Revenue Management & Being Vigilant amidst the impending Medicare backlash

“Although, physicians can expect their Medicare reimbursements to be unhindered at least for another year or so, they need to equally vigilant with their medical billing, coding, submission, realization, and the Revenue Cycle Management so as to be sure of not letting their Account Receivables (A/Rs) beyond the expiry of the current window for Sustainable Growth Rate (SGR) temporary fix.”

Dispelling all the speculation of a permanent solution to the impending Sustainable Growth Rate (SGR) fix, the Federal Government has deferred Medicare cuts till 2013, and with that it is pretty sure that the issue will meander for another year or so. Despite its possible impact on the Federal Budget, the Federal Government seems to be in no mood to stir hornet’s nest as it could possibly have demoralized physicians’ morale and motivation, resulting in deterioration of the quality of medical services – which remains the uttermost concern – across the nation’s healthcare industry.

Strangely, the Sustainable Growth Rate (SGR), which was promulgated to limit the Medicare expenditure within the permissible limit, has contributed to an alarming escalation of Medicare expenditure, which now stands cumulatively at 27.4%. The Federal Government, in a desperate attempt to keep the figure from swelling further, is diverting $11.6 billion from the Patient Protection and Affordable Care Act, including $5 billion from the prevention fund, and $2.5 billion from Medicaid funds earmarked for Louisiana. Although physicians can heave a temporary sigh of relief for having escaped the backlash of Medicare cuts, they would always carry the apprehension of the impending possibility.

Although, physicians can expect their Medicare reimbursements to be unhindered at least for another year or so, they need to equally vigilant with their medical billing, coding, submission, realization, and the Revenue Cycle Management so as to be sure of not letting their Account Receivables (A/Rs) beyond the expiry of the current window for Sustainable Growth Rate (SGR) temporary fix. When you consider the ominous task of being vigilant with medical billing practices along with the imminent healthcare reforms – mandatory EHR implementation, Accountable Care Organization (ACO) model, ICD-10 and HIPAA 5010 compliant coding & reporting amongst others – it is sure going to tell on the physicians’ ability to keep their quality of medical services unblemished.

Therefore, amidst all these realignments, outsourcing the medical billing Revenue Cycle Management (RCM) from credible and competent vendors seems to be more viable. Apart from easing the possible workload on physicians, the outsourced model of medical billing Revenue Cycle Management (RCM) can prove financially vindicated as it can offer the advantages of voluminous operations from being source to many medical practices, clinics, and multi-specialty hospitals.

But, like in case of decision involving trusting the credentials of a vendor, physicians need to be doubly sure of their service providers’ integrity so as to avoid falling prey to unscrupulous intentions.

Medicalbillersandcoders.com (www. medicalbillersnadcoders.com) – the largest consortium of medical billing services with over a decade of proven credibility and competence – has become a premier source of medical billing and operational management solutions for a majority of medical practices across the length and breadth of the U.S. Compliant with the best practices in the industry, its medical billing solutions – being ICD and HIPAA compliant, processed on the latest automated EHR platform – traverse the comprehensive Revenue Cycle Management – comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – is built for clinical, operational and revenue augmentation.

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Medical Reimbursement issues push Physicians to flee hospitals triggering a reverse trend

For over a decade, US healthcare has seen hospitals integrating with primary healthcare physicians across all the states of the US, challenging the traditional notion of primary care as a separate set of services from hospital healthcare, to provide all types of healthcare services under one roof and ensure mutual benefits that help all the sides involved in a treatment cycle and healthcare operations – access to physicians to a larger pool of healthcare opportunities; availability of all healthcare services ,etc.

Although the practice of independent primary healthcare providers joining hospitals has existed in the US healthcare for some time, the introduction of various payment modules, including bundled payments, accountable care organizations (ACOs) and medical home, by the Obama administration has made this alignment unavoidable, thanks to the common feature of these payment modules which is delivery of healthcare services based on a collaborative approach.

However, this collaborative nature of treatment leaves hospitals to do more of what they should be doing less, financial administration. And as financial administration – preparing insurance claims, following them up with insurers, etc. – is neither the core competency nor concern of healthcare providers, they are ill-equipped to handle the situation.

