Responding To Growth-Induced Orthopedic Medical Billing Needs with Specialist Intervention

Orthopedics have been on upward growth trajectory thanks to a host of conducive factors – continued pro-orthopedic Medicare reimbursement reforms, innovative care procedures, breakthroughs in orthopedic technology and anesthesia administration have largely been responsible for upsurge in practice volumes. The combination of these factors has enabled shifting orthopedic from hospital-based inpatient form to a more popular and affordable form – outpatient or ambulatory settings. It is noteworthy that this form of orthopedic care is currently growing at over 20%, which is comparable with other fastest growing specialties.

While orthopedic practitioners have reasons to be upbeat about their practice prospects, they should equally be cautious and prepared for billing complexities that may be accompanying the swelling practice volumes.

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One of the primary reasons why Orthopedic Billing may be susceptible to billing complexities is that orthopedic comprises a broad spectrum of procedures to treat a variety of orthopedic conditions, which are perceived and valued differently by payers. Therefore, it would require orthopedic practitioners to be versatile to respond with orthopedic billing and coding in conformity with individual perception of the payer who they are submitting their claim to. More than mere submission of claims, they should necessarily have a systematic Revenue Cycle Management with comprehensive processes such as coding, charge posting, claims filing, payment posting, A/R follow-up including denial management, and reporting.

Significantly, insurance underpayments, which are more rampant in orthopedic and as high as 10 to 15% of the actual claims, may push orthopedic practices into a state of revenue erosion that could jeopardize their clinical and operational efficiency. As a result, they might have to emphasize on monitoring and minimizing underpayments with an effective process of credentialing, verification, patient eligibility, and proper coding & billing.

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Coding revisions too would substantially add up to Orthopedic Billing woes – with the on-set ICD-10, orthopedic codes will be more complex, detailed, and numerically too many to code a wide array of orthopedic procedures such as bone graft, open surgical partial removal of collar bone, partial repair or removal of shoulder bone, open repair of rotator cuff, open repair of rotator cuff, reconstruction rotator cuff, open repair elbow fracture involving ulnar bone, wrist fracture pinning through skin, open surgical treatment wrist fracture, shoulder scope, repair cartilage tear, shoulder scope, partial removal collar bone, shoulder scope, bone shaving, shoulder scope, rotator cuff repair, injection of lower back joint, and many more. This monumental coding revision might warrant appointment of specialist coding professionals.

The changing orthopedic coding and billing landscape would require, among various other things,

To evaluate where you stand currently as against the projected requirements for a comprehensive orthopedic RCM comprising coding, charge posting, claims filing, payment posting, A/R follow-up including denial management, and reporting.

To earmark resources to monitor finances, and assigning them the responsibility of meeting with patients before admission to pre-collect copays, deductibles and co-insurance amounts, and work out payment plans as needed.

To improve front-end revenue cycle management, comprising checking coverage and verifying patient information before hand.

To facilitate training coders on coding revisions as and when they happen.

As in the case of most busy and critical medical disciplines, orthopedics may also be bound by an overriding clinical focus that may be limiting their exposure to full-pledged orthopedic medical billing reforms. Medicalbillersandcoders.com – having successfully mediated resource-deployment for growth-induced medical billing requirements across the broad spectrum of medical disciplines – offers to replicate it in orthopedics too. With an affiliation with chosen pool of orthopedic medical billing specialists across the 50 states in the U.S., orthopedics can expect to have instant access to specialist medical billing services.

Insurance Underpayments, the Issue That is Plaguing Orthopedic Billing the Most

Insurance underpayments continues to be a major concern for medical practices across the United States; more so for orthopedic surgeons, who, despite serving in a more critical specialty, find it hard to fully recover their medical cost. Because most of the orthopedic procedures happen to be highly expensive, even a marginal percentage of insurance underpayments might turn out to be a major drain on practitioners’ revenue, which could severely spoil clinical and operational efficiency. With orthopedic surgeons’ insurance underpayments touching an all-time high of 10 percent and potentiality to reach 20 percent, it may be time that orthopedic surgeons relooked at their medical billing practices and process, and aggressively track and resolve their underpayments. It is encouraging that significant portion of these underpayments (as high as 7 to 10 percent) can easily be made good with a refined and robust orthopedic-specific medical billing.

