The new coding system expected to bring huge changes: Learning how to transit form ICD-9 to ICD-10!

Medical Coders prepare for this change…

Learning New Codes and getting specific: According to the Centers for Medicare and Medicaid Services (CMS), the transition to ICD-10 is occurring because ICD-9 produces very limited data about patients’ medical conditions and hospital inpatient procedures. Medical coders need to be prepared with these new codes as:

• The ICD-10 transition includes seven-character codes from the three to five-digit ICD-9 codes to be able to capture the full nature of disease
• The 17,000 different codes currently used in ICD-9 will grow to more than 140,000 when ICD-10 is fully implemented
• The new codes will require more specificity in coding and documentation- for example one code currently used for acute otitis externa, becomes 28 potential codes
• Moreover, the U.S. is the only country using the ICD-10 system for billing purposes as most of the other nations use it mainly for epidemiological reasons. Canada is among those countries that use it only in hospitals.

Charting and Documentation for ICD-10 is a huge concern with laterality being introduced hence Medical coders and physicians in this case can assess the new codes and the current existing charts to see if their current documentation supports the more in-depth requirements of ICD-10 and start preparing for this change.

Training: Besides the Medical coding & billing staff but also the physicians need to be trained and educated. However care needs to be taken that training begins not more than six to nine months before the new codes are used as they will likely be forgotten by the time they are needed.

Physician concerns:

Implementation is likely to be very costly and a big financial concern amongst practices and a typical small practice of three physicians can expect costs of more than $83,000 by the time the changeover is complete, while a practice of 10 providers may spend as much as $285,000 to fully implement ICD-10. Besides these costs computers, software and staff training is a major financial concern during the transition to ICD-10. Payments flow is also a major concern post implementation as payments are not entirely in the practice’s control. Moreover every part of the practice will have to be assessed in tandem with ICD-10 along with assessment of vendors.

Practices need to start gathering enough information on ICD-10 and Billers and Coders proficient in ICD-10 transition are the need of the hour and highly demanded. Physicians amidst the transforming healthcare environment as a feasible option are opting for services of medical billers and coders who are proactive and prepared with material-requisites for ICD-10. Personnel updated at Medicialbillersandcoders.com are viable option for physicians in smooth transition to ICD-10; equipped with experience in HIPAA, ICD-10 and other compliances.

Moreover the unique ICD-10 Training Program encompassing 34 weeks of ICD-10 training and updates – strives to outline at no cost to medical billers and coders information & training- right from how ICD-10 will affect healthcare to how ICD-10 needs to be implemented within different specialties to ensure optimum revenue cycle management post ICD-10.

The Role of EHRs towards Physician Productivity and Medical Billing

Electronic Health Records (EHRs) definitely have an impact on physician productivity; however, little research has been carried out in this field compared to the other sectors such as the manufacturing sector where IT implementation has proven to be a successful booster of productivity. Measuring the impact of EHRs or EMRs on physician productivity and billing presents numerous other challenges and not just lack of research on the subject. Moreover, the challenges that are faced while calculating the impact on the productivity of physicians due to EHR implementation are encountered in numerous aspects of a particular practice or a hospital environment.

The biggest challenge for calculating the impact of productivity in the field of healthcare is that productivity differs by specialty and other factors and ought to be calculated considering the parameters accordingly. For instance, an hour operating on a patient may not be the same amount of work or finances as an hour spent examining a common cold patient. Researchers have used work relative value units (WRVUs) for uniformity in measuring the productivity across some selected specialties. A study called Electronic Medical Records and Physicians Productivity: Insights from Panel Data Analysis and Design Implications further states that the measurement of productivity is also different according to the setting, type of organization providing healthcare, the carrier of the patient and such other parameters that can make it difficult to measure the accurate impact of EHRs on productivity of providers.

The fact that information makes individuals or organizations more productive is a good feature for measuring the impact of IT on healthcare in the form of EHRs. Moreover, correct information at the right time can reduce uncertainty and delays, causing an improvement in decision making. The alignment of system functionalities and the task needs can lead to increased performance and when technology is compatible with the task at hand, it leads to efficiency in performance (Goodhue 1995). This implicates that the use of EHRs which target the need for information by providers can enhance the performance of providers along with their revenue. Therefore, streamlining of various processes involved in health care delivery is a prerequisite for successful installation and utilization of EHRs which in turn would lead to increased productivity in a holistic manner.

