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.

Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion.

Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation for meeting Medicaid expenditure as soon as the Federal Government’s ceases to support Medicaid related expenditure, it is imperative that, in a Federal Setup, states follow certain measures as dictated by the Federal mandate. Moreover, Medicaid, expansion, being a pro-healthcare measure, is destined to elevate the quality of public healthcare across the country in tandem with Medicare reforms.

Coming to the composition of the Medicaid expansion, the proposed scheme opens up health insurance eligibility to all people with household incomes up to 133 percent of the Federal poverty level. Irrespective of whether you are unemployed or the so-called working poor – there can be no denial of Medicaid coverage from January 2014. This is going to be a significant shift from the current coverage which covers only low-income parents and children, and the frail elderly and the disabled. Therefore, when it comes to pro-societal issue, quality healthcare should take precedence over the rest. Quite encouragingly, some states – California, Connecticut, Minnesota, New Jersey and Washington have already started with the expansion of Medicaid programs.

While Medicare expansion is going to bring an unprecedented population under the ambit of Medicaid, physicians will have a hard time in coping up with sudden influx of patients. The situation is going to even more serious if the patients happen to be in need of specialty services as there is already a dearth of specialty-specific physicians across the state. And, with the situation requiring sometime to become ideal, the existing physicians will have to bear the additional brunt. Although the additional workload would also bring in additional revenues from Medicaid reimbursements, their medical billing practices would be put to test as Medicaid reimbursement environment has progressively become more stringent over the years. When you consider dealing with such stringent environment along with the mandatory EHR compliance that support ICD-10 and HIPAA 5010 practices, you might get apprehensive of physicians’ ability to devote quality time to patient care.

Therefore, it becomes inevitable that they seek medical billing and Revenue Cycle Management Services (RCM) that would not only ensure maximization of their revenues but also elevate their clinical efficiency. Care should also be taken to analyze your prospective service providers’ credibility and competence for Medicaid-related reimbursement practices.

While you embark on seeking a suitable medical billing and Revenue Cycle Management Services (RCM) provider, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of long-standing reputation as a credible and competent source for Medicaid-related billing and Revenue Cycle Management Services (RCM) 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 – may well prove to be your preferential recourse.

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.

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”.