While most of the underpayments may be linked to refusal by the insurance carriers, the root-cause may be inherent in orthopedic surgeons’ medical billing policies and procedures: Orthopedic Billing

To begin with orthopedic surgeons may have not been enrolled and approved by insurers.

They may not have taken due diligence in verifying patients’ eligibility for services prior to the actual appointment; there could have been lack of technology integration with practice management system to verify coverage for patients’ orthopedic procedures.

Orthopedic surgeons may have not been cautious in seeing pre-authorization or precertification, in the absence which payers are automatically authorized to reject payments for  procedures and services even if they have been proved to be medically necessary.

Orthopedic surgeons’ staff may have left deductible or coinsurance uncollected from patients.

Major portion of patients may have been Medicare and Medicaid beneficiaries, whose reimbursements are lower than most of the popular commercial insurance plans.

There could have been coding errors (either under-coding or over-coding) due to coding staff’s incompetence. And with orthopedic coding likely to be more complex and vast post ICD-10, the scope for coding may be even more.

There could have been considerable in claim submission, so much so that insurance payers could reject them on grounds of being too late to be accepted.

Lack of denial management too may have been another reason; it takes special expertise to track and follow up denials in a system characterized by multiple payers

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It really takes an effective system to monitor and compare underpayments against contracted fee schedules, be it is Medicare, Medicaid or popular commercial health plans. The reasons for underpayments such as the ones highlighted can only be unearthed through a careful analysis of Revenue Cycle Management processes employed by orthopedic surgeons.

Medicalbillersandcoders.com – which has been a resource center for comprehensive medical billing solutions – can mediate the deployment of resources (orthopedic billing specialists) that offer remedial solutions to underpayment issue plaguing the orthopedic surgeons. Significant of advantage of sourcing resources through our platform is that you will get discover the real reason for a decrease in revenue; problems that should be addressed such as credentialing, insurance verification/precertification, collections, coding, and payer mix; and recognize the reasons for denials and comparing payments to the fee schedule to resolve issues with payers.

The Demands of Value-Based Reimbursement Model to Be Met With Medical Billing Specialists

With many of the healthcare reforms set to take effect shortly or having already been in force, providers may have entered a different phase of operational model, which is called value-based model. The unique feature of value-based model is that providers will get reimbursed for delivering superior medical care at a progressively lesser cost. As the public plans such as Medicare, Medicaid, and most of the commercial plans are likely to adopt value-based reimbursement models, it may be inevitable for providers to shift over or find a balance between fee-for-service model and value-based model in order to sustain profitable clinical practices.

To being with, you have Medicare's value-based payment modifier that will be launched for physicians in groups of 100 or more in 2015. The unique thing about this modified value-based payment model is that it works on the principle of ‘carrot and stick’ theory, meaning physicians may either be eligible for either positive or negative payment adjustment depending on their level of compliance with care quality and reporting. To prepare for the eventual 2015 model, it may even be necessary to demonstrate capability for PQRS reporting, beginning as early as 2013. Furthermore, the performance post 2015 will be significant as most of the value-based returns will start yielding from 2017 based on the PQRS reporting post 2015.

While Medicare and Medicaid reimbursements have already begun experimenting with ACO model as a superior form of reimbursing physicians for their services to public healthcare plan beneficiaries, commercial payers, sooner or later, too will be obliged to adopt modified versions of reimbursements. Therefore, providers will have to plan, be prepared and resourceful enough to realize their reimbursements from both public as well as commercial insurance payers.

As far as planning goes, it should all start with:

Thorough evaluation of payer market to find out what value-based payment opportunities await down the line. It may also be important to know the dynamics of payers’ reimbursement methodologies.

Assessment of your current documenting, coding, and billing practices against the requisite standards, dictated by the changing payment models.

Planning progress to the expected level through a phased manner.

Once you have the plan in place to progress to value-based payment model, providers may actually start implementation with:

Value addition to care delivery: It means minimizing the possibility of recurrence of medical conditions. When providers are able to minimize the recurrence, it would contribute to substantially savings in reimbursements that might happily shared by payers with responsible providers.

