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.

How will the Affordable Care Act Impact Cardiology Practitioners and Their RCM?

Healthcare industry has been undergoing steady reforms over the past couple of years and the changes are expected to continue. The objective of this ongoing transformation is to achieve improved healthcare services with increased focus on quality care. In such a scenario, Affordable Care Act is being viewed as a promising way of improving healthcare and strengthening financial conditions of the industry. However in addition to expansion of coverage, increased accountability of insurance companies, lowering of healthcare costs and enhancement of quality care for Medicare patients; ACA is expected to increase revenue risk for physicians as well. As a shift from fee-for-service to revenue and cost sharing model of ACOs (Accountable Care Organizations), Cardiology practitioners will face a lot of challenges in realigning their revenue cycles.

Some of the major RCM parameters that ACA will affect practitioners are –

• Due to bundling efforts, cardiovascular coding will undergo additional changes
• Medicare fee schedules will change for physicians in addition to the continued threat of reimbursement cuts by 30% due to SGR
• Penalties for non participation in federal incentive programs like EHR, quality reporting system and e-prescribing
• Government and commercial insurers will pay for value based services (pay for performance reimbursement model) instead of continuing with the volume based or fee for service model
• Increased number of Medicare patients to be covered by Cardiology practitioner participating in ACO project, meaning more financial risk and heightened burden on RCM

With rising focus on quality care and expected collaboration between hospitals and independent medical practitioners under ACA, to cut down costs and enhance care coverage, Cardiologists will have to adapt their practices and RCM as per the imminent changes.

RCM or Revenue Cycle Management is the strength of any medical practice aiming to stay financially viable. RCM cannot afford to stagnate in its processes as the healthcare environment is changing on a continual basis. With industry changes, RCM of a Cardiology Practice must transform to better suit the needs of the practice. Given a high likelihood of ACO participation by most Cardiology Practices, some well planned changes in RCM can prepare a practice to absorb heightened risk and derive better revenue from ACO –

• Compliance to changing regulations and participation in federal programs designed to incentivize practice performance can save your practice a lot of future costs and penalties. Thus RCM of your Cardiology practice must comply with new regulations and keep your practice up to date
• Change in fee schedules and expected reduced reimbursements by Medicare would mean diminished revenues. Thus focus of your RCM must be to diversify the payers mix to absorb this inevitable decline in revenue
• Coding and billing changes due to bundling must be tracked and updated in your system to avoid any claim denial or audit complications
• RCM must strive to adopt value based reimbursement model for your practice and gradually shift away from fee for service payment model

As RCM and billing experts, delivering optimum medical billing and coding services across all 50 US States, medicalbillersandcoders.com can help add value to your revenue model and save you tremendous costs and expenses. Your Cardiology Practice can benefit from our billing and coding experts help and our accurate revenue cycle management can transform a high risk ACO project into a high return venture for you.

Cardiologists Handle New Regulations and Coding Changes in 2013 with Efficient Medical Billing

Cardiologists are likely to face an entirely new scenario with respect to regulations and coding in the upcoming future. With healthcare industry implementing constant reforms and the government as well as private insurers subscribing to increasingly efficient methods of medical billing and claim filing, cardiologists can’t afford to lag behind. In addition to providing quality care to patients, Cardiologists are expected to follow regulations norms and update their billing practices as per new coding guidelines. 
Some of the imminent changes in 2013, which can affect billing and collections, are –

• New updates in CPS and HCPCS Level II codes, Place-of-service coding errors
• Noncompliance with Assignment rules and Excessive billing of beneficiaries to be penalized
• Inappropriate payments in 2010 by Medicare to be appropriated in 2013
• Questionable billing in electro-diagnostic testing to be introduced
• Part B payments for Glycated Hemoglobin A1C tests to be updated
• Claims processing errors to be corrected with regards to the Medicare payments for Part B claims with G Modifiers
• Use of Modifiers during Global Surgery Period to be evaluated and managed

In addition to these regulatory changes, there will be reduction in reimbursements and payouts to Cardiologists for office testing and medical services. This would mean financial turmoil for many Cardiology practices that are not maintaining efficient billing practices. With reduced government support, Cardiologists will have to manage their revenue cycles more carefully in order to remain financially viable. Thus following billing practices could be adopted by Cardiologists for better productivity and efficiency –

• Updating your billing system with coding changes at a regular interval. CPS and HCPCS coding changes can be readily monitored by keeping in touch with medical publications and coding manuals
• Educating your staff regarding regulatory changes and the expected impact of the same on your billing and collection practices
• Checking with insurance provider for pre-authorization and medical coverage details at the registration stage itself, in order to avoid claim denial later on
• Managing claim filing process and revenue cycle as per the requirements of insurers and reimbursing bodies
• Monitoring outgoing information and incoming requests or notifications from insurers regarding claim settlement, disputes, document requirements and regulatory changes
• Install a denial management system in place to track the reasons and trends in denied claims
• Resubmit corrected claims or file appeal for denied claims with in a turnaround time of 48 hours or less. Ensure review of medical codes, document requirements and grounds of appeal before taking any action
• Streamlining revenue and accounts to absorb the penalties and costs incurred by audit actions
• Adhere to all regulations pertaining to laboratory tests and electro-diagnostic tests. With decreased reimbursements and specific guidelines for conducting tests, even a minute oversight can prove to be expensive for your practice

Medicalbillersandcoders.com has been serving varied specialists including Cardiologists across all 50 US States for over a decade now. Our billing and coding experts can help you in handling new regulations and coding changes by creating an efficient medical billing system for you. We provide meticulous attention to detail and dedicated adherence to regulation and codes for billing practices. Our group of experts handle every detail, allowing you and your cardiology practice to focus on qualitative patient care.

Physicians Realign Their Strategies to Meet the Challenges of Healthcare Reform

After reforms, the American healthcare industry is seeing a curious change: healthcare providers are adjusting their practice models to suit the needs of Affordable Care Act. A quick look at some of the factors that are provoking these changes will bring about how the changes have not left (or will not leave) any aspect of healthcare operations untouched.

The reforms will completely alter the mode of payment in which healthcare providers are paid by insurance authorities. The mode of payment will go from pay-per-service to per-visit or per service mode. Additionally, the provider will be paid in the form of bundled payments so that there is scope for promoting quality even as costs are driven down.

As far back you can see Medicare’s Physicians’ Quality Reporting System (PQRS) was around as a quality reporting standard which laid down quality parameters for physicians to report on. Albeit, now this reporting is going to become more rigorous: unlike until recently when physicians used to report only on data, now their reports would have to show that they meet each quality metric.

