Challenges Push Family Practitioners to Partner with Billing Specialists to Improve Revenue

Despite the delay in implementation of 26.5 percent cut in Medicare family practitioners payment, AAFP continues to call on Congress for a repeal of the sustainable growth rate (SGR) formula. This is understandable because the deferment means a temporal relief for family practitioners and if SGR is around, given that it assesses growth solely from a financial standpoint, payment cuts introduced without taking medical and human factors into account will continue to recur.

Though, this cut which is framing the political discourse around primary healthcare in the US is a recent phenomenon (the cut was scheduled for implementation on 1st January, 2013), if we go about a year back and take the case of Dr. Hammond, we will see financial problems have been ailing family physicians for some time now.

Dr. Hammond is an independent family physician with a clinic in Denver who ramped up his in-house IT operations and staff to make his practice and services more holistic, such that with his increased staff strength and upgraded IT his practice is able to cover the entire need of a modern-day healthcare operations starting from keeping in touch with patients to track their health and progress to maintaining electronic data. It’s the most ideal practice to have, isn’t it?

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Though, Dr. Hammond and many family practitioners across the US have upgraded their family physician practices to meet the modern needs of healthcare (like outreach and coordination), the fact remains that these enhancements are not reimbursed under traditional insurance contracts making profitability difficult. This together with new payment reforms which encourage healthcare providers to come together is making independent family practitioners a dying breed in the US. Whether this is good or bad for US healthcare is debatable, but a close look at Dr. Hammond’s operations would reveal that it includes lot of things that are not part of core physician practice (like IT data maintenance) and could be kept out to keep the operations thin, nimble and cost-effective.

And as family practitioners wake up to the prospect of frequent cuts in Medicare family physician payments, there problems seem to be getting enough and counting. However, to upgrade their operations, thwart the effects of Medicare cuts and also to gear up for the innovative payment model, many family practices have been joining Accountable Care Organizations (ACOs) or setting them up.

But transitioning to ACOs from their traditional mode of practice may not be easy as it involves negotiating pay schedules, negotiating payer contracts etc. Also, it requires monitoring and analyzing information, like eligibility for Medicare, medical outcomes, Medicaid and private insurance, and clinical compliance and reimbursement requirements to name a few. Family practitioners in addition to the Medicare cut challenges will have to ensure ICD-10, HIPAA 5010 compliant billing and coding along with EHR and PQRS.

Medicalbillerandcoders.com, the largest consortium of billers and coders across US, has also been helping various healthcare providers with billing and coding services for over a decade now. MBC’s Revenue Management Consulting services can help family practitioners by assessing their in-house revenue management cycle and ensure sound coordination between various components of healthcare, facilitating smooth flow of medical data for ACO operations and otherwise.

We also identify gaps in your process blocking areas of revenue leakage and identifying areas of staff training.  Additionally, we can help train your staff to  replace applications where required and handle new billing and coding challenges like EHR, PQRS, and ICD-10, and HIPAA 5010 compliance so that they can make error-free insurance claims.

Overcoming Cardiology Billing Concerns in 2013 with Complete Revenue Cycle Management

As a specialized healthcare field, Cardiology has cherished generous government support for testing services and unhindered reimbursements. However, with new developments in Patient Protection and Affordable Care Act (PPACA) and lower reimbursements given recent healthcare reforms, Cardiology billing is expected to face some serious issues in 2013. In addition, ICD -10 and HIPAA regulations are bound to complicate the financial scenario for Cardiologists. Some of the major concerns in Cardiology Billing are expected to be –

• New Regulations & healthcare reforms – PPACA, ACA, HIPAA and ICD – 10 are some of the most popular regulations and reforms that have shaken the healthcare industry. Cardiologists are facing disconcerting billing issues, patient data documentation issues and coverage related dilemmas

• Reduced Reimbursements – Due to ever-increasing complexity of claim procedures for insurance providers and reduction in reimbursements from Medicare and Medicaid by up-to 25%, financial performance of every Cardiology Practice is bound to take a hit

• Consolidation and ACA – With increasing consolidation of large hospitals and independent practitioners, surgeons and physicians are losing their autonomy. Many organizations and practices are participating in Accountable Care projects to reduce costs but are in turn exposing themselves to heightened risks as well

• Increased no. of patients – With 30 million more patients expected to be covered by the end of the year 2013 as per new government healthcare reforms, burden on care providers is expected to increase multifold

• Stress on Quality of care – Increasing shift towards quality of care is adding to the service expectations from Cardiologists. Coverage is denied and audit issues arise in case of re-admittance of patients that had cardiac procedures administered on them within a 30 day time period

Despite prospects of difficult times ahead, Cardiology Billing concerns can be effectively addressed with efficient Revenue Cycle Management (RCM). RCM is gaining popularity with healthcare service providers due to the unparalleled time and freedom it offers practitioners to focus on patients. Judiciously aligned RCM can enhance productivity of billing process and reduce financial concerns dramatically-

• Accurate RCM reduces the claim denial rate by arranging pre-authorizations and checking patient coverage with insurer at the time of registration itself
• RCM monitors claim filing and coding process for immaculate documentation and patient record maintenance, that supports efficient billing
• Effective RCM improves revenue capturing and collection of outstanding bills by applying effective denial management, capturing proper documents, handling claim entry and secondary billing
• RCM also analyzes and realigns the payer mix, ensuring improved payouts per revenue cycle by cutting down the risk of practice

Expecting a Cardiologist to handle all this while delivering quality care service is like hoping for a daily miracle. Medicalbillersandcoders.com is therefore nothing short of a miracle partner that can solve all your Cardiology Billing concerns. We improve access management, handle regular claim denials with impeccable turn-around time and expedite cash collections. With a team of experts dedicated to handle all aspects of Revenue Cycle Management, medicalbillersandcoders.com transforms your Cardiology Billing concerns into guaranteed financial success.