Better care coordination: Coordinated care, involving physicians and support staff will likely facilitate better clinical outcomes, which are often deemed fit for specials incentives along with regular reimbursements by payers.

Extending patient reach and engagement: When providers begin exploring opportunities to increase their and involvement, it is definitely going to improve care quality, which is the fulcrum for deciding the value-based reimbursements.

Forming new clinical alliances: The value that clinical alliances bring to clinical quality is really unquestionable and the providers’ success as value-based providers will largely depend on how best they network their clinical services with competent specialists.

As providers find themselves engrossed with value-based clinical activities, it may require a dedicated medical billing to look after the process of documenting, coding, and billing claims for value-based reimbursements.

Medicalbillersandcoders.com – with a nation affiliation with resources (medical billing specialists) that can own and execute medical billing functions on behalf of providers stuck in the process of migrating from fee-for-service model and value-based model – offers to mediate the deployment of competent, experienced and versatile medical billing specialists that could effectively look after the operational side of value-based reimbursement model while providers concentrate on the clinical aspect.

Orthopedic Billing Specialist to Take Care of CPT Code Changes Made to Orthopedic Surgery Billing in 2013

This year’s CPT Manual has spelt out extensive coding changes and revisions to orthopedic surgical codes.  In all, there are 500 code changes to the Category I codes, including 251 revisions, 151 new codes and 100 deletions. Moreover, there has been significant overhauling of nerve conduction studies, some revisions to the radiology section, and E/M changes. The extent of these coding changes and revisions, having already taken effect from January 1, 2013, has begun to impact orthopedic reimbursements in a big way. As a result, orthopedic practices may have inherited an ominous task of migrating to   a higher order in orthopedic surgical coding. Given the CPT Manual’s full list of revisions, deletions, and additions to have been effected for 2013, orthopedic practices would require to be conversant with the guidelines for the following coding sections:

Spine CPT Errata, whereinchange has been added to the spine bone grafts (20930–20938), instrumentation (22840–22844, 22848, 22845–22847), and intervertebral device (22851) CPT codes.

Bone marrow aspirate, wherein explanation has been added to bone graft codes (20930–20938) related to bone marrow aspiration. Henceforth, Category III code 0232T should be used when bone marrow aspiration is performed for platelet-rich stem cell.

Cervical Spinal Arthrodesis, which is now required to be coded as per the new guidelines issued to CPT codes 22554, 22585, 63075, and 63076

Cast application, which now includesguideline changes made to “Application and Strapping” section addressing the application of the first cast, its removal, coding by the individual who performs the initial service, and restorative management.

Hip arthroscopy, under whichCPT code 29916 (Arthroscopic labral repair of a torn labrum) is now considered inherent to CPT codes 29915, 29862, and 29863.

Chemodenervation, in which a new guideline change is introduced for CPT code 64614 used in  Chemodenervation of muscle(s); extremity and/or trunk muscle(s)

Intraoperative nerve monitoring is now included in the primary surgical service and is not separately reportable.

New CPT codes applicable to procedures for spine, shoulder arthroplasty, elbow arthroplasty, nerve conduction, extracorporeal shock wave: wound healing, etc.

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While these are some of the notable changes and guidelines to have been effected for orthopedic surgical coding since the beginning of 2013, orthopedic practices may need to follow these action steps to be fully compliant with the changes and revisions:

• Analyze the 2013 CPT Manual in its entirety to understand the guideline changes found throughout it. Specifically focus on the E&M changes and new codes that may have applicability to your practice.
  
  
• Revise charge capture tools, electronic health record (EHR) lists and short lists or favorites, if charge capture is performed within the EHR.
  
  
• Enroll with an accredited orthopedic surgical coding course.

Medicalbillersandcoders.com – which has always stood by the physician community during times of medical billing and coding crisis – has arranged for networking with the right resources (orthopedic coding specialists) to maneuver through this major surgical orthopedic coding changes and revisions. The competence and experience of our select pool of surgical Orthopedic Billing specialists should help you minimize the impact of this coding change and revision while ensuring appreciable increase in orthopedic reimbursements.