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Bundled payment is perhaps the biggest change driver of the reform. Because bundled payments require coordination among various care disciplines involved in providing care, the reform gives the physician’s role prominence over that of the hospital.

As a result of this, surveys have revealed, 70% of hospitals are expanding the number of physicians on their staff to position themselves such that they can handle any initiatives resulting from the reform law. Additionally, bundled payment is also making care providers to either join or set up their own Accountable Care Organizations (ACOs).

Whether it is the mode of payment, the reporting methods, expansion of physician employment in hospitals, the singular area that the changes seem to gravitate towards is insurance reimbursement – how claims are made, medical data gathered to make them, codes (CDT) used, insurance claims paid, etc. And this is not a surprise as the reforms are focused towards bringing down the cost of care; promoting the number of people insured, and improving quality of care.

So equally unsurprising is the fact that the last few months have seen an increase in the number of care providers approaching professional billers and coders to help them sort out their post-reform concerns. However, you would require billing and coding organizations that can combine traditional knowledge with keen awareness of the current changes and how they affect the billing and coding processes and practices.

Following reforms, MBC has helped several healthcare providers to be equipped to face the challenges of reforms either by strengthening their internal operations or by handling their complete billing and coding responsibilities.

MBC’s Revenue Management Consulting services helps providers by assessing their in-house revenue management cycle and ensuring that there is 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 and address them if necessary.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, are constantly updating themselves with current healthcare industry trends. In addition serving all 50 US states across varied specialties for more than a decade, MBC experts have the required expertise and experience in Medical Billing and Coding to help clients handle the upcoming reform challenges effectively.

Providers Acquiring Medical Billing Services To Handle the ACA Impact on Revenue

The Affordable Care Act has left the healthcare providers in the US worried. A survey conducted sometime back reported that 55% of hospitals expect a dip in their revenue while only 28% think that there would be an increase in revenue. But the survey also revealed that a considerable number of those who are informed about the impact of the healthcare reform (about 58 %) plan to become accountable care organization to reap financial benefit of the reform and improve the quality of care.

The 58 percent that revealed their plan to become ACO organization are well informed about the finer points of The Affordable Care Act as the law aims to set up a national pilot program to encourage care providers of various stripes (doctors, physicians etc) to coordinate and work together to improve quality of care so that they can be reimbursed through a flat fee (bundled payment) for a singular episode of care which the law supposes will lower expense and promote quality of care.

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However, the concerns of the 55% hospitals that expect a dip in revenue can’t be dismissed either. The insurance authorities propose to pay a flat payment to healthcare providers of different stripes who have come together and formed an ACO. The problem with this model is that it requires sound coordination among the various providers involved in a treatment episode to ensure a centralized collation of medical data which would be used to prepare claims and appropriate codes assigned to them.

Another concern that has worried healthcare providers is that this reform has a punitive nature to it. Millions of tax paying Americans eligible for government-subsidized healthcare coverage but without government-mandated health insurance coverage will be penalized with higher taxes unless they get an insurance policy within a year.

This is indeed good because it will induce more and more Americans to get health insurance bringing them into the net of national healthcare security. Albeit, the problem is this will require healthcare providers to assess insurance eligibility accurately, handle instances of unrealized partial payments where the patient’s bill exceeded his/her coverage, and of course a phenomenal increase in non-medical activities for healthcare providers to handle. Additionally, under ACA insurance providers will provide more coverage for preventive services and these services would have to be coded using separate CPT codes with enrollee-costs waived.

These concerns have sparked a trend where healthcare organizations that were handling their billing and coding responsibilities themselves until now are hiring the services of professional billers and coders. However, it’s important to remember that to handle the above challenges brought by ACA, a billing and coding organization needs to be familiar with the current procedures; be able to handle medical details coming from varied medical practices for preparing claims for bundled payments; be able to negotiate the additional red-tapism in submitting claims; and ensure timely payment of claims through post submission follow-ups.

MBC’s revenue management consulting has been helping physicians by performing a thorough analysis of the Revenue Management Cycle and ensuring that there is sound coordination between various components of healthcare leading to smooth flow of medical data. Our RCM services also involve identifying gaps in the process and addressing them by advising physicians while 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, has also been helping several small to medium size healthcare providers with its Outsourcing services. MBC handles the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups, along with regularly updating themselves about the changing healthcare industry trends.

Aligning your medical billing goals with your Practice’s Goals!

A truly successful medical practice in today’s evolving healthcare industry is one that has its goals aligned with its medical billing goals. To a physician, however, it may seem like yet another time consuming task, but well determined objectives of a medical practice, if successfully translated into billing and coding practices can result in enhanced efficiency and greater profitability.

Many practices outsource their medical billing functions to third party experts, who work on pay-for-performance principle. This in-turn ensures that the billing experts work in sync with the revenue goals of the practice, for they get paid only when you get paid. Another way to go about medical billing is enhancing the in-house function; along with implementing performance based compensation to in-house staff may help do justice to your revenue goals.

Goal alignment has become the need of the hour for maintaining the competitiveness of your practice. The following steps can assist you in effective definition of practice goals and alignment of the same with medical billing goals –

• Identify your primary goals – Medical practice is built around the primary goals of patient care and service, which can resultantly improve revenues. Although profits and revenue are not primary goals, they are essential elements of every practice. Thus, it is crucial to write down goals in clear statements such as – “our goal is to maximize revenue while delivering unmatched healthcare and medical service to each and every patient” or “Assist patients in accessing healthcare service at reasonable costs and without wastage of time.”
  
  
• Communicate these goals to the medical billing staff – Once your goals are defined, make sure to discuss the same with your billing staff. Many physicians deign to indulge in the financial aspect of their practice and thereby lose out on a big chunk of their revenues. Medical billing goals are primarily focused on payment collection, correct coding, claim filing and reimbursements. Each activity takes new meaning if only practice goals are communicated well to the billing experts, whether external or internal.
  
  
• Monitor the gap in understanding and training – Keeping a track of staff activities and billing reports can effectively prove if medical billing goals and practice goals are aligned or if there is some gap in staff or consultant understanding. Regular interactions and consultations will lead to clearer goals and efficient achievement of the same.

• Update goals as per the changing industry scenario – HIPAA and HITECH guidelines, in addition to EHR regulations and RAC procedures have necessitated extreme caution and care to be applied while handling with patient data. Medical billing and coding goals are required to be more data and revenue centric rather than service oriented. However, a balance can always be established between conflicting goals.

Medicalbillersandcoders.com can help you define your practice goals and align them with medical billing goals. We can facilitate you in achievement of your financial and service objectives on a continual basis by understanding your practice objectives and applying them to your billing practices.

