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.

Physician Credentialing: Worth Getting Right to Get Paid

As physicians, despite your reputation for benchmarked medical services, you could be losing out when it comes to realizing medical bills reimbursed fully from respective health insurance carriers. And when you start to analyze that elusive reason responsible for hampering your reimbursements, you would invariably end up discovering ‘Credentialing’ as the chief culprit. Quite contrast to the earlier scenario, wherein your credential as a qualified and competent practitioner could alone determine your practice’s sustenance and growth, the present day scenario, characterized by innumerous practitioners and heterogeneous mix of insurance carriers, requires your practices to bear the stamp of ‘Credentialing’ to stay well clear of audit, delay or denial exposures.

Although, physician practices require to be credentialed from Federal Health Agencies (for being compliant with requisite health care standards) as well as Medicare and Medicaid, and respective private insurance carriers (for being compliant with medical billing standards), it is the latter that assumes greater significance as it has direct impact on operational optimization and revenue maximization. Credentialing in the medical billing context means that your medical practices are compliant with the benchmarked clinical and operational practices as deemed suitable by the prevailing health insurance convention. And as we stand at an important juncture when health insurance sector is realigning its revenue structure post the Federal Government’s radical healthcare reforms, there is a growing emphasis being laid on Credentialing, first by the Centre for Medical Services, and then by private insurance carriers – making it mandatory for physicians to have their practices duly Credentialed.

But, owing to its exhaustive process, Credentialing itself could be one of your major pre-occupation, relegating the all important medical practice to the second! Here are the series of process that would invariably have to clear for being eligible to Credentialing:

•  Preparation of paper CMS 855 & other Managed Care applications for all payers
•  Preparation and submission of online applications to federal and non-government carriers
•  New provider affiliations and Group Contracts
•  Maintaining and updating specific Provider information directly with carriers at frequent intervals or when requested
•  Resolving enrollment issues and tracking Managed Care contracts
•  Validating information provided by payers
•  Handling Provider letter of interest & enrollment transactions
•  Setting of Provider information in the Practice System
•  Obtaining Contracted Fee Schedules and negotiating changes
•  Preparation of contracting documents for scanning and long-term storage electronically
•  Preparing, maintaining and monitoring Managed Care Summaries that Provides Effective dates, Fee Schedule details and Group affiliation.
•  Monitoring Expiry dates for NYS-Registrations, DEAs, and CLIA registrations and also handling re-applications for the same.
•   Handling Re-Credentialing whenever required
• But, because of its inevitability and the incidental benefits that come with a well-documented Credentialing, it is prudent that you outsource from competent and proven medical billing companies that can offer quality services at a more economical cost than it would cost if it done internally. The following overriding advantages should amply justify the efficacy of going for outsourced Credentialing:
•  Insurance carriers pay better to the physicians who are in par with the insurance
•  Credentialed physicians are considered as reliable providers and are listed in the ‘preferred physicians group’ from which patients usually select their physicians in order to get maximum benefits and avoid ‘out of the pocket expenses’.
•  Since physician credentialing involves complete background check on providers’ educational qualifications, professional licenses, experience, fellowship programs, and residence, it helps in controlling the healthcare fraud-related crimes and ensures that only qualified physicians deliver services to patients and thereby improving the quality of healthcare in US
•  Credentialing offers comprehensive access to the fee schedule, which aids in knowing in advance the exact quantum of medical billing for diverse medical practices rendered.
•  Credentialing is also an accelerator of strategic clinical networks and market expansion as your practices begin to command unprecedented goodwill in the medical fraternity.

We, www.medicalbillersandcoders.com – known for offering imperial Credentialing, both as an individual component as well as an integral part of our comprehensive suite for Medical Billing Revenue Cycle Management – should be your preferential choice for “Outsourced Credentialing”.

Ohio tops in EHR usage, with the other states catching up

According to Ohio Health Information Partnership, around 6,750 doctors in Ohio, the maximum count of physicians compared to any other state, have committed to electronic health records (EHR), leading the nation in usage of EHR’s. Greater Cincinnati has nearly 985 physicians who have committed to or are already using the records systems. Ohio is currently transitioning its legacy Medicaid Management Information System (MMIS) into a new Medicaid Information Technology Architecture (MITA) compliant system.