Negotiating Your Reimbursement Rates during this Phase of Payer Consolidation & Health Insurer Monopoly Power

Physicians’ choice of health plans and contracts seem to be getting fewer and fewer with each passing moment as U.S. health insurance sector, particularly the private sector, witnesses unprecedented payer consolidation, acquisitions, and mergers amongst private health insurance carriers. Besides contradicting the hope that such consolidation, acquisitions, and mergers would bring down the cost premiums for patients, it has virtually helped a few players to wield monopoly over the entire commercial health insurance landscape. The situation has grown so unchecked 70 percent of 385 metropolitan areas in the U.S. do not have competitive conditions, and as much as 40 percent of these areas have a single health insurer controlling the majority share of the commercial health insurance market. As a result, physicians have virtually lost the bargaining leverage that they would have enforced had there been a perfect competitive market for commercial plans.

Physicians only source of revenue is from reimbursements from services they offer to patients, who may be supported commercial health insurance plans or public programs, such as Medicaid and Medicare. With most of the commercial health insurance market moving toward monopoly, physicians, mostly those practicing in small groups, are finding it difficult to negotiate adequate reimbursements. As a result, those insurers with monopoly powers are dictating the payment rates, which are often below the acceptable scale. Such unilateral administration of payments could leave physicians struggling to meet their financial obligations, obligations, including payroll, and to invest in and sustain desirable quality of medical care to their patients.

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Even the thought of accepting public insurance plans may not prove to be all that profitable – most of the patients may not have the resources to pay for out-of-pocket expenses well above the rates borne public programs, such as Medicare and Medicaid, whose rates are deemed insufficient to cover for a decent quality of medical cost. Thus, small physicians are often left with no choice but to accept rates dictated by dominant commercial insurers.

While the physicians associations have voiced strong protest against health insurer consolidations, in particular, mergers between two health insurers which threaten to create a single insurer with absolute power, it may take a while to disintegrate the trend towards a competitive market that can bring back bargaining power to physicians and patients alike. Till such time, physicians may well have to be content with rates as fixed their commercial payer. Alternatively, they can entrust their Medical Billing processes to an external entity that can use its competence and experience to arrive at as profitable a rate as possible. 

Medicalbillersandcoders.com – which has been a preferred platform for comprehensive medical billing resources – can help physicians impacted with the trend of commercial insurance consolidation. Our nation-wide affiliation with chosen pool of medical billing experts helps us to deploy resources that enhance medical billing efficiency, reduce the possibility of delay, denials, and improve practice revenues. Their expertise and experience could easily be extended for negotiating as best a reimbursement rate as possible even at this juncture of commercial payer monopoly.

How best are medical practices prepared to address HIPAA breaches?

Contrary to the notion that government’s move to digitize healthcare information would enable healthcare providers, doctors, and insurance companies comply more aptly with HIPAA’s guidelines for patients’ privacy and security, there has been an upsurge in HIPAA breaches with providers being reported for breaches of some kind or the other. Electronic Health Record (EHR) systems, which are made mandatory for providers seeking to attain ‘Meaningful Use’ status, have shown propensity to be manipulated either internally or by unscrupulous external elements. Either way, providers have been held accountable and penalized for breach of HIPAA’s mandate for ensuring patients’ information safety and security. With the cost data breaches being unbearable and providers or doctors’ credibility at stake, it is inevitable that HIPAA breaches are responded instantly with remedial measures, such as:

• Replacing or removing the staff that may have committed the violation at a particular EHR access point. If the HIPAA breach is traced to an external attack, EHR access may need to be secured against all possible external threats such as hacks or thefts by manipulating EHR system passwords.
  
  
• Parallel recommendation to improve the HIPAA program; an intrinsic part of such improvement program would necessarily mean reframing EHR policy and staff training or reorientation in accordance with changing EHR environment.
  
  
• Apprising your EHR vendors of the need for better customizing the EHR systems so that you may possibly withstand any kind of threats to patients’ health data.
  
  
• Establishing protocols for tasks, timelines and communication among the team to ensure everything on your EHR system runs as smoothly as possible.
  
