Physicians to Manage Revenues amidst the Impending 26.5% Medicare Cut with a Medical Billing Service

Ever since Sustainable Growth Rate (SGR) began overshooting budgeted Medicare spend, physicians have been under the constant threat of Medicare cut. While Congress’ intervention has delayed the inevitable thus far, it may be a little tougher this time – Centre for Medicare Services (CMS) has already indicated that its fee schedule for 2013 is designed to initiate 26.5% Medicare cut if the Congress fails to intervene before Jan. 1, 2013. While physicians may still be optimistic of a breakthrough in their favor, they still need to be prepared for any eventuality. And if 26.5 Medicare cut is indeed set in motion, it would have a debilitating effect on physicians’ clinical and operational efficiency – practices may not be able to support operational expenditure, leave alone the thought of ‘profit’.

Despite the looming fear, practices can still find ways to off-set the impact of Medicare cut – transition to new payment and delivery models will help meeting the primary objective of improving patient care as well as moving to a higher-performing Medicare program.

Accountable Care Organization (ACO) is one such care model, which will increasingly become mandatory for care providers in the Medicare network. ACO requires physicians to form a clinical network that can achieve optimum clinical efficiency at minimum cost to patients. ACO works on the formula that a clinical network with A-Z medical services can considerably bring down patients’ medical expenditure. While physicians in an ACO get to be recognized for high performance, they also stand to benefit from shared-savings. Moreover, being in an ACO is indeed helpful in building credibility among patients.

The provision of Affordable Care will also help physicians counter the impact of Medicare cut. The significant thing about this reform is that it extends Medicare to every uninsured citizen in U.S. With roughly one-third of population expected to be Medicare beneficiaries, physicians can look forward to off-set Medicare cut with operational volumes from Affordable Care provision.

But transiting to these novel care models may be seemingly difficult for physicians who have been used to protective health care models. Amongst possible challenges, understanding fee schedule, negotiating and renewing payer contracts, being conversant with multiple payer policies, and striking beneficial deal with payers will be more important. Moreover, a proper mix of public-private payers is more than advisable.

And, amidst these Medicare-cut-generated challenges, mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding too will add to the burden, which may be far too much to bear for physicians. With the in-house staff incapacitated to take responsibility of this enormity, outsourced medical billing services seem to be the only way out. Medical billing companies – with experience and competence in stage-managing transformation to high-performance Medicare models, managing mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding on behalf of physicians who are essentially focused on clinical efficiency – could provide helping hand.

Medicalbillersandcoders.com has time and again demonstrated its worth as being most reliable, flexible and transformation source for physicians’ billing and operational issues. Over the years, we have successfully helped practices of varied sizes and disciplines ease through operational hurdles. And, at a time when physicians are confronted with the impending 26.5% Medicare cut, we are committed to help them counter the impact with alternative and profitable operational practices. Our broad-base of resources – comprising competent medical billing professionals, who are conversant with dynamics of Medicare and other payer systems – essentially drives our mission across all the 50 states in U.S.

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.

Correlation between Practice Revenue and Operational Documentation

Documentation holds special significance in clinical care – care coordination, easy reference, clinical research, and clinical certification are all made possible by well-documented clinical encounters. But documentation got a new dimension when fee-for-service was first replaced by Medicare-supported reimbursements. And, with the gradual inclusion of private players in health insurance, the significant of documentation is felt operationally too – documentation is the single-most source for billing, coding, and verifying the accuracy of claim submission.

Over the years, there has been considerable increase in both incidence and volume of documentation – increase in insurance-backed patients has largely been responsible for this. As a result, staff’s documentation responsibilities too have gone up. What used to a few demographic entries, insurance eligibility verifications, charge entries, billing, coding, submission and follow ups, has suddenly assumed gigantic proportions. And, when internal staff is forced to manage beyond their capacity, issues such as delay, denial, resubmission, audit, and arbitration are bound to be common. The fact that physicians find themselves in multi-payer system – which continues to be tougher by the day – is reason enough to practice accurate documentation so as to be operationally viable.

