The Relevance of Using Perfect Modifiers in Medical Claims

The overlapping nature of certain medical procedures is such that it is impossible to report them with CPT codes alone. Although CPT coding has grown to be comprehensive enough to cover breakthrough procedures over the years, yet, physicians are not spared from submitting separate procedural forms for medical procedures requiring explanation that overshoot the CPT boundary. Recognizing a parallel system that not only obviates the necessity of submitting supplementary forms but also expedite the submission and realization of medical claims, American Medical Association (AMA) has long been known for promulgation of modifying those overlapping medical procedures through unique and efficient Modifiers, identified and approved for the very purpose of aiding physicians in successful submission and realization of medical claims for their medical services to the patient fraternity. Thus, physicians, having a unique recourse to their problems in medical billing, should be competent enough to not only know the definition of Modifiers but also the circumstances wherein they can apply them.

AMA defines Modifiers as codes that are used to “enhance or alter the description of a service or supply” under certain circumstances. From this definition, it can be inferred that modifiers provide the means by which the reporting physicians can indicate that services or procedures that have been performed have been altered by some specific circumstance but has not changed in its definition or code. Thus, modifiers can be attached along with the originally billed and coded forms, without being required to submit through separate forms. Further AMA has also identified the following circumstances that warrant the application of modifiers:

• a service or procedure which has both a professional and technical component
• a service or procedure which requires to be performed by more than one physician and/or in more than one location
• a service or procedure which has been increased or reduced
• a procedure wherein only part of a service is performed
• a procedure wherein an adjunctive service is performed
• a procedure wherein a bilateral procedure is performed
• a service or procedure which is provided more than once
• a procedure wherein rare events were witnessed

Having understood the circumstances and the extent to which modifiers can be applied during the course of preparing and submitting medical claims, physicians should also be conversant with the prevailing and acceptable modifiers that are unique to their individualistic practice specialties. Generally the following set of modifiers are frequently used and accepted by the insurance carriers:

• Modifier-25: needs to be attached with any evaluation management service done on the same day by the same physician. Further, the procedure needs to be beyond the usual preoperative and postoperative encounter.
• Modifier-24: can be used with any unrelated evaluation and management service by the same physician during postoperative period, and, like modifier 25, has no restriction as with the level of E/M code as long as it meets medical necessity. Also, all its components are time-based.
• Modifier-57: allowable when an evaluation and management service results in the initial decision to perform surgery.
• Modifier-50: allowable with bilateral procedure performed on the same day, during the same operative session, and on identical anatomical sites. Further, it can be used with add-on codes also; but cannot be used with procedures that are already described as bilateral procedures.
• Modifier-51: handy while reporting multiple procedures performed by the same physician on the same day. But, it can be clubbed with the procedure done on the same day by another physician.
• Modifier-59: necessitates reporting any distinct procedural service performed on the same day that is deemed apt under a medical situation. But, the physician needs to establish the need for such distinct or independent service while appending with the original procedure.
• Modifier-26: As certain procedures are combination of both professional and technical component, this modifier is useful while reporting the service as a professional component only.

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Although the Modifier System is comprehensive enough to mitigate all challenges while coding and submitting medical claims, the voluminous knowledge accompanying it would be hard to be digested by the physicians, who have a much more challenging task of keeping their medical practice benchmarks unblemished.

Fortunately, they can look forward to proven outsourced solutions on the horizon. Medicalbillersandcoders.com (www.medicalbillersandcoders.com), with a comprehensive outlook to their clients’ billing and coding management and with substantial hands-on experience across specialties, is uniquely poised to advise, own, and execute an efficient system of modification as part of its all-inclusive medical billing management.

Group Appointments: A new niche for Primary Care Practice

Group appointment, also referred to as shared medical appointment, includes multiple patients seen as a group for follow-up or routine care. These visits are voluntary for patients and provide a secure but interactive setting in which patients have:

• improved access to their physicians,
• the benefit of counseling with additional members of a health care team (such as a behaviorist, nutritionist, or health educator), and
• share experiences and advice with one another.

According to the AAFP, Group Appointments were utilized by around 6% of family physicians to provide some amount of patient care in 2005, and that number has gone up to 13% in 2010. Group medical appointments are also a key component of the patient-centered medical home (PCMH) model. There are three general models for the shared medical appointment:

• The cooperative health care clinic (CHCC), created for older patients requiring frequent, broad-spectrum care;
• The disease-specific CHCC, a diagnostically exclusive group that aids patients with chronic-disease management; and
• The drop-in group medical appointment (DIGMA), intended for established patients requiring a more comprehensive approach to their follow-up care.

