ICD-10 delay likely to cost healthcare industry billions: Proficient ICD-10 Coders in demand!

Even as the Department of Health & Human Services’ in order to reduce regulatory burdens, announced last month it would consider delaying the ICD-10 implementation deadline for certain entities, subsequent industry reactions depicted healthcare professionals being primarily not in favor of such a delay. Moreover a Survey conducted among more than 50 senior healthcare professionals attending the 2012 ICD-10 Summit, hosted by Edifecs, stated that most of the participants perceived a delay rather than improve would cause significant adverse effects on the healthcare industry.

The survey findings on ICD-10 delay:

64% (Nearly 2/3rdof respondents)	Stated a delay will not improve readiness
76%	Stated a delay will harm other healthcare reform efforts
69%	Stated a 2year delay would be either “ potentially catastrophic” or “unrecoverable”

Healthcare industry outlook towards Cost Implications due to a delay:

Healthcare professionals and the industry observe a delay would result in halting or slowing down work on ICD-10 which would derail the healthcare organization’s progress resulting in high cost implications. With both payers and providers investing heavily for the ICD-10 switch, cost is the chief concern. Hence the industry is in favor of moving ahead while they await the final decision on the extended deadline regarding entities which will be affected.

The cost of a one-year delay to be between 25 – 30%, while officials  estimate a one year delay based on existing overall cost estimates for ICD-10 from multiple sources, to cost the industry anywhere from $475 million to more than $4 billion.

A delay of longer than a year as per 85% of respondents surveyed said would freeze budgets, slow down schedules or stop work altogether, while 59% opined that the date should be universal for all covered entities rather than mandating different compliance dates for different types of entities, the main driver behind the same being the significant cost and effort involved for the dual processing in ICD-9 and ICD-10 code sets.

Proficient ICD-10 Coders in demand!

Hence with majority of physicians vary of a delay continue their preparation for ICD-10, Billers and Coders proficient in ICD-10 transition are the need of the hour and highly demanded. As adoption of ICD-10 will lead to expansion in the number of codes available from the currently used ICD-9 codes- organizations focusing on a successful ICD-10 implementation in 2013 are cautioned to start revamping their coder development and retention strategies, making ICD-10 coders in demand.

Projections from the Bureau of Labor Statistics depict a growth in job levels for coders far above average: 20% from 2008 – 2018 and Economic Modeling Specialists Inc. project growth of 8% between 2011- 2013. Physicians amidst the transforming healthcare environment as a feasible option are opting for services of medical billers and coders who are proactive and prepared with material-requisites for ICD-10.

Personnel updated at Medicialbillersandcoders.com are viable option for physicians in smooth transition to ICD-10; equipped with experience in HIPAA, ICD-10 and other compliances. Moreover the unique ICD-10 Training Program encompassing 87 weeks of ICD-10 training and updates – strives to outline at no cost to medical billers and coders information & training- right from how ICD-10 will affect healthcare to how ICD-10 needs to be implemented within different specialties to ensure optimum revenue cycle management post ICD-10.

The Crucial Role of Physician Assistants in EHR Implementation and the Reforms

The role of Physician assistants (PAs) is accentuated in a country such as United States where the physician to patient ratio is very low. The recent health reforms have added to the responsibilities of physician assistants due to numerous changes in policies and technologies. The implementation of Electronic Health Records (EHRs) or Electronic Medical Records (EMRs) is one of the biggest challenges that PAs face in the changing healthcare environment. Moreover, since physicians need time for numerous other core activities, PAs are the professionals who handle such important auxiliary functions such as successful implementation of EMRs or EHRs and handle other office based departmental processes. The health reforms also present opportunities for PAs in the country to take on more responsibility as well as prosper financially.

The incentives offered by the government for successfully implementing an EMR or EHR is not just limited to physicians but also include PAs. However, in order to receive such incentives, the PA must work in a Federally Qualified Health Center or Rural Health Clinic that is led by the PA. The need for PAs is strongly felt as a coordinator between physicians and nurses in order to provide better service to patients. They also take on numerous other responsibilities such as being on call, making house calls, providing therapy, and even prescribing medications in addition to all the work assigned by the supervising physicians and thus PAs have a holistic understanding of the various departmental processes as well as proficiency in the core aspects of medicine. These processes today cannot be carried out without extensive use of EHRs/EMRs and PAs utilize all their knowledge to optimize the EMR/EHR implementation process.