EHR provides the right platform needed to respond with operational documentation as required by your payers. As an EHR is capable of integrating clinical documentation with Practice Management System (PMS), billing and coding errors will be more unlikely. Further, with the capacity for large data base, EHR can be relied upon for any future reference or audit verification from payer side. Significantly, EHR is supposed to be a primary requirement for ensuring patients’ privacy and security as mandated by HIPAA 5010.

EHR-enabled documentation will be more than just a requirement as practices continue to negotiate economic uncertainty, declining reimbursements, healthcare reform and an increasing emphasis on performance improvement. While the imminent ICD-10 regime promises streamlined billing practices, physicians will have to do whatever best they can to have a documentation system that is consistent, comprehensive, and accurate enough to be translated into ICD-10 compliant billing and coding. Practices that lack the will and resources to adopt progressive EHR-enabled documentation may well lose considerable chunk of patients as well as practice revenues.

Therefore, medical practices have the ominous task of either find the solution themselves or with an external intervention – billing consultants or companies. The complexities involved in customizing operational documentation as demanded by individual practice structures make it apt to outsource from credible and competent sources. Medical billing service providers with strategic partnership with leading EHR vendors may just be the people to bank upon.

Medicalbillersandcoders.com is known to have implemented customized EHR systems as part of its comprehensive RCM services. Practices of varied sizes and disciplines across the 50 in U.S. have experienced clinical and operational utilities from our EHR implementation. And, at a time when medical documentation has begun to impact operational revenues, we are leveraging our internal competence (experts in EHR implementation) with external collaboration (leading EHR vendors or manufacturers) to set up revenue-promoting documentation systems.

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.

Financial Stability from Collaborative Partnership with Billing Companies

Business acumen is something that is generally lacking amongst health care professionals, particularly doctors or physicians. Physicians are primarily driven by clinical excellence, which they believe it to be pivotal to their existence, growth and credibility amongst the patient community. True, clinical excellence continues to be decisive factor even today. But, in a free economy where quality is generally standardized, practitioners’ financial stability and growth is not determined by clinical excellence alone, but innovative care, strategic expansion, and more importantly effective & efficient medical billing as well.

U.S. health care sector has always been at the fore-front of clinical innovations – adoption of improved clinical practices and technologies continue to enrich clinical experience and outcome. It is unquestionably true that patients are increasingly drawn towards practitioners with innovative attitude. As a result, many practices that are incompetent to reinvent themselves may slowly be on their way out.

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Practice expansion too is something that is generally neglected by physicians – many are happy with single-outlet practice. But it is quite possible that competition may gradually reduce what once used to be profitable practice to a loss-making one. To offset such adverse impact, it is prudent to think of expanding your practice base to regions with positive growth prospects.

Billing complexity is a major reason for practices’ financial woes. With fee-for-service completed replaced by health insurance reimbursements, physicians have entered a multi-payer environment characterized by region-specific rules on Medicare and Medicaid, diverse fee-schedules, and overtly strict reimbursement policies. As a result, delay and denials continue to pile up account receivables and erode practice revenues. The situation has grown so alarming that medical practices fail to collect 25% of the money they are owed; $125 billion is left in the bag as unpaid claims; Only 70% of claims are paid the first time they are submitted; of those denied claims, 60% are never resubmitted to payers; and medical practices never pursue 18% of claims at all. While payers (whether Medicare, Medicaid or private health insurance companies) are justified in refusing or withholding claims with inherent billing and coding errrors, physicians could still have averted revenue loss of this magnitude with collaborative partnership with billing companies.

Maintaining financial stability will be even more challenging post the series of recent health care reforms – Medicare cuts, affordable & ACO model of care, mandatory EHR compliance, HIPAA 5010 compliant patient privacy and security, and ICD-10 based billing & coding.  If Medicare cuts are indeed brought on, physicians will have to forego a considerable portion of their reimbursement.  ACO model of care too is designed to rationalize reimbursement. While mandatory EHR compliance, HIPAA 5010 compliant patient privacy and security, and ICD-10 based billing & coding all promise to streamline medical billing practices, compliance will not come about without investing on people and technology.

