Thursday 22 September 2011

Importance of IT for a Clinic

‘Notwithstanding their knowledge of how IT can do a world of good to their practices, it is the overwhelming investment on the constituents of Healthcare Information Technology that often is the bone of contention’


‘Incredible’ is the word that can best describe the way Information Technology has transformed health care industry – revolutionizing a human-intensive industry into technology-driven industry, IT has become indispensable in storing, retrieving, sharing, and using health care information, data, and knowledge for communication and decision making. Devising ingenious hardware tools and software applications, custom-made to the healthcare industry, Information Technology has taken the level of medical efficiency to unprecedented heights. Consequently, there has been appreciable


  • Improvement in health care quality
  • Prevention of medical errors
  • Reduction in health care costs
  • Increase in adminis\trative efficiencies
  • Decrease in paperwork
  • Expansion of access to affordable care

Therefore, it should not come as a surprise that a majority of hospitals in US are IT enabled – the recent Federal Healthcare Statistics puts it an impressive 60% of the total healthcare providers across the U.S. While the statistics holds true for hospitals, and multispecialty groups, it is the marginal clinical practitioners – who fall into non-adopter category – that need to be advised on the efficacy of being IT enabled. Notwithstanding their knowledge of how IT can do a world of good to their practices, it is the overwhelming investment on the constituents of Healthcare Information Technology that often is the bone of contention.


That brings us to discuss the various constituents of a comprehensive Healthcare Information Technology:


  • Electronic Medical Records: Apart from reducing errors in prescription drugs, preventive care, tests and procedures, Electronic Medical Records enables collaborative access of information related to disease management and patient care, and statistics for federal healthcare policies.
  • Clinical Decision Support (CDS): Clinical Decision Support system is another technological constituent that is integral to physicians’ decision-making on the course of medical intervention for a particular medical emergency. Known for providing historical references to similar medical emergencies, Clinical Decision Support System (CDSS) happens to be indispensable data base for future referencing.

Couple with these main constituents, there are auxiliary systems such as – Health Informatics, which provide crucial data on various medical-related knowledge; computerized physician order entry (CPOE); applications for dispensing including bar-coding at medication dispensing (BarD), robot for medication dispensing (ROBOT), and automated dispensing machines (ADM); and applications for administration comprising electronic medication administration records (EMAR), and bar-coding at medication administration (BarA).


Much like the demands of the constituents that form the core requirements, there is another equally demanding set of constituents that are associated with Medical Bill Submission and Realization with insurance carriers:


  • Electronic Medical Billing: Electronic Medical Billing – which lays the foundation for apt coding – demands the implementation of state-of-the-art technology platforms that demand heavy initial investments, felt imposing by individual or marginal practitioners.
  • Electronic Coding: Much like billing software, coding platforms too tend to be costly and heavy for individual physician practices.

Coupled with these demanding platforms, there are incidental IT adaptations for processing claims online. Despite their insurmountable demands, marginal physicians should invariably make their practices IT-driven as their sustenance and growth largely hinges on how best they adapt to the prevailing scenario in an increasingly IT-driven sector.


Having established the meaningful contribution of IT adaptation, what still needs to be reiterated is the limited ability of individual physicians to actively implement and incorporate these constituents in their processes. Not only do they have to bear heavy costs in implementing these changes but also in providing simultaneous training to upgrade their staff for its successful incorporation in the routine processes. While the incentives offered by the government can ease the financial load attached with the adaptation, the consultancy services offered by MBC, the leading medical billing and coding consortium in the US can go a long way in facilitating the implementation as well as staff up gradation processes.


Medicalbillersandcoders.com is capable of handling their clients’ information technology needs from a centralized state-of-the-art technology interface, presenting timely opportunities to the physicians faced with the ‘Ghost of IT’.


Browse All: LasVegas Medical Billing, Phoenix Medical Billing

Wednesday 21 September 2011

Impact ICD 10

ICD 10: Improving patient care and enhancing ROI


The transition from ICD 9 to ICD 10 codes is the core of the health reforms and marks an era where Health Information Technology is at its zenith in the United States. The conversion from Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010 aims to provide better patient care, speedy reimbursements for physicians, and shorter turnaround time for claims. The codes would be more elaborate compared to the older version and increase the accuracy in medical billing, coding, claims denial, and physician revenue. However, the sheer complexity of the codes and the looming deadlines for expected compliance by almost all the entities in the healthcare industry make it a formidable task.


The Deadlines

The deadline for utilization of ICD-10 codes in HIPAA transactions is October 1, 2013 and includes outpatient as well as inpatient claims. However, since the transition from ICD-9 to ICD -10 codes requires a change from ASC X12 version4010A1 to ASCX12 version 5010, the deadline for transition to 5010 is set for January 01, 2012. There would be a penalty for those who are not HIPAA compliant by the end of 2013 and a danger of falling behind in the quality of care provided to patients along with decreased revenue for clinics, hospitals and physicians.


Compliance Levels

There are two compliance levels – Compliance Level 1 and Compliance Level 2 where Level 1 Compliance according to CMS is “that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing”. This simply means that involved entities should be able to transact with others using the ICD-10 codes. Level 2 states “that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards”. Level 1 Compliance deadline is December 31, 2010 and Level 2 compliance is December 31, 2011 and full compliance is expected by January 1, 2012.