Our billing experts have been serving healthcare specialists in varied domains across all 50 US States for more than a decade now. We help physicians concentrate on patient care as we handle their entire revenue cycle process in line with their medical billing goal; along with assisting them in aligning their practice goals with the help of our experts’ in-dept healthcare industry knowledge.

Protecting Your Practice Against RAC Audits With the Help of Efficient Medical Billing Practices

Efficient medical billing practices can make or break your medical practice and if anything can verify this statement, it is an RAC audit. RAC audits of Recovery Audit Contractor audits are nothing short of a nightmare for any healthcare provider.

Medicare and Medicaid are two healthcare carriers that provide coverage and reimburse physicians and hospitals for the services they provide to patients covered under these carriers. However, medical practitioners are known to receive over-ayments due to incorrect claims or erroneous coding at the time of medical billing. In essence, government tries to ensure patients’ best interest and control the rate of fraud, error or wastage by putting RAC audits in place. But the resultant inconvenience caused to a medical practice in the event of an RAC audit is nothing short of disastrous.

Not only is error-free coding and meticulous book keeping of paramount importance, subsequent adjustment of office accounts can play an important role in case an RAC audit actually happens. To protect your practice against RAC audits, you must put efficient medical billing practices in place –

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• Follow correct coding for services –If a medical service is incorrectly coded for the sake of avoiding internal confusion or due to oversight and the incorrectly coded service is reimbursed by Medicare or Medicaid; then your practice can be in for an RAC audit. Transparent and efficient medical billing practices help you monitor coding of services on a regular basis and avoid simple yet latent disasters, hence with a little more attention, you can save your practice a lot of money and hassle.
  
• File claims for correct payment amounts – Scrutinizing the final claim statement filed with healthcare carriers is of paramount importance. If the government settled an incorrect payment amount to your practice, as long as five years ago (as per recent healthcare reforms, the RAC audit period for overpayment has been extended from three years to five years) then your current financials can suffer drastically. Diligent book-keeping is a medical billing practice that can help you avoid this scenario altogether.
  
• Avoid duplicate services – It may not be fraud at all, but mention of duplicate services is rarely ever seen as an honest human error by an auditor. A prudent medical billing practice is installing audit software or enlisting the service of a compliance auditor, to fix your errors before an actual audit.
  
• Don’t claim for non covered services – Services that are not necessary and reasonable under section 1862(a) (1) (A) of the social security act are not meant to be reimbursed by Medicare or Medicaid. Avoiding inclusion of the same in your claim amount can save you from a potential audit.

Medicalbillersandcoders.com an expert in medical billing and coding serving the healthcare industry for more than decade now can help protect your practice from potential RAC audits by offering immaculate medical billing consultancy and services.

RAC auditors conduct audits on providers in response to insider information or complaints, upon diagnosing irregularities in billing and coding practices as per the CERT or other CMS analysis. With comprehensive and efficient medical billing practices in place with the help of our experienced medical billers and coders, our client’s practices are well equipped with all the required defenses in place to protect themselves against an RAC audit.

Streamlined Medical Billing and Coding Helps Increase Physicians Revenue

Are denials, ignored or lost claims, inaccurate coding and underpayments making it difficult for you to collect the revenue you have earned? Physicians have a busy schedule and with the doctor patient ratio getting disproportionate across the US, handling the task of medical billing and coding has turned into a daunting task.

• Complexities of coding can take a toll on your revenue
  A huge problem can occur in case of coding errors. If your staffs happen to give the wrong code, claims will either be paid incorrectly to the wrong provider or not paid at all. Coding is getting complex with revisions in CPT and HCPCS Level II code annually and with the growing number of patients, just an in-house medical coding facility won’t make your task easy.
  
  
• Wrong information
  Filing insurance claims is already a daunting task and in case of wrong information not only will the claim will be denied but you might end up losing or ignoring the claims and not procure significant part of your revenue.

Moreover if you delay claim submission or fail to follow up, you can lose revenue. Can you afford to lose payments every time such an issue occurs?

How to make revenue procurement easier?

Accurate medical billing and claim processing is the only key to obtaining and maximizing revenue for your practice. There is no need to end up underpaid or leave your revenue uncollected just because it is a tedious task.

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• Updating documents as per the coding revisions-
  you will have to ensure that your clinical documents are updated according to the coding changes or revisions so that no error occurs. CPT coding guidelines will have to be applied to cut down the risk of denials
  
  
• Resubmissions of denied claims-
  don’t let denied or lost claims leak your revenue. You will have to make sure that claims are resubmitted accurately
  
  
• Follow ups with insurance companies-
  getting payment from insurance companies is a time-consuming process. You will have to keep following up with them regarding the procedure and resubmitting or making changes till the correct details are not provided to them
  
  
• Proper training to the medical billing and coding staff:
  if you want to rely on your in-house billing system, it is necessary to keep your staff trained and updated about the changes in the health care industry on a time to time basis

Is it too much to handle?

If the process to procure your payment is too much to handle while you struggle with lack of time and staff to attend your patients, why not outsource medical billing and coding services?

Medicalbillersandcoder.com has expert billers and coder who will not only improve your revenue collection but simplify each billing process to ensure smooth functioning of your practice. MBC deals with medical claim filing for physicians from more than 50 US states, relieving them from the headache of managing their funds and revenue cycle every month.

It Is Worth Paying for Medical Billing Services Than Be Affected with Suspended Reimbursements

Affordable Care Act, along with a few other pro-beneficiary health care policies, may have helped rationalize cost of health care as well as cost of health care insurance across the broad spectrum – Medicare, Medicaid, and a variety of private insurance plans offered across the U.S. Beneficiaries could even benefit from lesser co-payment obligations and deductibles. However, it may not be said with any certainty that their woes with delay and denial would come to end. If the recent reactions are any indicators, medical practitioners may well see denials and A/R days going up more than they used to be earlier – there have already been instances wherein physicians’ reimbursements have been held up for as long as 60 days and even more. Just, imagine the kind of negative impact it could have had on their clinical and operational efficiency!

With health insurance premiums reaching lowest levels, payors have resorted to various contingency strategies – abandoning their services altogether, restructuring their portfolios, and of course withholding reimbursements till they are pursued aggressively by the medical practitioners concerned. While payors are within their right to safeguard their financial and business interests, medical practitioners could do better with Medical Billing Practices that are better tuned to expedite A/Rs before they become impossible to be follow-up and may even have to be written off as bad debts.

When it is obvious that such A/R delays will become more common in the coming days, medical practitioners would be left with no alternative but to spruce up their A/R management beyond the routine Medical Coding and Billing exercises. As soon as your bills cross the permissible time, your A/R management team should take over the process of finding out the reason for delay, following up with possible remedial measures, and expediting the process of realization. Operating under multi-payer reimbursement environment, you may have entered into contracts with Medicare, Medicaid, and a host of private health insurance agencies. Therefore, you A/R management team need necessarily have to be versatile enough to deal with multiple payors.

