Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion.

Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation for meeting Medicaid expenditure as soon as the Federal Government’s ceases to support Medicaid related expenditure, it is imperative that, in a Federal Setup, states follow certain measures as dictated by the Federal mandate. Moreover, Medicaid, expansion, being a pro-healthcare measure, is destined to elevate the quality of public healthcare across the country in tandem with Medicare reforms.

Coming to the composition of the Medicaid expansion, the proposed scheme opens up health insurance eligibility to all people with household incomes up to 133 percent of the Federal poverty level. Irrespective of whether you are unemployed or the so-called working poor – there can be no denial of Medicaid coverage from January 2014. This is going to be a significant shift from the current coverage which covers only low-income parents and children, and the frail elderly and the disabled. Therefore, when it comes to pro-societal issue, quality healthcare should take precedence over the rest. Quite encouragingly, some states – California, Connecticut, Minnesota, New Jersey and Washington have already started with the expansion of Medicaid programs.

While Medicare expansion is going to bring an unprecedented population under the ambit of Medicaid, physicians will have a hard time in coping up with sudden influx of patients. The situation is going to even more serious if the patients happen to be in need of specialty services as there is already a dearth of specialty-specific physicians across the state. And, with the situation requiring sometime to become ideal, the existing physicians will have to bear the additional brunt. Although the additional workload would also bring in additional revenues from Medicaid reimbursements, their medical billing practices would be put to test as Medicaid reimbursement environment has progressively become more stringent over the years. When you consider dealing with such stringent environment along with the mandatory EHR compliance that support ICD-10 and HIPAA 5010 practices, you might get apprehensive of physicians’ ability to devote quality time to patient care.

Therefore, it becomes inevitable that they seek medical billing and Revenue Cycle Management Services (RCM) that would not only ensure maximization of their revenues but also elevate their clinical efficiency. Care should also be taken to analyze your prospective service providers’ credibility and competence for Medicaid-related reimbursement practices.

While you embark on seeking a suitable medical billing and Revenue Cycle Management Services (RCM) provider, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of long-standing reputation as a credible and competent source for Medicaid-related billing and Revenue Cycle Management Services (RCM) comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – may well prove to be your preferential recourse.

Navigating Through a Multiple Payer Environment – Providers’ Perspective

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

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

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

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

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

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

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

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

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

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

Monitoring Potential for Up-Coding Errors in EHR with the Help of a Medical Billing Service

There has been considerable resolve and persuasion from the Federal Government to introduce Electronic Health Record System across the health care continuum. The Health Information Technology for Economic and Clinical Health (HITECH) Act has indeed given much impetus to pace of conversion from paper to electronic medium. The bait of financial incentives and penalties for complying with ‘Meaningful Use Criterion’ or otherwise has done wonders to the overall macro clinical efficiency as well physicians’ operational efficiency. In fact, no one would have foreseen the extent of transformation when the Federal Government first announced its major IT reform in 2009.

One of the significant advantages of EHR is that it has enormously simplified complex documenting during the billing process. As a result physician practices have been able manage higher level coding with far more degree of confidence than before. But, amidst all these catalytic effects of EHR, EHR is also known to have paved for errors that had not been possible with paper documentation. While EHR’s ‘cloning feature’ allows one to copy previous notes to current notes, it could also inherit errors in the previous notes or be filled with information that may not be pertinent to the current visit. 

The consequence of such cloning is that it may promote coding inconsistencies or up-coding. While physicians may benefit initially with inflated reimbursements, they may be susceptible to audit later. Therefore, with their credibility at stake, they should see that EHR is utilized for the purpose it is meant for: safe and efficient patient care. Whether EHR errors come from system inadequacies or personnel incompetence during billing, physicians should actively involve themselves in resolving them through:

Charting reviews while processing bills through electronic systems

Sourcing EHR systems from vendors who promise what is right for you

Generating baseline CPT frequency report of your E&M services for each provider before you adopt an EHR

Evaluating variations in coding patterns

Reviewing your practice records and looking for evidence of cloning or carrying forward notes on physical exams and patient histories

Shutting down “auto-coder” if your EHR has one

Practically, it may seem too much to ask of physicians who are primarily motivated by clinical focus. The best recourse is to engage competent EHR consultants or medical billers and coders who offer EHR consultancy as an extended service. Medicalbillersandcoders.com– with an extended capability for EHR sourcing, implementing and monitoring for physician practices of varying sizes and specialties – should practically solve all of your EHR related woes. Our strategic alliance with leading EHR vendors will help you find custom-made EHR systems that make it easy to find out cloning and up-coding even before the claim is submitted to the payers or Medicare/Medicaid.

Medical Billing Partner: A Strategic Avenue for Achieving Revenue Integrity?

Healthcare providers in the current environment are aware of the fact that every step counts, leaving no room for errors as far as securing the revenues and reimbursements are concerned for their services. However, as the procedure of patient billing information has been traditionally managed by different departments in isolation, showing little integration the deficiencies of one department might impact the other department adversely, and even damage the revenue cycle of the healthcare provider, hence providers are now in need of a strategic avenue to procure the right revenue for their clinic.

Processes like medical billing, collections and denials managements are some of the prime activities handled by the health care providers, which play a significant part in ensuring revenue optimisation. However payment accuracy, resolving cases of denials and managing the underpayments are specifically critical in order to maintain the healthy bottom line. Additionally healthcare reforms like – Electronic Health Recording (EMR) mandatory for securing incentives under ARRA, transition to HIPAA and ICD-9 to ICD- 10, though improving quality of care are also slowing down the Revenue cycle. All in all physicians have very little option but to re –organize their clinics entire billing process.

Medical billing partners being specialists in their field provide a practical and optimum choice for improving the revenue cycle, streamlining medical billing functions, ensuring optimal reimbursements, operational efficiency and compliance, thus helping the physicians and health care providers to achieve revenue integrity. Billing partners regularly check for any coding errors adding any modifiers if necessary thus negating any chance of discrepancy in the billing process. Problems like denials and underpayment can also be dealt with on the same platform, as billers assist in helping streamline changes to the clinic due to health care reforms providing experts who are well versed with ICD-10, HIPAA & knowledge about the EMR software suitable for your clinic.

