Standards of ethical Medical coding: Part 1

Coding is one of the core functions of healthcare providers and, due to the complex regulatory requirements impinging upon the health information coding process, coding professionals are frequently faced with ethical challenges. There are stringent medical guidelines in place for the entire gamut of coding practices which include issues such as the privacy of patient healthcare data, accuracy, and regulation compliances.

This series of tutorials will help medical coders get comprehensive information about the standards of ethical medical coding norms and assist them in making ethically decisions in the workplace; these parameters can help evaluate the coding professionals’ commitment to integrity during the coding process.

Following are the set of guidelines recognized by AHIMA for ethical medical coding:

Accuracy and Consistency:
Coding professionals and managers shall apply accurate, complete, and consistent coding practices for the production of quality healthcare data. They should

• Support selection of appropriate diagnostic procedure and other types of health service-related codes such as type of disease, admission indicator, and discharge status
• Develop and comply with comprehensive internal coding policies and procedures that are consistent with official coding & regulation guidelines,
• prohibit coding practices that misrepresent the patient’s medical conditions and treatment provided or are not supported by the health record documentation
• Promote an environment that supports honest and ethical coding practices resulting in accurate and reliable data, irrespective of the purpose for which codes are being reported
• Refrain from alteration, or suppression of coded information

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Are You Prepared to Deal with Patient Information Breach?

‘The readily available sources for implementing security-rich technology platforms should not only make your search easier but also ensure Patient Privacy Compliance by sage-guarding critical information against undesirable proliferation, and sharing information only at the behest of patients’

Although there have been sporadic incidents of patient privacy breach, yet, the recent episode reported in a recent New York Times article (September 8th, 2011) – wherein Stanford Hospital and Clinics was quoted as saying that a spreadsheet of patient medical information, including names and diagnoses of more than 20,000 emergency room patients, was accidentally posted to a website, and remained posted for a more than a year – shows the extent of its severity. Whereas most of the hospitals, clinics, and physician practices have a secure system in place to safeguard privacy of patient information, still, the technology vulnerability, along with human negligence, remains a major impediment to shielding patient privacy from undesirable proliferation.

Technology Vulnerability has many faces

• Unsecure technology interface: Often, unsecure technology is the reason for breach of patient privacy norms as they inherit intrinsic lacunae in system security. It is usual to find such unsecure technology interface in low-budget healthcare centers. Further, technology, being a subject of perpetual innovation, your existing technology interface, despite being highly secure, can be shown to have security deficiencies by generation-next technology platforms.
• Fear of data high-jacking: As most of the data centers are centralized, it takes one unauthorized access for high-jacking your entire patient-centric data in a jiffy.

Human Negligence

• Untrained staff: Sometimes internal staff is not fully trained, do not have proper orientation to maintain patient information on technology-enabled platforms.
• Lack of responsibility: Coupled with lack of proper training, an overtly compromising attitude on the part of your internal staff may sometimes be the reason for breach of privacy of patient information.

Irrespective of whether the violation is technical or human, HIPAA has a very strict regimen in place, which is authorized to impose both criminal penalties and monetary penalty (amended from $250,000 to $1.5 million through the recent HITECH Act) on the violating institution and the individuals.

Apart from negative repercussions on the patients concerned, any breach in confidentiality – even the one that seems minor – can spread mistrust, and affect your credibility in the medical fraternity. Therefore, physicians/hospitals/multispecialty groups have a greater responsibility in not only safeguarding their patients’ confidentiality, but also keeping their credibility unblemished. Alternatively, they can, if hedged with limited resources, apprise their patients of their limitation in patient privacy practice, to avoid facing embarrassment subsequently.

Although HIPAA has authorized, under certain exceptional circumstances, covered entities to release protected health information without authorization only to facilitate treatment, payment or health care operations, usually physicians are prohibited from disseminating patient-centric information that can have emotional, personal, social, financial, and ethical repercussions. Thus, the onus is substantially on the physicians/clinics/hospitals/multispecialty groups to safeguard their patients’ confidentiality.

Given the history of unimpressive success rate from internally implemented Patient Privacy Regime, it is advisable that physicians consult proven sources that have competencies in installing secure technology interface, and properly orienting your staff to the requisite operations – which is likely to result in best practices in Patient Privacy as mandated by the HIPAA, and render transition to the ensuing HIPAA 5010 easier.

