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.

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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.