Since PAs work in such a demanding environment, they are most likely to succeed in implementation of EHRs and EMRs due to their knowledge of other aspects of medicine such as some “back-office” or departmental processes. However, for many PAs the workload is continuously increasing due to policy changes and the skyrocketing demand for healthcare services. Some factors that are hampering the handling of EHR systems by PAs are increasing demand for healthcare due to newly insured 31 million Americans, increased scrutiny by the government in the form of HIPAA, and ‘Meaningful Use’ (MU) policy compliance. Although PAs are qualified to handle EHRs and other related processes, it would definitely become difficult for them to handle the core functions involved in health care delivery due to workloads in various auxiliary processes.

The ideal solution for making time and saving money is to delegate some of these processes to experienced professionals through outsourcing. This would ensure that processes such as revenue cycle management, denial management, interaction with payers, accounts receivables, and charge entry, are carried out in a scientific and professional manner. Medical billers and coders at www.medicalbillersandcoders.com not just provide these services but also offer EHRs software that is suitable for almost all specialties and suggest after studying your practice’s processes the software best suited for your practice which would cover the gaps and shorten the revenue cycle. Medicalbillersandcoders.com also offer other value added services such as consultancy for keeping you updated on the changes taking place in the health industry.

Job Opportunities: A New Positive Outlook for New Physicians amidst healthcare reforms

The shortage of physicians, the health reforms, the skyrocketing costs of health care , the Medicare cuts worry and the influx of health IT into the health industry has created a bit worrying albeit a dynamic environment. Although there are critics who oppose the health reforms and suggest other methods, there are optimistic physicians as well as patients when it comes to improving healthcare even in this environment of hullaballoo that threatens to change the drudgery of the maintenance of the health care industry in the United States. According to the Bureau of Labor Statistics, a physician’s profession is much coveted and in demand and has immense growth prospects in the future which can be a good omen for the future of health care delivery in the country. A recent survey from physician search firm Merritt Hawkins revealed that more than 75% of physicians in their final year of training received at least 50 job solicitations, and 50% got 100 or more.

The reform has forced many solo and small group practices to pack up their practices and opt for employment at hospitals and along with bigger group of physicians since these have started to hire physicians. Hospitals are also hiring physicians since the number of insured in the country is soon going to rise by about 31 million and physicians in hospitals would be desperately needed to treat the patients who would inundate hospitals after the reforms take hold. Many physicians are retiring and almost one third of physicians in the country are set to retire in next few years which create opportunities for new young physicians and providers to take their place. Moreover, physicians are relieved of the non-clinical obligations while working in hospitals such as billing, extensive interaction with payers, and other administrative tasks.

Although solo practices and small group practices are slowly declining, it does not necessarily imply that new jobs for physicians are not being created. According to the Bureau of Labor Statistics, the employment of physicians and surgeons is set to increase by 22% between 2008 and 2018 and the reasons cited by the bureau are numerous. Physicians’ job outlook looks positive because of an expanding health industry, the increase in demand for the services of physicians, increased level of enrollment in medical schools and the policies implemented by the United States government to encourage the growth of this profession qualitatively as well as quantitatively.

The biggest challenge faced by new physicians is related not just to professional core issues but also to financial issues. There are numerous financial challenges and problems in the form of paying off the debt, implementing ‘Meaningful Use’, striving for the incentives provided by the government and avoiding financial penalties for non-compliance of health reform policies. Even with so many challenges and problems faced by new physicians who have just started practicing can successfully kick start their work in financially and professionally fruitful manner. However, support is available for physicians who are just stepping into this dynamic yet progressive health care industry in the form of processes that aim to maximize physician revenues and ease the problems faced by them in many departmental processes involved in running a practice or even when joining a hospital.

Whether as a physician, you work in a hospital or starting a solo practice, medical billers and coders at www.medicalbillersandcoders.com can offer you a wide range of services that will not only assist you in medical billing and coding but also facilitate services such as revenue cycle management, denial management, interaction with payers, research, consultancy, streamlining various processes for EMR or EHR implementation, and assistance in health IT implementation in this dynamic health industry. This will help you in avoiding the pitfalls faced by new physicians in the country and also assist in increasing your revenue in a lesser amount of time.