While your A/R Management team is doing what it is entrusted with, coding and billing efforts need to be equally supportive with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards. Although every medical practitioner aspires to be equipped with as comprehensive a medical billing as possible, he may be limited by time and financial factors. Hence, you may be required outsource your entire process of medical billing from patient enrollment, scheduling insurance verification, insurance authorizations, scheduling and re-scheduling, coding, billing and reconciling of accounts, collections, AR collections, to denial management & appeals. One big advantage from outsourcing is that billing companies can be expected to deliver services at a price that is within your budgetary constraints. Moreover, they are invariably versatile enough to deal with complex medical billing issues. 

As you begin to preempt the possibility of undue delay of A/Rs with external billing mediation, Medicalbillersandcoders.com may just be the platform for complete, flexible, affordable, and more importantly tailor-made to the critical situation when your claims are likely to run the risk of being held up far in excess of admissible period of time.  Our credibility is essentially built around chosen billing affiliates (across the 50 states in the U.S.), who are versatile enough to monitor, follow-up, and expedite claim realization when you seem be giving up on your aging or withheld Account Receivables.

How Crucial are Cardiology Billing Specialists during Reporting and Following-Up Cardiology Medical Bills?

In the last few years, cardiology has had to manage with negligible fee increase while having to cope up with numerous coding and billing changes. While cardiologists may have seen an increase of 1 to 2 percent increase in Medicare’s fees, they have had put up with reduction in medical reimbursements beyond permissible limits. To a large extent, these practice-related medical reimbursements reductions could have been triggered by a series of relentless medical billing and coding changes that have seemingly been more challenging than ever before.

It all began around 2009 when codes for implanted devices were replaced with an entire set of new codes. Notable among such revolutionary codes were the ones that would be applied specifically to internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for per procedural checks. While this coding overhaul may have helped streamline Cardiology Billing, cardiologists’ medical billing has not been fully able to decipher them to their best advantage.

Quite parallel to these intermittent cardiology coding revisions, 30 and 90 day global periods too have been active for follow-up for certain devices. What is more, the new codes are specific to either an interrogation evaluation or a reprogramming evaluation without being inquisitive of the happening of reprogramming. It is quite possible that cardiology practices may have found cardiology coding and billing rather difficult.

Interestingly, wearable cardiac telemetry devices too have been assigned specific codes, and it is impossible to assign unlisted codes that previously could be applied with slight modification. Moreover, these wearable cardiac telemetry devices are equally susceptible to complication of global periods as in the case of certain other cardiac devices. Yet again, cardiologists’ medical billing and coding may have found this coding-specificity an unusual thing.

Not least of them all, bundling multiple procedures under a single has limited cardiologists’ ability to breakdown a larger service into smaller components. As a result, insurance payors can now insist on bundling an echo with both a Doppler and color flow and a stress flow into a single and comprehensive CPT code. While this may have reduced multiple coding and billing, it certainly has limited cardiologists’ ability to maximize revenues from breaking down larger services into smaller components.

While Cardiology Medical Billing has already been affected by these monumental changes, cardiologists may still face harder challenges during reporting and insurance follow-up under the ensuing ICD-10 billing and coding regime. With the possibility of coding specificity, bundling, and billing and coding restrictions getting magnified even more, cardiologists may well have look beyond conservative cardiology medical billing practices. Hence, cardiology medical coding and billing, integrated with enhanced coding compliance, electronic processes, and competent billing practices could help measure up to challenges in insurance reporting and follow-up.

Medicalbillersandcoders.com has verifiable success as a leading and progressive medical billing consortium, more so for cardiology billing. Our cardiology medical billing mediation has been backed with deployment of experienced, techno-savvy, and competent medical billing specialists. As a result cardiologists across the 50 states in the U.S. can look forward to engaging medical specialists who have evolved with cardiology medical billing challenges.

Are Orthopedics Justified in Embracing HIPAA Compliant Orthopedic Billing to Boost Their Reimbursement

Reimbursements have generally been tight recently for orthopedics – Medicare cuts, shrinking fee schedules, increased technology intervention in medical billing, and a multi-payer environment that is more vigilant than ever have really made it tough for orthopedics to realize their reimbursements to the maximum. But amidst these monumental challenges, HIPAA compliant clinical and operational management may still offer avenues to keep reimbursements level above average. Thus, orthopedics across the U.S. are beginning to embrace technology-driven HIPAA compliant Orthopedic Billing to offset the impact of a series of restrictive impositions on medical billing.

The significant about HIPAA compliance is that it can not only endorse orthopedics as being responsive to patient privacy and security but also entitle them to incentives for showing up as responsible partners in effective and efficient health care delivery. Moreover, payors perceive HIPAA compliance to be yardstick for measuring orthopedics’ integrity for medical billing. Therefore, HIPAA compliant Orthopedic Medical Billing may just be the factor that can create a sense of trust among your payors. But HIPAA compliance needs to planned and executed in a way that best suits individual practitioners or hospitals; HIPAA compliance cannot be generalized even though you happen to be in the same discipline as orthopedics. The factors that will need to be taken care of while migrating to HIPAA compliant orthopedic medical billing are:

• Ensuring Protected Health Information (PHI) : HIPAA compliance requires you to protect health information, which may include anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written).
  
  
• Adhering to Principles of HIPAA : While HIPAA may allow smooth flow of PHI for healthcare operations subject to patient’s consent, it is deemed violation of HIPAA compliance if you disseminate PHI for purposes other than treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures
  
  
• Following HIPAA Implementation Process : HIPAA implementation need necessarily include both pre-emptive and retroactive controls and have process, technology, and personnel aspects.
  
• Sourcing right Technology for HIPAA Compliance : HIPAA compliance needs to be served with the right technology that can assure physical data center security, network security, and data security
  
  
• Being enabled role based access control (RBAC) : Because health care data under HIPAA compliance may accessed by multiple stakeholders across the clinical delivery system, it is important that data is made available based on Role Based Access Control (RBAC) to control the extent of data that may be shared with each of such stakeholders.

Because of interplay of these multiple factors in HIPAA compliant orthopedic clinical and medical billing operations, providers may have look beyond internal competence and outsource technology enabled HIPAA-compliant clinical and medical billing implementation. Medicalbillersandcoders.com offers to ease complexities during as critical an implementation as HIPAA compliant orthopedic medical billing. Our affiliation with experienced, competent, and credible orthopedic medical billing resources should provide the right choice of expertise to have your medical billing infused with HIPAA compliance standards.

