The Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

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.

The Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

Is Medicare and Medicaid Reimbursements fairer than Private Insurers: a Brief Comparison

Various providers despite being paid lesser by government than by commercial insurers believe that Medicare and Medicaid reimburse more fairly than commercial payers. Findings from a recent survey depicted that 93% of respondents feel that Medicare is fair always or frequently while 62% felt the same about Medicaid, whereas 62% were of the view that commercial plans are not fair in all or most cases; and 49% said commercials are fair sometimes. One of the factors in assessing fairness can be speed –approximately two-thirds of respondents said Medicare pays the fastest, 26% said Medicaid and only 9% opted for commercial payers.

The differences between Medicare, Medicaid and private insurers is not limited to the reimbursements but are also observed in various other fiscal features such as the overheads where private insurance companies have more overheads in the form of administrative costs, overhead for Medicare – approximately 2-3% whereas for private payers – 12%. This comparison sheds some light on the way government and private payers operate as far as their fiscal policies are concerned. However the looming Medicare cuts though postponed by the Congress time and again will affect physician perspective towards government payers.

The Committee on Ways and Means (US Congress) in its latest efforts in the health reforms regarding payments from private payers and its implementation in Medicare has started to explore how private payers are rewarding physicians who provide high quality and efficient care. The report released by the cites the Sustainable Growth Rate (SGR) formula in Medicare Fee-for-service (FFS) as lacking in recognizing the quality of care that is offered by the provider. A report by the U.S National Institute of Health clarifies that in 2004 31% of all outpatient physician income was derived from government sources and this number is set to rise as the reforms ensure health insurance for the remaining 32 million uninsured in the country. This essentially implies that even if Medicare and Medicaid pay a less amount per claim compared to private insurers, more than one-third of physician income is set to come from such government sources.

The inherent advantage that government payers seem to possess is the trust that the government enjoys from the public as well as from beneficiaries such as physicians. Private players bear more risks in terms of bankruptcy and losses compared to government payers. Moreover, Medicare historically accounts for more than 50% of total public spending by the government for US healthcare; this implies that the option of dropping Medicare patients due to any reason does not seem practical financial prudence. Another advantage of Medicare for physicians is that it pays providers roughly the same amount throughout the country regardless of the consumer’s socioeconomic status. Therefore, even though Medicare and Medicaid are faltering, they are still viewed as trustworthy services.

On the other hand Private payers have traditionally created numerous problems for physicians and patients in the form of errors in claim processing, delays in payment, incorrect payments and excessive denial of claims. Private payers at times deliberately commit errors in claims and such errors amount to almost 19% of the claims that are denied for no reason after submission. These claims need to be filed again which takes considerable departmental work and invariably increases costs and delays reimbursements. To deal with both upcoming healthcare reforms affecting government payers and policies of private payers, physicians require assistance of professional departmental processes. Medial billers and coders at medicalbillersandcoders.com not only offer such professional services in the form of denial management and revenue cycle management but also offer traditional medical billing and coding services for better returns.

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.

The Financial Importance of Timely Medical Claim Submission

The importance of timely claims submission is not lost on physicians or their staff and is an integral part of the revenue cycle management (RCM). The dynamic nature of the health industry and the reforms has further exacerbated the already volatile situation when it comes to claim submission, denials, and re-submissions. There are numerous factors that affect the efficiency of the claim submission process and these may range from type-o errors to other issues regarding medical billing and coding or policy matters. Moreover, the tendency to deny or reject claims based on simple errors seems to be the unwritten principle of most of the insurance companies in the market which further hampers the whole RCM process, thus affecting physician revenue and patient satisfaction.

The most important aspect in RCM is the timely filing of claims that has an undeniable impact on how much and when the providers get paid. There are, however, numerous hurdles in timely filing of claims that can be encountered in a clinic and by their staff or even medical billers and coders:

• One of the most common hurdles in timely filing of claims is the fact that simple errors can and do occur while submission and this rate is even higher for an in-house staff that juggles with numerous issues and interacts with numerous payers
• The biggest hurdle in timely filing is resubmission which is when the claim is denied and filed again due to some error or incompetence on the part of insurance companies
• However, there are other more practical hurdles such as unavailability of time, work pressure on staff, increased demand, and other pecuniary factors that influence the timely filing of the claim

The most important factor that affects the timely filing or submission of claim is whether the in-house staff is handling claim submission or interaction with payers or if the complete RCM process has been outsourced to a professional billing company that not only has competency and professionalism but is also professional and scientific in its approach. The dynamic insurance market also plays a role in the timely submission of medical claims and the rules and regulations governing various providers are also responsible for influencing the way in which claims are filed. Usually claims should be filed within 30 days of the day when the service(s) was provided; however, this may differ according to the provider policies and government guidelines.