The readily available sources for implementing security-rich technology platforms should not only make your search easier but also ensure Patient Privacy Compliance by safe-guarding critical information against undesirable proliferation, and sharing information only at the behest of patients.

Medicalbillersandcoders.com, who have a unique approach – combination of implementing security-rich technology platforms with prior orientation to your in-house staff on operational and administrative issues – that can mitigate the probability of embarrassment emanating from undesirable breach of patient privacy.

Small Practices: Adapting to the Challenges of Healthcare Reforms for Better Revenue

The major challenges faced by physicians who run a small practice or clinics that have less than four or five physicians are expanding exponentially. Many physicians find themselves worrying and spending time on administrative processes and interacting with payers rather than spending some quality time with their patients. The recent health reforms including the HITECH Act, implementation of EMR and EHR, the overhaul in medical coding and billing procedures, Medicare cuts, and the added burden of incorporating new technology in the face of increased patient volumes have brought single physicians and small clinics to the end of their tethers.

However, the challenges are difficult but not insurmountable and health providers who work as a small group or on their own or are Individual Practice Associations (IPAs) are finding solutions to these myriad hurdles. Here are some simple steps that you can take as a single physician, an IPA or a small group of physicians in order to increase the revenue without sacrificing the quality of services provided.

Technology
The use of Electronic Medical Records and Electronic Health Records has become a feature of the recent health reforms. However, many physicians and clinics are struggling to understand and use the healthcare technology, either because it seems too cumbersome or due to the inevitable resistance to new technology. This problem can be circumvented by partially or completely outsourcing your healthcare IT-related requirements to an entity that understands the changes and has had hands-on experience in using the latest technology for such processes. These experts can also support your staff in up grading the relevant skills for routine usage of these processes.

Medicare
Small practices and clinics usually find it difficult to balance the administrative processes and patient care without either dropping some insurance providers or putting in more time and effort that is not justified. Moreover, the looming Medicare cuts that seem inevitable along with increasing number of baby boomers have made many physicians and clinics consider dropping Medicare patients as well. The time and effort put into interaction with payers and delays in reimbursements cannot be justified if quality of patient care drops along with the revenue. An alternative would be to outsource such processes to medical billers and coders experienced in latest Medicare regulations, who can save time and effort for the physicians and their staff and ensure minimum losses by utilizing their experience and skills in this area.

Rural Physicians
IPAs or physicians practicing in rural areas are the ones who are going to be most challenged by the reforms since these are either nurse practitioners or single doctors with a small staff. The burden of implementing and testing the new technology according to CMS and HHS guidelines and handling claims denial, interacting with payers while providing patient care in relatively poor localities can take a toll on the revenue. Moreover, since there is a dearth of health care providers in rural areas it becomes difficult to just drop patients because of delayed claims or due to Medicare cuts since this would put patients’ health in jeopardy and lead to decreased revenues for physicians as well. The need for dedicated medical billers and coders who can also handle claims denial along with other tasks such as charge entry and payment posting can be felt in such times. These medical billers and coders would ensure that you as a health care provider dedicate most of the time to patient care instead of interacting with insurance companies and worrying about various guidelines to be followed.

The Solutions
There is no question that small practices and solo physicians would need to adapt to the reforms in the health care system. There are many ways of doing this and some small practices have joined bigger health care providers for training as far as the new technology is concerned. Other practices are grouping together in order to share knowledge about the changes and search for solutions. Another solution is to form a medical group so that you as a physician receive better benefits and pay by without worrying overmuch about routine administrative hassles all by yourself. These mergers can help solo or IPA physicians in understanding and sharing the risks and benefits of the health reforms, share resource expenses and also improve the quality of care for their patients.

Another feasible alternative is to tie up with a standard healthcare consultancy provider such as medicalbillersandcoders.com, for effective and customized solutions in healthcare IT, Revenue Management and strategic operational areas for small practices. This consortium is preferred by smaller practices due to its reach in all 50 states across

Visit medicalbillersandcoders.com for more information.