Relevance of Outsourced Medical Billing as Hospitals’ Rely More on Technology to Elevate Patient Satisfaction

Patient satisfaction has always been the yardstick for operational success, and hospitals have tried out novel ways to keep patient experience enriched. While physicians’ skills have primarily been pivotal, technology too has helped considerably. And, technology has begun to be so significant that hospitals seem to have accepted them to indispensable in enhancing overall patient satisfaction, comply with evolving industry regulations, and being competitively ahead. As growing number of hospitals across the U.S. are beginning to embrace technology to elevate patient satisfaction, they are realizing the need to integrate clinical activities with medical billing activities to arrive at mutually beneficial equation – patient satisfaction that promotes practice revenues. Therefore, they may have to leverage with outsourced hospital medical billing that are integrated with clinical and operational features.

When confronted with the question of finding technology that is clinically and operationally dependable, integrated Electronic Health Record (EHR) systems come to be recognized as the most reliable technology platforms. EHR systems integrated with Practice Management Systems (PMS), Clinical Decision Support Systems, and Patient Communication Network Systems can create both clinical and practice efficiencies, and promote opportunities for enhanced patient access to data and patient engagement. The combined impact of these features may significantly improve patient satisfaction as:

• Patients perceive them to be part of improved care system: Experience has shown that patients value doctors who are progressively tech-savvy. It is interesting to note that around 75 percent of U.S. population associate technology-inclusion with better care.
  
• It would enable convenient access to scheduling and communication through patient portals; patients would appreciate the ease and convenience of online tools that allow them to schedule appointments, request for appointments, ask questions, and more.
  
• There would be swift prescriptions with eRx; patients will benefit from the efficiencies created by e-prescribing capabilities within the EHR. With e-prescribing, a prescription is sent to the pharmacy as soon as the provider prescribes it, which means patients can avail their medications faster. E-prescribing also eliminates the need for patients carry and present paper prescription.
  
• EHR solutions offer the capability to automate email appointment reminders, which will help patients remember their appointments and show up on time.
  
  There would be enhanced clinical efficiency; clinical decision support tools and clinical protocol compliance tracking tools within EHR systems can help providers enhance the care they deliver to patients.
  
• Last, but most significant, robust EHR system can make medical billing and coding accurate and compliant with coding and billing conventions, thereby enabling hospitals show up as Meaningful Compliant with HIPAA practices and maximize reimbursements from Medicare, Medicaid, and commercial health insurance payors.

For a considerable segment of hospitals that are yet to migrate to full-pledged technology-defined clinical care delivery, it might seem a daunting task. Thus, they may have been drive to outsource medical billing services integrated with EHR platforms. Medicalbillersandcoders.com offers them the right window for sourcing resources (medical billers and coders) that are skillful, tech-savvy, and versatile enough to balance hospitals’ primary concern of patient satisfaction and operational success.

Improved and Advanced Billing Processes Help in Increasing Physicians’ Revenue

Medical practices and hospitals are required to deal with the challenging task of getting their due payments. The rules and procedures governing the payments have become increasingly complex and confusing, resulting in greater denials, lost claims or underpayments. Manual processes human errors and claims submission can be time consuming and slow down the claim process. Sophisticated electronic Medical Billing and Coding processes and advanced practice management software solutions can help improve the billing process and contribute towards increased physician revenue.

How do advanced billing processes help in improving revenue?

• Accuracy: Research conducted in Medicare as well as Medicaid centers suggests that hospitals routinely experience revenue leakage due to lost or denied claims. Of the 30 percent lost or denied claims, approximately 60 percent are never resubmitted. Practices and hospitals also fail to collect approximately 18 percent of the claims. It is therefore extremely critical for hospitals to ensure accurate submission of claims in the first instance. Sophisticated billing processes and technological tools can help in identifying inherent reasons for denials. Specialized software can identify claims that may be denied and robust procedural rules can ensure scrubbing of the claims.
  
  
• Faster collections and greater control: Sophisticated billing software is constantly updated and can also track denial trends to identify issues and improve the collection rates. Patient billing and Revenue Cycle Management Software can also easily manage complex payer contracts so as to ensure accurate collections. The different software tools can also help in tracking of patient co pays as well as deductibles.
  
  
• Improved collection with specific focus on accounts receivable management: The streamlined processes and advanced technological tools can ensure that practices achieve accuracy in billing and coding along with improved first time resolution rate. With faster and improved collections practices can concentrate on improving cash flow through aggressive follow-up on accounts receivables.

• Improved practice management: Advanced software solutions also allow practices and hospitals to take benefit of customized reporting feature. This can allow practices and hospitals to get reports of specific data, carefully track payments and increase overall efficiency within the organization. Practices can also forecast the future collections and analyze existing and future practice performance. Advanced data mining and reporting features can support critical decision making and help the management in exercising greater control over the practice or hospital performance.
  
  
• Improved patient satisfaction: Advanced billing processes ensure that all critical information is accurately handled and complete clarity is maintained regarding the billing practices of the hospital. In such a scenario the practices and hospitals can concentrate on providing the best possible medical care to the patients and patients are guaranteed of transparency and clarity.

Medicalbillersandcoders.com (MBC) is a recognized organization with a network of highly experienced coders and billers that have consistently exceeded industry benchmarks with their sophisticated solutions. Through a unique combination of highly trained professionals, systematized processes as well as proven software solutions, MBC helps physicians, practices and hospitals to improve their revenue and enjoy enhanced cash flows.

The Prominence of Health Records in Clinical and Medical Billing Efficiency

Health practitioners often find themselves dealing with a variety of records – from records pertaining to practice license and credentialing documents to financial and compliance records. But none of them are as significant as ‘health care records’ (often known as ‘patient records’) simply because of its clinical and Medical Billing value. While health care records may have practical applications in clinical management, research, and Federal health care policies, its holds special prominence in medical billing. Thus, the quality of health care records invariably decides the level or quantum of reimbursements for physicians.

Over the years, much like the continual advancements in clinical research and health care delivery system, documenting, storing, and sharing health care records too has undergone considerable change from paper-based to computer-aided, web-based, and networked mode.  While the improvement may have helped streamline medical billing, it has also made health records vulnerable to risks of being hacked or leaked to unscrupulous intentions. Coupled with these inherent risks, there is also the feeling that health care organizations have not been keen on investing in resources to protect patient data – the percent of healthcare organizations still to explore data-security options is still as high as 40%. This tendency may be limiting their Medical Bill Reimbursements apart from exposing them penalties for breach of patient privacy, which 94 percent of physicians have had to pay for breaching the privacy and security norm at least once in the last two years.