Denial Management

ICD 10 codes would play a major role in denial management since there would be almost eight times the number of codes to deal with and the amount of errors may increase. Insurance companies can simply deny a claim by pointing out a medical coding error whether it is due to non compliance of deadlines or due to the complexity of the codes. However, payers would also benefit from the fact that the ICD-10 codes are more detailed and would help payers to understand the reasons for various steps taken by physicians while providing patient care and whether they should pay for such procedures. Ideally ICD-10 codes should cut down on the turnaround time and make it easier for physicians to obtain speedy reimbursements while benefiting payers who have to spend lesser amount of time on the processes involved in managing claims. However, this is still a theory since it demands due diligence on the part of medical billers and coders as well as payers to make denial management an efficient process.


Costs

The costs of implementing ICD-10 codes are not just limited to software changes but also towards training staff, physicians, and insurance company professionals who would use these codes. Training for a migration from 4010 ICD-9 to ICD-10 codes can be costly and requires time and testing for ensuring efficiency. The easiest way of cutting costs is hiring a third party which is experienced and trained in ICD-10 medical billing and coding, claims denial, and armed with the latest technology to provide optimum utilization of resources at lower costs.


Patient Care

The most important aspect of the transition from the 32 year old ICD-9 codes to ICD-10 codes is enhanced patient care along with successful return on investments (ROI) for hospitals and physicians. ICD-10 codes would be HIPAA compliant and would ensure patient privacy, better provisions in areas such as ambulatory care, would include expanded substance or alcohol abuse codes, expanded injury codes, and combination of codes to make them explicit and transparent. This would benefit the patient in a direct manner since payers, physicians, and health care providers can understand trends, changes and future implication in the health industry and the standard of health as a nation.


For more information on how successful implementation of ICD-10 codes is likely to impact physicians and their billing processes effectively and cost-effectively cope with it, or to know more about our consultancy services on how physicians can handle such and similar issues in their practice, please visit medicalbillersandcoders.com, the largest consortium of billers and coders in the US across all specialties.


For More Information Visit: Seattle Medical Billing, Austin Medical Billing

Consequences of Non-Compliance with Federal Healthcare Reforms

As if the imminent repercussions of Debt ceiling and Sustainable Growth Rate Problem are not enough, physicians across United States are in for an additional dose of disciplining by the Federal Health body, in terms of penalties – both civil as well as criminal penalties – for either negligent or willful defiance of reforms and their deadlines. Although physicians are justified in airing their reaction and treating it as too harsh, yet the move is seen as an additional shield for the imminent Federal healthcare reforms aimed at transforming the nation’s healthcare qualitatively.

Browse All: Medical Billing

Devising a multi-pronged penalty regimen, the Federal Government has identified the mandatory programs that are required to be abided by the physicians desirous of avoiding stringent penalties that can adversely impact their credibility in the medical fraternity.

  • HIPAA Violations and Enforcement

    One of the areas where physicians are prone to civil and criminal penalties is the failure to comply with HIPAA mandate on healthcare reporting compliance. Depending on the severity of negligence the penalty can vary from minimum of $100 to $1.5 million, and 1 year to 10 years of imprisonment. Furthermore, the ensuing Version 5010 HIPAA Compliance – which is deemed more complex than its earlier Version 4010 – could make physicians highly vulnerable.
  • Non-adoption of Electronic Healthcare Reporting Compliance

    Another area where physicians are liable to be penalized is failure to comply by Electronic Healthcare Reporting compliance as mandated by the Health Information Technology for Clinical Health, or HITECH Act. Parallel to incentives for EHR adoption, it can also penalize Medicare and Medicaid physicians who do not adopt EHRs and use them appropriately. The penalty regimen will start with penalizing Medicare physicians for not meeting meaningful criteria in 2015: at 1 percent of Medicare allowed charges in 2015, and 2 percent in 2016 and 3 percent in 2017. Such impositions can hit solo and small physician practices hard, which may lack the resources to adopt health IT.


  • Imminent Repercussions of Debt Ceiling and Sustainable Growth Rate Problem


    Putting more weight into the heavy baggage are the repercussions of imminent recommendation of Affordable Care Act – which has mandated implementation of Accountable Care Organization for incentive based payments for Medicare physicians; imminent fix to perennial Sustainable Growth Rate (SGR) problem – which forecasts either an across the board 2 percent cut to Medicare physicians, or writing off of cumulative (already around a negative 22 percent) against Medicare physician payments, which would virtually render them cashless; and last but not the least, the impact of Debt ceiling, which can limit healthcare funding substantially resulting in an adverse situation for physicians.

Physicians, left with no choice but to comply by the Federal healthcare reforms, will inevitably be driven to search for the medical billing companies who can execute compliance programs as part of their comprehensive medical billing management. Medicalbillersandcoders.com who have been industry leaders for over a decade, are ideally poised to accomplish the compliance programs on their clients’ behalf with literally hundreds of AAPC-certified medical billers nationwide across all specialties who are tech-savvy, experienced, and constantly upgrade their professional knowledge and skills. Along with these services, Medicalbillersandcoders.com offer comprehensive consultancy services for operational, strategic, and financial solutions to support you in focusing on your core competencies. Houston Medical Billing , Chicago Medical Billing

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.

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

PCMH: Assisting Primary Care Physicians as well as Patients

A Patient Centered Medical Home (PCMH) is not a particular type of hospital or building but an alternative approach to delivering health care that provides coordinated, continuous patient-centric medical care, managed by a team of individuals led by a physician. PCMHs employ the latest technology available to make optimum use of time and funds in order to deliver best possible healthcare to the patients. Although the concept is not new it has gained recognition and popularity among patients and physicians alike due to the recent health reforms. There are numerous pilots being carried out in various parts of the country and the results are positive and fruitful for health care providers and patients.

