Upsurge in Migration to EHRS; Opportunities and Challenges

While this rapid transformation means ample business opportunities for competent technology providers, some of whom are already introducing second generation technology platforms; there also lies a challenge in aligning and customizing EHR platforms in congruence with individualistic needs of diverse medical disciplines.  Medical practices, on the other hand, will be required to orient themselves to the mechanism of these novel technology gadgets – meaning resource allocation for training the internal staff on these technology platforms. As medical practices, small and large, seek to outsource EHRS implementation process, they would eventually be spoilt for choices amongst innumerable service providers in the EHRS market.

As the realization dawns upon the medical practices, there seems an impressive migration from paper-based manual system of health record system to a more sophisticated, reliable and efficient way – Automated or Electronic Health Record System (EHRS). Notwithstanding the Federal Health Department mandate for compulsory implementation, the consensus amongst the medical practices is that EHRS is pivotal to turning around clinical and operational efficiency in an increasingly demanding healthcare industry. The combined effect of Federal Health Department mandate for compulsory implementation, and the growing belief of EHRS being indispensable to clinical and operational efficiency has been largely been responsible for an unprecedented upsurge in EHRS implementation amongst diverse medical practices across the United States of America – the current scope of EHRS implementation, as per the survey results by a leading consulting agency, stands at an impressive 25% of the potential EHR market.

 

While this rapid transformation means ample business opportunities for competent technology providers, some of whom are already introducing second generation technology platforms; there also lies a challenge in aligning and customizing EHR platforms in congruence with individualistic needs of diverse medical disciplines.  Medical practices, on the other hand, will be required to orient themselves to the mechanism of these novel technology gadgets – meaning resource allocation for training the internal staff on these technology platforms. As medical practices, small and large, seek to outsource part of their EHRS implementation process, they would eventually be spoilt for choices amongst innumerable service providers in the EHRS market.

Medicalbillersandcoders.com  – with long standing reputation of being a credible source for comprehensive medical billing solution – should be a preferential recourse. One of the early to include EHRS as part of its comprehensive medical billing revenue cycle management, its diverse pool of medical billing professionals are known for their ingenious competencies in advising towards EHRS implementation for an impressive list of clientele, ranging from independent  practices, small clinics, and multi-specialty groups. Apart from this intrinsic value-proposition, its strategic alliance with leading manufacturers of EHR platforms – ChatLogic, ClearPractice, BioSoftWorld, CitiusTech, OptumSight, MediLink, Clinicient, Aprima, and the rest – lends its EHRS implementation approach the requisite competitive edge.

Amidst a healthcare industry, characterized by Federal Government’s growing propensity to revolutionize healthcare services, collaborative clinical management and research, and operational optimization and revenue maximization through compliant medical coding and reporting, EHRS is the way to go.

Private practices withstanding healthcare reforms: Revenue Management

Private practices are facing many challenges and gone are the days when physicians could easily start their own practice in a small office. The complexities in the form of changing policies, added administrative work and changes in Healthcare IT has made it very difficult for physicians to start or maintain a small or solo practice. Policy changes in the form of EMR/EHR implementation, the need for demonstration of ‘Meaningful Use’ and numerous changes in various departmental processes has made solo or private practice enormously cumbersome to handle and to sustain in terms of profitability. There are numerous other reasons that are forcing private practitioners to turn towards hospitals or form larger groups in order to bring sustainability to the practice.

A survey by Accenture has shed more light on the matter and has revealed that small practices are in the decline. Physicians are packing up their practices due to the uncertain business environment, better access to Healthcare IT in bigger institutions, and for a better manageable workweek. The survey also shows that individual practitioners are in decline at the rate of two percent annually and would decline by five percent annually by the year 2013. Another white paper by The Physicians Foundation examines the effect of the Patient Protection and Affordable Care Act on physician practices in the United States. The report clarifies the attitude of physicians when it comes to reforms and the effect it is having on the way physician practices operate. The survey finds that the majority of physicians plan to alter their practice patterns where the full-time, independent practitioner accepting third party payment would largely be replaced by part-time, locum-tenens, and concierge practitioners.

Small private practices are finding it more difficult to comply with all the guidelines in the reform and upgrade their systems and staff to a level where they can be qualified for the incentives. However, some practices are able to survive this change by employing the services of specialists in various departmental processes. Better EMR/EHR implementation, professional revenue cycle management, better denial management, and error-free medical billing and coding can give an edge to physicians who have decided to continue with their private practice. Optimization of these processes can ensure that physicians reap the financial benefits of the reform even as they provide better health care delivery through a complex process. Medicalbillersandcoders.com is the largest consortium of medical billers and coders in the United States which provides these services for physicians in addition to consultancy and other value added services.