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Medicare generally pays for group visits if there is some one-on-one time with the physician, but practices should contact local carriers and other insurers about their policies; some carriers are still resistant to the idea. 

Who benefits from this type of program?
Shared medical appointments can be satisfying to both the physician and the patient, used as substitution or in addition to a traditional appointment. They are most appropriate for patients requiring routine follow-up care, or frequent time with the physician, or chronic patients. They can offer an increase in the productivity and efficiency of the health care team as well as enhance the patient’s visit by offering a holistic and therapeutic approach. 

Staff
Group appointments might require trained staff to act as facilitators, or even especially experienced billers and coders who are able to understand the process of group appointments, in order to get proper reimbursement for the providers, although physicians can outsource billing assistance for such appointments to professionals who are trained and experienced in group practice billing.

Implementing an Ideal EMR System for Your Practice

“Judging from the evidences of successful EMR implementation, customization has been the pivotal element, and will hold good for future also. Taking cue from such references, practices can benefit immensely, and successfully mitigate the probability of misadventure”

More than the mandatory obligation of digitalizing/computerizing/electronically recording healthcare data, it is the overwhelming benefits over investment outlay that have convinced physicians, clinics, hospitals, and multi-specialty groups of the efficacy of implementing Electronic Medical Recording (EMR) in their practices. But, implementing the EMR systems that best serves your individualistic needs is not as easy as arriving at the decision to implement it. In fact, there have been instances of unsuccessfully implemented ventures at it. Therefore, presuming EMR to be universal, and leaving your EMR implementation to your vendor’s discretion could prove to be a costly error.

Judging from the evidences of successful implementation, customization has been the pivotal element, and will hold good for future also. Taking cue from such references, practices can benefit immensely, and successfully mitigate the probability of misadventure. The following pro-active approach should be a guiding light in the search of an effective and efficient Electronic Medical Recording System Implementation:

• Defining your needs:
  The first step to an effective and efficient EMR system is an internal analysis leading to a clear definition of your needs in terms of scope and volume of data capture. Such an internal analysis aids in preparing an amicable budget outlay for your individualistic EMR system implementation.
• Spelling out your hardware and software requirements:
  Having defined your needs, you should be able to clearly spell out your hardware and software requirements in line with your scope and volume of data capture needs. Doing so can cut out unnecessarily over-installing your capacity at an exorbitant cost.
• Short listing vendors: In a market characterized by vendor-oligopoly, selection becomes tricky. Therefore, it is desirable that you prune down the list depending on vendors’ relative credentials. Being an important exercise on the way to successful implementation, this can be crucial in avoiding a wrong choice of vendor.
• Arranging for demo: A preliminary demonstration of EMR Systems can reduce your apprehension over their capability. Therefore, it is advisable that you are presented with demos by short-listed vendors.
• Confirming on pre and post installation training: Mere installation would not serve your purpose comprehensively; ensuring proper orientation of your staff to the technology assumes greater significance. Therefore, your vendor should be able to provide for such orientation.
• The extent of post installation services: Like your vendor’s capability for providing pre and post installation orientation, their promise for extensive after-sales service is also an important consideration prior to choosing an EMR system for your practice.

The fore-play of these factors is likely to pose mounting challenges to physicians, who may lack the foresight on something that is not their core competence. Inevitably, they would need to seek out help from Medical Billing Management Service providers.

Medicalbillersandcoders.com, with a wealth of knowledge on advising medical fraternity with proven solutions in Medical Billing Management – technology interface for seamless reporting of medical data being one of their niche solutions – should be an ideal ally in helping to choose the best EMR System mapped to your unique needs, ensure your practice in congruence with Federal Healthcare Mandate for EMR, and even make your practices eligible for incentives for meeting the Best Practices in Electronic Medical Record System.

Hospitalists registered a pay increase in 2010

The year 2010 has registered a hike in the median compensation for Hospitalists. The Hospitalists in adult medicine saw their compensation increase 2.6% to $220,619 from $215,000 while the Pediatric Hospitalists’ pay rose by 7.2% to $171,617.


The report, which is based on MGMA survey information, takes into account data from 4,633 hospitalists in 412 groups and 726 academic hospitalists in 68 academic medicine practices. The pay also varied region-wise; the median compensation for southern hospitalists was higher as compared to west, Midwest and eastern region, that is, $235,701, $231,831, $211,751, and $205,000 respectively.