RCM of a health care provider being quite complex, involves various processes and people, ranging from scheduling the patient to billing for the services and collection. MBC through it medical billing service has been helping physicians who are at a constant risk of losing considerable amount of revenue where lack of communication between various departments and inefficiency are common features. Medicalbillersandcoders.com has been involved in revenue maximization for healthcare organizations by billing and coding for over a decade now for physicians across the 50 US States and across varied specialties.

Our team is constantly training and updating themselves about industry requisites also providing consultancy right from the best EHR– to data analytics. At MBC our medical billing and coding experts are constantly striving to update themselves to achieve the right revenue for your organization.

Average Single Specialty practices cater to 42-49 percentage of Medicare Populace!

That means nearly half of your total patient population comprises of Medicare beneficiaries.  And, you could have remained indifferent as long as Medicare’s reimbursements continued to be as normal as private health insurance reimbursements.

While physicians’ have remained immune to its impending backlash thus far, they may not be so lucky henceforth; the Federal Government, unable to contain the exploding Medicare expenditure, has finally pressed the panic-button which physicians had been feared of –

 

Medicare reimbursements cut and their effects:

Approximately 4-5% cuts expected each year through 2012, – can result in a substantial erosion of practice revenues

Practice will find it hard to compete, sustain, and grow – on marginal revenues from private insurance reimbursements

Extreme possibility – the cumulative effect of such Medicare cuts may even bring practices on the brink of sell-out or closure

 

Ways to off-set the adverse impact of the imminent Medicare cuts:

Maximize your Medicare reimbursements – error-free billing, coding, and submission

Being eligible for Medicare bonuses and incentives – adopt ACO model of medical care dispensation and compliant EHR practice

Focusing on getting as many reimbursements as you can from – other sources (private health insurance reimbursements and fees)

Get credentialing services for your practices

 

Outsourcing your billing to dedicated specialists could be the key!

Specialization as their lone concern is to maximize their clients’ revenues from reimbursements

Voluminous operations – helps in reducing the cost of medical billing services

Market-orientation –  ensures that clients’ medical billing practices are compliant with the evolving industry standards

 

Tackling Medicare as well as other reimbursements with MBC …

Medicalbillersandcoders.com – by virtue of being the leading consortium of medical billers and coders across the U.S – is uniquely poised to play the defining role in this regard. Combining its unique legacy with a comprehensive process of medical billing RCM – Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, A/R Management, and Financial Management Reporting – Medicalbillersandcoders.com additionally offering value added services like consultancy and credentialing promises to guide physician practices through these testing times.

How much salary can Medical Coders expect in New Mexico?

• The New Mexico state government has introduced an incentive program where healthcare providers will be rewarded for moving their data operations to an electronic platform to be HIPPA complaint
• Chronic diseases and conditions prevalent in New Mexico have led to an increase in consumption of healthcare services like laboratory studies, radiologic imaging, oncology treatment and other specialties

These two seemingly disconnected developments, one relating to insurance compliance and another core care, have collectively made New Mexico a state highly in demand by medical billing and coding professional to be in for job and career opportunities.

This increase in demand of medical billers and coders in New Mexico is apparently a matter of concern for the state as despite being a fairly large state, New Mexico has only about 1290 medical billers and coders, reports a survey.

• The average billing and coding salary in New Mexico is about $32,070
• A professional with about 10 years of experience in billing and coding can command around $45,740

Moreover, a new billing and coding professional in New Mexico can expect his/her salary to span from $10.59 to $14.33 per hour.

Medical billers and coders in New Mexico and surrounding states are experiencing an increase in demand of billers and coders triggered by HIPPA and a climb in chronic diseases. Moreover fees of billers and coders in all states are souring with ICD-10 implementation on everyone’s mind, and states like New Mexico, Arizona, Tennessee, Michigan and Idaho experiencing minimum 20- 22 percent hike in their hourly rates.

Medical coders trained and certified in the methodologies of coding and familiar with the current software platforms required for compliance can make use of this industry trend in New Mexico, which many recruiters and industry insiders believe is an opportunity of the kind which comes once in long passage of time sometimes covering a lifespan of a career or two.

Present in all 50 US states and in New Mexico for over 10 years now, MBC can help meet this industry need with a team of highly trained in-house and outhouse billers and coders who have sound familiarity with New Mexico specific regulations.

MBC can further help meet this industry need by bringing care providers and billers and coders together through the MBC’s job board which is successfully catering to provider and biller needs across the US and in this way helping billers and coders to access job opportunities available in New Mexico and care providers to post their requirements.

Appealing a claim- Will a standard format work to improve your practice’s medical billing?

The procedure of appealing an insurance claim is intricate, although it can be successful if completed properly because there are many grounds for claims to be denied by an insurance company or a payer. The payer collects a lot of claims on a daily basis and the claim can be easily denied if there has been a mistake in analysis or medical billing and coding errors including many others. Furthermore, there is also a requirement to understand if the claim is of importance because a claim of a very small amount need not be appealed and can be written off but one which is worth a considerable sum needs to be scrutinized. However the physician’s office in this case may need to apply various measures considered the following challenges.

In Denial

The fact that a physician or practice receives the accurate amount of reimbursement even when the claim is not denied is a wrong assumption. Insurance companies may con a physician out of his or her fair share of reimbursements in many ways that are very difficult to detect and need a dedicated and keen professional to find the lacunae in the proper reimbursement of physicians since almost 19% of claims denied are due to errors of the insurance companies. This especially holds true in the case of private insurers due to errors made by the insurance companies in claims and detecting these errors requires skill and sustained effort. As a result some physicians and practices are reluctant to appeal denied or underpaid claims since this may increase the administrative work and expenses. However, nothing can be further from the truth when considering the long term repercussions of the monetary benefits that can be enjoyed even with 5-10% increase in revenue which can be a considerable amount.