For more information visit: medical billing

Countering the phenomenon of Physician Shortage: Medical Reimbursements

“Consequently, physician reimbursements would largely depend on their ability to seamlessly process medical claims with either Medicare or private insurance carriers. But, with the reimbursement environment promising to be more vigilant and stringent than ever, physicians would find their medical billing competencies invariably short of the requisite persistence.”

Physician shortage has been one of the major issues that have been plaguing the U.S. healthcare industry.  Significantly, twenty two states and 17 medical specialties have already felt the dearth of physicians. While the aging physician community and the lack of reserve pool of physicians may well have been the primary reason, it is also true that the aging patient base and an unprecedented population growth have contributed to the growing chasm. And when you consider the influx of an estimated 40 to 50 million people who were previously uninsured and the baby boomer generation now becoming eligible for Medicare, the issue is only going to be worse.

But, healthcare being one of the priority sectors and health of millions of Americans at stake, Federal Government is looking at policy changes that would make healthcare practices attractive to professionals. As Family practice, internal medicine, and geriatric specialists form the priority disciplines, a lot of stimulus is being given to physicians showing inclination to these specialties. Physicians, who used to take such disciplines as a societal cause, are now being made eligible for incentives. Apart from this priority-based stimulus, the Federal Government is also looking at correcting the regional imbalance, where in physicians from higher density regions are being wooed to regions that are acutely short on physicians.

Quite parallel to policy measures, the qualitative measures like mandatory EHR compliance – seen as augmenter of fast and efficient clinical and operational management – would pave the way for accelerating medical care. The penalty or incentive factor associated with EHR non-compliance or compliance is seen as qualitative measure for enhancing the scope of clinical reach to an ever-growing patient base. Then, you have the Accountable Care Organization (ACO) model, which would eventual ensure streamlined healthcare dispensation for a population that has grown disproportionately to the physician numbers.

While these qualitative measures by the Federal Government would invariably increase practice opportunities and revenue prospects for physicians across the U.S., there is also going to be unprecedented incidence of medical insurance reimbursements as most of the medical related expenditure is invariably met by health insurance schemes – either State sponsored Medicare or Medicaid, or private health insurance schemes sponsored by private insurance players. Consequently, physician reimbursements would largely depend on their ability to seamlessly process medical claims with either Medicare or private insurance carriers. But, with the reimbursement environment promising to be more vigilant and stringent than ever, physicians would find their medical billing competencies invariably short of the requisite persistence.

And, when physicians face up to such challenging medical billing  environment,  outsourced medical billing services would eventually become indispensable. Medicalbillersandcoders.com, whose medical billing Revenue Cycle Management is capable of ensuring both qualitative and qualitative dispensation, should prove to an ideal recourse. Its comprehensive medical billing 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 – is designed for augmenting revenue generation while also keeping medical efficiency enhanced perpetually.

Measuring the impact on physician reimbursements with upsurge in retail clinics

“As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them through effectively and efficiently.”

While there can be no substitute to full-fledged clinical settings as far as clinical management of chronic or acute medical conditions are concerned, retail clinics hold their own sway when it comes to managing trivial or superficial medical conditions. In fact, a study in the November 2011 American Journal of Managed Care, which analyzed the claims data of 13.3 million Aetna enrollees from 2007 to 2009, found a tenfold increase in patient traffic to clinics in grocery stores, pharmacies and big-box stores. Therefore, there is substantial truth in believing that patients are growing more comfortable with retail clinics, which offer them instant and easy access during times of medical exigency.

The growing fascination towards this retail model of clinical care can largely be attributed to the Federal Healthcare Reforms – which are going to accommodate health insurance for a substantial uninsured population, and promote accountable care organization model of healthcare and other aspects of health system reform – and the growing dearth of primary care centers which happen to be the connective clinical centers to major healthcare centers. While established clinical centers may feel the pinch of eroding patient base to these new-trend retail clinics, it could still be a blessing in the disguise as they concentrate on clinical management of far more critical medical conditions. And with the promise of a booming Medicare and private health insured population, there is every reason to remain optimistic.

