Orthopaedists Hiring a Medical Billing Service to Sail through Rising Expenses

Rising expenses amidst reimbursement cuts is one of the biggest challenges faced by orthopaedists in today’s time. It has not only affected the financial health of practices but it might also lead to restricted care for some patients in future.

Billing issues:

Decline in reimbursement has affected orthopaedic surgeons and healthcare providers across the US. Timely billing has become a challenge since new medical billing and coding changes were introduced for orthopaedics in 2013. In order to ensure that billing issues don’t reduce their payments further, orthopaedic practices are being compelled to invest money on hiring and training a team of skilled billers and coders who will ensure that the practice gets paid for all the services on time

Compliance with latest health IT:

Amidst Medicare cuts and reduced fee schedules, orthopaedic practices are being required to comply with latest health IT standards to conduct operational functions. This has also increased pressure on practices as implementation of required technology can be quite expensive

Recruitment of clinical and business staff:

In order to give an edge to your practice and offer excellent care and services to patients, recruitment of skilled and certified clinical and business office staff has become vital. This is also an area where orthopaedic practices will have to spend money for hiring and training

How can a billing partner help save your practice?

Apart from Medicare cuts, orthopaedic practices are also facing reimbursement cuts in the form of 10-15% insurance underpayments. Since these services are expensive, even 1% underpayment can result in significant revenue loss. In order to ensure that silly billing and coding errors don’t lead to payment cuts, many practices are seeking help from a billing company to streamline their billing procedure.

Orthopaedic practices can reap various other benefits through outsourcing such as:

• Quality assurance checks on a regular basis
• Effective account receivable management
• Progress report of filed claims in a timely basis
• Transparency in revenue cycle management
• Round the clock claim processing
• Usage of secure network to solve billing issues
• Enhanced cash flow
• Quick access to financial information and patient data

Hiring a billing partner will eliminate the cost involved in employing or training coders and billers, implementation of health IT, compliance to HIPAA and so on. It will not just result in timely payment, helping practices sail through rising expenses but also give enough time to physicians to concentrate on offering quality patient care.

Medicalbillersandcoders.com has the largest consortium of well-trained resources that can help you face the challenges of reimbursement cuts and rising expenses. MBC has affiliation with orthopaedic medical billing specialists across 50 states in the US and our team of certified coders and billers offer effective medical billing services to small as well as large orthopaedic practices.

From solving underpayment issues to ensuring error-free claim submission for timely payment, MBC makes sure that revenue cycle management of your practice is strong. We also focus on reduction of billing and coding changes on the revenue flow of your practice.

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid/TRICARE. While insurance payers (whether Federal or private) essentially cover health risks of the insured, they differentiate themselves with their respective restrictive operational requirements. The impact of this restrictive payment environment is such that health care providers are increasingly finding it difficult to procure their payments on time. And, with the Federal Government inclined to make health insurance mandatory, care providers’ only hope is to find a way to deal with multiple regulatory insurance payers.

Unlike United Kingdom and Canada, which have single-payer system, US is characterized by Federal and Private Payer systems. And Federal system is again sub-divided into Medicare/Medicaid/TRICARE.

The majority of insured Americans receive their health care (insurance) coverage via a private insurance company. Currently in the country, 59.3% of all insured Americans have coverage through private insurers. These private insurance holders can once again be classified under:

• Group insurance, which is availed through an employer with provision to cover spouses and children, based on the particular package
• Individual Insurance, which is purchased by the insured himself to cover his or his family health risks
• Managed-care plans: The two most popular types of managed-care plan providers in America are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). An HMO plan will have a predetermined facility and doctor for you and/or family. When you need treatment, you will have to visit the contracted facilities and see the contracted physicians in order for the insurance to pay the bill

With so many variants of private healthcare policies, healthcare providers usually have a hard time understanding and billing with private payers. The stress is so much that it is actually started to impede their clinical efficiency, which is their main concern. There is a whole lot of stressful restrictions that providers will come across, such as:

• dealing with deductibles and copayments,
• establishing medical necessity of a procedure
• dealing with preexisting conditions

Though dealing with Federal Payer system is relatively less difficult, providers have to deal with state-specific rules that govern Medicaid/Medicare:

• With the Federal Government hinting at extending Medicare base from the current 28%, providers will have more Medicaid/Medicare supported visitors
• Federal Government entertains Medicaid/Medicare beneficiaries’ bills from only a few designated providers. Therefore, care providers have an overriding duty to check insurance authorization prior to administering medical services
• Further, Medicare/Medicaid is also bound by restrictions on repetitive, pre-existing, and quantum of admissible medical expenditure to its beneficiaries

If understanding multiple payer system and their respective restriction constitutes half of the battle, billing and coding in ICD-10 and HIPAA 5010 Version will constitute the other half. But, providers, with their clinical efficiency at stake, would do well to assign these operational issues to external billing consultants.

Medicalbillersandcoders.com with credible history of helping physicians realize maximum claim realization amidst multiple payer environment – will help make the task a lot easier. Our medical billing professionals are highly trained and certified with experience in handling multiple payer environment and the latest coding practices. Their expertise combined with our technology edge is a sure way to turnaround your practices’ revenues.

‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system.

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true.

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position.

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.

How are States retaining physicians in times of shortage?

Physician shortages is a growing concern and is pushing various states to keep doctors trained in medical schools and residency programs from crossing state lines to practice medicine. According to new statistics from the Assn. of American Medical Colleges- nationwide, there were 258.7 active physicians per 100,000 people and in individual states, ratios range from a high of 415.5 physicians per 100,000 people in Massachusetts to a low of 176.4 per 100,000 in Mississippi.

In this scenario medical school, hospitals, medical societies and state legislatures are increasingly taking a practical approach to retain the physicians and doctors-in-training in their state. According to a report by AAMC Center for Workforce Studies on average:

39% of U.S. physicians practice	State where they went to medical school
48% of U.S. physicians practice	State where they completed graduate medical education

Methods adopted by states to retain physicians

AAMC projections depict that physician shortages nationwide are projected to reach 62,900 doctors by 2015 and 91,500 by 2020 and several states to retain physicians have:

• Opened new medical schools or expanded existing ones
• Are offering incentives such as bonuses, scholarships or loan repayment programs to physicians
• Communities are developing new residency programs with the aim that physicians will develop long-term professional and personal relationships during GME training and keep them from moving out
• Certain schools’ mission is to train physicians from their states to practice in their states. However states need enough GME training positions else this efforts are wasted as then physicians will shift to another state

Iowa is below national average retaining 22% of its medical school graduates and 37% of physicians who complete GME training in the state and several efforts in Iowa have been designed to attract physicians to stay in the state. Several other states including Kansas, Mississippi and Alabama offer loan repayment programs for doctors to practice locally.

In Oklahoma, the state offers scholarships and loans to medical students and residents who agree to practice in rural Oklahoma for a set amount of time. Hence Oklahoma is above national averages, retaining 48% of its medical school graduates and 52% of physicians who complete residency training.

Physician adapting to this shortage

Higher revenues and incentives would attract more physicians to the profession and also keep doctors from moving out from states. Healthcare reforms are striving to improve quality of care and physician incentives, to entice more doctors to stay in the profession; but this leaves doctors with little time to balance both patient care and Revenue Cycle Management. As physicians move towards a value based system of healthcare delivery, they would be well-off by partnering with experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization.

Medicalbillersandcoders.com experienced in offering cost-optimizing and revenue-maximizing Medical Billing Revenue Cycle Management in tandem with their goal to assist healthcare should be able to play an essential role in making physicians’ transition towards a value based model easier and profitable, hence also helping towards eliminating physician shortage in the long term.

Gauging your Medical Billing Company on ICD-10 compliant resource-capability

“As much as the intrinsic competencies of your medical billing companies, their ability to advise on EHR/EMR implementation for efficient clinical and operational management  should equally hold prominence. As HIPAA 5010 compliant EHR/EMR is the prerequisite to medical billing under ICD-10 system, your practices needs to be equipped with EHR/EMR that meets HIPPA 5010 standards both as a compliant measure as well as qualifying measure for incentives under Meaningful Use Criterion.”

Physician practices, clinics, and hospitals, who hitherto have been safely entrusting all their billing operations to their respective outsource providers, will soon have to run a reality check of the level of preparedness that their medical billing service providers possess or likely to possess in congruence with the ensuing ICD-10 – going to be operational from October 1, 2013. Although most of the medical billing companies are mindful of the efficacy to be resourceful with ICD-10 medical billing management requisites – as they themselves will not be able to operate with ICD-9 compliant practices, which are soon going to be obsolete – yet it is a kind of reassuring exercise that your medical billing reimbursements are channelized through incredible and safe hands.

Now, having been convinced of the efficacy of running a reality check of either your current or prospective medical billing companies, it is quite natural to be inquisitive of the nature and extent of such reality check. Primarily you need satisfy yourself whether the service provider is self-sufficient in resources – both human as well as technological – that render medical billing management possible in the ICD-10 compliant environment. Notwithstanding other things like credibility in the industry, composition of clients, and experience as a medical billing company, it is this resource capability for ICD-10 compliant medical billing that holds the key to your delay-free and denial-free medical reimbursements of your medical claims for clinical services rendered to the Medicare or private insurance beneficiaries. And, when you consider how vigilant and stringent health insurance carriers are becoming, your medical billing service providers’ ICD-10 compliant competencies assume ever more significance.

When it comes to gauging your medical biller’s human competencies, it is necessary that professionals are trained in ICD-10-CM Implementation Training, ICD-10-CM Anatomy and Pathophysiology, ICD-10-CM Code Set, and ICD-10-CM Specialty Code Set. Further, along with a knowledge background, they need necessarily hold qualifying certificates from authorizing agencies that confer professional certification in ICD-10 compliant billing and coding –  AAPC (American Association for Professional Coders) and American Health Information Management Association (AHIMA) happen to be the competent agencies in the U.S.

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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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.

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

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.

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