The Impact of Reforms

In the face of reforms, revenues are set to increase dramatically along with administrative and billing process as 31 million uninsured Americans receive insurance. Appealing a denied claim is becoming voluminous but the new billing and coding procedures are aimed at making this process of reimbursement or appealing much smoother with the transition from ICD-9 codes to ICD-10 codes and adoption of the 5010 platform and emphasis on quality care and patient privacy through HIPAA compliance. The importance of time and money cannot be overemphasized and denied claims, especially for private insurance companies, have to be appealed within a stipulated period of time after the claim is denied. Therefore preventive steps to save time such as error reduction through analysis and a scientific approach in Revenue Cycle Management (RCM)  is required in order to sustain the low rate of denial over longer periods of time.

Vital Signs

Analyzing the pattern in which claims are denied by an insurance companies and finding out the most common false denials is a crucial part of the process of appealing denied claims. Denied claims can fall in various categories such as:

• Errors in documentation
• Services not covered
• Mistakes in medical billing and coding
• Technical difficulties involving Electronic Health Records (EHRs)
• Not considered “medically necessary” by the payer

Arguing your case becomes more difficult due to the huge amount of laws, rules, and regulations that seem to drown the actual cause of the denial. Thus customization of claims becomes much easier when they can be categorized and scientifically solved within a given period of time.

Scientific approach

In this scenario appealing a claim may require more than a standard format and physicians short of time can benefit by acquiring services of a medical billing service. Medical billing and coding experts at Medicalbillersandcoders.com not just perform basic coding and billing functions but are also backed by a team of research professionals who ensure efficient RCM, productive payer interaction, and a scientific approach towards collections with the “bucket” approach in Accounts Receivables (AR) and prompt reimbursements for physicians and practices all over the country with complete HIPAA compliance.

‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system.

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true.

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position.

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.

HIPAA 5010 enforcement delayed to ensure doctors & entities complete transition

Enforcement of HIPAA 5010 transactions on March 15, 2012, was delayed for the second time for another 3 months by the government, with the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) pushing the date further to June 30, 2012, in order to not compromise physician cash flow. Physicians have previously communicated to AMA significant cash flow problems they encountered associated with the transition to HIPAA Version 5010. Essentially the rule called for compliance by January 1, 2012, however earlier on November 17, 2011 OESS announced its first enforcement delay of three months, referring to the move as “enforcement discretion”.

OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format

Commercial plans are reporting similar numbers

State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

How are States retaining physicians in times of shortage?

Physician shortages is a growing concern and is pushing various states to keep doctors trained in medical schools and residency programs from crossing state lines to practice medicine. According to new statistics from the Assn. of American Medical Colleges- nationwide, there were 258.7 active physicians per 100,000 people and in individual states, ratios range from a high of 415.5 physicians per 100,000 people in Massachusetts to a low of 176.4 per 100,000 in Mississippi.

In this scenario medical school, hospitals, medical societies and state legislatures are increasingly taking a practical approach to retain the physicians and doctors-in-training in their state. According to a report by AAMC Center for Workforce Studies on average:

39% of U.S. physicians practice	State where they went to medical school
48% of U.S. physicians practice	State where they completed graduate medical education

Methods adopted by states to retain physicians

AAMC projections depict that physician shortages nationwide are projected to reach 62,900 doctors by 2015 and 91,500 by 2020 and several states to retain physicians have:

• Opened new medical schools or expanded existing ones
• Are offering incentives such as bonuses, scholarships or loan repayment programs to physicians
• Communities are developing new residency programs with the aim that physicians will develop long-term professional and personal relationships during GME training and keep them from moving out
• Certain schools’ mission is to train physicians from their states to practice in their states. However states need enough GME training positions else this efforts are wasted as then physicians will shift to another state

Iowa is below national average retaining 22% of its medical school graduates and 37% of physicians who complete GME training in the state and several efforts in Iowa have been designed to attract physicians to stay in the state. Several other states including Kansas, Mississippi and Alabama offer loan repayment programs for doctors to practice locally.

In Oklahoma, the state offers scholarships and loans to medical students and residents who agree to practice in rural Oklahoma for a set amount of time. Hence Oklahoma is above national averages, retaining 48% of its medical school graduates and 52% of physicians who complete residency training.

Physician adapting to this shortage

Higher revenues and incentives would attract more physicians to the profession and also keep doctors from moving out from states. Healthcare reforms are striving to improve quality of care and physician incentives, to entice more doctors to stay in the profession; but this leaves doctors with little time to balance both patient care and Revenue Cycle Management. As physicians move towards a value based system of healthcare delivery, they would be well-off by partnering with experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization.

Medicalbillersandcoders.com experienced in offering cost-optimizing and revenue-maximizing Medical Billing Revenue Cycle Management in tandem with their goal to assist healthcare should be able to play an essential role in making physicians’ transition towards a value based model easier and profitable, hence also helping towards eliminating physician shortage in the long term.

Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion.

Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation for meeting Medicaid expenditure as soon as the Federal Government’s ceases to support Medicaid related expenditure, it is imperative that, in a Federal Setup, states follow certain measures as dictated by the Federal mandate. Moreover, Medicaid, expansion, being a pro-healthcare measure, is destined to elevate the quality of public healthcare across the country in tandem with Medicare reforms.

Coming to the composition of the Medicaid expansion, the proposed scheme opens up health insurance eligibility to all people with household incomes up to 133 percent of the Federal poverty level. Irrespective of whether you are unemployed or the so-called working poor – there can be no denial of Medicaid coverage from January 2014. This is going to be a significant shift from the current coverage which covers only low-income parents and children, and the frail elderly and the disabled. Therefore, when it comes to pro-societal issue, quality healthcare should take precedence over the rest. Quite encouragingly, some states – California, Connecticut, Minnesota, New Jersey and Washington have already started with the expansion of Medicaid programs.

