Healthcare Systems Adopt Trend of Outsourcing in the New Era of Value-Based Care

Accountable Care Organisation

In the time when both, federal and provincial healthcare quality initiatives have come up with healthcare reforms, thus making EHR mandatory in order to avail the incentives under ARRA, the compliance with Medicare Medical Billing norms, demand of documentation under Medicare’s Accountable Care Organisation (ACO) model and the transition of both ICD 10 and HIPAA 5010, health care documenting in healthcare would probably never be the same. Though these reforms have been introduced with the sole aim of increasing the clinical and operational efficiency in healthcare organizations, the physicians have a lot to cope up with and this can hinder them from focusing in their function of providing medical services.

In the era of value based care, physicians find it tough and time consuming to balance administrative along with their prime function of patient care on their own. Outsourcing the administrative processes which needs expertise and resources is significantly more appropriate approach when these aren’t available in house. Health care organizations and physicians are increasingly seeking contractors for services like billing, coding, medical staffing and information technology services in order to bridge the gap. The companies providing these services have no doubt proved to be beneficial for the growth of its clients. Moreover, it has been found that the growth in outsourcing between the 2010 and 2011 was reported to be around 13.1% with 20 outsourcing firms which served 16,463 clients.

Benefit of Outsourcing

Partnering with an outsourcing firm has brought more technology and expertise in the industry, thus expanding the job options in the field, along with helping physicians extract most of the money for the services they deliver.  Contrary to the popular belief that the small healthcare firms do not need outsourcing, truth is small facilities too are finding it beneficial to outsource as they adopt electronic billing and EMR implementation along other reforms in the new era of value-based care.

Outsourcing the task of medical billing relieves the medical professional from various administrative tasks. The health care organization can be saved from a few issues which are unavoidable like:

• Staff retention: with the outsourcing process, healthcare organization need not worry about recruiting, managing & retaining billing staff and training new billing staff  when old staff retires or moves on, hence helping in smooth functioning of the billing process
• Billing possible on all days: with in-house billing there is complete dependency on fixed staff members and in case of absence of any of the staff members or any holiday, the billing process is kept on hold, but with outsourcing this headache is eliminated ensuring on-going billing process throughout the year

Outsourcing can make your office run more efficiently and systematically with small investments which although go unnoticed, but are considerable in total like postage charges and telephone bills also reduce. Added costs for labour, office system and other operational expenses are also reduced considerably. Furthermore a better turnaround time with better revenue cycle is guaranteed along with improved collection rate on an average of nearly 20%.

MedicalBillersandCoders.com the biggest consortium of billing and coding experts, has been assisting medical practitioners and health care workers for over a decade now towards betterment of revenue cycle and management of administrative tasks. Our billing and coding experts are also constantly trained and updated with the latest reforms, thus rendering the clients stress free and relaxed as far as revenue is concerned.

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid/TRICARE. While insurance payers (whether Federal or private) essentially cover health risks of the insured, they differentiate themselves with their respective restrictive operational requirements. The impact of this restrictive payment environment is such that health care providers are increasingly finding it difficult to procure their payments on time. And, with the Federal Government inclined to make health insurance mandatory, care providers’ only hope is to find a way to deal with multiple regulatory insurance payers.

Unlike United Kingdom and Canada, which have single-payer system, US is characterized by Federal and Private Payer systems. And Federal system is again sub-divided into Medicare/Medicaid/TRICARE.

The majority of insured Americans receive their health care (insurance) coverage via a private insurance company. Currently in the country, 59.3% of all insured Americans have coverage through private insurers. These private insurance holders can once again be classified under:

• Group insurance, which is availed through an employer with provision to cover spouses and children, based on the particular package
• Individual Insurance, which is purchased by the insured himself to cover his or his family health risks
• Managed-care plans: The two most popular types of managed-care plan providers in America are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). An HMO plan will have a predetermined facility and doctor for you and/or family. When you need treatment, you will have to visit the contracted facilities and see the contracted physicians in order for the insurance to pay the bill

With so many variants of private healthcare policies, healthcare providers usually have a hard time understanding and billing with private payers. The stress is so much that it is actually started to impede their clinical efficiency, which is their main concern. There is a whole lot of stressful restrictions that providers will come across, such as:

• dealing with deductibles and copayments,
• establishing medical necessity of a procedure
• dealing with preexisting conditions

Though dealing with Federal Payer system is relatively less difficult, providers have to deal with state-specific rules that govern Medicaid/Medicare:

• With the Federal Government hinting at extending Medicare base from the current 28%, providers will have more Medicaid/Medicare supported visitors
• Federal Government entertains Medicaid/Medicare beneficiaries’ bills from only a few designated providers. Therefore, care providers have an overriding duty to check insurance authorization prior to administering medical services
• Further, Medicare/Medicaid is also bound by restrictions on repetitive, pre-existing, and quantum of admissible medical expenditure to its beneficiaries

If understanding multiple payer system and their respective restriction constitutes half of the battle, billing and coding in ICD-10 and HIPAA 5010 Version will constitute the other half. But, providers, with their clinical efficiency at stake, would do well to assign these operational issues to external billing consultants.

Medicalbillersandcoders.com with credible history of helping physicians realize maximum claim realization amidst multiple payer environment – will help make the task a lot easier. Our medical billing professionals are highly trained and certified with experience in handling multiple payer environment and the latest coding practices. Their expertise combined with our technology edge is a sure way to turnaround your practices’ revenues.

The Financial Importance of Timely Medical Claim Submission

The importance of timely claims submission is not lost on physicians or their staff and is an integral part of the revenue cycle management (RCM). The dynamic nature of the health industry and the reforms has further exacerbated the already volatile situation when it comes to claim submission, denials, and re-submissions. There are numerous factors that affect the efficiency of the claim submission process and these may range from type-o errors to other issues regarding medical billing and coding or policy matters. Moreover, the tendency to deny or reject claims based on simple errors seems to be the unwritten principle of most of the insurance companies in the market which further hampers the whole RCM process, thus affecting physician revenue and patient satisfaction.

The most important aspect in RCM is the timely filing of claims that has an undeniable impact on how much and when the providers get paid. There are, however, numerous hurdles in timely filing of claims that can be encountered in a clinic and by their staff or even medical billers and coders:

• One of the most common hurdles in timely filing of claims is the fact that simple errors can and do occur while submission and this rate is even higher for an in-house staff that juggles with numerous issues and interacts with numerous payers
• The biggest hurdle in timely filing is resubmission which is when the claim is denied and filed again due to some error or incompetence on the part of insurance companies
• However, there are other more practical hurdles such as unavailability of time, work pressure on staff, increased demand, and other pecuniary factors that influence the timely filing of the claim

The most important factor that affects the timely filing or submission of claim is whether the in-house staff is handling claim submission or interaction with payers or if the complete RCM process has been outsourced to a professional billing company that not only has competency and professionalism but is also professional and scientific in its approach. The dynamic insurance market also plays a role in the timely submission of medical claims and the rules and regulations governing various providers are also responsible for influencing the way in which claims are filed. Usually claims should be filed within 30 days of the day when the service(s) was provided; however, this may differ according to the provider policies and government guidelines.

There are many ways of dealing with the issue of untimely claims submission and its inevitable negative repercussions. However, the most important method of ensuring that claims are filed on a timely basis is to analyze the whole process of RCM so that the lacunae and repeated errors can be isolated and corrected. For instance, if a provider is denying more claims or is denying claims even when filed in a timely manner, then such situations need to be analyzed and resolved immediately. This process of finding habitual and regular errors in the process of timely submission can be easily handled by a medical billing specialist in a better manner compared to a novice or an in-house staff member.

The inevitable impact of the health reforms on claim submission and RCM is palpable in the form of adoption of 5010 platforms, Electronic Health Records (EHRs) and numerous other factors and requires specialized training and skill that can only be achieved by dedicated professionals who are capable of submitting claims in a timely manner. Moreover, recent issues such as the rapid changes in legislation, intervention of the Supreme court, legal, financial, and administrative issues surrounding ‘Obamacare’ have made it necessary to have specialized professionals who can keep up with the changes and assist in timely submission of medical claims.