Various other states are following suit, more than 60% Medicaid providers in Florida are interested in applying for incentive payments for the meaningful use of electronic health records as reported by the journal Health Affairs, while more than 1,000 providers in South Carolina are now on the road to meaningful use. California Healthcare Foundation has reported that 55% percent of California’s primary care physicians use an electronic health record in their practice.

The federal coordinator for health information technology announced that almost 100,000 primary care providers across all the states have committed to electronic records. An upward trend has been observed across US states in consumer use of EHR’s, with total EHR market revenues expected to increase by $6.5 billion in 2012 as compared to $973.2 million in 2009, according to a report by  Frost & Sullivan.

• In contrast to the growing trend, implementing the meaningful use attestation standards by the current healthcare organizations has been at a slower rate
• Amongst the total of 114644 users registered in an EHR system, only 8303 actually meet meaningful use standards and qualify for federal incentives

In this scenario, physicians can look for medical healthcare experts/services to achieve the required benefits of an electronically governed paperless office. Amongst the top reasons for other Physicians not accepting EHR uncertainty, time involvement and implementation efforts seem to be topping the list. They are fervently looking for professionally unbiased opinion on choosing the right EMR and successfully implementing it.

Medicalbillersandcoders.com has been helping physicians not only in Ohio but across the 50 states choose appropriate technology for their individual practices and also offers professional support and assistance to healthcare providers to keep abreast of the changing industry norms, and successfully qualify for federal incentives through meaningful use of electronic health records.

For more information visit:Medical billing companies, Ohio Medical Billing

Driving Physicians’ Practices towards Accelerated EMR Implementation

“Notwithstanding the incentive bait for ‘Meaningful Use’, and penalty threat for ‘Non-compliance’, there has an encouraging statistics about migration from manual to digital form of healthcare practice management. But, considering the quantum of target to be reached to meet Macro EMR/EHR objectives, we are miles away from the originally conceived vision of idealizing healthcare management processes.”

There has been an unprecedented impetus on EMR/EHR system since the recent Healthcare Reforms promulgated by the Federal Government. While the decision to emphasis on EMR/EHR stems out of the overriding necessity of providing a controllable and qualitative medical care to the growing population base, the healthcare fraternity itself is going to be the beneficiary at large.  Eventually efficient EMR/EHR system implementation will bring about a transformational change in capturing, processing, and collaborating clinical data for enriching quality medical care as well as efficient practice management that augment practitioners’ operational efficiency and revenue maximization.

Notwithstanding the incentive bait for ‘Meaningful Use’, and penalty threat for ‘Non-compliance’, there has an encouraging statistics about migration from manual to digital form of healthcare practice management. But, considering the quantum of target to be reached to meet Macro EMR/EHR objectives, we are miles away from the originally conceived vision of idealizing healthcare management processes.

In view of this prevailing scenario, physicians’ practices that are apprehensive of joining the EMR/EHR bandwagon should be taken into confidence, and be familiarized with the efficacy of migrating to the digital form. The following list of potentially transformational advantages will make a world of good to dispel clouds of apprehension amongst physicians:

• EMR/EHR as a means of improving Patient Care:
  The ultimate goal of an EMR is to improve patient care by offering physicians and clinical staff a consolidated view of relevant patient information and enabling immediate EHR access to the data. By digitizing and making patient information available online, there are fewer paper records in circulation and, therefore, less risk of lost records and incomplete data at the point of care.
• Leveraging Record Storage Facility:
  EMR/EHR platforms provide unimaginable the quantum of data storage for future clinical reference and collaboration; physicians would do well to benefit from such technology installations.
• Increased Physician Productivity:
  Physicians can sign deficient records online – increasing productivity while reducing record delinquencies and administrative costs associated with retrieving and processing incomplete medical records.
•  Enhanced Turn-Around Times
  Electronic, secure and centralized patient records result in a more efficient process for responding to audit requests – improving turn-around times, reducing costs and minimizing the risk of audit-related penalties.
• Increased Patient Throughput:
  Many functions of medical record processing, such as assembly, filing and manual retrieval, can be eliminated – improving overall processing time and patient throughput.
• Improved Revenue Cycle:
  A consolidated electronic medical record minimizes the time necessary to collect patient information after discharge and enables bills to be dropped faster – improving accounts receivable (AR) days and discharged-not-final-billed (DNFB) accounts.
• Centralized Coding:
  Digitizing patient records upon discharge enables healthcare providers to leverage offsite coders – centralizing coding functions for multi-facility organizations and further reducing the revenue cycle.