Browse All: Medical Billing

Coordinating patient care

Primarily, a PCMH integrates care across the healthcare spectrum including specialists, hospitals, therapists, laboratories, druggists, and home health to avoid duplicate care and curtail errors. It aims to assist physicians in keeping up-to-date with the patient history and also helps patients by giving them the opportunity to receive care from one physician over long periods of time. This simply ensures that the physician knows the patient history and the patient trusts the type of care that is being provided. This in-depth knowledge of a patient’s history in a practical manner and on record allows physicians to make decisions that are relevant and efficient at the same time. It also offers extended hours which goes a long way in keeping patients out of expensive emergency rooms. Moreover, by sharing the information and decision-making with the patients, it enables and supports them to manage their own care and keep healthy.

Health Information Technology

The healthcareIT sector is another feature of PCMH that helps primary care providers to enhance the efficiency of the work flow process, improve the quality of care, and provide outcome measurements as well as accountability. Physicians, nurses and primary healthcare providers are using this technology to make informed decisions on the latest and real-time information available due to Electronic Health Records (EHR).

Time

The time factor plays a vital role in the health care industry and patients and physicians can suffer due to the delays in various process. PCMH aims to ensure that patients can visit a health care provider without scheduling on the same day that they think they need a health check up. Time is also saved due to the e-prescriptions which are a feature of PCMH and let the physicians prescribe medicines online. Moreover, due to such e-prescriptions, patients do not have to wait for their medicines since they are already ready to be delivered when the patient visits a PCMH.

Money

In the PCMH model, cost effectiveness results from enhanced care and improved patient health, which reduce the need for healthcare services? Patient Centered Medical Homes not only increase the efficiency of primary care physicians but also help in augmenting the revenue by rewarding the quality of the outcome rather than the volume. PCMHs are also good for the revenue and affordable for patients because of the incentives provided by the government to physicians to adopt new technology such as EMR or EHR. The New England Journal of Medicine has reported that PCMH increase the revenue because of the sharing of savings among many physicians as a coordinated effort.

The Future

The future of PCMHs is good for primary care physicians who can increase their revenue and provide better care for patients. This can be especially effective in caring for ailments such as diabetes, chronic illnesses, and enhance preventive care. However, it can be more beneficial for primary care physicians rather than specialists and thus provides a solution to the most problematic area in medicine in the United States. PCMHs can act as an efficient entry point for patients in the health industry and provide long term primary care for patients.

For more information on how PCMHs are likely to impact Primary physicians and their billing processes effectively and cost-effectively cope with it, or to know more about our consultancy services on how physicians can handle these and similar issues in their practice, please visit medicalbillersandcoders.com, the largest consortium of billers and coders in the US across all specialties.


Source: Medical billing (http://www.medicalbillersandcodersblog.com/medicalbilling/pcmh.html)

Have you implemented your EMR successfully

Successful EMR Implementation: Vital Signs

The implementation of Electronic Medical Records (EMR) is an integral part of the recent health reforms and many hospitals, clinics and physicians have already started using EMRs successfully. There are numerous ways to gauge the efficiency and the compliance of EMRs with government guidelines to be eligible for the incentives provided by the Government. Successful implementation of EMR or EHR entails numerous criteria laid down by the government such as “meaningful use”, and other guidelines that can range from recording patient information using EMRs to E-prescriptions. However, there are several other additional factors that determine if the EMR that has been in use is successful and would remain that way in the future.

Meaningful Use

The most important aspect of successful implementation of Electronic Medical Records or EHR is the Meaningful Use criteria. If the EMR is not being used in a meaningful manner then physicians may not qualify for the incentives and also end up wasting time, effort and money because of improper use or major technical problems. This can lead to a decrease in revenue and a drop in the quality of care provided to the patient and completely defeats the purpose of EMRs and EHRs. There are 15 core requirements under the stage 1 of Meaningful Use and hospitals and physicians can analyze whether all these requirements are being met. There are another set of requirements out of which at least 5 must be met in order to demonstrate meaningful use.

Technical Analysis

The successful implementation of EMRs also depends on the technical performance of the various systems involved in the healthcare IT sector. It is important to analyze whether there have been problems with particular software and what type of support the vendor has provided after implementation. It is also essential to analyze whether to hire a technician if there have been disruptions due to technical hurdles. Good technical support can ensure that the system being used for EMRs is safe from hackers and patient privacy is not jeopardized.

Cost Benefit Analysis

The cost benefit analysis of EMRs can be calculated not just monetarily but also in the form of the quality of the care provided to patients. The cost of successfully maintaining and using EMRs is certainly justified if physicians and hospitals can qualify for the incentive which means that an effort toward better patient care is being carried out even as costs. Some of the costs that EMRs will directly cut are towards maintaining and storing paper records, costs related to the software itself which will partially be paid off by the incentives, administration costs, and the cost of opportunities foregone due to time constraints.

Reduction of Errors

EMRs can provide a system to physicians, hospitals, administrators, and medical billers and coders that helps in reducing errors. The reduction of errors directly impacts costs as well as patient care so analyzing the amount of reduction in errors in medical billing, medical coding, and administration can assist in deciding whether the EHR implementation is successful. Moreover, reduction in errors can also save time for physicians which can be utilized for concentrating on better patient care.