There are many ways of dealing with the issue of untimely claims submission and its inevitable negative repercussions. However, the most important method of ensuring that claims are filed on a timely basis is to analyze the whole process of RCM so that the lacunae and repeated errors can be isolated and corrected. For instance, if a provider is denying more claims or is denying claims even when filed in a timely manner, then such situations need to be analyzed and resolved immediately. This process of finding habitual and regular errors in the process of timely submission can be easily handled by a medical billing specialist in a better manner compared to a novice or an in-house staff member.

The inevitable impact of the health reforms on claim submission and RCM is palpable in the form of adoption of 5010 platforms, Electronic Health Records (EHRs) and numerous other factors and requires specialized training and skill that can only be achieved by dedicated professionals who are capable of submitting claims in a timely manner. Moreover, recent issues such as the rapid changes in legislation, intervention of the Supreme court, legal, financial, and administrative issues surrounding ‘Obamacare’ have made it necessary to have specialized professionals who can keep up with the changes and assist in timely submission of medical claims.

Medical billers and coders at www.medicalbillersandcoders.com are not just HIPAA compliant and legally updated but also perform research and analysis of claims and strive to achieve the maximum efficiency through a scientific approach, be it claims submission or accounts receivables. To find more information and for consultancy as well as other medical billing and coding services.

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.

Predicting the scope of medical billing consultants after 2014 and beyond

Although it has been quite a while since the Federal Government announced a series of far-reaching healthcare reforms, we are yet to experience their full impact across the healthcare continuum. And, with the Senate bill deferring a major chunk of the reforms further, it is expected that we may have to wait as late as 2014 to witness their full impact.

Amongst a string of reforms that will take effect from 2014 are the ones emanating from the Patient Protection and Affordable Care Act, which will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act:

• Access to affordable coverage for the uninsured with pre-existing conditions, which means the act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions

• Re-insurance for Retiree Health Benefit Plans, wherein the act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees

• Closing the Coverage Gap in the Medicare (Part D) Drug Benefit, under which the act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500. There would also be guarantee of 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap

• Extension of dependent coverage for young adults, wherein act requires insurers to permit children to stay on family policies until age 26

Coupled with this set of reforms, which are believed to improve physicians’ revenues, there are also reforms that are likely to test their ability to practice delay-and-denial-free reimbursement practices:

• The Accountable Care Organization Model, which requires physicians to realign their practices in congruence with Medicare incentive framework

• The ghost of Sustainable Growth Rate (SGR) fix, which threatens to substantially erode physicians’ share of Medicare reimbursements

• Last but not the least, the radical ICD-10 and HIPAA 5010 compliant clinical and coding practices, which, though indispensable to reduce healthcare fraud and abuse, are going to force medical practices into a more stringent reimbursement environment than ever

While the impact of the ensuing healthcare reforms are going to be felt across the whole healthcare continuum, it is the medical billing practices that would be most affected. Therefore, it is going to be crucial that medical billers and coders respond with highest degree of professional dynamism to mitigate the chances of physicians’ medical claims running the risk of denial or delay. When one thinks of the possible areas that medical billers and coders would be addressing post 2014, the following come up to the fore:

1. Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
2. Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
3. Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
4. Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physicians’ medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
5. Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
6. Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s Medical Billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

As physicians, in the wake of these sweeping healthcare reforms, look to elevate their billing and coding practices through outsourced Medical Billing Services, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – should be a preferential choice for streamlined medical billing practices.

HIPAA 5010 enforcement delayed to ensure doctors & entities complete transition

Enforcement of HIPAA 5010 transactions on March 15, 2012, was delayed for the second time for another 3 months by the government, with the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) pushing the date further to June 30, 2012, in order to not compromise physician cash flow. Physicians have previously communicated to AMA significant cash flow problems they encountered associated with the transition to HIPAA Version 5010. Essentially the rule called for compliance by January 1, 2012, however earlier on November 17, 2011 OESS announced its first enforcement delay of three months, referring to the move as “enforcement discretion”.

OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format

Commercial plans are reporting similar numbers

State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

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.

Medical Billing Companies: Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Medical Billing Companies: Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Electronic Health Records (EHRs) are complex systems and a dedicated team of professionals are required for handling and maintaining these systems for smooth operation of such records. The drawbacks of paper based records, the projected advantages of EHRs, and the incentives offered along with the penalties for non-adoption of EHRs are driving hospitals and small practices towards implementing EHR related policies. There are numerous reasons for the slow rate of adoption of EHRs and range from reluctance to accept new technology, the changes brought about by government intervention and practical causes such as financial burdens, increased amount of work and shortage of time. 

Although there are challenges in the initial stages of implementing EHRs, the benefits in the long run are holistic in nature and can benefit physicians as well as consumers. One of the important aspects of the financial and professional growth of the practice is the maintenance of the viability of the equipment and the resources available for efficient operation. One of the important steps in ensuring such efficient operation is the hiring of reliable staff that are not only educated in their own profession  but are also computer savvy and familiar with EHRs and such other systems required for everyday activities. 

Some other factors that may add to the costs are health IT services which are a recurring one along with some other costs such as upgrading the system and keeping the systems secure as per HIPAA guidelines. However, the fact that the initial cost of EHR would be offset due to the incentives provided and the benefits in the long run, financially or otherwise, cannot be denied. The costs of EMR or EHR implementation and maintenance can be reduced by using various methods to streamline the departmental processes by optimizing services such as revenue cycle management and denial management along with numerous other services. These processes require accuracy in order to reduce duplication and rejection of claims, and errors while billing and coding. 

Professional medical billing and coding companies can provide dedicated services such as payment posting, where accurate comprehension of Explanation of benefits (EOB) is required, and accounts receivable where time is the most crucial factor in receipt of accurate reimbursement. Moreover, the advent of EHRs and numerous new polices, physicians are trying to hire more staff for health IT support which is in short supply. Costs of health IT services for upkeep of successful EHRs are rising and some of the ways of cutting costs is to outsource as many departmental processes as possible in order to find relief from some financial burden. 

Medical billing and coding companies that offer specialized services in this field not just cater to physicians’ billing and coding needs but also provide numerous other services. Medical billers and coders at www.medicalbillersandcoders.com offer other value added services such as physician credentialing, consultancy and denial management.

Simplify EHR Systems by Restructuring Your Medical Billing

EHR systems have changed over the last decade and the health reforms have given new meaning to such systems by making rules regarding ‘Meaningful Use” (MU) of such systems. Older versions of EHRs were simple digitized versions replacing paper based records and did not have the specific guidelines in MU to be implemented for the incentives. However, almost all EHR vendors now are MU compliant but only 10.1% of physicians in the country have a fully functional EHR system. This is due to the fact that those who have a basic system are not equipped with features to handle MU compliance along with the changing face of the health industry including the attitudes of payers towards billing processes.

A report prepared by the University of North Texas on providing – Guidance in Documentation, Coding, and Billing of Medical Services for Compliance-  clarifies the documentation and billing requirements and also the general rules to be followed while documenting. For instance – the medical record should be complete without any errors and the documentation of each patient should include the reason for encounter, relevant history, prior diagnostic test results, and physical examination findings. The past and present diagnoses should be accessible to the consulting or treating physician, the patients progress is to be documented and appropriate health risk factors identified. The code reported on the claim form or billing statement needs to be supported by documentation in the medial record.

Hence the requirement for a separate billing system can be felt and is one of the solutions for such complex compliance requirements and the above subset of information can be sent to a billing system designed to specifically handle such information. There are numerous other documentation standards that need to be observed and these standards are easily handled by EHRs and can be made to fit the billing system. The information corresponding to all the documentation standards mentioned above can be sent directly to the billing system at the time of the visit, making the whole process smoother. Moreover, HIPAA compliance can be easily observed because the medical documentation is stored in the billing system and does not require the clerical staff to access the actual EHR.

Billing and related processes need to be reorganized to fit the requirements of not just MU compliant EHR systems but also for accurate and timely reimbursements. These documentation standards and compliance are extremely important in light of the way in which payment models are changing in the industry. Physicians would be paid according to the quality of the service provided and the outcomes rather than the traditional per-patient method. For more information about medical billing processes and to restructure your billing and assistance with EHR implementation, visit www.medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States that also provides services such as revenue cycle management, denial management, and consultancy.