This leads to physicians having to do non-clinical activities, like paperwork, and additionally results in an upshot in claim denials- resulting in the healthcare providers mounting unrealized account receivables and the primary healthcare physicians not getting their dues. This phenomenon is predominantly responsible for triggering a reverse trend in US healthcare – disgruntled primary care physicians dissociating themselves with hospitals and returning to reoccupy their traditional position in the healthcare industry outside the sphere of organized hospital healthcare.

According to a report published by The Physicians Foundation, regulations and administrative responsibilities brought by the Patient Protection Care Act (PPCA) have caused physicians to spend more time on administrative responsibilities and less time on patients, impacting their relationship with patients.  “In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients,” the report warned.

While healthcare providers can’t ignore the exigencies of a changing industry neither can, they lessen their focus on delivery of quality healthcare services. This makes the role of medical billers and coders more pronounced than earlier in the US healthcare industry, in a post reform scenario. One way, to meet this post-reform challenge and is by bringing the benefits of outsourcing financial administrative responsibilities by a care provider to a medical biller and coder who has a sound knowledge of the healthcare industry and its changing trends, latest technologies and experience in handling technical details involved in healthcare claims and a proven track record to show for its capabilities.

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By combining the above competencies, Medicalbillersandcoders.com, the largest consortium of medical billers and coders in the US, has been able to ensure seamless claim realization and greater control over operating costs for healthcare providers resulting in redirecting of internal healthcare staff to core activities, leading to enhanced focus on healthcare and saved costs. These benefits, if seen vis-à-vis the challenges brought about by the healthcare reforms, cited by the report discussed above, are necessary to arrest the reform-triggered trend of physicians parting ways with hospitals.

Job outlook for medical billers & coders looking optimistic in Idaho, Florida & other US states

Various factors playing a role in altering the salary of a medical biller and coder including work experience, geographic location and type of employer, the job outlook for medical billers and coders in Idaho is very optimistic according to the United States Bureau of Labor Statistics (BLS), mainly due to the growing healthcare trend in this state. Moreover, BLS reports that with already 1000 individuals working as professional billers and coders, around 110 more job openings are expected every year in Idaho.

Statistics depicts that top earning potential in this profession in Idaho make a median annual wage of $40,930 while the bottom earners receive $21,180, the average annual medical billing and coding salary in Idaho being $30,910, comparing closely to Alabama salaries of approximately $29,000 annually.

According to the BLS data, the job outlook in Florida as well looks very promising with the top three employers along with other health centers expected to offer numerous jobs in the coming years, largely owing to the retirement of the elderly medical billers and coders in this state. Based on the BLS report there are around 10,880 medical billers and coders in Florida, and the average annual medical billing and coding salary is $33,860. Florida’s being one of the states in the US that have different pay rates for its billers and its coders, the top earners make around $53,930 in a year while the bottom earners get $20,590.

Analysts at Altarum Institute’s Center for Sustainable Health Spending reported in their latest labor brief an all round growth in health care employment last month of 23,000 jobs, nearly reaching the two-year average. Five US states depicting high potential of growth for education and health services where health care jobs are likely to grow the most are:-

Florida – 4.8 percent

Kentucky – 4.2 percent

Delaware – 4.1 percent

Wyoming – 4 percent

West Virginia – 3.9 percent

Source: Moody’s Economy.com

Medical Billing Outlook:  Compared to the average for all occupations through 2014, medical coding jobs are expected to grow the fastest according to the Bureau of Labor Statistics.

Current and Projected Employment:
2008 Employment	528,800
2018 Employment	609,600
Employment Change	80, 800
Growth Rate	15%

A medical biller’s job is more secure with a strong background in medical coding due to the increased amount of paperwork involved in filing insurance claims. Health care has grown with the scope of health information management over the past five years and to combat the shortage of billers across US states one of the new techniques evolved include contract services.

Contract coding companies have emerged as a trend and have become nearly a $5 billion dollar business and are now helping many hospitals in US states to increase their revenue by almost 50%. Due to outsourcing hospitals and physician revenues are rising and in turn coders salaries too are increasing as they can earn 20 to 25% more than what is offered at most hospitals. Medicalbillersandcoders.com’s coding professionals are well versed with the industry needs and standards. We have 1000 medical billers and our certified medical coders are constantly trained and upgrading themselves to completely understand the procedures to be coded. The medical coding professional works as part of a team to achieve the best quality patient care and revenue maximization.