  
• Accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic protected health information (EPHI).Irrespective of the compliance requirements, it is important that scope of the assessment is clearly defined, and communicated across the staff entrusted with the responsibility of conducting healthcare data in accordance with ‘Meaningful Use’ criterion under HIPAA.
  
  
• Determining how personal health information (PHI) and electronic personal health information (EPHI) are received, stored, transmitted, accessed or disclosed.
  
  
• Documenting HHS, which will require the analysis in writing, including material gathered and the corrective actions took to remediate problems uncovered by the assessment. The significance of such reports is that they act reference as well as proof during audits or verification by authorities.
  
  
• Conducting periodic risk assessments to mitigate the possibility of a potential data breach.

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While providers or doctors may have some form mechanism to respond any case of healthcare data breach or violation, it may not always possible for everyone to have comprehensive set of measures, working to put their EHR systems compliant with HIPAA audits. Therefore, they may have to seek external help to keep eternal vigil on their data systems.

And, when it is the question of sourcing resources for such an array of data-related tasks, Medicalbillersandcoders.com offers to mediate for the deployment of best resources that have demonstrated expertise and experience in implementing secure and HIPAA compliant healthcare data management systems and processes.

What Do Stage 2 Meaningful Use Guidelines Have in Store for Radiologists?

Stage 2 meaningful use guidelines are finally out, and radiologists may heave a sigh of relief since most of the ambiguity that existed in Stage 1 about their eligibility and the ways to approach the qualification criterion seem to have been made amply clear by CMS and the Office of the National Coordinator (ONC). The American College of Radiology (ACR) needs word praise for its relentless effort in getting most of the necessary changes made to radiology guidelines before the Stage 2 meaningful compliance regime comes into force.  While it is not before 2014 that radiologists should complying with newly laid out guidelines, it may still require some crucial adjustments in processes and technology to be fully ready for compliance and qualification under State 2 of meaningful use criterion.

Even as the Stage 2 requirements offer clarity for how computerized physician order entry (CPOE) will impact radiology, providers would still be required to use CPOE to order more than 30 percent — instead of the 60 percent CMS originally proposed — of radiology procedures during an EHR reporting period in order to qualify for MU incentive payments. Therefore, the necessity of having an efficient and effective computerized physician order entry (CPOE) would still be there.

As regards the problem of complying with the MU requirements on account of rarity of face-to-face contact with patients, radiologists and other providers may get reprieve from noncompliance penalties, but still they would be required to be versatile with specialty codes use in the Provider Enrollment Chain and Ownership System (PECOS). And this proficiency in using the Provider Enrollment Chain and Ownership System (PECOS) would definitely require specialized training or they might have to appoint external coding specialists for the purpose.

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While Stage 2 rules do not require an EHR to store images, providers or radiologist would still be required to ensure that they an active link to the images. Despite the initially proposed linkage of 40% being brought down to 10% finally, it would still be quite a task to keep those 10% active as and when required for clinical study, interpretation, or sought by patients for various documentation needs.

Along with these inherent challenges, providers or radiologists may still have to sort out the issue with employing clinical decision support (CDS) as The Stage 2 rules to do not expand the definition of CPOE to include computerized decision support (CDS). Also, there may be issues with transporting images in the absence of clear cut rules even in Stage 2. While DICOM mode can be relied upon for secure encoding images,   IHE profiles, such as XDS-I and XDR-I would still have to be sent via secure email, which may sometimes be vulnerable to security and privacy threats. Therefore, it could require a dedicated monitoring to see that such files are not exposed to threats.

Amidst managing as critical a practice as radiology, complying with these set of Stage 2 guidelines for meaningful use might either be too demanding or detrimental to the very purpose of diagnostic or imaging excellence.  Medicalbillersandcoders.com – with an objective to ensure diagnostic or imaging excellence unaffected by Stage 2 demands – has offered to mediate the deployment of Radiology Billing specialists that have the requisite competence and experience to implement processes and technology on behalf of radiologists, seeking to comply with the Stage 2 guidelines, and qualify for incentives.

Medicare Fraud Claims, A New Challenge Even For Honest US Physicians – is Competent Billing and Coding A Way Out?