Decoding Common Billing Blunders & Devising Ways To Quell Them

The growing incidence of delays, denials, audits, and resubmission of physicians’ medical bill claims is reason enough to have a relook at the way physicians’ services are billed and coded. In a medical insurance environment, characterized by stringent billing and coding compliance, inherent billing and coding errors are easy to catch. Further, lack of knowledge or negligence can be no excuse as payers go by the set rules that govern medical bill reimbursements.

As physicians try to figure out lacunae in their billing and coding practice, researchers have traced the reasons to lack of knowledge, negligence, outdated coding knowledge (physicians still trust what they learned 10 years ago!), inadequate in-house billing and coding competence, and, sometimes, incompetent outsourced medical billing and coding solutions. Delving further, they have even identified patterns of usual billing blunders.

• Failure to document services billed: A common error, physicians often forget to bill for incidental services while addressing the main medical disorder, which can substantially reduce the final realization. Therefore, physicians should realize the importance of billing for medically necessary, though incidental, services also.

• Failure to provide signatures: There have been instances of medical claims being returned unpaid and to-be-resubmitted again on account of omission of signatures by the physicians billing for their medical services. As physicians’ signatures only can validate the medical services that are billed for reimbursement, it is important that physicians, while submitting claims, do not forget to sign in wherever required so as to avoid being embarrassed with notices for resubmission.

• Consistent assignment to the same level of service: It is inviting suspicion as your payers might term ‘consistent assignment to the same level of service’ as duplication, and return the subsequent claims as invalid. Further, they may ask for explanation on the efficacy of repeating the same service again. To avoid, such undesirable scenario, a higher order coding is advised for subsequent services.

• Billing as a consult rather than an office visit: Although, at the outset, they might seem similar, consulting fee is deemed higher than regular office visit. Misrepresenting your manner of service will have a direct bearing on the outcome of reimbursement, and upon being found out by the payers’ audit checks, you may be called upon to furnish a suitable explanation. Therefore, code for the correct context to avoid being exposed during audits.

• Use of invalid codes (for example, codes taken from an outdated resource): The prime reason behind most billing blunders is the physicians’ perception that billing and coding standards are permanent; whereas there have been as many reforms as one can think of in billing and coding. Therefore, they need to keep themselves abreast of frequent changes in coding.

• Unbundling of procedure codes: Physicians, albeit unknowingly, or their billers, tend to fragment their procedure into parts, and assign codes accordingly. Whereas insurance companies, which feel such fragmentation tends to disproportionately increase claims, are known to have sent notices requesting physicians to not to unbundle their services.

• Misinterpreted abbreviations: Abbreviations, meant for reducing description, need to be used suitably to avoid a billing lapse.

• Failure to list chief complaint: Physicians, sometimes, looking for incidental charges may forget to state the chief medical complaint itself. Such mistake can render your claim as ‘insufficiently substantiated,’ and returned with audit remarks.

• Billing as a separate professional fee for those services included in a global fee: Physicians – not knowing the extent of coverage that their patients insurance schemes allow – sometimes, tend to club additional professional services while billing for certain cases that carry global-fee tag. As the insurance companies are obliged to reimburse only the global fees, physicians might not get the reimbursement for what they claim to be additional services.

• Use of an inappropriate modifier or no modifier for accurate payment of a claim: Modifiers – which play an important role in suitably modifying codes for incidental medical services – need to be used with discretion. Rampant and indiscriminate use of modifiers can be termed as ‘unacceptable practice’ and be eligible for ‘audit notes’ from your insurance carriers.

Given the pattern of billing blunders, and their consequences on claims realizations, individual physicians, clinics, hospitals, and multispecialty groups should look at devising a preventive program that can mitigate the recurrence of billing blunders in the larger interest of their sustainable practice and growth. Consequently, the preventive program entails 

• Educating themselves and their staff on proper coding
• Continuous upgrades in terms of latest updates in coding
• Continuously assessing the coding procedures to identify the most common errors and reduce them

Whereas these positive measures can be practiced internally, yet, physicians – who tend to be wary of exhaustive billing management practices – can fall back on proven outsourced solutions to meaningfully streamline their billing processes for optimized reimbursements. Medicalbillersandcoders.com, who a have long-standing reputation of being the largest medical billing consortium with a substantial presence across all states of the US, should be of immense help in devising a comprehensive program that can effectively quell billing blunders.