 

When health records are detected to have compromised with patients’ secrecy and privacy, it could start impacting negatively on their credibility as well as their good medical billing terms with payors. Therefore, it is important that physicians have a policy to:

• Streamline documenting, storing, and sharing healthcare data
• Save it from being exposed to malicious and criminal intentions
• Protect from being targeted by criminal social engineers
• Allocate enough resources, IT, expertise to data security

Fortunately, you have Electronic Health Record (EHR) systems that seem to have panacea for all medical records-related ills, and contribute to enhanced medical bill reimbursements. The right EHR solutions can create both clinical and practice efficiencies, and can make health care records private and safe to be accessed and shared for multiple purposes that are potentially laden with benefits such as:

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Quick access to patient records from inpatient and remote locations for more coordinated, efficient care

Enhanced decision support, clinical alerts, reminders, and medical information

Performance-improving tools, real-time quality reporting

Legible, complete documentation that facilitates accurate coding and billing

Interfaces with labs, registries, other EHRs and HIEs

Safer, more reliable prescribing

Reduced need to fill out the same forms at each office visit

Reliable point-of-care information and reminders notifying providers of important health interventions

Convenience of e-prescriptions electronically sent to the pharmacy

Patient portals for online interaction with providers

Electronic referrals allow for easier access to follow-up care with specialists

Increased accuracy in coding

Improved care delivery from clinical decision support capabilities

Increased patient flow, staff productivity and increased revenue

Irrespective of where you stand in terms of having your health records streamlined to the requisite level, it always advisable to have your EHR systems reviewed and upgraded to serve patient privacy, security, and medical billing purposes. Medicalbillersandcoders.com offers the right platform for sourcing and engaging resources (medical billers and coders) that are versatile enough to advise, implement, and monitor health records in the way that best supports your patients’ privacy, security, and medical billing efficiency.

What Prompts Providers to Hire Specialists in Transition to ICD-10?

When The Department of Health and Human Services' drew out a time table for ICD-10 transition, all the stakeholders including the providers felt the time-frame was sufficient to migrate comprehensively to ICD-10 compliant clinical and operational practices. But that has not been the case – in view of woefully slow pace of transition across the health care, The Department of Health and Human Services' has acceded to the demand for extending original deadline from Oct. 1, 2013 to Oct. 1, 2014. And, with no possibility of further extension, majority of providers are not risking going all by themselves. Instead, they are seeking out specialists for the purpose – nearly two-thirds (65 percent) of them are understood to have employed third-party specialist to look after the entire process of transition to new coding system.

The providers’ decision may have been prompted by inherent challenges in transforming to as gigantic and as complex a transition as ICD-10.  The ICD-10 code structure is distinctly unique and more elaborative than its predecessor, ICD-9. Because the previous coding system was inadequate to cover the evolving diagnosis and disease management procedures, ICD-10 was conceived with as many as 69,000 diagnosis codes and 72,000 procedural codes. While such extensive coding may eventually eradicate ambiguity, the accuracy of coding demands proficiency in anatomy, pathophysiology, Medical Terminology, and ICD-10 coding conventions. Because of such complex, time consuming, and costly upgrading, providers may not ventured on their own. Amongst many crucial areas where ICD-10 specialists may be required to intervene are:

Cross over ICD-10 compliant IT platforms, which requires choosing and engaging IT vendors that are credible and competent in implementing customized IT architecture.

Anticipate and prepare providers for possible productivity loss when crossing over form ICD-9 to ICD-10. As the entire health information management/coding, case management, claims processing and follow-up, research, and decision support gets revamped, there may be likelihood of increased number of claims denials.

Chalk out a detailed training program for staff the concerned with clinical documentation and coding, which would comprise anatomy and physiology courses, detailed clinical documentation requirements, practice coding experience with real-time feedback, and general awareness sessions for staff currently using ICD-9 data.

Address the possible escalation of A/R days and respond to RAC audits for any errors in coding Medicare/Medicaid bills (classified as fraud and abuse)

Restricting access to sensitive data during multiple unit and integration testing cycles when Protected Health Information (PHI) may be most vulnerable to security and privacy risks.

Despite ICD-10 transition being complex, time consuming, and costly, it could eventually result in:  

Improved reimbursement as specificity in the ICD 10 codes can equate to more accurate claims, more efficiency in the billing and reimbursement process, and the ability to differentiate reimbursement based on patient acuity, complexity and outcomes. Reimbursement for new procedures may come from improved claims adjudication between provider and health plans.

Superior collaborative clinical management as appropriate application of ICD 10 codes can lead to increased efficiency in the exchange of patient profile information, treatments across the care process, and hospital resource management.

Enhanced Patient Safety as efficient use of all the data generated by the ICD 10 process can improve patient care and safety by observing usage trends and analyzing outcomes.

Better compliance with quality yardsticks as improved clinical documentation and coding accuracy will enhance the assessment and monitoring of patient quality indicators, as well as compliance with third-party payer coding and billing rules and regulations.

While fully endorsing providers’ decision to seek third-party specialists’ intervention in ICD-10 transition, Medicalbillersandcoders.com is confident and competent of engaging providers with specialists that are resourceful enough to plan, test, and implement ICD-10 compliant clinical documentation, coding and billing practices. Our affiliation with ICD-10 specialists across the 50 states in the U.S. makes us the leading source of ICD-10 change-agents for medical practices of diverse sizes and disciplines.

Streamlining your thoracic and cardiovascular surgery medical billing practices with integrated PMS

Practice in Thoracic and cardiovascular surgery means expensive facilities that often need to be upgraded to clinical innovations. Despite such expensive cost outlays, continued shortage of physicians may still have allowed them to see more patients, thereby garnering revenues well over capital expenditure. But, severity of health care reforms and Medical Billing challenges has not allowed physicians in thoracic and cardiovascular practice to realize their dues fully. While Medicare, Medicaid, and private insurance fee schedules have greatly been reduced these days, accountability in terms of coding compliance, meaningful use of information technology, and reporting under accountable care organization model (ACO) has increased beyond the control of traditional practice management. As a result health care practitioners, particularly thoracic and cardiovascular surgery practitioners may need to streamline their medical billing in order to remain financially healthy.

Primary prerequisite to streamline thoracic and cardiovascular surgery medical billing is to have competent and experienced billers and coders who are adept at applying correct ICD-CM, CPT, HCPCS Level II and modifier coding assignments to thoracic and cardiovascular surgical procedures; evaluation and management of documentation guidelines; Medicare billing rules and regulations on coding of surgical procedures performed by thoracic and cardiovascular surgeons; familiarity with medical terminology associated with Thoracic and Cardiovascular specialty; and proficiency in Thoracic & Cardiovascular anatomy and physiology.