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One of the reasons for the hike in compensation is the increase in hospitalist productivity; hospitalists are being recognized for their value in other arenas, as it relates to the transition from the fee-for-service to pay-for-value-type models, championing effective transitions of care, leading process improvement teams, etc. Another reason for the rising trend in pay is the fact that the demand for hospitalists has exceeded the supply.
Another potentially significant variable that could strongly impact the future trends in the Hospitalists’ salary is the drastic healthcare reforms and regulations sweeping the industry.

Medicaid claims audits slated for January

The Medicaid recovery Audit program is due to get implemented nationwide in January, carrying on in a similar vein as Medicare RAC program, as announced by CMS on 14th September, 2011. The Medicare RAC had recovered $451.3 million in overpayments and corrected $78.5 million in underpayment within six months in 2011.

The Dept. of Health and Human Services estimates that Medicaid RACs will save the program $2.1 billion over the next five years, of which $900 million will revert to the states. The states must implement Medicaid RACs by Jan. 1, 2012, according to the final ruling.

The states will enter into a contract with the Medicaid RACs, which will review the past claims that have already been paid and scrutinize them for fraud, waste and abuse. The auditors will be recompensed by getting a percentage of the funds they recover as having been inappropriately paid to doctors, hospitals and others. However, AMA has indicated its discomfort over the fact that RACs will be paid on the basis of their recoveries.

At the same time, the final rule also directs states to pay reviewers for uncovering underpayments that must be reimbursed to those filing the claims.

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The CMS has incorporated certain points in the Medicaid Audit program which were not present in the Medicare Audit program:

• Each Medicaid RAC must hire a physician as medical director
• The CMS has called upon the states to place a limit on the frequency and age of claims that Medicaid RACs can request from claimants for review
• Requiring states to coordinate their Medicaid RAC activities with those of other auditors; RACs cannot audit claims already being investigated by another entity
• Requiring RACs to return their fee if an overpayment determination is reversed at any level of appeal

The audit program is likely to aggravate the reimbursement as well as administrative burdens of the providers. Overall a need has been expressed for the CMS to take effective measures to educate providers as well as other health professionals to pre-empt inadvertent coding mistakes and the consequent incurring of penalties. In fact, these issues once again underscore the wisdom in utilizing trained and experienced billing and coding professionals well versed in handling RACs audits to pro-actively avoid auditor scrutiny.

How crucial will medical billers’ role be after healthcare reforms?

“Proactively realizing the need for preparing to face up to these challenges, many professional medical billing companies have taken up upgrading their system and human capabilities to the probable demands emanating from healthcare reforms”.

A string of healthcare reforms announced by the Federal Government over a year or so have changed the landscape of the healthcare industry nationally. The expected extension of insurance coverage for more than 30 million people, removing pre-existing condition clause, and an incentive based healthcare regime are going to influence and alter the equation for all the stakeholders concerned, more so the medical billing management companies/professionals. While the extensive coverage of health insurance should open avenues for more business and revenues, the ensuing stringent billing regimen – the mandatory EMR System Implementation, ICD-10and HIPAA 5010 compliant coding and reporting norms, and highly rigid insurance carriers – is going to test Medical Billers’ ability to adapt to the changing landscape. Never before has the role of medical billers been more debatable than now.

As the healthcare reforms take effect, Medical Billers will be called upon to redefine their role in as far as:

• Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.

• Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.

• Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.

• Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physcian’s medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.

• Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.

• Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s medical billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

Proactively realizing the need for preparing to face up to these challenges, many professional medical billing companies have taken up upgrading their system and human capabilities to meet the probable demands emanating from healthcare reforms. Likewise, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – has taken up advancing their system and human capability on a massive scale. With their vast hands-on experience on innumerable projects, and updated knowledge of healthcare regulations and IT, our MBC billers and coders bring a plethora of value-added services to enhance your processes and RCM.

Combating Healthcare Fraud and Abuse – a challenging task for providers

The inherent nature of Health Insurance is such that it is highly susceptible to fraud and abuse by unscrupulous healthcare providers and beneficiaries. Consequently, there has been an unbridled rate of fraud and abuse amounting to billions of dollars – a reliable statistics puts it around 300 billion dollars, and still counting. Whereas, primarily, it is a staggering erosion of Private and Federal Government’s Health Insurance Funds, it has wider repercussions: payers, employers and patients having to pay higher premiums, lower benefits, higher taxes and higher copayments on account of rising cost of health benefits, necessitated by unethical erosion of healthcare insurance funds.