Research has shown that productivity drops for a certain period of time immediately after EHR adoption due to the initial shock of changes in workflow processes and the steep learning curve involved in successfully implementing EHRs and qualifying for the ‘Meaningful Use’ (MU) incentives. However, the productivity slowly increases over a period of time due to streamlining of various processes involved and due to the increased familiarity with health IT and EHRs. Moreover, the incentives play a major role in boosting the productivity and revenue of providers who successfully demonstrate MU. However, while making such changes in workflow processes and in numerous other aspects of healthcare delivery the future is also going to bring immense pressure on providers due to a sudden increase in the demand for healthcare and the shortage of supply.

The various departmental processes involved in healthcare delivery play a huge role in the productivity of physicians and with EHRs and other changes in medical billing and coding procedures, and changes in health insurance policies due to the reforms. Without matching the technology with various workflow processes such as revenue cycle management, denial management, payer interaction, and successful implementation of EHRs, the revenue would drop considerably keeping in mind the penalties for non compliance of reform policies. Moreover, increased demand implicates increased revenue and workload as well, and outsourcing such departmental processes to professional that have experience in this field and are updated about the recent changes in the health care industry can bring about positive revenue changes.

Medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States has such professionals who can not only solve the problems faced due to the increased workload in medical billing and coding but also in other processes such as revenue cycle management, denial management, successful interaction with payers and assistance in the streamlining of these processes for EHRs.

For More Information : http://www.medicalbillersandcoders.com/

Factors Affecting Hospital Employment and Physicians’ Revenue

There has been an increasing trend in the healthcare industry where physicians are opting for hospital employments and the reasons and repercussions of these seem numerous. It cannot be argued that there are many positives for ‘being your own boss’ in a private practice. However, due to numerous reasons and changes taking place in the health industry, physicians are seeking hospital employment not just for the financial benefits but also due to numerous factors such as increased responsibility, risk, high overheads,  and a host of other reasons that come with managing a private practice.

The health care reforms taking place in the country are also profoundly affecting the way in which delivery of healthcare is carried out. Physicians seem to be caught in this maelstrom of the choice between a private practice and hospital employment and are seemingly struggling to stay financially afloat; especially in private practices. One of the motivating move hospitals are making for physicians is shelling out a salaries to fresh graduates that are considerably high compared to what they would earn in a private practice and the promise of financial stability along with incentives provided by hospitals to physicians. The risk factor involved in starting a private practice is also slowly but steadily pushing solo and small group physicians to seek employment in hospitals. 

Inevitably, this increasing trend of physicians abandoning their private practice and choosing hospital employment is also having an effect on hospitals. Moreover, the demand for healthcare is dramatically increasing due to millions being newly insured and hospitals require physicians to slake this demand by pouring in more physicians in the facility in a short period of time. In addition to these factors, the steep learning curve involved in the implementation and maintenance of Electronic Health Records (EHRs) and other compliance issues regarding government policies in health care has driven a small part of physicians to completely close their practices and find hospital employment. 

Hospitals are increasingly hiring more staff and providers in face of increasing demand but it is a fact that the amount of workload would dramatically increase not just in the core aspects in hospitals but also in administrative and in other departmental processes. The challenges faced by hospitals are not just limited to providing quality care but also includes getting paid for the services that they provide.  Moreover, increased internal workflow and departmental processes due to this increased demand for services can lead to high costs which has a direct affect not only on the revenue but the quality of care as well. The changes in the health industry are affecting almost all the entities and processes involved in health care delivery and departmental processes are no different. 

The changes in various processes and departmental protocols due to the recent reforms have challenged many professionals who carry out such processes. The changes in medical billing and coding, stricter insurance policies by the Federal government, and the extensive implementation of Health IT have made these processes more cumbersome and highly skilled, more than ever before.  Medicalbillersandcoders.com is the largest consortium of medical billers and coders in the United States that provide medical billing and coding services that are not just limited to medical billing and coding but also encompasses Revenue Cycle Management, interaction with payers, denial management and streamlining of these processes for IT adoption. The consortium has adapted to the new changes in policies and processes to provide optimized solutions to business needs and increase your bottom line.

The Primary Barriers in Physician Billing and HIT Adoption

Physicians and healthcare provides across the country are slowly but surely adopting EHRs or Electronic Health Records as a part of the recent health reforms in the United States. Moreover, it has been reported by the Centers for Disease Control and Prevention (CDC) that there has been a substantial increase in the adoption rates across the country and this trend is gaining momentum as the financial and health benefits of Health IT are understood and implemented successfully however some states still lag behind in “Basic” EHR adoption. 

The adoption of EHRs may be increasing but some of the statistics are misleading. “Basic” adoption of EHRs is not considered as qualified for the ‘Meaningful Use’ (MU) incentives, there are time restrictions and this was apparent in the Stage 1 of MU when a lease was given to numerous physicians to fully start implementing their EHR systems. Moreover, the costs of implementing a fully functional EHR or EMR System is so high that it is financially cumbersome for providers and staff to handle their core job aspects as well as train on EHRs and maintain these systems. 