Medical billers and coders at www.medicalbillersandcoders.com are not just HIPAA compliant and legally updated but also perform research and analysis of claims and strive to achieve the maximum efficiency through a scientific approach, be it claims submission or accounts receivables. To find more information and for consultancy as well as other medical billing and coding services.

Predicting the scope of medical billing consultants after 2014 and beyond

Although it has been quite a while since the Federal Government announced a series of far-reaching healthcare reforms, we are yet to experience their full impact across the healthcare continuum. And, with the Senate bill deferring a major chunk of the reforms further, it is expected that we may have to wait as late as 2014 to witness their full impact.

Amongst a string of reforms that will take effect from 2014 are the ones emanating from the Patient Protection and Affordable Care Act, which will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act:

• Access to affordable coverage for the uninsured with pre-existing conditions, which means the act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions
• Re-insurance for Retiree Health Benefit Plans, wherein the act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees
• Closing the Coverage Gap in the Medicare (Part D) Drug Benefit, under which the act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500. There would also be guarantee of 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap
• Extension of dependent coverage for young adults, wherein act requires insurers to permit children to stay on family policies until age 26

Coupled with this set of reforms, which are believed to improve physicians’ revenues, there are also reforms that are likely to test their ability to practice delay-and-denial-free reimbursement practices:

• The Accountable Care Organization Model, which requires physicians to realign their practices in congruence with Medicare incentive framework
• The ghost of Sustainable Growth Rate (SGR) fix, which threatens to substantially erode physicians’ share of Medicare reimbursements
• Last but not the least, the radical ICD-10 and HIPAA 5010 compliant clinical and coding practices, which, though indispensable to reduce healthcare fraud and abuse, are going to force medical practices into a more stringent reimbursement environment than ever

While the impact of the ensuing healthcare reforms are going to be felt across the whole healthcare continuum, it is the medical billing practices that would be most affected. Therefore, it is going to be crucial that medical billers and coders respond with highest degree of professional dynamism to mitigate the chances of physicians’ medical claims running the risk of denial or delay. When one thinks of the possible areas that medical billers and coders would be addressing post 2014, the following come up to the fore:

1. Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
2. Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
3. Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
4. Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physicians’ medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
5. Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
6. Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s medical billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

As physicians, in the wake of these sweeping healthcare reforms, look to elevate their billing and coding practices through outsourced medical billing services, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – should be a preferential choice for streamlined medical billing practices.

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.

For more information visit: medical billing companies

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.

Browse All: Medical Billing Companies, Medical Billing Services

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.

Medical Billing professional’s career prospects brighten

Growth in Employment of medical record and health information technicians is expected to accelerate much faster than the average field according to the United States Bureau of Labor. The Bureau of Labor Statistics reported health information technicians are one of the 10 fastest-growing allied health occupations, being a challenging interesting career where you are compensated according to your level of skills and how effectively you use them.

Evolving prospects

Medical billers and coders requirement is escalating almost exponentially due to an aging population and changes in medical technology. As the healthcare field shifts patient documentation to electronic data storage methods, health information filed is undergoing a radical change and positions related to medical billing and coding demand will as a consequence, provide lots of options in the market.

• Expand your outlook- Medical billing professionals at this point can widen their scope of work, coders who have been serving one clinic for 15-20 years with their experience can expand their outlook and include a group of clinics in their network and consult and train other younger medical billing entrants
• Accountable Care Organization model – is attracting the attention of hospitals, hence changes in hospital billing structure and increased patient volume will require increased coders to align this process.  The Bureau of Labor Statistics’ Occupational Outlook Handbook reported Medical billing and coding demand accounted for 40% of opportunities in hospitals and the rest in provider offices, nursing care, outpatient centers and home health service areas
• Income Potential- Medical billing and coding demand in big cities equals to more wages compared to smaller cities, and hospitals offer better compensation compared to clinics. According to statistics, the median income for medical billing and coding jobs ranges between $35,999 and $44,562, topping out around $74,000

Moreover the U. S. Bureau of Labor Statistics is predicting an 18% growth in job prospects between 2006 and 2016 and Pharmacies and insurance companies are also experiencing a growing medical billing and coding demand. Besides being restricted to only the doctor’s office the scope of medical billing has now grown to hospitals, pharmacies, nursing homes, mental healthcare facilities, rehabilitation centers, insurance companies, health maintenance organizations (HMOs), consulting firms, and health data organizations, or even from home.