 

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Superbill Analysis – an imperial stamp of authentication

“Consequently, physicians’ medical bills get an imperial stamp of authenticity, and nullify the chances of undesirable delay, denial, resubmission, and audits from highly stringent medical insurance companies”

Notwithstanding physicians’ integrity in preparing honest Superbills, comprehensive analysis has become imperative before these can be submitted to payers for reimbursement because of the highly dynamic nature of US healthcare industry. Apart from being assured of the accuracy of the bill, a routine analysis saves the healthcare providers from being embarrassed with undesirable delay, denial, and resubmission notices from insurance payers on account of factual errors in the claim forms. Considering the efficacy of such a convention, the question is who should carry out Superbill analysis? Well, it is immaterial whether physicians get it verified in-house or outsource the procedure to an expert third party as long as it serves the purpose of authenticating medical bills.

But, judging from the historic reference of failed in-house verification experiments, outsourcing Superbill analysis, from proven Medical Billing Management providers with their professional expertise, seems an ideal solution.

How is Superbill analysis carried out?

Having established the wisdom in outsourcing Superbill analysis, it would make sense to highlight how Superbill review vets out the accuracy of various crucial pieces of information contained in the document. Well, getting to the crux of the matter, Medical Billing Management specialists scrutinize the Superbills for accuracy of:

• Provider Information, wherein last/first name and degree, service location, and signature are verified
• Ordering/referring/attending physician, wherein last/first name and degree, NPI (national provider identifier) are scrutinized.
• Patient Information, wherein patient’s first and last name, patient DOB, insurance information (insurance name/and id), date of first symptom (upon necessity), and last date seen (upon necessity) are checked.
• Visit information, wherein date of service; procedure codes (CPT) – list of commonly used codes by medical provider according to the provider specialty; diagnosis codes (ICD-9) – list of commonly used codes by medical provider according to the provider specialty; modifiers (location and conditions modifiers); time (for timed codes); units and quantity for drugs, and authorization information, (if applicable), are cross- verified.

Thus, Superbill review and analysis process culminates in authenticating the Superbills for claim submission only after ensuring the following:

• Establishing the legitimacy of the bills in terms of signature by provider of service
• Filling up of required fields for information
• Legibility of the information
• Apt CPT and ICD-9 codes with corresponding description of service/diagnosis

Physicians can hire outside services for the entire process of Superbills preparation, verification, submission, and realization of medical bills from the insurance companies. Such services come with utilities such as preparation of super bills from the physician notes and transcriptions that are available in their system; utmost care while coding; adherence to HIPAA compliance and CPT, ICD-9, and HCPCS coding; and assigning of appropriate modifiers and related information into the Medical Billing Software accurately.

Consequently, physicians’ medical bills get an imperial stamp of authenticity, and nullify the chances of undesirable delay, denial, resubmission, and audits from highly stringent medical insurance companies.
Medicalbillersandcoders.com, being the largest consortium of medical billers in the US, has made Superbill analysis – comprising coding of the diagnosis and the procedure, checking the compatibility of the diagnosis with the procedure code, checking for the modifiers in relation to the procedure, quality checking before the generation of the claim – an integral part of its comprehensive Medical Billing Management Services.

Sustainable Physician Practices: A Judicious Mix of Human Resources and IT

While physicians’ competence will forever remain pivotal to excellence in patient care, the auxiliary services – on duty nurses, para-medical staff, and administrative staff – which ease the load off physicians are equally crucial. There are ample instances, wherein, despite best efforts of physicians, healthcare services have been found well short of bench-marked quality, largely on account of disoriented auxiliary medical staff. Consequently, along with a direct impact on patient’s well-being, it will also show up in physicians’ inability to practice sustainable growth.

Streamlining clinical administration through an optimum mix of technology and human resources 

In an industry characterized by radical computerization of healthcare administration, the recent Federal Health Reforms, calling for more emphasis on further automating medical operations, should come as a relief to practitioners seeking to balance their auxiliary and administrative functions with an optimum mix of technology and human resources. But, finding an optimum mix of technology and human resources is no easy task: cost of installing technology interface, and training required to orient human resources to the installed technology comes in the way of providing medical services at competitive prices.