In 2010, Medicare improper payment amounted to $47.9 billion. Human and Health Services, in 2011, recovered $4.1 billion paid through reimbursements as a result of ‘fraudulent’ or ‘improper’ claims. You may be right if you think you won’t ever be among the fraudulent care practitioners who contributed to these figures because you are scrupulous.

But being scrupulous can’t prevent you from being suspected by federal authorities, thanks to the profusion of fraudulent cases – because bizarrely all some care providers have had to do to attract the scrutiny of federal authorities is over use a billing code, regardless of whether they did it for right or wrong reasons.

Why guard against Medicare fraud claims?

What federal authorities track is which codes are being used the most in terms of charges and unit volume at a national level. And then monitors the use of these codes by care practitioners. Currently E&M codes, for instance, have been found to be high in terms of charges and unit volume at a national level and are expected to be a potential target. It means merely using E&M codes can actually expose physician centers to scrutiny by Medicare authorities.

However, to negotiate this situation, you have to understand why it’s happening. And to understand this phenomenon, let us use E&M codes as an example to see how they actually can become subjects of potential abuse. (Remember, it could be any codes; E&M has just been used as an example here.) E&M services are ones provided by physicians and non-physician practitioners to assess patients and manage their care – and the code to get reimbursement is chosen based on the location where the service is performed, medical history, examination and medical decision making.

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As is evident, while some of the bases of choosing E&M codes are objective and straightforward, others are subjective in nature and dependent on availability of information (medical decision making, medical history etc) to the coder who is making the choice. This leaves a scope for human error (both deliberate and otherwise) and misjudgment.

The problems physician practices face today are in the subjective areas. Their in-house billers and coders mostly contend with ineffective in-house coordination between billing and coding and medical processes leading to inadequate medical information based on which coding judgments are made. Even if medical information is available, billers and coders are sometimes beset by lack of sound-enough familiarity with complex medical procedures where diagnoses may often overlap making it difficult to decipher where one ends and another starts leading to wrong assignment of codes and overbilling through coding of diagnoses not covered by Medicare.

With most physician centers the concern is not intended fraud but misinformation and inaccuracy in coding construed as fraud by Medicare or over coding a code under surveillance without documents and details to support it.

Guarding your practice...

You can guard yourself against eventualities stemming from this by tightening up your revenue management system so that there is adequate coordination between various processes ensuring a seamless flow of information and then conducting periodic internal audits by certified coders who will randomly pull up billing and coding documentation of recent patients to check their accuracy.

A clean in-house process or billing and coding handled by experienced billers and coders is the best way to avoid fraudulence and wrong data leading to financial penalties and resulting and attendant consequences.

MBC has helped several big and small care providers to spruce up their revenue management system through its Revenue Management Consulting services. We perform a thorough analysis of your revenue management cycle and lubricate various points of interaction it has with other areas of operation ensuring smooth flow of data. This involves identifying gaps in your process and addressing them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.  

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, who are experienced, certified and updated regularly, has helped medical practices improve their finances due to accurate electronic billing, intricate procedure coding, electronic filing of claims and a multi-layered application process - collectively resulting in reduced claim denials and enhanced core-business focus.

Protect Your Medical Practice in Uncertain Times with a Medical Billing Specialist

The healthcare reforms brought by the Obama administration have in many ways been an industry-churning affair. They have changed the number of patients the healthcare centers receive today, affected the administrative activities that revolve around a typical treatment episode, shifted the professional location of several medical practitioners (independent physicians aligning with hospitals) etc.

These changes have caused severe hurt to small healthcare centers and left the big ones financially ruffled, leaving organizations ill-equipped to meet their future goals leaving them far behind organizational aspirations.  

If we look at the changes triggered by reforms as separate facts without any connecting link between them, the situation will look irretrievable. But if we look a little closer to find out that link which unites them, what will spring to our attention is the fact that all of them have a revenue impact on a healthcare organization.

For example, a healthcare organization receiving more patients stems from the fact that the reforms have widened the healthcare security net to include more people than before. It is commendable but more patients may lead to more rejection of reimbursement claims if their insurance eligibility and extent of insurance coverage are not properly checked and proper codes not assigned while preparing their claims, not to mention the fact that more volume causes oversight of minor details.