While Medicare expansion is going to bring an unprecedented population under the ambit of Medicaid, physicians will have a hard time in coping up with sudden influx of patients. The situation is going to even more serious if the patients happen to be in need of specialty services as there is already a dearth of specialty-specific physicians across the state. And, with the situation requiring sometime to become ideal, the existing physicians will have to bear the additional brunt. Although the additional workload would also bring in additional revenues from Medicaid reimbursements, their medical billing practices would be put to test as Medicaid reimbursement environment has progressively become more stringent over the years. When you consider dealing with such stringent environment along with the mandatory EHR compliance that support ICD-10 and HIPAA 5010 practices, you might get apprehensive of physicians’ ability to devote quality time to patient care.

Therefore, it becomes inevitable that they seek medical billing and Revenue Cycle Management Services (RCM) that would not only ensure maximization of their revenues but also elevate their clinical efficiency. Care should also be taken to analyze your prospective service providers’ credibility and competence for Medicaid-related reimbursement practices.

While you embark on seeking a suitable medical billing and Revenue Cycle Management Services (RCM) provider, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of long-standing reputation as a credible and competent source for Medicaid-related billing and Revenue Cycle Management Services (RCM) comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – may well prove to be your preferential recourse.

How medical billing consultants are crucial to Credentialing with Medicare & Medicaid?

Over the years, Credentialing has become an indispensable thing to medical practitioners’ sustenance and growth; so much so that it is impossible to think of undertaking medical practicing without a valid credentialing from the authorized health agencies. Today, credentialing, as much as a mandatory requirement for commencing and running clinical operations, is also physicians’ passport to attract and retain patients. Moreover, unlike during the pay-for-service era, the job of Credentialing does not stop just with attracting and retaining but far beyond that.  Today, physicians have to contend with Credentialing of a different type – Credentialed with healthcare insurance providers.

Sometime ago, when medical practices had only to deal with either the Federal Government sponsored Medicare or state-wise Medicaid schemes, the process of getting Credentialed was seemingly manageable by physicians themselves. But, as the healthcare industry opened up to private insurance carriers, the task got a bit heavier as they had to deal with multiple insurance carriers along with Medicare and Medicaid. As physicians were treated to a multiple portfolio of reimbursement sources, they started to feel a decline in their ability to bargain positively with these multiple sources. Consequently, this started to reflect negatively on their revenue generation. Eventually, they had no recourse but to opt for specialized Credentialing services from medical billing companies.

While outsourced Credentialing has been able to nullify the adverse effects on medical reimbursements, its significance may once again be re-emphasized as Medicare and Medicaid reimbursement environment is going to be even more stringent post Federal Government’s decision to bring in quantitative and qualitative reforms to Medicare and Medicaid. Given the likely scenario,  physicians will have to seek  outsourced Credentialing  that  can effectively and efficiently steer them through laborious Medicare & Medicaid Credentialing process comprising:

• Setting up of all Medicare and Medicaid applications
• Proofing of submitted Medicare and Medicaid errors and omissions
• Submission of the Medicare and Medicaid application
• Setting up and submission of all provider assignment forms and documents
• Following up with Medicare to insure the completion of all required processes
• Following up with Medicaid / designated agent to insure the completion of all required processes
• Archiving of all filed documents for future reference

Medicalbillersandcoders.com (www.medicalbillersandcoders.com)  – by virtue of credible source for Credentialing with Medicare, Medicaid, and prominent private insurance providers – should be physicians’ preferential choice for outsourced Credentialing services. Our process follows tried and tested path: clients set up their account with our firm by utilizing our secure online form. Once the form is submitted, we will obtain the credentialing documentation from the Insurance providers (Medicare, Medicaid, and private insurance carriers) or directly from the Physicians. Medicalbillersandcoders.com will then set up all complicated, and laborious process till physician offices are credentialed amicably.

For more information visit: medical billing

Gauging your Medical Billing Company on ICD-10 compliant resource-capability

“As much as the intrinsic competencies of your medical billing companies, their ability to advise on EHR/EMR implementation for efficient clinical and operational management  should equally hold prominence. As HIPAA 5010 compliant EHR/EMR is the prerequisite to medical billing under ICD-10 system, your practices needs to be equipped with EHR/EMR that meets HIPPA 5010 standards both as a compliant measure as well as qualifying measure for incentives under Meaningful Use Criterion.”

Physician practices, clinics, and hospitals, who hitherto have been safely entrusting all their billing operations to their respective outsource providers, will soon have to run a reality check of the level of preparedness that their medical billing service providers possess or likely to possess in congruence with the ensuing ICD-10 – going to be operational from October 1, 2013. Although most of the medical billing companies are mindful of the efficacy to be resourceful with ICD-10 medical billing management requisites – as they themselves will not be able to operate with ICD-9 compliant practices, which are soon going to be obsolete – yet it is a kind of reassuring exercise that your medical billing reimbursements are channelized through incredible and safe hands.

Now, having been convinced of the efficacy of running a reality check of either your current or prospective medical billing companies, it is quite natural to be inquisitive of the nature and extent of such reality check. Primarily you need satisfy yourself whether the service provider is self-sufficient in resources – both human as well as technological – that render medical billing management possible in the ICD-10 compliant environment. Notwithstanding other things like credibility in the industry, composition of clients, and experience as a medical billing company, it is this resource capability for ICD-10 compliant medical billing that holds the key to your delay-free and denial-free medical reimbursements of your medical claims for clinical services rendered to the Medicare or private insurance beneficiaries. And, when you consider how vigilant and stringent health insurance carriers are becoming, your medical billing service providers’ ICD-10 compliant competencies assume ever more significance.

When it comes to gauging your medical biller’s human competencies, it is necessary that professionals are trained in ICD-10-CM Implementation Training, ICD-10-CM Anatomy and Pathophysiology, ICD-10-CM Code Set, and ICD-10-CM Specialty Code Set. Further, along with a knowledge background, they need necessarily hold qualifying certificates from authorizing agencies that confer professional certification in ICD-10 compliant billing and coding –  AAPC (American Association for Professional Coders) and American Health Information Management Association (AHIMA) happen to be the competent agencies in the U.S.