States mimicking Medicare – experimenting with Accountable Care Models for Medicaid

Accountable Care Organizations (ACO) model’s popularity is growing and mirroring Medicare almost 11 states are trying ACO models for their Medicaid programs by adding initiatives resembling ACO’s to their programs, moreover various providers who initially were vary of Medicare ACO models are showing interest in the state versions as well.

With the exact number of states experimenting with ACO model programs unknown, 13 states have already submitted Medicaid amendments to the CMS to implement the new medical home model including aspects of ACOs, with four amendments already approved as reported by Federal officials. According to health policy experts, state interest has evolved in the past two years, to control spending due to their increasingly costly Medicaid programs; moreover part of the increased interest could be an outcome of the national attention the federal Medicare ACO programs received.

In North Carolina one Medicaid program is building an ACO-like structure off a longstanding medical home model. Other states are modifying their Medicaid managed-care programs into ACO-type pilots- in January, Minnesota, launched a two-year expansion of its managed-care program that will provide extra provider payments for up to 10,000 Medicaid beneficiaries. In another initiative viewed as an ACO-like model, a Colorado Medicaid program launched in mid-2011 gives providers regular bonus payments for offering extra care to patients, with plans to add bonus payments to practitioners whose patient’s outcomes improve.

Various states are still implementing their ACO-like Medicaid changes but are expected to complete their plans soon. The Cambridge Health Alliance, Massachusetts, already considers itself an ACO and has begun moving some of its Medicaid patients into a global payment model through the managed-care plan under which it operates.

High potential to improve health while saving money, practitioners eventually expect the state and federal efforts to result in widespread ACO adoption within Medicaid programs. As the ACO model transforms the system from the current fee for service system to pay for value system – physicians would benefit from seeking help from medical billing companies, who can provide consultancy for integrating this system of healthcare delivery. Medicalbillersandcoders.com having capability of providing operational and revenue management to various specialties and being equipped with an insider-knowledge of the Healthcare Industry can help make the choice of transitioning to the ACO model easier.

Upfront Realization as the catalyst for accelerating Physician reimbursement

“As physicians juggle with their core medical focus and issues related Upfront Collections, there would eventually be an adverse impact on their ability to afford quality medical care. Therefore, sooner or later, they would have to decide on outsourcing the competent services that can offer the best upfront Collection as part of the comprehensive Revenue Cycle Management.”

Seamless reimbursements have remained pivotal to sustenance and growth of medical practices large and small, and will remain so in future also. As the ability to render quality medical services primarily hinges on physicians’ capacity to fund and install the requisite infrastructure, an efficient Revenue Cycle Management becomes indispensable. Amongst many approaches to successful Revenue Cycle Management, Upfront Realization of the eventual cost of medical care has consistently been more effective.

Upfront Collection thrives on the ground that patient understand the importance of supporting physicians’ endeavors for quality medical care; also, being realized during scheduling and admitting, the cost of realization would seem negligible. Although it might seem an easier task than done, alas, the actual execution can be exhausting and tricky – ascertaining and communicating financial obligation upfront is altogether a different proposition involving structured financial clearance prior to service, metrics for performance improvement, and crucial strategies for developing a culture of collection.

One popular way doing this is using a price estimator of the eventual cost of medical care during pre-registration based on the incidental medical benefits. But, because most of the patients would not be able to fulfill their financial obligation fully, physicians may well have to either operate on discounted fee or serving on good faith. Alternatively, CPT code correlated estimation, wherein the actual description of medical services is tallied against the conforming CPT code for arriving at the eventual cost of medical care, may also be followed. And for those patients who cannot afford the immediate payment, long-term payment plans may prove to be suitable option.

In normal course, these reimbursement exercises would not have been so demanding. But, because of the intricacies involved in medical insurance policy arrangements – co-pays, deductibles, the extend of coverage, communication void between the providers and the insurance carriers – the Upfront Realization has tended to be grueling exercise for the physician fraternity.

As preemptive solution for easing the complexity, physicians can have recourse to:

• Streamlined communication strategy to instill up-front collection as part of a provider’s culture: a patient-friendly means to communicate with patients aimed at promoting a culture of asking for upfront payment of the eventual cost of medical care from the patients.
• Staff training, including role playing, scripting, and training on using the tools available when discussing financial responsibility with patients. Involving CFOs to help hold their teams accountable, monitoring performance, and frequently discussing importance with associates.
• Advanced software infrastructure that supports metric-based calculation of such upfront medical fees

As physicians juggle with their core medial focus and issues related Upfront Collections, there would eventually be an adverse impact on their ability to afford quality medical care. Therefore, sooner or later, they would have to decide on outsourcing the competent services that can offer the best Upfront Collection as part of the comprehensive Revenue Cycle Management.

MedicalbillersandCoders.com – possessing the requisite human and technology resources for comprehensive medical billing and 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 – should offer physicians the comforting zone.