The possible loss from Medicare cuts will have to be off-set with increase in volumes or being eligible for lion’s share in incentives from ACO model.  More importantly the capital investment on people and technology needs to be recouped as early as possible if practices wish to remain profitable. All these finer aspects of financial management may prove to be beyond physicians’ capability, whose scope is limited to clinical management. Therefore, medical billing companies – with experience and competence in advising physicians of profitable practices, negotiating higher fees schedule with payers, setting up contract with multiple payers, and more importantly streamlining business practices with coding & billing accuracy – should assume the mantle of financial management.

Medicalbillersandcoders.com has already proved its worth as a reliable medical billing and financial management partner to practices of varied size and specialization across the 50 states in the U.S. We are well-served by a team of expert medical billing professionals with expertise in finer aspects of financial management for care providers. Their familiarity with multiple payers, government agencies, and prominent knowledge & technology sources gives us a distinctive edge when it comes to managing practices’ financial aspect.

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.

Recognizing Value in Healthcare Reforms with the Help of a Billing Service

U.S. health care industry is characterized by multiple stakeholders – patients, care providers, and payers. The Federal Government, being the custodian of this priority sector, has had to keep each of these stakeholders in good humor. But, during the recent, there have been a multitude of reforms which have sought “quality medical care at affordable price”. And, if there is one group that is little apprehensive about these seemingly patient-centric reforms is the “care providers”. Care providers’ fear is based on the premise that the proposed cuts to Medicare – which is still the largest player in the multi-payer system – would force them to forgo a major portion of their practice revenues. Incentive-based reimbursements (ACOs), mandatory EHR implementation, and ICD-10 too may have further escalated the apprehension. But, providers may have actually missed to discern “the value” residing deep inside these seemingly pro-patient reforms.

The Patient Protection and Affordable Care Act (PPACA), which was one of the earliest of the recent health care reforms, promises to generate ample scope for practice growth and expansion. Even if it is certain that fees or cost of medical services would further get rationalized, providers would still be able to off-set or even make surplus revenues with Affordable Care’s ambitious plan for extending Medical insurance to every uninsured U.S. citizen.

Accountable Care Organization Model of Care, which seeks to incentivize providers on shared quality medical care, would help grow providers into more credible and competent. And, credibility and competence would essentially drive up practice volumes and revenues.

The purpose behind EHR compliance is to document and exchange and clinical data in sync with privacy and security norms under HIPAA. By attesting to these norms, providers will be able to project themselves as responsible, and avoid violation of privacy and security norms. Moreover, “Meaningful Use of EHR” could further qualify them for incentives under EHR Stimulus Package Scheme. Therefore, the cost of implementing EHR would prove to be less than its eventual returns.

ICD-10, with all the hype surrounding its scope, has evoked a sense of great awe amongst a majority of providers. No doubt, ICD-10 require complete overhaul of billing and coding. Upgrading systems and training staff as per the new coding system would involve considerable expenditure; sourcing right knowledge and system provider would be even more challenging. But, despite these inherent challenges, ICD-10 promises to be the most efficient coding system ever. When coding efficiency is destined to be the best, it should mean fewer denials and rejections. Therefore, providers should be able to recoup the investment faster than they actually estimate.

But maneuvering through reforms of this magnitude would require external intervention, and it is the medical billing service providers who are likely to help realize the value that potentially reside inside these reforms. Medicalbillersandcoders.com – which has time and again demonstrated their ability to mediate providers’ clinical and operational challenges – is confident of convincing providers’ of the efficacy of the recent healthcare reforms. Our core group of expert medical billing professionals – adept at transforming mandates into providers’ advantages – continues to lead our charge as a leading consortium for medical billing and allied services across the 50 states in the U.S.

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.

How Medical Billing Consortiums Are Superior to Medical Billing Companies

The origin of medical billing practices in the U.S. can be traced back to the 1960s when Medicare was introduced as a parallel to cash-based medical services. Since then, insurance-backed medical service has grown enormously, and two-third of the total physicians’ fees is routed through insurance of some form or the other. This shift in compensating physicians has made medical billing more complex than ever before. While medical practices initially tried to manage with in-house medical billing practices, they gradually had to give up because of internal incompetence and escalating cost of training and system deployment. As a result, outsourced medical billing practices have become the order of the day.