The recent study by Healthcare Information and Management Systems Society (HIMSS) has unfolded some interesting facts about prevailing status of technologically oriented medical services:

• Most hospitals are still capturing patient data manually, fouling up clinical transformation goals
• While many healthcare organizations have teams in place to modernize clinical practice across the enterprise, plenty still struggle to capture the right data and provide optimal staffing to produce ongoing quality improvement
• An astonishing 79% of respondents said they still gather outcomes data by hand – manual processes for capturing, collating, and analyzing data responsible for the lack of electronic means to conduct these functions.
• Close to two-thirds total respondents said the staff at their organizations simply did not have enough time to participate in all necessary quality-improvement activities, which becomes a particular concern when hospital executives cannot have direct access to quality reports or specialized IT staff has to intervene to develop reports because the staff running the reports do not have the authority to directly create them.
• Sometimes, organizations lacked the right types of employees, meaning inability to find a right mix of support and administration staff.

Outsourcing staffing requirements to Medicalbillersandcoders

While the result of the survey is an eye-opener on the current problems plaguing Physicians’ practice in the US, it is also a guideline for finding a useful mix of administration staff, and technology for advanced quality in medical care. Still, the word ‘Optimum’, being subjective, should be left to the discretion of concerned practitioners, who can best judge depending on their operational and revenue margins. Alternatively, there are proven agencies, which have the requisite expertise on advising optimum staffing for technology-driven medical operations. What is more, they even source and supply compatible human resources to complement their comprehensive advisory solutions.

Medicalbillersandcoders.com, being the premier advisory for administrative medical services, has the credentials and competence to deliver custom-made solutions for medical practices seeking a judicious mix of technology and human resources in their administrative functions.

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Patient Engagement Model: Enhancing Patient Care & Revenue Through IT

Notwithstanding best quality of medical care offered by individual physicians, clinics, hospitals, and multispecialty groups across the US, there has been an interesting debate – how to leverage digital technology in pushing the prevailing medical care standard to the next rung while also optimizing revenue in the process. Whereas Patient Engagement Model is not a novel entity, yet, given its compatibility with Digital Technology, it assumes greater significance than ever before. In fact, the report released by a consortium of health IT experts affiliated to the Institute for Health Technology Transformation vindicates the importance of technology-driven business model for patient engagement, which also works to enhance your revenue returns.

Increasing patient volume through enhanced engagement
Calling for research and collaborations among industry stakeholders, the report is optimistic of a turnaround in quality, safety and efficiency of medical care should healthcare providers realize efficacy of Patient Engagement through Digital Technology Tools. Providing a broader guideline for implementation, the white paper (published by the consortium) has also spelt out ways to engage patients for seamless medical efficiency. Thus, gone are the days when your medical competence alone could attract, retain, and swell your patient base. In a highly technology-enabled modern healthcare industry, you are equally vulnerable to lose your patient-base to your competitors, who – not withstanding their equally competent medical knowledge – may have a better Patient Engagement Model in place. Therefore, it is advisable that individual physicians, clinics, hospitals, and multispecialty groups alike adopt the guidelines – issued by the experts at the Institute for Health Technology Transformation – as the commandments for IT-enabled Patient Engagement Model.

• Complementing your patients’ healthcare-related information needs with customized delivery through various IT Media channels: although patients themselves derive health-related information for better management of their diagnosis and treatment, yet channelizing information – through online health tools, such as reminders, instructions and educational information about their diagnosis and treatments – from your end can be more apt and assuring. And satisfied patients translate into enhanced reputation and increasing patient volume.
  
• While there can be no substitute for your medical competence, yet enabling a dialogue across your patient-base is seen as promoter of transparency, and goodwill amongst your patients. Social Media tools – Facebook, Healthgrades, ICYou, Patientslikeme and Twitter – are ideally suited for ensuring a networked dialogue.
  
• Whereas targeting young patient-base – who are generally tech-savvy – assumes greater significance, there is an interesting phenomenon that elderly group and their well-wishers are equally fascinated with the web medium. This can provide interesting opportunities for physicians to include their patients from all age groups in meaningful online interaction. Therefore, there is a balancing act to be done that can go a long way to increase your patient base.
  