The second example pertains to administrative responsibilities. While administrative responsibilities were always part of a treatment episode, they have become a concern today as the new changes brought by reforms need a greater collaboration among medical and nonmedical (billing and coding) sections of a healthcare organization to ensure a steady flow of medical information between them based on which decisions will be made. A point in case is the Medicare frauds coming to light in case of E&M coding where the choice of appropriate codes is done by the coder based on medical inputs he/she receives. 

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There is also a need to understand the medical information (about procedures and diagnoses) passed on to billers and coders accurately so that proper coding choices can be made preventing making under-claims and over-claims, especially the latter as it can lead to security by Medicare authorities, now overly sensitized by rising insurance frauds. Similarly, there are other operational challenges brought in by reforms.

Independent physicians aligning with hospital is not a very old phenomenon and one that had been sparked by healthcare reforms – because, to transfer cost benefit to the patient, reimbursement requires services to be bundled up, which has forced hospitals to align with independent physicians to offer varied medical services under one roof, begetting a new set of problems for in-house billing and coding and administrative teams to contend with.

And the impacts of these challenges accumulated over a period of time starts showing on the financial performance of a healthcare organization leading to a situation where yearly financial targets missed by small margins each year adds up to form a big lag after the lapse of a passage of time, sapping vigor and life out of the organization. 

Medicalbillersandcoders.com the largest billing and coding consortium in the US has helped both small and big healthcare centers to avoid this scenario by offering billing and coding service modules that are flexible and can be adjusted to fit the billing and coding needs of any healthcare organization regardless of size.

If you are a large medical outfit with an in-house team of billers and coders to handle claims, as part of our Revenue Management Consulting services, we can prune up your revenue management system by advising you about software applications suiting your purpose and environment, sprucing up your lengthy processes or replacing them with new ones if required and training people in new billing and coding techniques and methodologies.

However, if you neither have an in-house team of billers and coders nor any reason to have one, you can outsource your entire billing and coding process to us and nullify your claim rejection rates and boost your revenues.

The Significance of HIPAA Compliant Medical Billing Services for Gastroenterologists

Gastroenterologists trade patient-centric information for a variety of purposes, and Medical Billing is one of them. While physicians clinical notes on gastroenterology procedures are made use of by coding and billing staff, there may be possibility, intentionally or accidentally, that vital patient-centric information being exposed to security and privacy breach in the form of theft or hacking.  As we know that any compromise with patients’ data security and privacy could lead to monetary as well criminal penalties. Therefore, with gastroenterologists’ practice credibility and reimbursements at stake, it is inevitable that Gastroenterology Billing partners or service providers become HIPAA compliant.

Fundamentally, HIPAA compliant Gastroenterology Billing services are required to be  integrated with various advanced systems to protect all health information that can identify a patient including name, dates, zip code, e-mail ID, telephone or fax numbers, medical record information, health plan and social security information, license numbers, and photographs. Gastroenterologists who happen to source HIPAA compliant medical billing services would invariably be assured of:

• Requirement-specific application of medical billing software
  
  
• Web based medical billing software with EMR solutions
  
  
• High security measures
  
  
• VPN system
  
  
• Frequent reports
  
  
• Insurance authorization
  
  
• AR follow-up
  
  
• Higher confidentiality
  
  
• Anti-virus and firewall software on each computer
  
  
• 24/7 response management

While gastroenterologists’ medical billing staff may have been using HIPAA 4010 platform until now, they certainly need to migrate to HIPPA 5010 in view of ICD-10 coding replacing the erstwhile ICD-9 system. ICD-10 being more specific and alphanumeric, HIPAA 4010 software platforms would certainly not support ICD-10 compliant gastroenterology coding and billing. Therefore, HIPAA 5010 version would invariably have to be introduced, and aligned with advanced billing software such as Lytec, Medic, Misys, Medisoft, Inception, IDX, and NextGen. Such monumental system-change can only be achieved with highly efficient workforce that is conversant with electronic medical records (EMR) and electronic practice management (EPM) systems – believed to be crucial in providing a complete and quality medical billing service as per the requirements of gastroenterology clinics, hospitals, and practitioners.