Feedback

The successful implementation of EMR involves not just the technology but also the people who utilize it on a daily basis. Taking feedback about the EMR from the medical staff and administrators can help physicians in gauging the success of the implementation of the EMR and help in analyzing the strengths, weaknesses, opportunities and threats in the system. The feedback can be in the form of staff meetings or discussions where problems related to EMR and other related issues are taken up. Such feedback can also be taken from medical billers and coders who have experience in dealing with payers and the changing technology as well as the latest compliance guidelines. However, the best feedback is in the form of monetary results and better patient care which can be strong indicators that the EMR implementation has been successful.


For more information on how successful implementation of EMRs is likely to impact physicians and their billing processes effectively and cost-effectively cope with it, and to know more about our consultancy services on how physicians can handle EMR implementation better and similar issues in their practice, please visit medicalbillersandcoders.com, the largest consortium of billers and coders in the US across all specialties.

Tuesday 20 September 2011

Physician Staff Shortage: Problems &Solutions

There is an acute shortage of medical billers and coders along with other clinical staff for physicians in the United States and the health reforms are making it even more difficult for providers to recruit experienced and well trained staff. The recent health reforms bring with them numerous changes in the way in which reimbursement is processed by insurers or payers in addition to the reforms in medical billing and coding.

Moreover, the extensive utilization of healthcare IT in the form of Electronic Medical Records (EMR), Electronic Health Records (EHR) and such other technologies makes it important for physicians, hospitals and clinics to quickly adopt such changes or lose time, money, and even patients. Here are a few ways in which these hurdles can be overcome in order to ensure timely and correct reimbursements for health care providers without sacrificing the quality of care that is provided.

Training Costs
The changing face of the health care industry due to changes in medical billing and coding procedures, the migration from ICD-9 codes to ICD-10 codes, the adoption of HIPAA 5010 platform, integration and standardization of data related to health care, and the health care IT sector reforms necessitate rigorous training. This training is not just limited to medical billers and coders but is also required for nurses, assistants, and insurance companies. However, training requires a lot of time and money because of the sheer volume and complexity of codes, adoption of new health care IT reforms, and compliance of HIPAA guidelines.

By outsourcing your billing and coding requirements fully or partially to a third party vendor such as medicalbillersandcoders who can expertly implement and integrate medical billing and coding along with denial management and has the requisite training updates in the latest guidelines and codes, can substantially cut down on your training costs. The MBC consultancy experts can also motivate the physicians’ team to adopt these compliances by underlining their relevance in effective patient healthcare and RCM management.

Testing hiccups
Physicians, hospitals, payers, and medical billers and coders are required to test the new codes for HIPAA compliance in various stages. The best way to ensure that you as a health provider do not lag behind at any stage due to the inevitable testing hiccups is to delegate the responsibility to a professional third party such as medical billers and coders who can effortlessly integrate these upgrades and compliances into physicians’ system through the testing and transition phase as also after the regulation deadline, thus increasing revenue and saving time and hassle.

Technical Support
The implementation of Electronic Medical Records and Electronic Health records would also require technical support for ensuring there are no delays due to downtime of software or hardware. Many physicians and small clinics have successfully installed the required hardware or technology but have lost precious time and revenue due to system crashes and downtime. A professional medical billing and coding company can ensure that there is minimum damage due to technical glitches since they usually have dedicated professionals who can handle such situations and get the system fixed whenever there are technical difficulties.

Handling Errors
Many hospitals and health care providers have found that errors while coding and billing can lead to denied claims and loss of time as well as revenue. Moreover, the quality of patient care can drop due to this directly impacting the revenue of clinics, physicians, and hospitals. The best way to ensure that no errors are committed by the staff is to outsource the complete process of billing and coding and denial management to a company that is an expert in handling billing, coding, and other related administrative services and ample experience.

This would directly lead to reduction of errors and ensure that claims are not denied just because of wrong entries in the system. Moreover since the number of codes would increase more than six times after adopting 5010 platform makes it crucial that the billing, coding, and interaction with payers is delegated to an experienced and already trained staff instead of investing in training and testing of new codes and standards.

For more information about better solutions to physician staff shortages and professional medical billing and coding services please visit medicalbillersandcoders.com, San Francisco Medical Billing, SAN JOSE Medical Billing.

Sunday 18 September 2011

Physicians Apprehensive of Retiring Early: Recourse to Feasible Medical Practice

There seems to be no respite for physicians, who are already reeling under immense pressure from radical healthcare reforms introduced by the Federal Government. Faced with prospect of unsafe retirement life in the face of continuously receding economy, physicians – who earlier had planned retirement in 5-6 years – are actively reconsidering such plans. The recent survey by the physician recruitment firm, Jackson & Coker – has found 52 percent (of the total 522 physicians interviewed) to have deviated from their original stand of going in for an early retirement. Attributing their rethinking to adverse factors — devalued assets, the continued economic uncertainty, governmental cutbacks on healthcare spending, and a general lack of confidence – the survey has been able to delve deeply into physicians’ alternative course of action.

The survey goes on to highlight the growing level of dissatisfaction with governmental healthcare policies, amidst which physicians would find it difficult to sustain a feasible medical practice. Foreseeing an adverse future, many physicians are contemplating:

  • Working part time or locum tenens,
  • Intensifying their present practice further
  • Switching position in the same field
  • Deviating to a new thing altogether

Therefore, it is timely that such an exodus be mitigated in the larger interest of the healthcare-needy population, which is growing at an alarming rate already. And with an impending population of senior citizens eagerly waiting to be inducted into Medicare, the situation is going to get worse. Since the Federal Government has made it clear that there is no going back on reforms, physicians have the added responsibility of finding recourse somehow.

