How Can Outsourcing Help Better Position Your Practice for Pay-for-Performance?

Pay-for-performance programs are a great way of rewarding health care providers but do you have the time and resources to make your medical practice eligible for such rewards?
There is no doubt that these programs provide encouragement to doctors and better services to patients but several challenges are also related to pay-for-performance-

• In order to become eligible for these programs, you will be required to reduce variation in your clinical practice
  
• You will have to reduce errors by promoting effective medical safety practice and offering best care to chronically ill patients
  
• As per the present system for Pay-for-performance, factor like reduction in glycohemoglobin for diabetic patients is also a scale on which your performance will be measured
  
• Whether or not your practice will become eligible for P4P also depends on your patient’s hospital stay and emergency room visits. Care co-ordination of patients suffering from chronic diseases between home, hospital and office is also a criteria for rewards
  
• If you happen to use health information technology for improving health of your chronically ill Medicare patient, you will be rewarded under these programs. You will also have to devote enough time and energy to ensure that patients coming at your clinic are well-informed and empowered
  
• In case you don’t participate in P4P programs, you will not only lose patients but also your market share

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How can pay-for-performance benefit you?
If your practice gets to win an incentive award under pay-for-performance program, it will give you an edge over other health care providers. This will result in increased flow of patients at your clinic which will eventually add to your income.

How to make it happen?

At a time when the US healthcare system is facing strain on finance and healthcare delivery due to inflation of medical cost, it has become imperative to offer high quality medical services at an attractive cost. This can happen only when you make your practice eligible for these P4P program by concentrating more on patient care rather than billing and account receivables.

Is AR management and medical billing restricting you?

You may have the capability to offer enhanced medical care to the patients and tackle P4P challenges but tasks like medical billing and account receivable management can eat up all your precious time that can be otherwise devoted in best medical care facilities.

Taking into consideration the complexities of healthcare industry in the US, many physicians are outsourcing these services and buying precious time to prepare their practices for pay-for-performance programs. So, if you also want to improve your services and get the competitive edge, why not make use of increased time and look into patient care?

Medicalbillerandcoder.com has been offering outsourced billing and AR management services to physicians across 50 states in the US. The expert team at MBC also provides consultancy to help doctors enhance their in-house practices and improve health care services to their patients.

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.

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.

Spiraling Cost of Gastroenterology Services to Warrant Billing Partner!

Despite Gastroenterology being one of the high-yielding practices, practitioners’ revenues from reimbursements continue to remain below par. This can be a distressing trend considering the spiraling cost of administering gastroenterology services. While clinical and technological advancements have brought in unimaginable precision to care, billing requirements too have become more demanding than ever before. As a result, a considerable portion of gastroenterology bills are susceptible to delays and denials, most of which are never pursued owing to incompetent billing practices. With the combined cost of such unrealized claims amounting to almost 20% of the total bills submitted, gastroenterology practices would do well to find better billing alternatives. While internal billing resources may be brought up with training and orientation, its success rate has not been all that impressive. Moreover, it could prove costly.

In view of the uncertainty over internal billing capabilities, hiring or outsourcing the entire gastroenterology billing management could prove to be a wise decision.  While the quality of outsourced gastroenterology generally happens to be good, you may still have to assess your prospective billing partners’ competence and experience against your requirements and the prevailing gastroenterology billing complexities. Primarily, your gastroenterology billing partner needs to be proficient in:

• Complex gastroenterology billing codes and rules
• Gastroenterology-related terminology
• Office notes and operative notes, coding for surgical procedures
• Code variations related to multiple procedure rules
• Denial process and appeal denied claims quickly and efficiently to ensure speedy reimbursement

The advantage of evaluating your prospective Gastroenterology Billing partner against these requirements is that it make you believe that you will be assured of comprehensive billing, collections, and practice management services, interspersed with:

• Account receivables management
• Round-the-clock claims processing
• Checking system based eligibility
• Quarterly coding updates
• System-based claims scrubbing
• Comprehensive response to all billing calls
• Regular quality assurance checks
• Weekly meetings to discuss progress and go over reports
• Customized monthly reports

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Such proven gastroenterology billing practices would invariably facilitate:

• Improved collections and income
• Accelerated payments and reduced stress
• 24/7 accessibility to your patient data and financial information
• Transparency throughout the revenue cycle
• Full financial and practice management reporting

Even as you scout for your prospective gastroenterology billing partner, Medicalbillersandcoders.com – with impeccable success in deploying apt gastroenterology billing specialists for practices across the 50 states in the US – offers a chosen pool of gastroenterology billers, adept at coding, billing, payer relations, patient relations, collections, financial reporting, fee analysis, managed-care contracts.