The retail health clinics, on their part, should strive to be connective link in the clinical management of patients; retail clinics, rather than operating in isolation, should establish ways to ensure continuity of care with physicians and have processes for referring patients who require primary care. One of the major impediments to this integration, as noted by majority of specialist practices, is that retail clinics may not be able to share medical necessary reports that render collaborative clinical management possible. But, with proper coordination, retail clinics and specialist clinics or hospitals can both share the workload as well as promote clinical efficiency. In fact, many established hospital groups themselves are open to the idea of opening their own retail clinics that could become window advertisements for their specialist services.

As medical service providers try to adapt themselves to these altering equations, their ability to manage clinical and operational functions would invariably involve the next level of efficiency. While there is ample scope for revenue augmentation amidst a booming health insurance scenario, there is also the issue of keeping the quality of medical services on par with the industry’s best practices. Left with such opportunity-responsibility bait, medical practices would do well to trust outsourced service providers that have the competence and credibility to maneuver them effectively and efficiently. Medicalbillersandcoders.com – with long-standing reputation of being competent and a credible source for comprehensive medical billing and operational services – may well have the right answers to such opportunity-responsibility bait.

For more information visit: medical billing companies, medical billing services

Physicians strive to strike a balance between managing HIPAA 5010 and medical billing

The financial and data-centric nature of the healthcare reforms in the US has left healthcare organizations in all the states of the US to do more data care than healthcare – to manage their finances, maintain data integrity and be complaint with regulatory standards. Health Insurance Portability and Accountability Act (HIPAA) is an example, which, however well-meaning otherwise, burdens the healthcare provider with a series of compliance activities, involving technical intricacies, which, if not followed to the letter, lead to claim denials and expose the care provider to a post-denial support system that’s lumbering and unresponsive.

HIPPA, framed to promote convenience and continuity of health insurance coverage for individuals or groups either changing jobs or unemployed through safe data handling and transfer, seeks to establish a standardized method to electronically transfer data by healthcare providers to Medicare contractors to submit insurance claims and be reimbursed.  However, when healthcare organizations are submitting claims through HIPPA’s electronic conduit, HIPPA 5010, they are facing claim rejections due to a number of teething problems HIPPA 5010 is going through currently.

The problems are mostly of administrative and technical in nature, like issues with billing secondary payers, national provider identifiers not being recognized, the care providers are facing while submitting their medical bills to Medicare contractors via HIPPA 5010. The billing process is not just leading to futile administrative works for care providers but also financial losses with Medicare contractors rejecting claims for such minor omissions and errors as claims not having descriptions on them, error in addresses etc. Rejected claims submitted again are meeting with sporadic reimbursements and attempts to contact contractors are resulting in one to two hours of call-hold period.

However, in response to this chaotic situation, The Centers for Medicare & Medicaid Services (CMS), the agency overseeing the transition from HIPPA 4010 to HIPPA 5010, has delayed the enforcement of HIPPA 5010 But will a delayed enforcement of HIPPA 5010, even if it leads to some order and stability, be an answer to healthcare providers’ woes? No. Even in a sanitized atmosphere, healthcare providers would need to handle what they are not meant to, financial administrative activities and compliance matters. This leaves healthcare providers in a ‘rock and a hard place’ situation: avoiding the reform-induced responsibilities would mean falling foul of regulations and attracting penalties; attending to them would lead to increased cost, unrealized claims and time spent on non-healthcare activities.

To survive the onslaught of reforms and changing industry trends, healthcare organizations would require a robust Revenue Cycle Management (RCM) process, a look at the challenges posed by HIPPA 5010, discussed above, indicates that a complete outsourcing model which would enable healthcare providers to offload the complete cycle of financial administrative activities to a biller and coder may not be an imprudent choice.

Medicalbillersandcoders.com provides RCM consulting services help build a coherent RCM process by analyzing the areas of deficiencies in your RCM process, starting from trimming out outdated processes, identifying software inadequacies, under-optimized workforce to unidentified training needs and most importantly plugging revenue leakage sources resulting in a sound RCM process which helps healthcare organizations meet the current financial and administrative challenges better.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its outsourced billing and coding services which involves development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process – collectively resulting in reduced claim denials an enhanced core-business focus.