Medical coding one of the fastest growing sectors in health care: Coders getting certified!

Health information technicians are considered as one of the 10 fastest-growing allied health occupations according to the US Bureau of Labor Statistics (BLS), with Medical billers and coders being in high demand among the allied health occupations.

Further increase in terms of job outlook is expected in the sector of Medical Coding with demand for professionals expected to increase by 18% considering the increased shift from paper to data storage in patient documentation and increased shortage of qualified professionals with specialized skill-sets.

According to the U.S. Department of Labor continued job growth for medical coders and billers is stimulated due to the increased medical need of geriatric population and the number of health practitioners. Moreover the Occupational Outlook Handbook states that earnings vary widely and pay levels are ascertained mainly as per experience and qualifications, hence various medical coders are opting for certifications in varied specializations to make the most of the growth in this sector.

Medical Coders rational in getting certified: Opportunities through certification

A national study of workers in their mid-30’s illustrated that 43% of license and certificate holders earned more than associate’s degree graduates, moreover as many employers prefer to hire candidates with certification, earning a medical billing and coding certification gives the coder an added competitive edge in the job market. On gaining experience in this field pursuing medical billing and coding certification in a particular specialty—beyond just basic certification— can immensely help in capturing the growth in this industry. In general, average salary for a medical billing and coding professionals is anywhere between $38,000 and $50,000 per year, while the ones at the top of their pay scale can earn more than $74,000.

A recent survey by American Hospital Association depicts that nearly 18% of billing and coding positions remain vacant due to a lack of qualified candidates, with most physician practices in preference of hiring well qualified medical billers and coders – certified in their field, to as far as possible avoid legal ramifications of incorrect billing. Also various medical coders working independently from home at times need to get additional licenses and certification.

Growing opportunities

In the scenario where Insurance companies and government are putting more emphasis in researching and controlling claims’ fraud, abusive practices, and medical necessity issues, has led to an increase in hiring by related healthcare entities. Being a challenging, attractive career with growing opportunities – where compensation is as per level of skills, individuals seeking a career in medical administration are well advised to opt for medical billing and coding with the entry-level pay being higher than that of comparative health care professionals in the field.

Medicialbillersandcoders.com equipped with experienced Billers and Coders well-versed with HIPAA, ICD-9-CM, ICD-10 –CM, CPT/HCPCS, DSM-IV, and ICPM, gives coders a platform to excel in their domain. Our coders are constantly training and updating themselves as per the industry requirements, striving to make the most and assist in the evolving healthcare industry effort in improving patient care.

Medical coding and billing salary range is wide, with a low percentage of employees in this medical field expecting to see a salary of $31,000 per year while another percentage expecting to see a salary range as high as $48,000 per year. However the average salary for a medical coder and biller as stated earlier is expected to get a higher scope in upcoming years, nevertheless eventually only the medical biller and coder can determine their earnings depending on variables they adopt. Medicialbillersandcoders.com providing updated knowledge, placement opportunities and analyzing current salary trends has been serving physicians for more than a decade and offers medical billers and coders an avenue to get connected with these doctors and can register with us for future job prospects. (Link to register for jobs)

ICD-10 delay likely to cost healthcare industry billions: Proficient ICD-10 Coders in demand!

Even as the Department of Health & Human Services’ in order to reduce regulatory burdens, announced last month it would consider delaying the ICD-10 implementation deadline for certain entities, subsequent industry reactions depicted healthcare professionals being primarily not in favor of such a delay. Moreover a Survey conducted among more than 50 senior healthcare professionals attending the 2012 ICD-10 Summit, hosted by Edifecs, stated that most of the participants perceived a delay rather than improve would cause significant adverse effects on the healthcare industry.

The survey findings on ICD-10 delay:

64% (Nearly 2/3rdof respondents)	Stated a delay will not improve readiness
76%	Stated a delay will harm other healthcare reform efforts
69%	Stated a 2year delay would be either “ potentially catastrophic” or “unrecoverable”

Healthcare industry outlook towards Cost Implications due to a delay:

Healthcare professionals and the industry observe a delay would result in halting or slowing down work on ICD-10 which would derail the healthcare organization’s progress resulting in high cost implications. With both payers and providers investing heavily for the ICD-10 switch, cost is the chief concern. Hence the industry is in favor of moving ahead while they await the final decision on the extended deadline regarding entities which will be affected.

The cost of a one-year delay to be between 25 – 30%, while officials  estimate a one year delay based on existing overall cost estimates for ICD-10 from multiple sources, to cost the industry anywhere from $475 million to more than $4 billion.

A delay of longer than a year as per 85% of respondents surveyed said would freeze budgets, slow down schedules or stop work altogether, while 59% opined that the date should be universal for all covered entities rather than mandating different compliance dates for different types of entities, the main driver behind the same being the significant cost and effort involved for the dual processing in ICD-9 and ICD-10 code sets.

Proficient ICD-10 Coders in demand!

Hence with majority of physicians vary of a delay continue their preparation for ICD-10, Billers and Coders proficient in ICD-10 transition are the need of the hour and highly demanded. As adoption of ICD-10 will lead to expansion in the number of codes available from the currently used ICD-9 codes- organizations focusing on a successful ICD-10 implementation in 2013 are cautioned to start revamping their coder development and retention strategies, making ICD-10 coders in demand.

Projections from the Bureau of Labor Statistics depict a growth in job levels for coders far above average: 20% from 2008 – 2018 and Economic Modeling Specialists Inc. project growth of 8% between 2011- 2013. Physicians amidst the transforming healthcare environment as a feasible option are opting for services of medical billers and coders who are proactive and prepared with material-requisites for ICD-10.