Equally important is to have such billing staff oriented to electronic practice management systems that have effectively replaced paper and manual process of billing, coding, and submission of claims. The unique value proposition of an integrated practice management system is that allows physicians to streamline their medical billing and other administrative tasks without requiring the time and expenses of setting up their own IT architectures. Therefore, it is crucial that Thoracic & Cardiovascular Surgical practices chose practice management systems that are integrated with seamlessly integrated with electronic health records and medical billing software in order to streamline medical billing and other administrative functions. Further, it is imperative that such systems conform to Federal security requirements and HIPPA regulations.

Here is a list of capabilities that you seek while selecting an integrated practice management system for your Thoracic & Cardiovascular Surgical practice:

Can it process third-party payer claims with reduced occurrence of errors and realize claims within permissible time limit?

Whether it can accomplish insurance verification and authorizations?

Does it facilitate monitoring, and following up on denied claims and collections under account receivable status?

Is it capable of producing reports for audits and reporting requirement?

Is it flexible enough to adjust to operational requirements?

Is it scalable to suit your evolving operational size and volumes?

The significance of verifying your prospective practice management systems against the checklist stated above is that it saves you from making inadvertent decision. Thoracic & Cardiovascular surgical practices on the verge of streamlining their medical billing practices may even have to rely on external sources while migrating to integrated practice management systems. Medicalbillersandcoders.com – with resource capability and strategic partnership with credible practice management systems manufacturers and vendors – might just be the platform to engage with right choices for streamlining your Thoracic & Cardiovascular surgery medical billing, and expect:

To get your patient information transferred over secure software platforms, thereby conforming to HIPAA rules and regulations for patient health information and data transfer.

To have your bills accurately coded, billed, and processed electronically in time to be submitted to insurance carriers.

Expedite the process of claim realization, resubmission, follow-up and conversion of account receivables.

To be assisted with quality medical billing reports comprising of patient demographics, referrals, coding, insurance verifications, account receivables and collection.

And more importantly, show up as conforming to Meaningful Use of EHR, which not only saves you from being penalized but also help qualify for monetary incentives.

How Rising Usage of Thoracic Ultra-Sonography Would Prompt Physicians to Opt for External Medical Billing

How Rising Usage of Thoracic Ultra-Sonography Would Prompt Physicians to Opt for External Medical Billing The safety and precision factors associated with Thoracic ultrasonography have made it a more indispensable and preferred imaging modality to the traditional radiology imaging procedures that often have been criticized for compromising with patient safety and accuracy of diagnosis.

Thoracic ultrasonography, as a noninvasive imaging modality, has significant applications in pulmonary medicine, allowing the physician to diagnose a variety of thoracic disorders at the point of care. It has been found to be extremely useful in imaging of the chest wall, pleural space, diaphragms, and the lungs; lung consolidation, pleural-based masses and effusions, pneumothorax, and diaphragmatic dysfunction can now be accurately diagnosed and assessed.  Observation, palpation, percussion, and auscultation are key elements in the evaluation of any patient, and physicians seem to be better managing these disease processes with Thoracic ultrasonography. With so many noticeable advantages, it may not be surprising to see patients and physicians alike opting for Thoracic ultrasonography.

Just when physicians feel that they have found a way to appreciate their practice volumes with Thoracic ultrasonography, there is a parallel realization that charging, coding and claim realization may not be all that easy. They may come across a variety of billing and coding issues such as global fee, technical fee, and professional fee. And these fees may have to be billed in combination or isolation depending upon how and where utlrasnography services are offered –  if thoracic ultrasonography is performed in the hospital setting, all of the technical costs are absorbed by the institution, as the hospital owns the machine and provides the supplies required for scanning. The clinician receives payment only for the professional component of the procedure. In contrast, office-based thoracic ultrasonography allows reimbursement for both the technical and professional component, provided the pulmonary practice owns the ultrasound machine.

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Further, they should necessarily have to be conversant some of the crucial and high-yielding codes, such as: 

Code-76604 when real time image with documentation is generated for chest (including mediastinum)

Code-76942 when ultrasonography used to guide needle insertion with image documentation.

Code-75989 for guidance of drainage devices (chest tubes, tunneled catheters) that will stay in the patient for some period of time

76604-26 codes that allow professional component only

76942-26 codes that allow professional and 76942 that allows coding global component

The payout on these codes or reimbursement rates vary according to geographic area and insurer, thus the physicians need to be mindful of these geographic-specific and insurer-specific variations. With possible increase in ultrasonography cases, physicians may entirely find themselves occupied with clinical quality, with little time to manage complexities of charging, billing and reimbursement. Therefore, it might warrant the intervention of experts in ultrasonography medical billing and coding. Medicalbillersandcoders.com serves as an ideal platform for physicians seeking ultrasonography billing experts. We have ready access to a chosen pool of ultrasonography billing experts who can be entrusted with managing intricacies associated with ultrasonography medical fee charging, billing and reimbursement processes.

How Vital Is an Effective and Efficient Medical Billing and Coding in Preserving Thoracic Surgery Practice Profitability?

Thoracic surgical specialty is one of those priority specialties that have always been in high demand across the 50 states in the U.S., and the forecast is for an increased incidence of thoracic surgical cases. While practitioners in thoracic surgical specialty may continue to be optimistic about their future practice, constant clinical innovations and complexity of the procedures would still have to be taken care of.  Thoracic surgery often involves preoperative, operative, and surgical critical care of patients with problems within the chest. The magnitude of focus leaves physicians confined to clinical care alone, leaving them largely ignorant of finer aspects of Thoracic medical billing & coding, and reimbursement management.

A specialty as complex and critical as Thoracic surgery requires physicians to be conversant with the entire process of Thoracic medical billing, beginning with:

Ability to read and abstract physician office notes and operative notes to apply correct ICD-CM, CPT, HCPCS Level II and modifier coding assignments

Evaluation and management (both the 1995 and 1997 Documentation Guidelines)

Rules and regulations of Medicare billing including (but not limited to) incident to, eaching situations, shared visits, consultations and global surgery

Coding of surgical procedures performed

Knowledge of Medical terminology associated with Thoracic specialty

Complete proficiency in Thoracic Anatomy and physiology

They may further be required to:

Customize and generate HIPAA compliant claim codes as per situational needs that vary depending upon on patients’ health insurance coverage under Medicare, Medicaid, or private health insurance policies.

Create separate reports for diagnosis, treatment, and procedures.

Function in collaboration with major healthcare Insurances such as Medicare, Medicaid, and a host of private insurers such as Oxford, United, Aetna, Hip, No Fault, Medicaid, Humana, etc.

