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.

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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