Browse All: Medical Billing

While the reasons for such drastic measures are profound, physicians – who are justified in their instant reaction to impending problems – need an extra degree of caution prior to arriving at any decision for which they would repent later. Having been physicians all through their lives, it is advisable that they continue doing what they know best. And as far as addressing governmental healthcare impositions is concerned, there is always recourse to engage competent professionals who can ensure sustainable practice through:

  • Setting Up Electronic Medical Recording Compliance (EMR) for Incentive Eligibility
  • Advising on feasible composition for Accountable Care Organization (ACO)
  • Efficient Management of Medical Billing Reimbursement
  • Proactive measures for cost-effective implementation of ensuing ICD-10 and HIPAA 5010 Compliant System of Health Recording
  • Owing and executing all compliance and administration functions that would relieve physicians off an undesirable burden, and concentrate on their core-concern (medical efficiency) for sustenance and growth.

Physicians re-considering moving to part time practice require effective administrative support to optimize the part time investment of time and effort in delivering quality healthcare. Expert support on reimbursement and appointment scheduling can help physicians have a profitable part time practice as well.

Physicians looking to “Intensifying their present practice” need to manage their practices more efficiently by focusing on the healthcare as their core service and relying on reimbursement experts to enhance revenue in a growing practice. Expert Medical Billing professionals can facilitate the initial return on investment strategy better.

Medicalbillersandcoders.com, with a long-standing credibility for owning and executing their clients’ compliance and administration functions in congruence with the prevailing standards, can prove to be an ideal ally in such a scenario. Armed with extensive multispecialty experience and expertise in billing and coding and healthcare IT-related services, MBCis well equipped to extend professional support to healthcare providers by optimizing their existing practice.

The largest consortium for professional billers and coders for healthcare providers in the US, MBC offer consultancy services across all states of US, for the implementation of their strategic, operational, and financial purposes, no matter the size of their organization.

For More Information visit: Denver Medical Billing, Nashville Medical Billing

Author Box

Medicalbillersandcoders.com is the largest consortium of Medical Billers and Coders in the United States. We offer Medical Billing, Denver Medical Billing, Nashville Medical Billing, and Washington Medical Billing.

Friday 16 September 2011

Demand for primary care doctors peaks

Gone are the days when radiologists and cardiologist were amongst the most in demand specialties in healthcare; family practice and general internal medicine physicians have taken over as the two top sought after specialties.

According to a survey, need is driving the demand for primary care physicians; listed below are the major reasons for this increased demand:

  • Many healthcare groups are in the process of forming patient-centered medical homes (PCMH), ACOs, and various other employment models which have strengthen the demand for primary care physicians as they form the base for these emerging delivery systems.
  • There is a shortage of primary care physicians as the number of medical students willing to opt for primary care is very low.
  • Practice style and physician demographics are additional factors inhibiting the supply of primary care physicians; many physicians are looking for part-time practice work or more structured practice hours that fit better with their personal lifestyles.
  • Population growth in the United States is creating a greater demand for primary care physicians. An estimated 32 million uninsured are expected to join the ranks of medically insured under healthcare reform, so the healthcare system is likely to register a surge in the demand for Primary care physicians.

For More Information Visit: Dallas Medical Billing, Los Angeles Medical Billing

To attract and retain primary care physlicians, healthcare organizations continue to offer massive signing bonuses and relocation and medical education allowances in recruitment packages. Also, it has become very important for these healthcare organizations to keep their revenue cycle intact in order to properly pay their current employees to retain them. It makes good business sense to improve the revenue cycle by letting an expert handle this; Dallas Medical Billing, Los Angeles Medical Billing, and Washington Medical Billing.

Thursday 15 September 2011

Bundled payment initiative to lower healthcare costs, help coordinate care

A new program to aid and improve patient care while patients are in the hospital and after they are discharged has been announced by the U.S. department of Health and Human Services (HHS).

These initiatives will also motivate doctors, nurses and specialist to perform coordinated care and hence reduce cost. Till date, hospitals, physicians, and other clinicians who provide care for beneficiaries’ bill are paid separately for their services by Medicare. However, with this initiative they can get bundled payments to treat a patient for specific medical condition during a single hospital stay, also termed as episode of care.

Doctors, hospitals and other healthcare providers can apply to participate in this program. It offers four models:

  • Model 1:
    In this model, the episode of care would be defined as the inpatient stay in the general acute care hospital. Medicare will pay the hospital a discounted amount based on the payment rates established under the Inpatient Prospective Payment System (IPPS). Medicare will pay physicians separately for their services under the Medicare Physician Fee Schedule. Hospitals and physicians will be permitted to share gains arising from better coordination of care.

  • Model 2:
    The episode of care would include the inpatient stay and post-acute care and would end, at the applicant’s option, either a minimum of 30, or 90 days after discharge; the bundle would include physicians’ services, care by a post-acute provider, related re-admissions, and other services proposed in the episode definition such as clinical laboratory services


  • Model 3:
    The episode of care would begin at discharge from the inpatient stay and would end no sooner than 30 days after discharge.
    In both Models 2 and 3, the bundle would include physicians’ services, care by a post-acute provider, related readmissions, and other services.

  • Model 4:
    CMS would make a single, prospectively determined bundled payment to the hospital that would encompass all services furnished during the inpatient stay by the hospital, physicians and other practitioners. Physicians and other practitioners would submit “no-pay” claims to Medicare and would be paid by the hospital out of the bundled payment.

For More Information Visit: Dallas Medical Billing, Los Angeles Medical Billing

The final date for registration for model 1 is 21st October 2011; and for rest of the models is 15th March, 2012.