As practitioners embark on these transformational practices, they are bound to encounter the decision on choosing apt EMR/EHR installations from amongst innumerable available in the market. And, with their limited to core-medical practices, such decisions are not going to be easy and can sometimes be repenting. But, with competent service providers at their disposal, practitioners can easily off-load such risky decisions to the providers who possess the requisite credentials.

Medicalbillersandcoders.com, being credible source for comprehensive revenue cycle management, stands uniquely poised to address EMR/EHR issues that have a direct bearing on:

• The Meaningful Use mandate, which is part of the American Reinvestment and Recovery Act of 2009 (ARRA)
• The requirement to adopt ICD-10-CM [International Classification of Diseases, Clinical Modification/Procedure Coding System (ICD-10)]
•  HIPAA 5010 standards (Health Insurance Portability and Accountability Act of 1996)

Hospitalist Medical Billing | Radiology Medical Billing | Minnesota Medical Billing

Doctors contemplate opting out due to continued Medicare hassles

Physician participating in the Medicare program are scheduled to face a 27.4% cut in their payments, effective 1^st January, 2012, and with providers anyway complaining about current reimbursement rates, the cut is likely to considerably impact both patients as well as doctors adversely. As a result of the cut the Medicare physician conversion factor will decrease to $24.67, approximately $15 less than it was in 2001. In this scenario, the Association of American Physicians and Surgeons reports that various physicians are declining to take on new Medicare patients and many are thinking about cancelling enrollment from the program.

Medicare hassles:

Since the past 10 years physicians and Congress have been grappling with similar situations; however the difference which is pushing doctors to consider opting out is the severity of the cut and the escalating costs of a permanent solution, and few can continue to operate in an environment where revenues are cut by 27% while costs continue to rise at a rate of 3% or higher. An internal medicine physician in New London whose approximately 80% patients are covered by Medicare, with this cut is likely to lose about one-third of his revenues, possibly forcing him to restructure his entire practice.

Another issue that has created problems for Medicare beneficiaries and their medical providers for years is the sluggishness of the claims process and the payment process. Medicare doctors in three western states – California, Hawaii and Nevada, are in a situation where Medicare’s payment backlog has created a multimillion dollar problem.  Various doctors have not been paid since February, a backlog of almost 10 months,  forcing some doctors to have to drop some or all of their Medicare patients while others are on the verge of declaring bankruptcy or have already done so.

Physicians’ current & upcoming scenario:

President of the New London County Medical Society said that the prolonged uncertainty about Medicare reimbursement rates has motivated some doctors to take an early retirement. A survey by the Medicare Payment Advisory Commission (MedPAC) indicates that by 2025 there will not be enough primary care physicians. Additionally, this cut comes at a time when physicians face potential penalties associated with  HIPAA 5010 , electronic prescribing, ICD-10, PQRS and electronic health records which are difficult to adhere to in a time of dramatically falling revenue.

However, even though physicians are pushed to consider other options, in the next 20 years senior citizens requiring Medicare will rise, and doctors who can sustain the current pressures and adapt to the reforms have a vast potential for growth. The physicians need to face this challenge of payment cuts by making their system more efficient; reduce their extra administrative burdens and revamp their revenue cycle giving them a competitive edge. Medicalbillersandcoders.com can optimize physicians’ billing process and reimbursement cycle, which will help doctors maintain their revenues as they tackle Medicare issues.