Coders who are proficient with healthcare compliances like the Health Insurance Portability and Accountability Act (HIPAA) are already on the way to changing their work scope, Medicialbillersandcoders.com experts fulfill this need as key players in the healthcare workplace to deliver quality healthcare by capturing accurate and timely medical data. Our Coding professionals possess a thorough understanding of the health record’s content we have thousands of medical billers and our certified medical coders are trained to understand procedures to be coded better.

Increased usage of Mobile Devices by Physicians while accessing medical records

Smartphones and other mobile devices have made it easier for physicians to perform some of their duties from any remote location and have also pushed many physicians to test the plausibility of these technologies being used in the healthcare industry. CompTIA, an information technology association, survey reported that 56% of physicians are using smartphones, and 25% are using tablets for work. However, there have also been some concerns over the security of patients’ privacy and the information about the health of a patient. Hence advantages of using mobile technology come with its own risks and threats.

Some of the most common wireless threats to physicians include device risk content where the data on the device is susceptible to malicious executable files, unauthorized intrusion risk where unauthorized third parties may gain control and data integrity, confidentiality and authenticity risk where patients data could travel from the mobile device to the access point without being integrated and this can compromise the patients data to third parties. However, these threats can be reduced by protecting patient data when transferred between devices.

Usage of mobile devices by physicians in hospitals as well is advantageous to physicians as mobile access helps in drawing more value out of the big investments hospitals have made in electronic records. However, patient data needs to be protected and to further elaborate this – The National Institute of Standards and technology (NIST) has released a report regarding the security of information as far as storage devices are concerned.  Additionally a report by the United States Department of Health and Human Services titled “Reassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care Practices” states some of the methods in which HIPAA compliance can be maintained.

In the changing healthcare industry, usage of mobile technology to access Electronic Health Records is vastly advantageous and almost imperative, however physicians need to maintain patient privacy through administrative, technical and physical safeguards and observe HIPAA guidelines and physicians pressed for time can make this possible by outsourcing their services.

Medicalbillersandcoders.com well updated with HIPAA compliance and other issues related to the Health IT sector, maintain utmost confidentiality regarding client data. Equipped in handling all the administrative and technical details to preserve patient’s data security, MBC has guided thousands of practices across the 50 states in the US to exchange data securely and supported doctors to automate their practices making healthcare more electronically secure.

Meaningful Use’ Compliant EHR Technology Implementation – specialists’ perspective

“While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners.”

There has hardly been anything that has got as much an attention as the CMS’ Meaningful Use criterion for medical practitioners – a program for eligible practitioners to be able to qualify for Medicare incentives upon meeting a certain set of core objectives set out in the Meaningful Use Clause under the ARRA. Although CMS has laid down guidelines for general practitioners, who serve the bulk of Medicare beneficiaries, yet their specialist colleagues – such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. – are not out of the CMS’ Meaningful Use ambit; after all they too are indispensable to CMS’ initiative towards an efficient healthcare environment. But, because their service-composition and documenting varies from general practitioners, specialists’ requisite compliance with core objectives set out in the Meaningful Use Clause under the ARRA gets a little different.

Recognizing the diverse nature of specialists, CMS has allowed for certain exceptions and exemptions from complying with certain objectives that does not owe allegiance to these specialist practices. Therefore, of the 20 mandatory objectives to be met out a possible list of 25, specialist practitioners can still seek exemptions on the ground of being unique fields of medicine. Consequently, their mandatory objective-list ultimately becomes less than 20; while CPOE, eRx, Vital Signs, Smoking Status, Electronic Copy of Health Information, and Clinical Summaries are usually allowed exemptions from Meaningful Use objectives, the following exclusions may still be claimed under substantiated evidence: Drug Formulary Checks, Clinical Lab Test Results, Patients Reminders, Patient Electronic Access, Medication Reconciliation, Summary Care Record, Immunization Registries Data Submission, and Syndromic Surveillance Data Submission.