Dallas Medical Billing, Los Angeles Medical Billing, and Washington Medical Billing.

Physicians hit by higher operating losses in Group Practices

Physicians hit by higher operating losses in Group Practices

2010 has registered an increase in physician’s compensation across specialties even as most of the medical groups have been operating at significant financial losses; in fact, the specialties have registered a compensation increase of 2.6% for Primary Care, 3.8% for surgical specialty, and 2.4% for other medical specialties.

According to AGMA survey conducted amongst 49,700 US healthcare providers, the group practices in the northern region have topped the list by averaging a loss of $10,669, followed by those in the southern region with an average loss of $1,870 and eastern region with an average loss of $1,597. Western regions neared the breakeven point of last year i.e. $27.

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

In the current economic climate, these medical groups continue to face the challenge of delivering the highest quality, coordinated care to the patients they serve, due to these high operating losses. According to this survey a major reason for the negative operating margin is due to the increased integration of medical groups and health systems where funding from each physician goes to their medical group corpus. Another reason that contributes to operating losses is the difficulty involved in retrieving expenses incurred due to enhancing patient care in the context of volume based reimbursement system in the US.

Hence, it is advisable for these group practices to look for experts who can provide relevant consultancy services to identifying the lacunas and streamline the overall functioning of their group practices by decreasing the administrative cost while increasing operating revenue.

Medicalbillersandcoders.com has expertise in providing consultancy services for group practices to enhance their revenue in the time of flat reimbursement from both government and private payers along with other administrative challenges. Offering the best solutions in strategic, financial, and operational consultancy, MBC offer professional support and assistance to healthcare providers to keep abreast of the changing industry norms, so that they can concentrate on their core services such as patient care.

For More Information Visit: Dallas Medical Billing, Los Angeles Medical Billing

Resource Box

Medicalbillersandcoders.com is the largest consortium of Medical Billers and Coders in the United States. We offer Medical Billing, Dallas Medical Billing, Los Angeles Medical Billing, and Washington Medical Billing.

Wednesday 14 September 2011

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

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

Is ICD-10 Transition Feasible by October, 2013 Deadline?

As we stand at the mid of the intervening period, there is growing apprehension over achieving comprehensive realization of ICD-10 and other Compliance standard implementation by the October 1, 2013 deadline across the spectrum of healthcare stake-holding: health care providers, payers, software vendors, and clearinghouses/third-party billers.

The CMS has drawn up detailed timelines for phased implementation:

  • payers and providers to begin internal testing of version 5010 standards for electronic claims by January 1, 2010
  • Internal testing of version 5010 to be completed to achieve Level I of version 5010 compliance by December 31, 2010
  • External testing of Version 5010 for electronic claims to be complete to achieve Level II of version 5010 compliance by December 31, 2011
  • By January 1, 2012, all electronic claims to use version 5010 as version 4010 claims will no longer be accepted
  • Beginning with October 1, 2013, claims for services provided on or after this date to use ICD-10 codes for medical diagnosis and inpatient procedures Whereas CPT codes will continue to be used for only outpatient services

Despite the specified deadlines, the medical fraternity, already rattled by imminent impact of Debt ceiling and SGR reforms on Medicare payments, may not be as responsive as it would have been normally.

HIPAA 5010 – which requires over 800 changes from the 9 transactions in the previous 4010 – is seen as enabler of comprehensive classification and coverage of transactions for privacy compliant reporting, and a platform for adopting ICD-10 codes, and ICD-10 – which accommodates over 68,000 ICD-10-CM codes, and 87,000 ICD-10-PCS codes – proves to be pervasive coding system eliminating ambiguity surrounding the preceding ICD-9.

Despite their respective merits, physicians/hospitals – who are already grappling with operational costs associated with medical billing services – will find it even more cumbersome to adopt them owing to

  • Heavy Cost Associated with Migration
  • Complex Technology Implementation
  • Training and Orienting Staff to New System, and
  • Establishing Logistical Relationship with Medical Billers and Insurance Carriers

Federal Government subsidies or incentive too cannot be counted on as the Federal Government itself is preoccupied with solving monstrous economic problems. But, having to abide by Federal dictum, physicians/hospitals will be left with no avail but to practice the system as mandated, absence of which will render their medical billing ineffective.

In such a scenario, proactive medical billing companies that have the requisite competence in place to enable their trusting clients to migrate smoothly and efficiently to the ensuing ICD-10 system of medical coding, and HIPAA 5010 compliant reporting are of crucial help. Moreover, hiring expert support will go a long way in realistically realizing the anticipated return on the investment incurred during the transition.

Specifically geared up for the occasion, Medicalbillersandcoders.com – having delivered efficient medical billing management for a majority of physicians/hospitals/clinics across the United States – has the wherewithal to successfully manage the demands of the ICD-10 system of medical coding, and HIPAA 5010 compliant reporting.

Riding on an paralleled set of pre-qualifiers – certified by the American Association of Professional Coders (AAPC); proficient in using advanced medical billing and coding software as required by the ICD-10 system of medical coding, and HIPAA 5010 compliant reporting; 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 – our medical billing professionals carry an imperial edge in the industry.

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 crucial to physicians/clinics/hospitals’ operational efficiency and revenue maximization.

