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.

Utah Medical Billing | Pediatrics Medical Billing

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:
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108 West, 13th street,
Wilmington, DE 19801
Tel : +1-888-357-3226
Email : info@medicalbillersandcoders.com
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