• In an environment, where patients believe your advice to be authenticated, physicians and hospitals can leverage that trust by ensuring their patients with factual report on their personal health information, generated and delivered through networked systems.
  
• As your patient-base tends to be highly mobile, you need to find a delivery mode that best suits your patients who are always on the move. The new age smart-phones, and tablet androids – which are capable of replicating computer-aided features – are made for the situation.
  
• Although IT-enabled information channels can take your Patient Engagement Program to a new level, there is always an element of security threat as the sensitive health information is prone to undesirable proliferation over the web or wireless medium. Therefore, system security tools need to be in place for mitigating such scenario.
  
• Contrary to the general conception of technology being expensive, IT-enabled Patient Engagement Program can be implemented at no cost at all through free social media tools like Facebook, YouTube and Twitter.
  
• Although your Patient Engagement Program may not show tangible benefits directly like dramatic increase in your Rate of Return on your Investment (ROI), yet, being a quality measure at increasing medical care efficiency, it is bound to yield goodwill to practice or institution, which is invaluable.

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IT-enabled Patient Engagement Model: an opportunity not an option
Judging by its inherent potential, IT-enabled Patient Engagement Model should never be an option but an opportunity for individual physicians, clinics, hospitals, and multi-specialty groups to provide meaningful and enhanced patient care. While they can be adopted freely, healthcare providers can tackle that burden by subscribing to the consultancy services from a credible source such as Medicalbillersandcoders.com for implementing medical management systems. While the government incentives can hugely subsidize the financial investments involved in the implementation of these processes, the consultancy services offered by Medicalbillersandcoders can easily streamline the implementation process as well as staff training involved in it.

Family Physicians

Medical Billing Challenges in Family Practice

Family Medicine forms a crucial point of entry in the health care system, and the need as well as the shortage of family physicians in the United States is becoming a growing concern. Other specialties such as radiology, neurosurgery, and dermatology are more attractive due to the higher amount of compensation provided to physicians in these areas. Moreover, the looming Medicare cuts that have been postponed for a long time and are now extended to January 1, 2012 presents another problem for family practitioners for avoiding losses in income.

Another important factor is the health reforms coupled with increasing number of aging baby boomers in the coming years which would keep family physicians busier than before and hard pressed for time and money.

Chronic Hurdles

Medicare is facing problems because of Federal fiscal troubles and Medicare cuts have been proposed in order to compensate for the rising health care costs. The recent debt ceiling increase at the eleventh hour by the government bears witness to the fact that Medicare is unable to withstand the increasing pressure brought on by a large number of aging population in the country. The inevitable solution to this income crisis faced by family physicians and in the field of primary medicine is better payer performance and adhering to the guidelines in regards to administrative or other processes involved in the revenue cycle management. These chronic pressures in the revenue of family physicians can be relieved by ensuring reduction of errors in the billing and coding procedures which are becoming more complex and extended in nature. Professionals who can perform better payer interaction and medical coding and billing can bring about speedy and fair reimbursement compared to an inexperienced or overworked in-house staff.

The Geriatric Paradox

The increasing number of baby boomers and elder people indicates better life expectancy but also makes physicians, hospitals and clinics dealing with chronic illnesses associated with old age busier by the day. Moreover, the Medicare fiscal issues exacerbate the problem by proposing to provide easy access to insurance for the elderly but lesser payments for physicians. As the baby boomer population grows, the number of physician-patient encounters by the elderly would also increase drastically, leaving very less or no time for physicians to handle paperwork or administrative tasks. Outsourcing the whole process of billing, coding, and payer interaction can be an easy and a frugal solution to relieve the administrative burden faced by physicians and health care providers.

ICD-10 and Family Practice

The migration from ICD-9 to ICD-10 codes is a major overhaul in the medical billing and coding industry and brings more complexity to the billing and coding procedures. Moreover, the fact that family physicians face diagnostic as well as treatment challenges across all ages, gender, diseases and parts of body makes billing and coding more detailed which requires dedicated professionals in order to avoid errors. The repercussions of errors impact not only the amount of reimbursement for physicians but can also jeopardize the privacy of patients’ healthcare data, emphasizing the importance of error-free billing and coding practices.