Tuesday 13 September 2011

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

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

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

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

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

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

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

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

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

Browse All: Dallas Medical Billing, Atlanta Medical Billing

Impact of Federal Debt Ceiling on Medicare Payments to Physicians

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

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

Among the many interest-groups that are likely to be impacted by the Debt ceiling, Healthcare sector – which accounts for a majority of share in the Federal Budget – is going to feel the heat more. Consequently, its stakeholders – physicians/hospitals, patients, insurance carriers, and medical billing professionals will all be forced to rethink their operational efficiency to stave off the negative impact of Debt ceiling. Federal Government, already faced with the impending Sustainable Growth Rate (SGR) problem, will be pushed to float unprecedented radical reforms to its popular Medicare and Medicaid programs, such as

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

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

Browse All: medical billing, Chicago Medical Billing, Los Angeles Medical Billing

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

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

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

Friday 9 September 2011

The Proposed Medicare Cuts, and Its Imminent Repercussions

The Congress’ balancing act aimed at increasing nation’s debt, and decreasing federal spending has quite expectedly singled out Medicare – which is one of the priority spending sectors in the Federal Budget – as the nucleus of its growing deficit budget, and the one that requires immediate controlling measures either in terms of careful structural reform to the Medical Sustainable Growth Rate (SGR), or blunt across-the-board 2% cut to Medicare and other domestic programs. What is alarming is that the accumulated SGR is pegged at a negative 21.3% for 2011, though deferred till the end of the year, would have meant a drastic 21.3% cut to physicians bills for Medicare beneficiaries.

Having already come in for widespread criticism from all the stakeholders, the implementation will have serious repercussions across the spectrum of nation’s primary healthcare sector: Medicare Physicians, Beneficiaries, Medicare Insurance Carriers, and Medicare Billing Companies.
  • Medicare Physicians, who are already finding it impossible to serve Medicare beneficiaries for fees well below the market-driven rates, would find it even more tougher to balance their operating costs and revenues, and consequently be driven to reconsider their services for Medicare beneficiaries in the aftermath of such recommendation on Medicare.
  • Medicare Beneficiaries, who are already at loss finding suitable Medicare physicians, will find it even harder if the Medicare physicians consider migrating to private practice altogether, forcing Medicare beneficiaries spend at market-driven health cost. Further compounding the issue is the fact that the imminent percentage of seniors waiting to swell the-already-brimming dam of Medicare beneficiaries.
  • Medicare Insurance, which accounts for a majority of medical insurance reimbursement, would adversely be hit in as far is its percentage of medical insurance share is concerned should there be an exodus of Medicare beneficiaries to private insurance carriers.
  • Medical Billing Companies that until now considered Medicare processing as one of their priority businesses will be compelled to relegate Medicare down their portfolios of insurance carriers.
Having carried forward the perennially cumulative negative Sustainable Growth Rate (SGR) for more than a decade in the lager interest of Medicare beneficiaries (comprising senior citizens), the Federal Government has realized the proportion of negative impact of Sustainable Growth Rate on its fiscal composition and effectiveness of Medicare. Accordingly, it is contemplating either to repeal the Sustainable Growth Rate (SGR) formula for Medicare (meaning further Federal deficit to already trouble-stricken economy) or phased writing-off of the cumulative Sustainable Growth Rate projected to yield $575 billion in savings in the first 10 years (meaning a drastic reduction in payments to physicians attending Medicare beneficiaries, which could affect the physicians’ motivation level for serving Medicare patients).

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), which is the largest consortium of medical billers with a deep concern for the medical billing market in the U.S., hopes that the Federal Government – having to tread on a thin line – will eventually come up with a solution that, apart from ensuring a balanced health budget, fosters Medicare as the health scheme promoting multiple stakeholders’ interests: Medicare Physicians, Medicare Beneficiaries, Medicare Insurance Carriers, and Medical Billing Companies catering to Medicare beneficiaries.

For More information visit: Albuquerque Medical Billing, Atlanta Medical Billing

Top 4 Challenges in Healthcare Information Exchange (HIE)

Healthcare Information Exchange is the end goal of the recent health reforms in the United States and aims to provide better patient care on a continual basis by multiple organizations. The implementation of HIE not only helps in providing quality care to patients but also assists in reducing costs and errors that arise due to duplicate tests, cost of paperwork, and other manual efforts such as scanning of documents, printing, and traditional procedures that consume time and money. Since HIE is still in its implementation stage, many health care providers, hospitals and the government are facing numerous challenges in this area.
Meaningful Use
The biggest hurdle that the government and physicians are facing is the Meaningful Use of EMR. Physicians, clinics, and hospitals have to demonstrate that they have been using the IT reforms in a meaningful manner and this entails numerous requirements to be met. These can range from recording the smoking status of patients above the age of 13 years to providing e-prescriptions. Many physicians are finding it hard to implement the technology and successfully demonstrate meaningful use due to many reasons. Some of these include resistance to new technology by the staff or physicians, older physicians who are set to retire in a few years and are reluctant to adopt such technology, and the possible adverse legal implications of successfully implementing EMR and EHRs.
Legal Implications
The utilization of HIE can have legal implications for small providers of EHR systems but larger government sponsored providers face lesser risks in the form of legal actions. Moreover, physicians and hospitals may face legal penalties if the system is not used in an appropriate manner which can lead to reduced quality of patient care. The legislation regarding HIE and EMRs or EHR is still being developed and this uncertainty and lack of proper regulations in the initial stages of the HIE implementation is creating anxiety among health care providers.
Costs
Health Information Exchange is a complicated and sensitive issue where there is very little scope for errors and so the costs for implementation and utilization over longer periods of time are another problem physicians and the government is facing. The major issue as far as costs are concerned is the downtime costs which would be borne by physicians. If the HIE or EMR systems are down even for a short period of time, it can cost the physicians a lot of money and result in a drop in their revenue. As many physicians and hospitals scramble to implement Electronic Health Records to assist in the HIE process, this aspect of system downtime is sometimes ignored by system providers and health care providers as well.
Privacy
The biggest concern that physicians and patients have is the privacy of their records since there are many professionals who would have access to their health information. Since the information shared by them can be misused by many agencies such as competing insurance companies, training physicians, pharmaceutical companies and unauthorized research agencies, there certainly is a growing concern over the security of such sensitive data.
Solutions
There are many opinions, debates and solutions which are being proposed to meet these Healthcare IT sector reform challenges. However, some of the most simple and cost effective measures are physician education about HIE, legal reforms related to HIE, ensuring technical efficiency, and better administrative processes including efficient medical billing and coding, medical transcription, lesser turnaround time and efficient interaction with payers. In fact, to focus on optimizing your processes in keeping with the HIE injunctions you could hire the support of excellent consultants. These HIE specialists have the capability of directing your precious time and effort towards implementation of technology and processes rather than creating trouble.
Although there are various challenges faced by HIE in the United States, it is possible to successfully implement it with the help of experienced HIE and revenue cycle consultants. For more information regarding healthcare IT reforms and end to end revenue cycle consultancy you can visit medicalbillersandcoders.com – the largest consortium of medical billing professionals across all states, handling all specialties.