Outsourced medical billing practices come in various forms – freelance consultants offering billing services, dedicated medical billing companies providing comprehensive billing services, and billing consortiums with differentiated billing practices. While practices can choose the one that best suits their budget and expectation, there is an over-whelming inclination towards Medical Billing Consortium.

Medical Billing Consortiums versus Medical Billing Companies

Cost is a major factor that has made medical billing consortium more popular than medical billing company. Medical billing companies operate from a pre-determined location, which may be far away from care providers’ facilities. As movement of resources involves considerable expenditure, physicians feel burdened with inclusion of such expenditure in fees payable to medical billing companies. Whereas billing consortiums, with affiliates across major clinical destinations, provide economies of mobile resources.

U.S. health care reimbursement environment is characterized by multi-payer system – Medicare, Medicaid, and a host of prominent private payers. Moreover, these health insurance schemes are governed and get modified according to state-specific laws. A medical billing company may not be conversant with region-specific variations prevailing in all of the 50 states. But a billing consortium, with affiliates drawn across the states, can be relied upon to deal with such variations.

Comprehensiveness is another trait lacking in most of the medical billing companies. While there are certain companies that are highly specialized in billing select-few disciplines, billing companies with competence for the entire range of medical disciplines is a rarity these days. Large hospitals that require billing services for the entire range of medical disciplines may not like the idea of dealing with too many service providers. Medical billing consortiums, which normally comprise professionals of diverse billing specializations, are preferred for their inclusive medical billing practices.

Care providers’ are put through a host of healthcare reforms – Medicare cuts, mandatory EHR compliance, possible shift to ACO model, and ICD-10. While opting for outsourced mediation from medical billing companies may seem an instant justification, billing companies too are restricted by geographical confinement, resource constraints, and limited competence. Consortiums, on the other hand, are agile, resource-rich, and infinitely competent with their vast and varied professional base.

Medical billing companies may be susceptible to resource-crunch during times of attrition or turnover of professionals, which is likely to affect practices’ clinical and operational rhythm. Conversely, medical consortiums rarely face such adverse times due to their vast affiliation. With readily available reserve-pool of resources, consortium can ensure that practices’ do not experience cluttered service flow.

Medicalbillersandcoders.com is a leading billing consortium with a professional base across the 50 states in the U.S. Over the years, practices of varied size and specialization have tried, tested, and endorsed our billing services as comprehensive, practical, and transformational. With a credible history and agile, resource-rich and infinitely competent affiliations across the 50 states, we are confident of transforming the recent health care directives into opportunities for care 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.

The Value of Accurate Documentation in Medical Bill Reimbursement

Medical documentation has myriad applications in today’s health care administration – being reference-source for future encounters; enabling coordinated care, both within and across the clinical network; contributing to macro health care planning and reforms; ensuring clinical data privacy and security as per HIPAA norms; and ensuring flawless medical billing. Notwithstanding providers’ effort to document as best as they can, “accuracy” continues to be a matter of great concern. While inaccuracies in medical documentation can lead to lapse in medical care quality and breach of trust, it is the reimbursement that will be most affected.

Every reimbursement starts with medical billing, which is calculating the cost of administering medical services. Clinical documentation – which contains physicians’ narration of entire course of medical management – is the source on which billers rely upon in assigning monetary value to medical services. Because most of the physician documentation is supposed to be true, medical billing is as good as your clinical documentation. But, physicians, with all their good intention and focus, may not always be expected to document without omission or error. And any omission or error may either correspondingly reduce reimbursement or expose your bills to chances of denial or delay.

One way to do away with omission or error is to encourage doctors to check back on every chart before they move on to the next patient. But doctors are seemingly busy, and may not wish to keep the next patient waiting or compromise on clinical priorities. In such cases, internal staff may be assigned with the job of elaborating the doctor’s notes into comprehensive charge sheets or case summary. Training and orienting the so deputed staff is crucial before they take over the charge and start feeding medical billers with charge notes.