How Do Healthcare IT Reforms affect Family Practice Physicians

The health reforms also extend to the health IT sector which would provide easy access to physicians, administrators, medical billers and coders, as well as insurance companies regarding the information related to the treatment and other relevant data. Dedicated medical billers, transcriptionists, and medical coders can understand these changes from implementation and testing of EMR and EHR to following up with payers to receive timely and accurate reimbursements. The need for medical coders and billers who can cut down on the errors and save physicians’ time and money is being felt more in the field of primary care and by family physicians due to the extensive changes in the health industry as the latest health reforms are being implemented across the country.

For more information about meaningful solutions to tackle these issues in the context of family practice and other specialties, as also for professional medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, also specializing in Family Practice Billing.

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Coping with financial challenges in US healthcare

A Brief Anatomy of Financial Challenges Faced by Physicians 

The US healthcare system is facing major reforms in the next two years and this not only includes adoption of new healthcare IT reforms such as EHR (Electronic Health Records) and EMR (Electronic Medical Records) but also changes in the way physicians are reimbursed. The most crucial aspect of health care in the United States is cuts in Medicare which would leave doctors with reduced revenue resulting in dropping of Medicare patients by physicians. This 21% cut in the reimbursement for Medicare is scheduled to take effect on January 1, 2012 and would have negative financial repercussions for physicians, clinics, hospitals as well as patients. However, President Obama mentioned in a Whitehouse weekly address that such cuts would be unfair for health providers and the senior citizens of the country adding that this problem can be counteracted by reducing abuse and fraud in the health care industry.

The Overheads

One of the major problems that physicians and health providers face is the overheads that amount to more than 40% of the revenue that is earned. In an era where baby boomers are at their highest, it does not make sense to drop Medicare patients when the cuts take place (if they, in fact, do take place, which is unlikely). Instead reining in the overheads can work wonders if the cutbacks happen. Getting partial or even full-time support for billing and coding requirements as well as other revenue cycle management areas from expert professionals can help healthcare providers in cutting costs to some extent. It also frees up the staff to focus on voluminous core areas such as patient care and research etc. Apart from that, getting experienced and expert support for medical billing and coding and denial management can reduce avoidable errors and improve revenue as well as save time and efforts.

Revenue Cycle Management

Revenue cycle management is an integral part of a financially successful physicians practice and optimization of the same can lead to prevention of losses due to an inefficient or ineffective revenue cycle management. The process of revenue cycle management is a job that requires meticulousness and understanding the technology that boosts the outcome of such management. Using the latest technology can not only increase the revenue by saving time but also through the incentives provided by the government for using such technology. However, successful revenue cycle management also entails shorter turnaround time for reimbursement and efficient and productive interaction with payers which can be done much more effectively by a dedicated and professional team of medical billers and coders rather than a physician’s assistant.

Codes and Ethics

The transformation from ICD-9 codes to ICD-10 codes is going to impact the finances and the cash flow of hospitals, clinics, and physicians because of the complexity and increased volume of codes. The number of codes are going to increase more than six times and handling and navigating through this maze of medical codes would increase the chances of errors. To solve this problem, it is imperative that physicians and healthcare providers hire dedicated medical billers and coders who are experienced and trained in utilizing ICD-10 codes. Moreover, HIPAA guidelines also require that patient privacy be given paramount importance since information would be transmitted to various entities using the internet. To establish patient data privacy, the healthcare providers need to ensure that the third party vendors who support their administrative, technical and revenue cycle management are fully conversant with HIPAA privacy laws, as also their staff has stringent training in HIPAA compliances as they are the first ones to handle PHI data. This would ensure that HIPAA guidelines are not compromised even by mistake and they do not have to bear the financial brunt of breaking such regulations.

Facing financial challenges in the current scenario is not likely to be easy but for long term gains and standardization it makes good sense to initiate meaningful changes and actions now. And doing this with an expert’s support will only establish those changes more efficiently and effectively in the physicians’ practice. For more information on how to bring about desirable changes to enhance your practice and revenue management and move ahead in these challenging times, please visit Medicalbillersandcoders.com – the largest consortium of healthcare professionals dealing with Financial Challenges in the industry.

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Medicalbillersandcoders.com Caters to Physical Therapy Payment Issues through Expert Billing Services