While there have been regular reforms – medical billing and coding compliances such as EHR System, CPT coding regimen, and HIPAA compliant medical reporting, auditing programs – for checking this burgeoning problem, yet, insurance carriers are unable to shield themselves completely from this menace. The duality of this menace further compounds the issue:

Duality of Fraud and Abuse of Health Insurance Schemes
Fraud by Beneficiaries of Healthcare Providers Fraud by Healthcare Providers

• Using a member ID card that does not belong to that person
• Billing for services that were not provided
• Adding someone to a policy that is not eligible for coverage
• Duplicate submission of a claim for the same service
• Failing to remove someone from a policy when that person is no longer eligible
• Misrepresenting the service provided
• Doctor Shopping – visiting several doctors to obtain multiple prescriptions
• Upcoding – charging for a more complex or expensive service than was actually provided
• Billing for a covered service when the service actually provided was not covered

What is more alarming is that these dual entities have the propensity to collude and operate through an unholy nexus. Faced with such imminent threats, it is high time that health insurance providers implemented an effective program that can detect, investigate, prevent, prosecute, and recover the loss of corporate and customer assets resulting from fraudulent and abusive actions committed by providers, members, groups, brokers, and others. Although RAC audits have been able to recover a substantial amount of fraudulently claimed reimbursements, still, a considerable number of cases find ways to sneak in under their nose; the high cost of appointing Recovery Audit Contractors (RACs) – nearly ¼ of the total reimbursement to be audited for fraudulent realization – is not helping the cause either.

But, in the face of radical health care reforms – Affordable Care Organizations, proposed cuts to Medicare, and the negative impact of imminent Sustainable Growth Rate backlash – Federal Government’s Medicare and Medicaid – which account for a major share in the nation’s healthcare insurance scheme – along with major private insurance carriers, have the monumental task of safeguarding against adverse impact of health insurance frauds and abuse including higher premiums, lower benefits, higher taxes and higher copayments.

The scenario warrants these providers to either build or outsource proven anti-fraudulent measures that can ensure a profit-building model through raising premiums or adding new members. Such anti-fraudulent measures assume greater weight when they are faced with the undesirable prospect of erosion of their funds by 10% to frauds and abuse. With historical experience of internal anti-fraudulent measures leaving a lot to be desired for, recourse to proven agencies that have demonstrated optimum efficiency in anti-fraud measures and recovery rate is recommended.

Medicalbillersandcoders.com – having the distinction of being the largest medical billing consortium, and advisory to many insurance carriers – should be of immense help in this regard. With their exposure in billing and coding across specialties and payers, and expertise in all billing issues related to the latest compliances and regulations, their consultancy services can assist in scrutinizing inadvertent billing and book-keeping oversights, and pro-actively minimize compliance exposure by healthcare providers.

Appealing Denied Insurance Claims: An Overview

The process of appealing a denied insurance claim is complicated but can be effective if done correctly since there are numerous reasons for claims to be denied by an insurance company. The payer or insurance company receives thousands of claims everyday and the claim can be quickly denied if there has been an error in any aspect from diagnosis to medical billing and coding. The reason for a denied claim is given in the Explanation of Benefits or EOB and is the most crucial aspect when appealing a denied claim. Moreover, there is also a need to comprehend if the claim is worth appealing since a claim that amounts to just $1 is not worth appealing but one which is worth a substantial amount needs to be investigated. Here are some of the reasons for claims to be denied and how to go about appealing such denied claims. 

Services not covered
The insurance company can rightly deny a claim if the services rendered to the patient are not covered under the insurance plan. In such cases there is not much a person or a medical biller and coder can do to get paid since this is a legitimate reason for denying a claim. Therefore it becomes important for a physician or health care provider to determine if the services provided are covered under the insurance plan before commencing to provide such treatment. There is no point in wasting time and money if such a scenario occurs and appealing and re-appealing would only result in denials and re-denials. 

Errors in Clinical Documentation
Errors in documentation can lead to denied claims and such claims have a good chance of a successful appeal if there are no other reasons for the denial. These errors can range from not specifying the correct codes or even mistakes in spelling and procedure to be followed. The error can arise from the physician’s office or due to a mistake in medical billing and coding. These errors can easily be rectified by professionals who understand the CPT codes and ICD codes involved in the procedure. However, time is of essence here and if the claim is not appealed within the stipulated period of time, it cannot be appealed after such time has elapsed after the claim denial. 