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.

Effects on Physicians reimbursements: Insurance Denials and uncertainty of health reforms

Insurance denials are one of the major factors that affect a physician’s revenue even though health reforms do address some issues faced by patients and physicians in dealing with insurance companies, the denial rate of claims has not significantly altered due to such reforms. These insurance denials are avoidable especially as they create problems for physicians and providers and delay or even eliminate the possibility of proper provider reimbursement. Dealing with insurance companies is tough enough for experienced physicians; it is even tougher for new physicians who have limited hands-on experience in such matters.

The reforms have played a significant role in reining in insurance companies and some of these policies may work but still remain to be fully tested. The survey conducted by The United States Department of Health and Human Services finds that the rate of denial is 19% but the denial rate increases with the age group of the patient. People who are older face more denials compared to young individuals and this is a worrying trend for a population which is continuously aging. The Government Accountability Office (GAO) has released a report on insurance denials which sheds some light on the nature of insurance denials- it states that in many cases the denied claim, if appealed, is often reversed. This survey also clarifies that the number of denials due to the inappropriateness of the service provided by the physician are less than those because of billing errors and eligibility issues.

The health reforms are going to  affect the insurance scenario in the sense that as now even people with pre-existing conditions can get insurance- this essentially means that physicians are more likely to see increased number of sick patients which in turn would increase the average physician-patient encounter time. The other aspects that will affect the insurance scenario in the country are that since there would be a large influx of consumers in the form of the previously uninsured 32 million Americans which would benefit the insurance companies to grow. However, initially insurance providers would see a drop in their revenue due to decreased profits and increasing number of claims.

Physicians and providers stand to gain from the health reforms in the long run and the way in which these new policies will affect payers even though some payers may decrease the Physician Reimbursement amount. Nevertheless, insurance denials are always going to be one of the major problems that providers will have to face in the future even after the implementation of reform policies.

The best way to deal with insurance denials is to ensure that denial management and payer interaction are performed by experienced professionals for better results. Such denial management and payer interaction can be performed in a professional and efficient manner by the largest consortium of medical billers and coders in the United States, medicalbillersandcoders.com Billers and coders in the consortium can not only assist in better Denial Management and payer interaction but also offer numerous other value added services such as revenue cycle management, research, and consultancy.

US Healthcare adapting to Reforms: Hospitals to Ease Physician Shortages

The health reforms have affected every aspect of the health care delivery system in the United States and smaller and solo practices in the country are finding it difficult to cope with the changes on almost every level of health care delivery. The changes in health IT sector, policies in government intervention, and changing reimbursement models are making it difficult for solo and small practices to cope with all these changes financially as well as functionally. Physicians as one of the options are turning towards hospitals and large group practices for better job prospects with reduced amount of responsibility.

The challenges faced by small and solo practices are not just limited to the core aspects of health care delivery. These challenges can range from functional impairments, workflow redesigns and other financial factors. The amount of work required to comply with the health reform guidelines is not just limited to implementation of EMRs and EHRs and ‘Meaningful Use’ objectives but also entails numerous other responsibilities in the form of maintenance of such EHR systems and changes in various departmental processes that are essential for boosting revenues. Increasingly physicians are struggling to find a holistic approach towards the practice and succeed due to the new reform guidelines that are complex and exhaustive in nature.

Hospitals are also taking steps in order to boost the revenue and streamline various processes by forming tie-ups with other group of physicians and hospitals. This not only encourages innovation but also cuts costs and saves time. This can also be a solution for reducing the shortages of physicians by giving an opportunity to those physicians who would have failed in Meaningful Use implementation or had decided to stop practicing due to the complex guidelines of the health reforms. Moreover, the implementation of successful Meaningful Use is carried by more physicians since they have the support of hospitals and larger clinics to comply with reform guidelines.

Due to the many reasons cited above, hospitals are starting to recruit physicians who are finding it very challenging to cope with the recent changes in the health industry. This can obviously help in relieving the pressures in big and medium sized hospitals and give an opportunity for better health outcomes. Such services backed up by departmental processes such as medical billing and coding, revenue cycle management, better accounts receivable handling, active interaction with payers offered by www.medicalbillersandcoders.com can assist any hospital in properly handing the financial side of the health care delivery.