Personnel updated at Medicialbillersandcoders.com are viable option for physicians in smooth transition to ICD-10; equipped with experience in HIPAA, ICD-10 and other compliances. Moreover the unique ICD-10 Training Program encompassing 87 weeks of ICD-10 training and updates – strives to outline at no cost to medical billers and coders information & training- right from how ICD-10 will affect healthcare to how ICD-10 needs to be implemented within different specialties to ensure optimum revenue cycle management post ICD-10.

The Crucial Role of Physician Assistants in EHR Implementation and the Reforms

The role of Physician assistants (PAs) is accentuated in a country such as United States where the physician to patient ratio is very low. The recent health reforms have added to the responsibilities of physician assistants due to numerous changes in policies and technologies. The implementation of Electronic Health Records (EHRs) or Electronic Medical Records (EMRs) is one of the biggest challenges that PAs face in the changing healthcare environment. Moreover, since physicians need time for numerous other core activities, PAs are the professionals who handle such important auxiliary functions such as successful implementation of EMRs or EHRs and handle other office based departmental processes. The health reforms also present opportunities for PAs in the country to take on more responsibility as well as prosper financially.

The incentives offered by the government for successfully implementing an EMR or EHR is not just limited to physicians but also include PAs. However, in order to receive such incentives, the PA must work in a Federally Qualified Health Center or Rural Health Clinic that is led by the PA. The need for PAs is strongly felt as a coordinator between physicians and nurses in order to provide better service to patients. They also take on numerous other responsibilities such as being on call, making house calls, providing therapy, and even prescribing medications in addition to all the work assigned by the supervising physicians and thus PAs have a holistic understanding of the various departmental processes as well as proficiency in the core aspects of medicine. These processes today cannot be carried out without extensive use of EHRs/EMRs and PAs utilize all their knowledge to optimize the EMR/EHR implementation process.

Since PAs work in such a demanding environment, they are most likely to succeed in implementation of EHRs and EMRs due to their knowledge of other aspects of medicine such as some “back-office” or departmental processes. However, for many PAs the workload is continuously increasing due to policy changes and the skyrocketing demand for healthcare services. Some factors that are hampering the handling of EHR systems by PAs are increasing demand for healthcare due to newly insured 31 million Americans, increased scrutiny by the government in the form of HIPAA, and ‘Meaningful Use’ (MU) policy compliance. Although PAs are qualified to handle EHRs and other related processes, it would definitely become difficult for them to handle the core functions involved in health care delivery due to workloads in various auxiliary processes.

The ideal solution for making time and saving money is to delegate some of these processes to experienced professionals through outsourcing. This would ensure that processes such as revenue cycle management, denial management, interaction with payers, accounts receivables, and charge entry, are carried out in a scientific and professional manner. Medical billers and coders at www.medicalbillersandcoders.com not just provide these services but also offer EHRs software that is suitable for almost all specialties and suggest after studying your practice’s processes the software best suited for your practice which would cover the gaps and shorten the revenue cycle. Medicalbillersandcoders.com also offer other value added services such as consultancy for keeping you updated on the changes taking place in the health industry.

Job Opportunities: A New Positive Outlook for New Physicians amidst healthcare reforms

The shortage of physicians, the health reforms, the skyrocketing costs of health care , the Medicare cuts worry and the influx of health IT into the health industry has created a bit worrying albeit a dynamic environment. Although there are critics who oppose the health reforms and suggest other methods, there are optimistic physicians as well as patients when it comes to improving healthcare even in this environment of hullaballoo that threatens to change the drudgery of the maintenance of the health care industry in the United States. According to the Bureau of Labor Statistics, a physician’s profession is much coveted and in demand and has immense growth prospects in the future which can be a good omen for the future of health care delivery in the country. A recent survey from physician search firm Merritt Hawkins revealed that more than 75% of physicians in their final year of training received at least 50 job solicitations, and 50% got 100 or more.

The reform has forced many solo and small group practices to pack up their practices and opt for employment at hospitals and along with bigger group of physicians since these have started to hire physicians. Hospitals are also hiring physicians since the number of insured in the country is soon going to rise by about 31 million and physicians in hospitals would be desperately needed to treat the patients who would inundate hospitals after the reforms take hold. Many physicians are retiring and almost one third of physicians in the country are set to retire in next few years which create opportunities for new young physicians and providers to take their place. Moreover, physicians are relieved of the non-clinical obligations while working in hospitals such as billing, extensive interaction with payers, and other administrative tasks.

Although solo practices and small group practices are slowly declining, it does not necessarily imply that new jobs for physicians are not being created. According to the Bureau of Labor Statistics, the employment of physicians and surgeons is set to increase by 22% between 2008 and 2018 and the reasons cited by the bureau are numerous. Physicians’ job outlook looks positive because of an expanding health industry, the increase in demand for the services of physicians, increased level of enrollment in medical schools and the policies implemented by the United States government to encourage the growth of this profession qualitatively as well as quantitatively.

The biggest challenge faced by new physicians is related not just to professional core issues but also to financial issues. There are numerous financial challenges and problems in the form of paying off the debt, implementing ‘Meaningful Use’, striving for the incentives provided by the government and avoiding financial penalties for non-compliance of health reform policies. Even with so many challenges and problems faced by new physicians who have just started practicing can successfully kick start their work in financially and professionally fruitful manner. However, support is available for physicians who are just stepping into this dynamic yet progressive health care industry in the form of processes that aim to maximize physician revenues and ease the problems faced by them in many departmental processes involved in running a practice or even when joining a hospital.

Whether as a physician, you work in a hospital or starting a solo practice, medical billers and coders at www.medicalbillersandcoders.com can offer you a wide range of services that will not only assist you in medical billing and coding but also facilitate services such as revenue cycle management, denial management, interaction with payers, research, consultancy, streamlining various processes for EMR or EHR implementation, and assistance in health IT implementation in this dynamic health industry. This will help you in avoiding the pitfalls faced by new physicians in the country and also assist in increasing your revenue in a lesser amount of time.