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Physicians to make the most of 5010 Enforcement Delay

Physicians were mainly relieved with the announcement made by Centers for Medicare & Medicaid Services (CMS) Office of E-health Standards and Services (OESS) on 17^th November, to delay enforcement of Health Insurance Portability and Accountability Act HIPAA 5010  transaction standards with a 90-day discretion period for all HIPAA covered entities. CMS stated that their decision is based on industry feedback that a number of organizations and their trading partners would not be able to finalize system upgrades to 5010 standards in time with the initial 1^st January, 2012 deadline.

Contrary to what many physicians anticipated, the process of transitioning from Version 4010 to 5010 is much more difficult, hence the delay has been a boon for physician’s practices, if CMS had not taken this step there could have been a possibility of a revenue-cycle train wreck.

Any claims or bills submitted after January 1, 2012, that are not in HIPAA 5010 will still get rejected, but delay in enforcement allows physicians to resubmit in the appropriate HIPAA 5010 format without penalty, hence it is imperative for doctors who have not upgraded to HIPAA 5010 to utilize the next 90 days to upgrade to 5010 standards. Survey by the Medical Group Medical Association (MGMA) estimated that upgrading to HIPAA 5010 could set providers back $16,575, and 45.2% of practices have not yet started the implementation of software upgrades necessary for HIPAA 5010.

Practice’s preparing to implement 5010 standards –

• Update software to work under the new standards and contact the software vendors, claims clearinghouses and payers to verify that they are operating as per 5010 standards
• Practices without up-to-date software can take what Hawkins called the “secondary path” of asking their billing clearinghouses if they are translating claims transactions from the 4010 format to the 5010 standard

As the transition to HIPAA 5010 standards is a necessary step before moving to the ICD-10 set of diagnostic codes physicians need to gear up for the changes. In this crucial time of healthcare reforms physicians short of time can benefit from partnering with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care. Even looking out for a software change to HIPAA 5010 compliance Medical Billing software could ease the pressure of physicians trying to migrate to a software solution.

Medicalbillersandcoders.com expert consultancy and software advice services support healthcare providers across the US with their revenue cycle management. MBC also offers professional support and assistance to healthcare providers to keep abreast of the changing industry norms, so that they can concentrate on their core services such as patient care.

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Radiology: Finding New Meaning in “Meaningful Use”

Radiologists in the United States are currently facing a dilemma as far as “meaningful use” (MU) of Electronic Health Records (EHRs) is concerned. The American College of Radiology (ACR) IT and Informatics Committee leaders and staff have met the National Coordinator for HIT (ONC) as well as Center for Medicare and Medicaid Services (CMS) staff to discuss the HR incentive program from the point of view of radiologists, on October 13, 2011.

The American College of Radiology committee reiterated its previous requests for certain criteria regarding meaningful use such as – the sharing or accessing imaging data as part of Meaningful Use, robust radiology order entry requirements for referring physicians with appropriate clinical decision support, and addressing Meaningful Use challenges within the radiology community and other specialties.

The American College of Radiology Meaningful Use Report

A report released by the ACR regarding Meaningful Use for radiologists specifies the steps taken by the CMS regarding some of the “Core” and “Menu” objectives and their relevance to radiology. The reports summary states that according to the Continuing Extension Act, outpatient hospital settings (POS Code22) are not considered hospitals in the EHR incentive program. A vast majority of radiologists will be eligible for the Medicare version of the EHR incentive program.

Defining Hospital-based Physicians

The report by ACR also states who would be considered as hospital-based by the CMS and would be ineligible for the incentive program. The CMS defines hospital-based physicians as those providing 90 percent or more of their covered professional services in inpatient (POS Code 21) and emergency room (POS Code 23) settings. Therefore hospital-based radiologists who do not meet the above mentioned criteria are eligible for the Medicare incentive program. However, Medicaid eligibility has stricter rules that require the EP’s 30 percent volume must be attributable to Medicaid which is a tall order for any radiologist if not impossible.

Who is Qualified?

The Medicare version of the incentive program only applies to physicians and radiologic technologists, medical physicists, or other technical staff is not eligible. However, the Medicaid version of the incentive program is limited to physicians, Certified Nurse Midwives, Nurse Practitioners, and Physician Assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a Physician Assistant.