While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners. Thus, everything points towards sourcing and implementing EHR software’s that best serve unique needs of diverse practices while also being compliant with the CMS mandate on Certified EHR Technology for achieving Meaningful Use criterion bench-mark.

Despite the market being replete with numerous EHR software – a prior advisory on judicious selection is always advisable as any hasty selection can have multiple repercussions: adverse impact on clinical documenting, practice management, and revenue generation. Given the prevailing scenario, Medicalbillersandcoders.com proven credentials in advising and implementing certified EHR software platforms –  Medisoft , Misys Tiger, Eclinicalworks, Advanced MD, Office Ally, Sage Medical Manager, GE centricity, Lytec, Altapoint, Dentrix being some its leading names in an exhaustive portfolio innovative and futuristic models – for diverse clients comprising Allergy, Anesthesiology, Cardiology, Dermatology, ENT, Endocrinology, Family Med, GI, Geriatrics, Internal Medicine, Long-Term Care, Multi-Specialty, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Ophthalmology, Optometry, Orthopedics, Pediatrics, Plastic Surgery, Podiatry, Psychiatry, Psychology, Pulmonology, Rheumatology, Surgery, SurgicalCenter, Urgent Care, Urology, and the rest.

About Medicalbillersandcoders.com (www.medicalbillersandcoders.com)

Medicalbillersandcoders.com has been a leading source for comprehensive medical billing revenue cycle management. A talent-pool of qualified and competent medical billing professionals with diverse skills specific to unique needs of multiple medical disciplines has been instrumental in our being a leading consortium for medical billing management.

Doctors contemplate opting out due to continued Medicare hassles

Physician participating in the Medicare program are scheduled to face a 27.4% cut in their payments, effective 1^st January, 2012, and with providers anyway complaining about current reimbursement rates, the cut is likely to considerably impact both patients as well as doctors adversely. As a result of the cut the Medicare physician conversion factor will decrease to $24.67, approximately $15 less than it was in 2001. In this scenario, the Association of American Physicians and Surgeons reports that various physicians are declining to take on new Medicare patients and many are thinking about cancelling enrollment from the program.

Medicare hassles:

Since the past 10 years physicians and Congress have been grappling with similar situations; however the difference which is pushing doctors to consider opting out is the severity of the cut and the escalating costs of a permanent solution, and few can continue to operate in an environment where revenues are cut by 27% while costs continue to rise at a rate of 3% or higher. An internal medicine physician in New London whose approximately 80% patients are covered by Medicare, with this cut is likely to lose about one-third of his revenues, possibly forcing him to restructure his entire practice.

Another issue that has created problems for Medicare beneficiaries and their medical providers for years is the sluggishness of the claims process and the payment process. Medicare doctors in three western states – California, Hawaii and Nevada, are in a situation where Medicare’s payment backlog has created a multimillion dollar problem.  Various doctors have not been paid since February, a backlog of almost 10 months,  forcing some doctors to have to drop some or all of their Medicare patients while others are on the verge of declaring bankruptcy or have already done so.

Physicians’ current & upcoming scenario:

President of the New London County Medical Society said that the prolonged uncertainty about Medicare reimbursement rates has motivated some doctors to take an early retirement. A survey by the Medicare Payment Advisory Commission (MedPAC) indicates that by 2025 there will not be enough primary care physicians. Additionally, this cut comes at a time when physicians face potential penalties associated with  HIPAA 5010 , electronic prescribing, ICD-10, PQRS and electronic health records which are difficult to adhere to in a time of dramatically falling revenue.

However, even though physicians are pushed to consider other options, in the next 20 years senior citizens requiring Medicare will rise, and doctors who can sustain the current pressures and adapt to the reforms have a vast potential for growth. The physicians need to face this challenge of payment cuts by making their system more efficient; reduce their extra administrative burdens and revamp their revenue cycle giving them a competitive edge. Medicalbillersandcoders.com can optimize physicians’ billing process and reimbursement cycle, which will help doctors maintain their revenues as they tackle Medicare issues.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.