The cost of IT services can be very high and since it is a recurring fixed cost, it can form a dent in a physician’s revenue. The stage 2 timelines are also of concern since those who do not implement Health IT would fall behind and find financial as well as policy hurdles. However, this can be counterbalanced by the incentives offered in the long run due to increased revenue because of EHRs and HIT implementation. The costs of IT in health care come in the form of continuous IT support for services not just in the core aspects of the medicine but also in the other departmental processes involved in getting paid. However, some relief in the form of incentives is providing financial relief to private practices as well as hospitals. 

The deadlines for the implementation of Stage 2 of MU have also been extended to the year 2014 instead of 2013 due to hurdles such as costs and the skill required along with the learning curve to fully implement both the stages of MU. The need to cope with such costs and pressures is not limited to the core aspects of medicine. The effect of exhaustive changes in Medical Billing and coding procedures, handling the costs associated with IT maintenance, dramatically increased interaction with payers, and increasing your revenue at the same time is a process that needs dedicated professionals who are not just HIPAA compliant but also ensure the accurate and timely delivery of reimbursement for providers. Medicalbillersandcoders.com is the largest consortium of medical billers and coders in the United States that can carry out all these departmental processes in an efficient and timely manner. 

The services delivered by this largest consortium include revenue cycle management (RCM), denial management, extensive and fruitful co-ordination with payers, and streamlining of these processes to integrate with EHRs.


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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. 

For more information visit: Medical Billing Services

EHR Adoption gains popularity with Oregon, Georgia, Washington and Virginia leading the trend

The EHR adoption rates in the United States are definitely increasing and this fact is corroborated by a report released by the CDC (Centers for Disease Control and Prevention) which states that – “American Hospital Association’s Survey of IT adoption, 15.1 percent of acute care non-federal hospitals have adopted at least a “basic” EHR. Moreover, according to the report 24.9% of office-based physicians have implemented at least a “basic” EHR. This figure is twice what it was in 2008 depicting an increase in the adoption rates by almost 50% as far as office based physicians are concerned and this trend is observed in almost all health provider settings such as various hospitals and private practices. The survey also shows that 79% of intended applicants are in the process of preparation to apply for adoption in the year 2011 or in 2012. 

Oregon, Georgia, and Washington among some others are some of the States that are leading in the adoption of EHRs due to this national trend. The data released by researchers from the Doctors Company gives a state wise adoption percentage of physicians in the country. According to the report, Forty-one percent of Oregon’s physicians have adopted electronic health records, following Oregon for physician adoption are Georgia at 39 percent, Florida at 37 percent, Washington at 35 percent and Virginia at 34 percent. 

The repercussions of such increases in the adoption of EHRs in hospitals and by physicians are not just limited to positive outcomes related to the health of the population and the efficiency of the hospital, provider, or practice but also have an excellent impact on the revenue of providers. This is not just because of the increased work and thus revenue but also due to the incentives provided by the Government. The adoption of EHRs usually brings profits and revenues in the long run but it is not surprising that a certain period of time passes before you see positive financial outcomes. This is due to the fact that EHR adoption can be a little cumbersome, has a steep learning curve, and is being implemented for the first time on a national level. 

The successful adoption of EHRs is only possible if all the processes involved in the delivery of healthcare are streamlined and integrated with EHRs. The other departmental processes have also undergone changes and the staff also has to learn these new IT innovations in the industry for increasing the revenue of providers. With new polices implemented by the government concerning not just insurance but also Medical Billing and coding and such other processes, reform is seen in all processes involved in the ”back-office” functions. 

Changes need to be taken place in many processes such as Revenue Cycle Management, insurance interaction, billing codes, and denial management. We at Medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, not only provide these services but are also aware of the latest changes in policies such as HIPAA compliance and billing issues among many others to provide optimization of revenue and better quality of service to providers. 

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

For more information visit: Medical Billing Services

Specialty EMR Market not completely tapped

Recent estimates conclude there are various specialists in the EMR market who rather than using specialty EMR, usually follow the trend of using a general EMR which has a few extra functions; however user views suggest that general EMRs with extra functions/templates are usually not sufficient for many specialists. 

The U.S. EMR market space is highly fragmented with more than 1000 players in the market with the EMR market expected to grow to $6,054 million in 2015 at an estimated CAGR of 18.1%. Most doctors recognize that EMR adoption is inevitable and are willing to invest in a good EMR, but specialists find it difficult to access a broad range of options when they want a system tailored to their needs. Various EMRs lack the sophistication needed to be effective in specialized medical environments and if an EMR has been designed for everyone, for every specialty, it has in reality very little value. 