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Even as gastroenterologists try to bring about these HIPAA compliant gastroenterology billing changes, the extent of system upgrading and staff orientation may be too much to take in. As a result, they would have to depend on outsourced HIPAA compliant gastroenterology billing services that:

• Ensure periodic backup of data and critical facilities accessibility
  
  
• Are fortified with secure workstations, storage facility and authorized access
  
  
• See Firewalls and antivirus software on all systems are updated frequently
  
  
• Ensure technical evaluations are performed on a routine basis
  
  
• Come with affordable pricing: with 30 to 40% cost savings
  
  
• Provide free billing analysis
  
  
• Employ password protected lockers

Medicalbillersandcoders.com – by virtue of having nation-wide affiliation with a chosen pool of gastroenterology billing professionals attuned to HIPAA compliant Gastroenterology medical billing practices – can help gastroenterologists reap the benefits of HIPAA compliant  medical coding, medical insurance collection, medical paper and insurance electronic billing, charge entry, cash posting and reconciliation, management of old accounts receivable collections, and insurance verification and authorization.

Demand for Gastroenterology Services to Impact Medical Billing in Clinics and Hospitals?

The consistent rise in demand for Gastroenterology services has really been a boon for clinics and hospitals. But the growth has been so overwhelming that it started affecting their reimbursements in a big way. While practitioners have generally been preoccupied with clinical duties, their medical billing staff have found the voluminous growth simply hard to cope with. As a result, there may been considerable delay in processing claims, leaving physicians’ bills to pile up as ‘account receivables’. The situation is likely to be even more demanding as a large percentage of population is going to be brought under Medicare and other insurance schemes. As per the reliable industry sources, Gastroenterology specialty alone will see 20 to 25 percent growth over the next five years or so.

Fortunately, Gastroenterology practices can replace or ease medical billing woes with outsourced Gastroenterology medical billing solutions. The quality of services offered is generally good across the US, but it is still advisable to gauge your prospective service providers’ credentials before taking them onboard. Amongst many parameters against which you may judge your prospective Gastroenterology Billing partners’ competence, following assume more significance than the rest:

History of your prospective Gastroenterology billing partners: It is always safe and prudent to engage with billing partners with considerable and demonstrated ability to handle medical claims with Medicare, Medicaid and commercial carriers.

Staff’s experience and credentials: It is the billing professionals’ experience and credentials that translate into tangible benefits for you. Thus, it is important to verify your prospective billing company’s staff’s experience and credentials such as being certified billers and coders from authorized institutes.

Timeliness and accuracy of service: Notwithstanding your Gastroenterology billing company’s credentials, it all the more important that they deliver on-time and accurate billing services.

Being compliant with Federal as well as state-specific Gastroenterology regulatory compliance: Outsourced billing service providers are bound by the regulatory compliance standards, either Federal or state-specific. As outsourced service providers, it is imperative that your prospective Gastroenterology billing partners comply with either of the two

Competitive cost: With other things being equal, you should insist on those partners whose prices are relatively less.

Inclusiveness of services: While you may be availing Gastroenterology billing solutions, yet your billing partners should be judged for their ability to offer inclusive set of services, such as the entire process of Gastroenterology Revenue Cycle Management (RCM).

The advantage of this fact-checking is that it you can be sure of the following benefits from your billing partners:

Timely Processing and Submission of Claims: Once you have chosen Gastroenterology billing company against the parameters listed above, it is more or less guaranteed that your claims will be processed and submitted in time either through paper or electronically. The timeliness and accuracy of submission will go a long way in fast realization of your Gastroenterology claims with Medicare or commercial carriers.

Follow up with payors: Follow up, being an integral component of your billing providers’ services, will help isolate partially paid or unpaid claims and entitle you to the amount due to you.

Report Generation: The utility of having an inclusive Gastroenterology billing service partner is that you can expect to be fed with reports that can be used to bring about clinical and operational improvement.

As you begin your search for inclusive Gastroenterology Billing service providers, you may find the selection a bit tricky. That is precisely why we, at Medicalbillersandcoders.com, are committed to mediate the deployment of Gastroenterology billing resources chosen from a talent-pool of Gastroenterology billers across the 50 states in the U.S.