Clinical documentation has undergone remarkable changes recently – paper-based charts have given way to automated documentation. Medical practitioners are lot happier with pace and ease with which modern-day systems can generate voluminous reports that can easily be exchange across the health care network system. But, automated documentation is also inherent with investment, implementation, and training issues. Moreover, patient security and privacy may be at a higher risk from hacking concerns. All these issues may prompt the intervention of competent medical billing service providers who know how to upgrade providers’ internal clinical documentation in sync with medical billing and coding.

Medicalbillersandcoders.com – known for its catalytic role in clinical and operational management of a majority of medical practices across the 50 states – is prepared for the next challenge: changing face of clinical documentation in ICD-10 and HIPAA 5010. With the entire provider-fraternity transiting to a more robust, comprehensive, and technology-driven clinical documentation environment, it hopes to own up the responsibility of transformation. It is well-served by its core group, comprising clinical documentation specialist, expert medical billers and coders, and strategic partnership with best-known vendors of automated documentation systems. The fact that it has already executed documentation upgrading as part of its comprehensive RCM services is a testimony to its credential and competence.

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.

Small Medical Practices Register Meteoric Rise in EHR Adoption

It seems solo and small medical practices have decided to take the plunge in a big way – recent statistics reveal that small practices have been able to half-bridge the gap with their larger cousins, whose EHR penetration stands at an impressive 80% since the EHR became mandatory under “Meaningful Use Clause” in 2011.

Remarkably, the growth of around 40% has come about all of sudden – not so long ago, small medical practices had a single-digit adoption rate. What is even more interesting is that larger practices could add only 5% to their growth during this momentous rise by smaller medical practices. Within small practices, practices with less than two physicians are relatively ahead of practices with 6 to 10 physicians. Penetration of this scale could not have come about without valid reasons.

Many believe the government's incentive program and funding of the regional extension centers – which are helping to train smaller practices – to have helped boost small practitioners’ confidence. Credit should also to go EHR vendors, who seem to have shifted their focus to smaller segments. These two factors may have helped small practitioners’ overcome cost, training, and implementation inhibitions.

There has also been considerable improvisation in EHR technology – technology is becoming more portable, less expensive, customized, easier to operate and maintain. Small practices now have choices as against standardized versions initially. This may have considerably influenced their decision in favor of EHR adoption.

Significantly, hosting has become unbelievable easy – small practices can now rely on cloud-based EHRs, which essentially help doing away with all those difficulties associated with Onsite hosting. Moreover, small practices have begun forming pools as a means to optimize the investment on EHR hosting – a remote hosting facility is entrusted with the task of hosting the entire pool’s customized EHRs. The advantage of this form of hosting is that small practices are saved from investing individually on hosting infrastructure facility. This too may have hastened the decision on EHR implementation.

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Above all, small practices seem to have been convinced of EHRs ability to dramatically improve clinical and operational functions. News of EHR’s catalytic effect on large practices’ revenues must have been a great motivator.

Despite all these positives, small practices’ EHR implementation has not been all that easy – there have been challenges in terms of deciding on proper vendors, training internal staff, resource mobilization, and integrating with external clinical and operational network. While they deserve to be applauded for their commendable progress, the remaining portion may well face similar roadblocks. Medical billing service providers, being the vital cog in the EHR adoption, will have a huge role to play in helping the rest of the small practitioners to make right decisions on vendor, training internal staff, resource mobilization, and integrating with external clinical and operational network.

Medicalbillersandcoders.com – which is a leading consortium for mediating the entire range of medical billing services – has already begun its catalytic effect on small practices’ EHR implementation. It is distinguished by extensive knowledge of medical billing domain, strategic partnership with EHR manufacturers and vendors, and payers. While small practices in few states may already have felt its catalytic advantage, Medicalbillersandcoders.com – with resource mobilization to rest of the 50 states – hopes to bring about complete EHR compliance.

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.