The Appeal Process
The process of appealing a denied claim can differ from one payer to another and it is important to understand the correct procedure for appealing the claim in order to be successful. If the claim is not appealed in a manner which the policy describes, it can be turned down by the payer. For instance, the procedure for appealing a denied claim by Medicare is different from other private insurance companies. Even under Medicare there are different ways to appeal a claim which depend on the type of coverage chosen. There are different procedures for appealing a claim for Original Medicare, a Medicare Health Plan, and a Medicare Prescription Drug Plan. The appeal forms are available on the Medicare website and can be downloaded or printed for appealing a claim. A Medicare Redetermination Request form is available on the CMS website and can help you understand the procedure and file a claim according to this form. 

Medically necessary claims
In many cases appealing a denied claim hinges on the fact if the treatment provided is medically necessary or scientifically proven. This means that the insurance company regards the claim as medically unnecessary or the treatment is scientifically not proven to provide better health outcomes for the patient. In such a case the help of recognized medical journals such as Pubmed.com can be used as evidence to prove the necessity or the scientific viability of the treatment. Physicians can make an undeniable claim based on such evidence in order to get paid in a timely manner. 

Medicalbillersandcoders: an ideal ally to handle claim appealing process
The reason and the process of appealing a claim can be time consuming and complex since there are many grounds on which the claim can be denied. Some of the common reasons include policy limitations or guidelines, untimely appeals of claims, denied authorization for prescription drugs, denied the transportation to an Emergency Hospital, services received without a referral or authorization, and denied due to the physician being out of network.

The complexity in the reasons for denials and the appeals process makes it a task in itself requiring in-depth knowledge of such processes. This problem can be solved by medical billers and coders who are experienced and know the usual pitfalls and reasons for claims being denied. Utilizing the services of medical billers and coders can help physicians and patients in saving time and money which have become an important issue in the light of recent health reforms.

For more information about better solutions for issues related to appealing denied claims and professional medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States for all specialties. Our medical billing experts – who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – have been crucial to physicians/clinics/hospitals’ operational efficiency and revenue maximization.

Under-Coding: Financial Repercussions and Solutions

Under-coding can be defined as the procedure of medical coding where the codes do not reflect the full extent of the treatment provided to a patient. This can usually happen due to many reasons but the most common are errors or misreading of codes or because of the misconception that the chances of insurers paying would increase because of under-coding. The truth is that under-coding can affect your revenue in a negative manner as a health care provider and even get you into the habit of chronic under-coding which can lead to losses and improper patient care in the future.

Reasons
Under-coding can occur due to numerous reasons such as lack of skilled staff, the fear of rejection of claims by payers, or errors in understanding the correct codes. The skill of the physician staff can be increased by providing proper training which would also ensure lesser amounts of errors. Another situation which can lead to under-coding can be avoided by providing uniform coding for patients who are fully insured and those who choose to pay cash for smaller illnesses or visits. Discrepancy in the codes for the same procedure provided to an insured patient and cash-paying patients can be termed as discriminatory billing by payers. 

Avoiding under-coding
Under-coding can be avoided by familiarizing with the latest codes and hiring or training the staff and hire professional medical billers and coders who have tested the new codes with other entities such as payers and clearinghouses. This would ensure that the performance of physicians and the treatment is correctly captured. Another way of avoiding under-coding and mistakes in coding is to refer to the annual updates of ICD-9 codes and identify the most under coded procedures using ICD-9. In times where ICD 10 implementation is just round the corner, the threat of under-coding is at its peak. Proper training and implementation can help in avoiding these mistakes when the use of ICD-10 codes becomes imperative. 

Legality
The fact that under coding is seen as an unethical if not an illegal practice even when revenues for health care providers decrease may implicate negligence on the part of physicians, clinics, or hospitals. While under-coding for cash patients is on no account correct, in the case of Medicare, it can be seen as inducement, which could then be regarded as fraud or abuse or both. According to Medicare, inducement is “offering any free service to a patient to encourage providing a service that would be covered by Medicare.” Such abuse can lead to legal actions since these indicate non-uniformity and providing of free goods or services to patients in order to influence future purchases by consumers of the covered services. 

Training
Training for proper coding procedures is an integral part of avoiding under-coding and such training can be provided to assistants, while physicians themselves can train on basic codes that are often needed and encountered. CMS provides training as far as the technology is concerned and this can also help in familiarizing with EMRs and EHRs which can be an added advantage for health care providers, especially solo practitioners or physicians working as a small group. 

