee at a negative 25% are still more alarming. The current scenario would have meant a negative Medicare budget, and cut in physicians’ fees by 25%, in which case physicians would have resorted to boycott the Medicare patients.

In the long run this scenario is also going to affect the quality of healthcare as the physicians would be wary of investing money in new equipment or latest technology to enhance their patient care and management services if they are unsure of their potential revenue and expenses. Another pertinent fact here is that the implications of the SGR stalemate go beyond Medicare as most private insurers take a cue from Medicare to set their payment rates.

Fortunately, like it has been since 1997, there has been yet another extension to the implementation of conversion factor; Medicare and Medicaid Extenders Act of 2010 has deferred it till January 1, 2012. But at some point of time, the inevitable question will have to be answered and permanent solution to be given amidst booming demography of senior citizens, which will further escalate SGR problem. It is heartening to see the premier health body, AMA actively pursuing the issue with the congressional leadership for a long-term solution.

We, Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billing and coding advisory are equally interested in witnessing a permanent solution to this perennial SGR problem. Being an integral part of medical endeavors, we hope it is realized sooner.

Boston Medical Billing, San Jose Medical Billing, Phoenix Medical Billing, LasVegas Medical Billing

About Medicalbillersandcoders.com

Medicalbillersandcoders.com is the largest ‘Consortium of Medical Billers and Coders,’ across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US (Iowa Medical Billing, New York Medical Billing, Ohio Medical Billing, Texas Medical Billing), with the most prominent being Cardiology Medical Billing, Mental Health Medical Billing, Dental Billing, Oncology Medical Billing, and General Practice.

Five Ways to Better Denial Management for Physicians

Denial management is one of the crucial aspects for a physician and can assist in improving the revenue cycle management. This can not only reduce errors while managing claim denials but also help in increasing the physician’s revenue. This process is carried out by medical billers and coders who have specialized knowledge in the field and are aware of its legal aspects. Efficient denial management can increase the revenue in numerous ways; some of which are obvious while others enhance the revenue in an indirect manner.


Specialized medical billers and coders


Medical billers who are experienced and specialized in this field can perform better by utilizing their skills with incisive understanding of why the claim was denied in the first place. Specialized billers also represent your case strongly when the claim is correctly filed and the payer denies the claim on unclear grounds. Denial ratios are steadily increasing with payers in the given healthcare scenario.


Analysis


The best way to speed up the process of denial management is to analyze the grounds on which the claims are denied. Once the reason for claim denial is known, it becomes easier for medical billers and coders to correct the error and receive the deserved reimbursement. In Denial Management, Root cause analysis is more important than re-filing the claim.


Moreover, once the reasons for revenue leakage have been identified, any further loss can be pre-empted or stopped before it has occurred for the first time. Proactive Denial Management can increase the cash flow and the revenue by almost 10% by reducing the number of first-time claim denials.


Expertise


Denial management can involve communication with various entities and it is important to be trained in the process of collections from such entities. These involve recovering collectibles from any of the payers such as Medicare, Medicaid, BCBS, United Healthcare, Aetna and many local payers.


Appeals


A crucial part of claims denials is “appeals” and these are explanations for re-eligibility of the claim for payment which was denied earlier. Since these claims can only be appealed within a set period of time, it becomes important to prioritize them. Not every claim can be appealed thus this tool must be used judiciously. The Billing specialist must also possess the skill required to write appeal letters as the explanation with correction is what gets you paid in most cases.


Prioritize Denials as per value


Managing denied claims or appealing them can be made cost effective by reviewing the most commonly denied claims according to the dollar value and volume. This helps in determining which claims should be given the most importance and which are less likely to produce positive results. This can assist in cutting costs as well as saving time in the revenue cycle management.


Medical billing and coding specialists at medicalbillersandcoders.com are experienced in denial management and are skilled in other areas of medical billing and coding services such as charge entry, payment posting, credentialing, and managing accounts receivables.


For further information and medical billing and coding services please visit medicalbillersandcoders.com.


Ohio Medical Billing | Michigan Medical Billing | Maryland Medical Billing | Arizona Medical Billing | Washington Medical Billing | Oklahoma Medical Billing 

Five Ways to Better Denial Management for Physicians

Fraud and Abuse: A major reason for waste in the US healthcare spending

Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.


According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.


The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.



Source: Healthcare analytics, Thomson Reuters


What is healthcare fraud and abuse?


Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.


How to prevent it?


Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public. The question is how to prevent it?
Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:


• Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported
• Protect insurance card and personal information at all times
• Count pills each time they pick up a prescription
• Research providers with state’s medical boards
• Report suspected fraud and abuse as soon as possible


Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.

Ohio Medical Billing | Michigan Medical Billing | Maryland Medical Billing | Arizona Medical Billing | Washington Medical Billing | Oklahoma Medical Billing 

Fraud and Abuse: A major reason for waste in the US healthcare spending

Remote Mental Health Billers

Mental health services are very hard to access in rural areas and those suffering from mental illnesses have to encounter unavailability and isolation from mental health services. This is due to the fact that almost 75% of the total population in rural counties lacks a psychiatry specialist and almost 95% do not have access to child psychiatry specialists. A crucial shortage of medical staff is being seen as a prime concern here. Due to its sparse population and low quality of care compared to those in the urban areas, it is difficult to attract mental health workers to these areas.

Medical Billing

If the rural is hit with such a shortage of healthcare professionals then the availability of medical billers catering to mental health can be even tougher. Billers generally like to be available to doctors in their vicinity but to combat this shortage, nowadays mental health billers communicate with rural practices either by the usage of software provided by these physician offices or medical billing software of their own choice.


It turns out to be more efficient since it enables the provider to manage their practice which otherwise would not have been possible with their overworked staff. Smaller practices such as those in the rural areas are much benefited by these mental health billers since they offer a host of other services such as answering patient and carrier queries and insurance verification that makes your practice flow better.


These billers can help you not only with their software support but also help you improve your denial as well as your rejection ratios. Thus, you will be receiving reports on your clinical and billing information the way you want them to be provided to you and help you take better and informed decisions about the financial strength of your practice.


Remote mental health billers are able to file their claims electronically; the EOBs reaching the practitioners in the rural areas are also transferred to billers electronically. These medical billing specialists manage multiple mental health practices as the number of claims is less but the expertise required to bill these procedures are high. Their efficiency is quite high and they take well informed decisions about maximizing your revenue.


A remote mental health biller can still communicate with physician office and accomplish the billing tasks. This single remote biller can manage the most crucial part of your practice without multitasking with other administrative jobs. The focus on other administrative jobs helps your current staff to improve the clinic’s efficiency and helps you cater to more patients qualitatively. Moreover the full time salary can be avoided and a performance based deal may be devised with Remote billers, as they are already used to this model.


All in all, many of the practices in rural areas are adopting remote mental health billing since this is a significant step in terms of solutions for their rural based mental health practice and they are equipped to handle multiple locations and deal with your revenue cycle management issues with specialization in rural mental health.

Medical Billing Florida | Medical Billing California | Texas Medical Billing