For more information visit: Medical Billing companies

Medicalbillersandcoders.com offers 35 weeks of ICD-10 training updates for Billers & Coders across 50 US States

Wilmington, 1st March, 2012

Medical Billers and Coders consistently updating themselves on industry requirements, is gearing up for ICD-10 and is launching an 87 week journey towards ICD-10 orientation today. Being more than two years since the final rule was released and at the mid-point for ICD-10-CM/PCS implementation, Medicalbillersandcoders.com cautions all Medical Billing and Coding Professionals especially those who haven’t, to start planning for the transition right away!

The 1st step in a long journey being the most important, Medicalbillersandcoders.com invites all Medical Billers and Coders to take the first step in the initial 35 week journey - when updates and training material will be shared to help them evolve with the US healthcare industry.

For Medicalbillersandcoders.com ICD 10 orientation, countdown begins 1st of March 2012 and ends 13thof October 2013- in this 87 week program Medicalbillersandcoders.com in the first 35 weeks will share updates and build base for the latest coding updates, while in the remaining 52 weeks will comprise of actual training. In the scenario where The Centers for Medicare and Medicaid Services stands firm on the ICD-10 compliance date of 1st October 2013, stating there will be no delays or grace period, and post this date providers claims only in ICD-10 format will be paid, Medicalbillersandcoders.com urges all related healthcare professionals to get ready to ensure smooth flow of revenue and avoid reimbursement issues.

Medicalbillersandcoders.com boosts billers and coders to face the humungous ICD-10 challenge

Preparation for ICD-10 brings huge and exciting challenges to the healthcare industry along with benefits in the form of improvement of the capture of healthcare information. However Medicalbillersandcoders.com in anticipation of the changes it can bring about in medical billing practices, likely to cause considerable slowdowns in billing and payment and the upheaval it can create if not implemented the right way, encourages all medical billers and coders to be ready for this challenge.

ICD-10 & challenges:

• ICD-10 has 10 times the number of codes compared to ICD 9CM - Coders knowledge of anatomy and physiology, as well as medical terminology will require to be more detailed
• Coders will need to work more closely with doctors to update them on proper coding methods
• More codes to choose from may eliminate use of super bills – a means of quick coding diagnoses
• Providers may need to invest in new software designed to accept the longer digit codes
• Physicians will need to be more specific in their documentation and code observations as ICD-10 codes include more payment limitations for services
• Case managers will need to increase patient education on coverage charges

Medicalbillersandcoders.com is gearing up for this change already and wants to contribute in propelling the concerned professionals to meet these challenges keeping in mind industry standards and ICD-10 deadline of 13th October 2013. The expert panel of advisors at Medicalbillersandcoders.com is striving through the ICD training program to help all billing and coding professionals on any training or information they may need to gear up for this change.

Brief insight into what MBC’s ICD-10 training program is offering to counteract ICD-10 challenges:

• Tips for a smooth transition from ICD 9 to ICD 10
• Problem solving webinars
• Weekly updates of ICD implementation
• FAQ documents of ICD 10
• Coding Practices forum with other experts and participants

This training program also offers subscribers to share their views participate in polls and associate with industry experts and contribute to ICD-10 in their own way at no cost.

As physicians are undergoing healthcare revolution, we as Billing & Coding professionals will need to go through a learning evolution to streamline practices. Medicalbillersandcoders.com billing and coding professionals are charged up for the change and to further this trend Medicalbillersandcoders.com is offering a platform to a career revamp ensuring transition to ICD-10 with confidence. All Medical billers and coders are invited to be a part of this endeavor along with Medicalbillersandcoders.com at no cost from the 1st of March.

About Medicalbillersandcoders.com

Medicalbillersandcoders.com is the largest 'Consortium of Medical Billers and Coders,' across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US ( California Medical Billing, Pennsylvania Medical Billing, Idaho Medical Billing, Mississippi Medical Billing, New Jersey Medical Billing, Virginia Medical Billing, Arizona Medical Billing ) with the most prominent being Dental Medical Billing, Chiropractic Medical Billing, Pain Management Medical Billing, Physical Therapy Medical Billing and General Practice.

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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.