Revenue
The most important aspect as far as under coding is concerned is the amount of revenue which can dramatically decrease due to incorrect coding for multiple reasons. The easiest way to make sure that revenue is not affected in a negative manner is to familiarize you as a physician with some of the most commonly used codes and hire medical billers and coders who can provide relevant advice in order to use the correct codes. Dedicated medical billers and coders are aware of the pitfalls and the areas where mistakes are often made and can ensure these errors are not repeated. 

The migration from ICD-9 to ICD-10 codes
The reason for migration from ICD-9 to ICD-10 codes is not just because they are extensive but also because of the sheer volume of codes and the extent to which they can cover the treatment that is provided. However, on the other hand, ICD-10 codes are so extensive that payers can deny claims that do not accurately reflect the treatment or diagnosis provided. The scope for mistakes and under-coding is becoming a growing concern among physicians and health care providers since payers would be happy to deny claims based on a technicality. Since the number of codes have increased almost 9 times compared to ICD-9, it becomes imperative to train the in-house staff cope with the ensuing changes at various levels, while the core process of medical billing and coding can be outsourced to professionals who are specialized in this area.


For more information on how under coding is likely to impact physicians and their billing processes, and how to cope with it in an effective and pro-active manner, or to know more about our coding services and coding training services on how physicians can handle such and similar issues in their practice, please visit medicalbillersandcoders.com, the largest consortium of billers and coders in the US across all specialties.

Revenue Cycle Management – prescription for optimum medical claim realization

“Despite such volatile environment, physicians have to find means to realize their each and every dollar owed them as their very sustenance and growth hinges on efficient reimbursement of medical bills”

Unlike other professional services that realize their professional fees instantly, without having to rely on a third party (insurance carriers), physicians have to go through an intricate process to realize their fees for medical services rendered. And, with every citizen resorting to healthcare insurance, the physicians will have no recourse but to realize their claims through insurance carriers alone. But, the prevalence of complex regulations, multiple payers, and stringent reimbursement environment have altogether made their task even harder. Despite such volatile environment, physicians have to find means to realize their each and every dollar owed them as their very sustenance and growth hinges on efficient reimbursement of medical bills.

As physicians find the intricate process involved in revenue reimbursement too hot to handle, there is growing inclination to outsource solutions under the umbrella name, ‘Revenue Cycle Management’, a comprehensive procedure – Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management, Appeals, and Physician Credentialing – for optimum realization medical claims from insurance carriers. While market is replete with numerous Revenue Cycle Management providers, physician practices would do well to source those that devise integrated approach: advising on internal adequacies (both human and technology), seamlessly integrating RCM process with compliant norms (coding and reporting) and technology interface (billing and coding software), and recommending innovative business models that are more efficient, scalable and flexible.

Having been a niche Revenue Cycle Management service provider for small and large practices alike, Medicalbillersandcoders.com has a unique Revenue Cycle Management capable of custom-delivering optimum reimbursement of their clients’ medical claims at incredibly less turnaround time (TAT).

Features of Medicalbillersandcoders.Com’s Revenue Cycle Management (RCM)

• Improving Patient Experience: Our transformational solutions that improve efficiency of patient-facing functions help in enhancing the ease with which patients can be enrolled and treated at your facilities.
• Technology Interface: Infusing technology, both at clients’ facilities as well as centralized control, ensures fast, reliable and efficient functioning of RCM for our clients.
• Regulatory Compliance for Reimbursement: Our proactive outlook to updating competence in congruence with evolving Regulatory Compliance (ICD-10 and HIPAA 5010) mitigates the probability of undesirable delay, denial, resubmission, or audit issues on clients claim sheets.

Therefore, our unique Revenue Cycle Management – enriched with end-to-end revenue cycle transformation, improved patient experience, integrity in charge capture, billing and coding, proven operating models, enabling self-pay collection through better analysis and management practices, and inspiring your staff with innovative training models – should greatly appreciate your bottom-line through:

• Realization of additional recovery of 5-10% claims, which would have gone unrealized without a proper Revenue Cycle Management Cycle (RCM) in place.
• Expedite Account Receivables through timely follow up and persistence with insurance carriers.
• Substantial reduction in operating costs through innovative business models, and appreciable increase in revenues through seamless reimbursements.
• Expanding practice without additional outlay on human resources; our recommended technology interface can withstand your growing business/practice needs.
• Last but not the least, enhanced patient satisfaction through unprecedented patient experience

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