Radiologists vs. Primary Care

The meaningful use objectives appear to be focused on primary care and present some confusion as to how radiologists would comply with such objectives. However, CMS provides exclusions to many meaningful use measures as well as “menu set” measures to counteract this problem to adjust specialties such as radiology.

RIS and PACS

According to the report by ACR many HIT products that are not considered traditional, complete EHR/EMR could still achieve certification via the EHR module pathway. However, these modules need to be tested and certified before they are considered certified EHR technology. Moreover, there are advanced RIS solutions that have already received complete EHR certification or are in the process of receiving it. This implies that RIS/ PACS can be adopted so as to be certified EHR technology in the near future.

The Exclusions for Radiology in Core and Menu Objectives

Out of the 15 core objectives there are nine that are not excluded and are – Drug-Drug and Drug-Allergy interaction checks, update problem list, medication list, medication allergy list, record demographics, report clinical quality measures to CMS, implement CDS rule, HIE test, and security risk analysis. For all other core objectives, exclusion is available for radiologists. As far as the “menu” objectives or discretionary objectives are concerned, only two out of the ten objectives are given exclusion for radiologists. These two menu objectives exclusions are – generate list of patients by specific conditions and patient-specific education resources. All the other eight objectives are not excluded for radiologists.

The anxieties over radiologists’ eligibility for the incentive program are now slowly being dissolved due to the correction and amendments made by ONC. The vast majority of radiologists are eligible for incentives; even those that are hospital based, if they meet certain criteria laid out by the ONC.

For more information about “meaningful use”, EHR certification and implementation, PMS implementation, consultancy, and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

Dealing with overpayments in your practice

“Simple it might seem, yet given the time and the resources that such monitoring and reporting eventually consumes, physician practices can find it hard to take up such intensive scrutiny amidst the overriding challenge of keeping their medical service quality benchmarked to the perennially raising medical standards. All such apprehensions point towards outsourcing medical billing management that comes with the value-addition of surveillance-check on Overpayments”.

Strange it might seem, frequency of overpayments from insurance carriers, particularly Medicare, seem to grow as the volume of health insurance claims swells with each passing day. Irrespective of the reason, whether stemming out of up-coding or lapse on the part of the payer, it is never recommended that you keep the overpayment without informing your medical insurer. As Medicare has made it mandatory for physicians to report any incident of overpayment within 60 days from the actual day of receiving such payment, failure to comply by scheduled time-frame can constitute fraud and abuse inviting penalties, such as cancellation of practice-license, monetary penalty, or imprisonment depending upon the severity of the intentional fraud and abuse. More than the material punishment, it is the credibility that you may be risking while going for unscrupulous overpayments.

Having convinced of the efficacy of reporting overpayment, now it is time to know how to report, whom to report, and how to be immune to such overpayments:

Upon finding out overpayment, the physician concerned should write a refund note to the Medicare carrier along with a brief explanation of the reason for the refund; certain extraordinary cases may need to be reported to federal and/or state criminal authorities such as the Department of Justice or the Office of Inspector General (OIG).

Further, there needs to be consistency in reporting overpayments: reporting selective or randomly may not be sufficient for building goodwill with your payer as it still opens up chance for audit exposure
Appoint your staff to specifically look into the genuineness of payment posting, and monitoring of the actual realization against the claim realization.

Simple it might seem, yet given the time and the resources that such monitoring and reporting eventually consumes, physician practices can find it hard to take up such intensive scrutiny amidst the overriding challenge of keeping their medical service quality benchmarked to the perennially raising medical standards. All such apprehensions point towards outsourcing medical billing management that comes with the value-addition of surveillance-check on Overpayments. Therefore, it becomes crucial that your prospective medical biller’s scope of Revenue Cycle Management – along with the usual patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices),

Insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), AR management (insurance and patient), financial management reporting – is inclusive enough to identify and report such odd incidents of overpayments.

Medicalbillersandcoders.com being a leading provider of such inclusive medical billing revenue cycle management, holds key to physicians’ endeavors towards honest and credible practice management.