Seeking Possible Solution to Intensifying Medical Billing Documentation

“Beset with spiraling Medicare expenditure amidst a rather volatile economy, the Federal Government policy of linking physician reimbursement to quality outcomes will not only test physicians’ level of quality medical care, but also how they are going to document patient encounters. Therefore, physicians, required to furnish evidence-based healthcare documenting & reporting, will find hard to manage within the limited time and resources”.

Amidst healthcare reforms (both federal as well as provincial healthcare quality initiatives) –  linking physician reimbursements to quality outcomes, making Electronic Health Recording mandatory for availing incentives under ARRA, the possible compliance to Medicare Medical Billing norms, the documentation demand under Medicare’s Accountable Care Organization (ACO) model, and the last but not the least, the imminent ICD-10 and HIPAA 5010 transition – healthcare documenting is never going to be the same. While these healthcare reforms are objectively promulgated for ushering in clinical and operational efficiency, the level of transformation those physician offices need to cope up with can severely come in the way of the core-focus of medical services.

Beset with spiraling Medicare expenditure amidst a rather volatile economy, the Federal Government policy of linking physician reimbursement to quality outcomes will not only test physicians’ level of quality medical care, but also how they are going to document patient encounters. Therefore, physicians, required to furnish evidence-based reporting, will find hard to manage within the limited time and resources.

As Electronic Health Recording becomes mandatory, physicians may not be able to afford heavy capital investments associated with installing the requisite technology. But, as the EHR carries clinical and operational consequences – incentives for meeting and surpassing the benchmark as well as penalty for compliance – physicians will invariably have to outsource their EHR capability. Even then, amidst numerous service providers, their decision to decide upon competent provider will become crucial.

Further, Medicare, being revamped radically, physicians’ documentation for medical billing reimbursement is likely to be more detailed and exhaustive, resulting in complex medical billing procedures that can only be managed by competent medical billing houses. Invariably, physicians will have to allocate overheads for advisory from such medical billing houses. Although, the initial expenditure might seem high, yet, the associated returns will eventually outweigh the expenditure.

Above all, the imminent ICD-10 transition looming large, physicians’ medical coding is in for a major overhaul, prompting allocation of resources and time on an unprecedented scale. But, with internal competencies likely to fall short of the requisite ICD-10 benchmark, yet again, outsourcing could become a possible recourse, prompting judicious selection of competent service provider.

As physicians seek to safeguard clinical, operational, and revenue-generation interests, Medicalbillersandcoders.com tried, tested and proven credentials in medical billing management may well become indispensable. Its proven credentials in Revenue Cycle Management for clinical and operational excellence – complete with   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 – could proactively address the documentation challenges in the changing landscape.

Unbalanced equilibrium: US States facing shortage of Medical Coders in spite of high supply

As if hospital shortages of nurses and pharmacists were not enough, the shortage of medical coders has risen to high levels in some areas in the US and physicians need to act fast least they lose millions of dollars in unbilled charges. American Health Information Management Association (AHIMA) has reported a nationwide shortage of certified medical coders in hospitals, physician practices, and other healthcare facilities, with the most critical shortage in the northeastern and western parts of the country.

President of Provider HealthNet Services Health Information Management Inc. estimates a nationwide shortage of almost 30%. According to The Bureau of Labor Statistics, U.S. hospitals will need a large number of new medical record and medical health technicians to replace those who are leaving the field now.

Imbalanced scales 

On the upside with the increasing demand for coders, their role in health management is expanding, however there is a nationwide shortage of credentialed coding professionals, Coders already present in the profession are facing a difficult time keeping up with the various changes demanded by the industry. There are a multitude of circumstances contributing to this shortage-most graduates are unaware about medical record coding professions, while ongoing changes in the coding profession make it difficult for even skilled coders to keep up. A recent American Hospital Association survey showed that about 18% of billing and coding positions remain unfilled due to a lack of qualified candidates.

Many hospitals are also beginning to implement internal measures to ease the shortage: upgraded pay scales; sign-on bonuses; flex-time and overtime opportunities; scholarship programs for coding education; online training programs; in-house training for internal employees; and increased use of freelance coders.

Increased demand for coders

Coding is highly critical to a physicians practice as any discrepancy in this area can result in high penalties. The scope of health information management (HIM) has grown significantly over the past five years. The health care system has employed a number of techniques to combat the shortage, including contract services. According to the U.S. Bureau of Labor Statistics, medical billing and coding demand is projected to increase by nearly 20% by 2018.

Coders are an integral part of a health care system playing a key role in reimbursement and processing claims. Medicialbillersandcoders.com is the largest consortium of medical billers and coders in the US providing updated knowledge, placement opportunities and analyzing current salary trends.