For more information visit: medical billing

Countering the phenomenon of Physician Shortage: Medical Reimbursements

“Consequently, physician reimbursements would largely depend on their ability to seamlessly process medical claims with either Medicare or private insurance carriers. But, with the reimbursement environment promising to be more vigilant and stringent than ever, physicians would find their medical billing competencies invariably short of the requisite persistence.”

Physician shortage has been one of the major issues that have been plaguing the U.S. healthcare industry.  Significantly, twenty two states and 17 medical specialties have already felt the dearth of physicians. While the aging physician community and the lack of reserve pool of physicians may well have been the primary reason, it is also true that the aging patient base and an unprecedented population growth have contributed to the growing chasm. And when you consider the influx of an estimated 40 to 50 million people who were previously uninsured and the baby boomer generation now becoming eligible for Medicare, the issue is only going to be worse.

But, healthcare being one of the priority sectors and health of millions of Americans at stake, Federal Government is looking at policy changes that would make healthcare practices attractive to professionals. As Family practice, internal medicine, and geriatric specialists form the priority disciplines, a lot of stimulus is being given to physicians showing inclination to these specialties. Physicians, who used to take such disciplines as a societal cause, are now being made eligible for incentives. Apart from this priority-based stimulus, the Federal Government is also looking at correcting the regional imbalance, where in physicians from higher density regions are being wooed to regions that are acutely short on physicians.

Quite parallel to policy measures, the qualitative measures like mandatory EHR compliance – seen as augmenter of fast and efficient clinical and operational management – would pave the way for accelerating medical care. The penalty or incentive factor associated with EHR non-compliance or compliance is seen as qualitative measure for enhancing the scope of clinical reach to an ever-growing patient base. Then, you have the Accountable Care Organization (ACO) model, which would eventual ensure streamlined healthcare dispensation for a population that has grown disproportionately to the physician numbers.

While these qualitative measures by the Federal Government would invariably increase practice opportunities and revenue prospects for physicians across the U.S., there is also going to be unprecedented incidence of medical insurance reimbursements as most of the medical related expenditure is invariably met by health insurance schemes – either State sponsored Medicare or Medicaid, or private health insurance schemes sponsored by private insurance players. Consequently, physician reimbursements would largely depend on their ability to seamlessly process medical claims with either Medicare or private insurance carriers. But, with the reimbursement environment promising to be more vigilant and stringent than ever, physicians would find their medical billing competencies invariably short of the requisite persistence.

And, when physicians face up to such challenging medical billing  environment,  outsourced medical billing services would eventually become indispensable. Medicalbillersandcoders.com, whose medical billing Revenue Cycle Management is capable of ensuring both qualitative and qualitative dispensation, should prove to an ideal recourse. Its comprehensive medical billing Revenue Cycle Management – comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – is designed for augmenting revenue generation while also keeping medical efficiency enhanced perpetually.

Measuring the impact on physician reimbursements with upsurge in retail clinics

“As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them through effectively and efficiently.”

While there can be no substitute to full-fledged clinical settings as far as clinical management of chronic or acute medical conditions are concerned, retail clinics hold their own sway when it comes to managing trivial or superficial medical conditions. In fact, a study in the November 2011 American Journal of Managed Care, which analyzed the claims data of 13.3 million Aetna enrollees from 2007 to 2009, found a tenfold increase in patient traffic to clinics in grocery stores, pharmacies and big-box stores. Therefore, there is substantial truth in believing that patients are growing more comfortable with retail clinics, which offer them instant and easy access during times of medical exigency.

The growing fascination towards this retail model of clinical care can largely be attributed to the Federal Healthcare Reforms – which are going to accommodate health insurance for a substantial uninsured population, and promote accountable care organization model of healthcare and other aspects of health system reform – and the growing dearth of primary care centers which happen to be the connective clinical centers to major healthcare centers. While established clinical centers may feel the pinch of eroding patient base to these new-trend retail clinics, it could still be a blessing in the disguise as they concentrate on clinical management of far more critical medical conditions. And with the promise of a booming Medicare and private health insured population, there is every reason to remain optimistic.

The retail health clinics, on their part, should strive to be connective link in the clinical management of patients; retail clinics, rather than operating in isolation, should establish ways to ensure continuity of care with physicians and have processes for referring patients who require primary care. One of the major impediments to this integration, as noted by majority of specialist practices, is that retail clinics may not be able to share medical necessary reports that render collaborative clinical management possible. But, with proper coordination, retail clinics and specialist clinics or hospitals can both share the workload as well as promote clinical efficiency. In fact, many established hospital groups themselves are open to the idea of opening their own retail clinics that could become window advertisements for their specialist services.

As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them effectively and efficiently. Medicalbillersandcoders.com – with long-standing reputation of being competent and a credible source for comprehensive medical billing and operational services – may well have the right answers to such opportunity-responsibility bait.

For more information visit: medical billing companies, medical billing services

Physicians strive to strike a balance between managing HIPAA 5010 and medical billing

The financial and data-centric nature of the healthcare reforms in the US has left healthcare organizations in all the states of the US to do more data care than healthcare – to manage their finances, maintain data integrity and be complaint with regulatory standards. Health Insurance Portability and Accountability Act (HIPAA) is an example, which, however well-meaning otherwise, burdens the healthcare provider with a series of compliance activities, involving technical intricacies, which, if not followed to the letter, lead to claim denials and expose the care provider to a post-denial support system that’s lumbering and unresponsive.

HIPPA, framed to promote convenience and continuity of health insurance coverage for individuals or groups either changing jobs or unemployed through safe data handling and transfer, seeks to establish a standardized method to electronically transfer data by healthcare providers to Medicare contractors to submit insurance claims and be reimbursed.  However, when healthcare organizations are submitting claims through HIPPA’s electronic conduit, HIPPA 5010, they are facing claim rejections due to a number of teething problems HIPPA 5010 is going through currently.

The problems are mostly of administrative and technical in nature, like issues with billing secondary payers, national provider identifiers not being recognized, the care providers are facing while submitting their medical bills to Medicare contractors via HIPPA 5010. The billing process is not just leading to futile administrative works for care providers but also financial losses with Medicare contractors rejecting claims for such minor omissions and errors as claims not having descriptions on them, error in addresses etc. Rejected claims submitted again are meeting with sporadic reimbursements and attempts to contact contractors are resulting in one to two hours of call-hold period.

