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.

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.