To be certified by certified by the AAPC (American Association of Professional Coders) and conform to coding norms as defined by AMA and CMS.

To be comfortable with generating medical codes on both paper and electronic formats. In addition, they should also be trained on medical billing and coding software to generate instant medical billing reports.

Have a thorough A/R management in place to monitor, track, and expedite the claims within the permissible time limit

Take up delayed or rejected claims with appropriate arbitrary agencies for possible remediation.

Thoracic surgery physicians, who happen to be more concerned about clinical quality, may not be too interested in doing medical billing, follow up, A/R and denial management by themselves. Thus, experts in Thoracic billing and coding may have a crucial role to play in ensuring unhindered practice revenues from reimbursements. Medicalbillersandcoders.com has a credible history in deploying medical billing resources for a variety of priority specialties across the 5O states in U.S. As Thoracic Surgical specialty is expected to be inundated with unprecedented patient influx, physicians may look forward to leverage their Thoracic medical billing with cost-efficient, technology-driven, and revenue-maximizing Thoracic medical billing practices from our chosen pool of Thoracic billing experts, accessible at all major clinical destinations in the U.S.

Will Outsourced Medical Billing Ease the Burden on Fewer Doctors Due to Healthcare Law?

The doctor-patient ratio has woefully been disproportionate across the 50 states in the U.S., and researchers believe that it may continue to be far from ideal and even worsen in the coming years:

Researchers have estimated that even in the absence of the health care reform law, the shortage of doctors would have exceeded 100,000 by 2025.

When the ACA is included, the Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed.

This figure is expected to double by 2025 when the retirement of the baby boomers and the implementation of the ACA are in full force.

And, when you consider the recommendation of the recent health care law authorizing the induction of 30 million Americans into the health insurance coverage, it may simply be an overwhelming proposition both clinically and operational. Majority of the new inductees are believed to be baby boomers, whose medical needs tend to be complex; Medicare officials predict that enrollment will surge to 73.2 million in 2025.

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While the patient population has constantly been increasing, there have not been enough doctors in the pool to respond to the clinical demand. Even though medical schools have seen a steady increase in enrollment, the problem of trained and job-ready graduates still persists. Moreover, younger doctors are more selective about their work-hours. And, the fact that about a third of the nation’s doctors are well beyond the age of 55 and fast approaching retirement has not helped the cause at all.

Another possible reason behind shortage of doctors could be disparity in compensation to physicians – a study by the Medical Group Management Association found primary care doctors make about $200,000 a year while specialists often earn twice as much. As a result, the proportion of medical students choosing to enter primary care has declined steadily in the past 15 years.

While The Obama Administration has pledged to ease the shortage, it may not entirely possible to respond to the demand of around 45,000 primary care doctors by the next decade; the proposed increase in Medicaid’s primary care payment rates in 2013 and 2014 may at best encourage an increase of around 5000 primary care doctors by 2020.

The trend is certainly bad from patients’ perspective as there may not be sufficient doctors around to deliver quality medical care. And, for doctors it could mean stretching the limits clinically, and submitting far too many medical claims with multiple health insurance carriers. While physicians should continue to shoulder unprecedented clinical responsibilities till such time when the doctor-patient ratio balance evens out, they can at least control and maximize their reimbursements with external medical billing.

Medicalbillersandcoders.com has been physicians’ choice during times of clinical and operational crisis. Our nation-wide affiliation with expert medical billing resources help physicians chose and engage medical billers either on contingency or on-going basis. As the new health care law is likely to enhance clinical and operational responsibilities, physicians’ could easily off load their burden to our pool of credible and competent medical billers.

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How ‘Malpractice Insurance’ Can Save You From Drowning Financially During Malpractice Law Suits

Physicians, who are generally known for highest professional integrity, often have to live with the tag of ‘malpractice’ despite clinical errors being unintentional. While patients’ have every right to get indemnified for the grievance, physicians’ sole choice of protection against monetary liability – which may vary from few thousand to many thousand dollars depending on the severity of the clinical error – happens to be 'malpractice liability’. Thus, whether you like or not, malpractice insurance is now more a necessity than an option. Moreover, malpractice insurance often needs to chosen carefully depending on the context in which physicians find themselves in –  physicians employed in a hospital may need to be insured differently from those who may be operating their clinics. Because of these inherent priorities, physicians have to aware and knowledgeable of the malpractice insurance that best safeguards them against any eventuality. 

It may be remembered that professional liability insurance can be availed as either ‘occurrence’ or ‘claims-made’ policy. While most of the policies offered by the insurers are claims-made, you can still avail opt for occurrence policies, which are relatively costlier than claims-made policies.

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Claims-Made Policies

In claims-made insurance, carrier is obligated to provide coverage only for the incidents that occur and get reported during the time of your insurance being active. Therefore, it is necessary that both the incident and the filing of the claim happen while the policy is in effect.

Suppose you discontinue with a claims-made policy, and get sued for a malpractice during the time when your claims-made was still in force, you will not be covered against any such suit unless you have kept alive your original claim-made policy with ‘tail coverage’, the term used for extended reporting endorsement. Despite tail coverage being expensive – as far as three times the value of an annual premium – it is often recommended to be active with tail coverage for any claims that could be reported years after they first happened. Tail coverage is also beneficial to physicians who change over to private practice from hospital employment where employer may have been covering them with claims-made policies alone.

Occurrence Policies

On the other hand, occurrence policies are more protective in nature, offering lifetime coverage for the incidents the incidents gets reported long after the expiry of policies. Suppose, you are sued in 2013 for a malpractice that took five years earlier when you were covered under an occurrence policy, you still are entitled to be covered under the your erstwhile occurrence policy even though it has expired.  But a major drawback with occurrence insurance is that they are apparently too costly to be borne by smaller physicians.

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While physicians may possible chose among the forms of malpractice insurance, malpractice   liability is something that is quite inescapable. The alarming increase professional liability claims does quite vindicate the significance of having some form of malpractice insurance. While it may not restore the possible loss of credibility of goodwill of your clinical practices, it could surely prevent you from drowning financially. Therefore, your choice and quantum of malpractice insurance should necessarily be tailored to your practice specialty, practice location, ability to offer collateral security, and more importantly according to state legal requirements under which you are operating.

However, you may find it hard to reconcile these multiple considerations, and possible be better off with some external advice availing malpractice insurance. Medicalbillersandcoders.com, which holds the distinction of being a premier platform for sourcing medical billing solutions, is equally adept at suggesting and securing ‘malpractice insurance’ for physicians either employed in a hospital setting or practicing independently. Our broad base of experts, knowledgeable with various malpractice insurance policies and state-specific rules can be relied upon for implementing the insurance policies that best suit your need and capability.