However, in response to this chaotic situation, The Centers for Medicare & Medicaid Services (CMS), the agency overseeing the transition from HIPPA 4010 to HIPPA 5010, has delayed the enforcement of HIPPA 5010 But will a delayed enforcement of HIPPA 5010, even if it leads to some order and stability, be an answer to healthcare providers’ woes? No. Even in a sanitized atmosphere, healthcare providers would need to handle what they are not meant to, financial administrative activities and compliance matters. This leaves healthcare providers in a ‘rock and a hard place’ situation: avoiding the reform-induced responsibilities would mean falling foul of regulations and attracting penalties; attending to them would lead to increased cost, unrealized claims and time spent on non-healthcare activities.

To survive the onslaught of reforms and changing industry trends, healthcare organizations would require a robust Revenue Cycle Management (RCM) process, a look at the challenges posed by HIPPA 5010, discussed above, indicates that a complete outsourcing model which would enable healthcare providers to offload the complete cycle of financial administrative activities to a biller and coder may not be an imprudent choice.

Medicalbillersandcoders.com provides RCM consulting services help build a coherent RCM process by analyzing the areas of deficiencies in your RCM process, starting from trimming out outdated processes, identifying software inadequacies, under-optimized workforce to unidentified training needs and most importantly plugging revenue leakage sources resulting in a sound RCM process which helps healthcare organizations meet the current financial and administrative challenges better.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its outsourced billing and coding services which involves development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process – collectively resulting in reduced claim denials an enhanced core-business focus.

For more information visit: Medical Billing companies

Medicalbillersandcoders.com offers 35 weeks of ICD-10 training updates for Billers & Coders across 50 US States

Wilmington, 1st March, 2012

Medical Billers and Coders consistently updating themselves on industry requirements, is gearing up for ICD-10 and is launching an 87 week journey towards ICD-10 orientation today. Being more than two years since the final rule was released and at the mid-point for ICD-10-CM/PCS implementation, Medicalbillersandcoders.com cautions all Medical Billing and Coding Professionals especially those who haven’t, to start planning for the transition right away!

The 1st step in a long journey being the most important, Medicalbillersandcoders.com invites all Medical Billers and Coders to take the first step in the initial 35 week journey - when updates and training material will be shared to help them evolve with the US healthcare industry.

For Medicalbillersandcoders.com ICD 10 orientation, countdown begins 1st of March 2012 and ends 13thof October 2013- in this 87 week program Medicalbillersandcoders.com in the first 35 weeks will share updates and build base for the latest coding updates, while in the remaining 52 weeks will comprise of actual training. In the scenario where The Centers for Medicare and Medicaid Services stands firm on the ICD-10 compliance date of 1st October 2013, stating there will be no delays or grace period, and post this date providers claims only in ICD-10 format will be paid, Medicalbillersandcoders.com urges all related healthcare professionals to get ready to ensure smooth flow of revenue and avoid reimbursement issues.

Medicalbillersandcoders.com boosts billers and coders to face the humungous ICD-10 challenge

Preparation for ICD-10 brings huge and exciting challenges to the healthcare industry along with benefits in the form of improvement of the capture of healthcare information. However Medicalbillersandcoders.com in anticipation of the changes it can bring about in medical billing practices, likely to cause considerable slowdowns in billing and payment and the upheaval it can create if not implemented the right way, encourages all medical billers and coders to be ready for this challenge.

ICD-10 & challenges:

• ICD-10 has 10 times the number of codes compared to ICD 9CM - Coders knowledge of anatomy and physiology, as well as medical terminology will require to be more detailed
• Coders will need to work more closely with doctors to update them on proper coding methods
• More codes to choose from may eliminate use of super bills – a means of quick coding diagnoses
• Providers may need to invest in new software designed to accept the longer digit codes
• Physicians will need to be more specific in their documentation and code observations as ICD-10 codes include more payment limitations for services
• Case managers will need to increase patient education on coverage charges

Medicalbillersandcoders.com is gearing up for this change already and wants to contribute in propelling the concerned professionals to meet these challenges keeping in mind industry standards and ICD-10 deadline of 13th October 2013. The expert panel of advisors at Medicalbillersandcoders.com is striving through the ICD training program to help all billing and coding professionals on any training or information they may need to gear up for this change.

Brief insight into what MBC’s ICD-10 training program is offering to counteract ICD-10 challenges:

• Tips for a smooth transition from ICD 9 to ICD 10
• Problem solving webinars
• Weekly updates of ICD implementation
• FAQ documents of ICD 10
• Coding Practices forum with other experts and participants

This training program also offers subscribers to share their views participate in polls and associate with industry experts and contribute to ICD-10 in their own way at no cost.

As physicians are undergoing healthcare revolution, we as Billing & Coding professionals will need to go through a learning evolution to streamline practices. Medicalbillersandcoders.com billing and coding professionals are charged up for the change and to further this trend Medicalbillersandcoders.com is offering a platform to a career revamp ensuring transition to ICD-10 with confidence. All Medical billers and coders are invited to be a part of this endeavor along with Medicalbillersandcoders.com at no cost from the 1st of March.

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 ( California Medical Billing, Pennsylvania Medical Billing, Idaho Medical Billing, Mississippi Medical Billing, New Jersey Medical Billing, Virginia Medical Billing, Arizona Medical Billing ) with the most prominent being Dental Medical Billing, Chiropractic Medical Billing, Pain Management Medical Billing, Physical Therapy Medical Billing and General Practice.

Contact:
Prerna Gupta, Media Relations
108 West, 13th street,
Wilmington, DE 19801
Tel: +1-888-357-3226
Email: info@medicalbillersandcoders.com
http://www.medicalbillersandcoders.com/
http://www.medicalbillersandcodersblog.com/