There is a wide disconnecting between futurist visions and current EMR implementation rates amongst medical specialists, such as otolaryngologists and orthopedic surgeons. But generally EMR vendors provide solutions that are designed for generalized medical fields, rather than specialties as they focus their R&D efforts and finances on solving the needs of physicians such as family practitioners or pediatricians. Furthermore certain manufacturers choose an even wider approach and attempt to build systems that suit the needs of physicians across today’s very broad medical spectrum. 

Multi specialties can do well by choosing generically built EMR if they suit their purpose, however it suits a specialist more to use specialty EMR’s to avoid higher costs and implementation. Physicians aware of this can definitely benefit from the right EMR. 

Certain Advantages for a specialist of a customizable specialty EMR system over a generic system: 

• Specialty EMR takes less time to implement and adopt 

• Customized with the library of required forms and templates which helps the user to focus on quality of care rather than writing templates 

• Generalized EMR’s could take a month to work properly and user has higher chance of making errors while preparing templates. Specialized EMR’s leave little room or no room for errors and omissions 

• A specialty EMR is designed according to the workflow of a particular practice 

• A general EMR system comes loaded with all types of features and functionalities whether a user needs it or not leading in distracting the user’s attention and efficient workflow 

• Specialty EMR helps to improve competence through the accuracy of medical decisions 

Hence it is evident that there is a large market for EMRs that specialize by practice type and gradually there is developing a trend amongst smaller EMR vendors who are trying to carve out their niche in the EMR market by focusing on certain specialties, but the market for specialty EMRs has a long way to go before it matures. Moreover doctors while choosing their EMR have an option of choosing from more than 300 EMR companies. 

Balancing their act between healthcare reforms demands and patient care physicians can do well by partnering with a Medical Billing Consultant who can guide them and give them advice on the right EMR after studying their practice medical billing process completely. 

MedicalBilersandCoders.com is offering a wide array of EMR’s for them to choose from besides providing consultation in selection of the right EMR which generate records through successful implementation in the healthcare practices which are eventually used by the practice for various purposes such as patient care, administration, research, healthcare quality improvement, and processing of reimbursements. 

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies  in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services  according to their preferences of specialty, city, software and services performed.

Increasing Impetus on Physician Reimbursements becoming value-based

Both federal and private payers are shifting compensation from volume to value of services. According to American Medical News one of such payers is UnitedHealth Group who is to start offering approximately 50- 70% of its physician’s bonuses for reaching cost and quality targets and/or participating in new care models. 

Increased numbers of physician practices are likely to experience this shift soon with other large health plans, like Aetna and WellPoint, already using the value-based incentives model. In addition Medicare’s shared savings program is also offering “shared savings” to the pioneers of Accountable Care Organization (ACO) who are improving quality of care and reducing costs. Overall the shift to value is not a passing trend states American Medical News especially with UnitedHealth Group US’s largest health plan, with physicians in every state, also adopting this trend. 

Shift putting physicians at risk for lower reimbursements? 

As of now as a majority of insurers shift reimbursements towards value, are not yet putting their physicians at risk for lower reimbursements. Nevertheless this is likely to change soon- with physicians who do not meet quality outcome requirements and lower readmissions will in most probability begin experiencing reimbursement reductions. 

Medicare and other payers are expected to continue taking steps to encourage increased number of medical groups to concentrate on the outcome rather than volume consequently in this scenario practices need to start gearing up and adjusting themselves accordingly for a shift from volume to value to assure smooth revenue generation. 

Physicians get geared 

Contrary to what some entities may feel physicians can do well in areas of both quality and productivity at the same time, but for that physicians will need to apply best practices for streamlining care, learn from other successful practices and understand resources needed to track quality and cost indicators. Outlined below are some measures Physicians may find necessary to take to help in value based reimbursements: 

• Proof: physicians may need to establish that they are providing quality care at reduced cost 

• Documents: fully utilize EHR to document patient information and be able to quickly share patient information with other providers due to increased care coordination 

• Data Analysis: analyze data generated through EHR to help determine performance 

• Patient engagement:  soon to become an increasing factor related to payments 

Though the shift from volume to value is stressful, it has potential for physicians as if it is successful they may see higher reimbursements, for which they need to spend  good quality time with patients, but may be pressed for time to address the other measures mentioned earlier. As physicians move towards a value based system of healthcare delivery, they would be well-off having an advisory from experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization. 

Medicalbillersandcoders.com besides managing your practice’s Medical Billing our medical billers and coders can guide the practice right from the EHR best suited for your practice to data analysis and assist in incentive maximization contributing towards the healthcare goal of providing quality and cost‐effective healthcare services. 

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