Friday 2 September 2011

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.
SanAntonio Medical Billing | San Diego Medical Billing | San Francisco Medical Billing

Primary Healthcare: A Critical Reassessment in the Changing Healthcare Scenario

The Primary Health Care (PHC) system in the US has so far served as a platform for providing frontline care with services provided by medical professionals ranging from family physicians and assistants, internal medicine specialists, nursing practitioners and clinicians.
However, the diversity in patient backgrounds and medical needs of individuals, special needs patients (e.g. disabled persons or community crisis victims) along with the wide spectrum of the care demanded can take a toll on veteran medical experts, so it’s quite easy to imagine what newly qualified PHC professionals or facilities have to deal with.
PHC Burnout Reasons Regarded as the quarterback of primary patient care, clinicians have issues of performing at optimum levels consistently, since they are the first point of contact for health problems that have so far not been diagnosed, have the responsibility of providing comprehensive personal care and also building long-term relationships with patients who come in with chronic problems.
Now, add to these duties, the necessity of effectively coordinating across multiple sectors for ensuring health services offered at their clinic are customized for all patients, in the correct setting and provided by the most appropriate medical expert in keeping with a patient’s values and it is easy to understand why PHC professionals are often stressed and overworked.
PHC professionals have to manage key stakeholders, such as employees, legislators and patients in addition to their increasing workload, with fewer trainees and support care personnel available to meet with rising demands of quality primary healthcare and strict government policies.
Having to further work within the narrow confines of antiquated administrative systems of Primary Health care delivery further debilitates PHC providers.
PHC providers need efficient, measurable and guaranteed systems for integrating different primary care disciplines so they can ensure advanced support, adequate community networking and improved primary care services for a wide range of patients – without having to commit hands-on time or labor for transforming their practice.
Solutions For Growing Primary Health Care Services Learning about new models of PHC, latest clinical innovations, exposure to the latest billing and coding software, having access to reformed curriculums and medical billing and coding systems that augment the nature of services provided by Primary health care professionals are some ways of solving the problems of burned out physicians specializing in PHC. However, it may not be practical for many Primary Health Care practitioners to personally handle all of these issues or even acquire trained, dedicated and experienced staff in-house to manage competencies needed for enhanced primary care without significantly affecting revenue.
Here is where outsourcing certain competencies to specialized medical billing and coding companies and firms trained to provide expert administrative support services to medical practitioners, clinics and healthcare centers can play an important role in transforming the way medical care is provided. In addition to the growing number of patients a PHC provider or organization serves, the government adds more duties through laws and regulations, making this burden even heavier especially on the primary healthcare professional, the first-contact medical help provider.
Though government initiatives are aimed at reducing the patients’ burden by providing Medicare and Medicaid to improve the quality of service – via enforcement of PQRS (Physician Quality Reporting Service), setting up and maintenance of Electronic Health Record (EHS) systems – these additional regulations and procedures place an extra burden on the physician. They involve setup costs, maintenance, staff and training etc. -facts that should be considered seriously by PHC providers keen to build credibility without neglecting revenue optimization for their practice.
PQRS requires doctors to report to a particular set of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. This is no easy task, since PQRS helps the physician gain credibility in his or her work sphere, but the cost implications far outweigh this advantage for most PHC providers. Sourcing support staff or training existing staff to use this new and complex technology can be time-consuming and a drain on resources.
However, using the services of professionals like Medicalbillersandcoders.com to hire skilled CPC certified coders and CCHIT certified-software can help the physicians to focus on quality of patient care by PQRS participation while these experts ensure a healthy revenue generation for the organization.
Specialist medical billing and coding firms such as medicalbillersandcoders.com cater to individual professionals as well as large hospitals. HIPAA compliancy, insurance pre-authorization, denial management and appeals, account receivables, as well as customized consultancy services for optimizing revenue cycle management – you name it and their team members are certified and well equipped to handle every administration duty you can think of!
So, if you are a Primary Care Physician jostling with hundreds of changes in the healthcare industry and want to optimize your revenue, click www.medicalbillersandcoders.com to learn more!
For more information visit: Cleveland Medical Billing, Charlotte Medical Billing, Chicago Medical Billing