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.

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.

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.

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.

Would Dwindling Medicare and Medicaid Payment Rates Turn Providers to Private Insurance Beneficiaries?

It is an irony that Medicare and Medicaid, which reimburse more than the half of the nation’s total health insurance, have come in for heavy flak by physicians, who claim to have lost considerable revenues that they could otherwise have rightfully earned had they avoided seeing Medicare and Medicaid beneficiaries and favored patients with private health insurance policies. The problem seems to originate from the sustainable growth rate (SGR) formula that has been proved unscientific against exponential growth in public health care beneficiaries and medical cost associated. Thus, physicians have constantly been put to Medicare and Medicaid cuts. And with Affordable Care Act recommending inclusion of millions of uninsured and baby boomers into the fold, physicians may get highly selective in admitting Medicare and Medicaid beneficiaries in an effort to save themselves from being affected with rather discouraging payments rates.

As a matter of fact these two popular government health schemes have been woefully behind payment rates offered by private insurance carriers. As a result, there has considerable shift in insurance pattern, which has resulted in escalation of the private health insurance cost by as much as 25 to 30 percent during the last 5 years. While private insurance beneficiaries have been fetching providers appreciably revenues well over their operational costs, Medicare and Medicaid have seemingly been returning revenues well below the operational costs. To be precise, doctor or hospital receives 10% less in Medicare and Medicaid umbrella as against 20% more on every dollar spent as clinical and operational cost on patients. What is even more worrying is that physicians have consistently been undergoing Medicare cuts, which now threatens to erode physicians’ revenues by as much as 25%.

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If Medicare reimbursements are staring at a monumental cut of 25%, Medicaid reimbursements too have not been that impressive either. Medicaid reimbursements have historically been varying from state to state. Moreover, Medicaid has traditionally been paying much less than Medicare. Although efforts are on to keep Medicaid reimbursements on par with Medicare’s, the expected inclusion of 15 million into Medicaid fold may not eventual allow it happen.

While the inclusion of 77 million baby boomers into the public insurance ambit may provide voluminous clinical opportunities to doctors, the proposed cut to Medicare spending by as much as $426 billion over the next decade could drastically spoil their revenue prospects. With reimbursements revenues expected to decrease even further, physicians or hospitals may not be inclined to seeing more of Medicare and Medicaid beneficiaries. Thus, they may have to substitute their portfolio with more and more private health insurance beneficiaries. While patients with private health insurance policies may be more lucrative, there would always be the risk of dealing with private insurance carriers, who are seemingly more vigilant and stricter when it comes to reimbursements. Given the challenges of private insurance reimbursement environment, it may require an external medical billing mediation to orchestrate the entire process of billing, submitting and realizing the claims to their fullest.

Medicalbillersandcoders.com has considerable experience in deploying medical billing resources as demanded by unique operational challenges. As providers shift their preference towards private health insurance beneficiaries, our nation-wide affiliation with medical billing specialists that are versatile enough to deal with heterogeneous payers should offer them the requisite leverage to manage their medical billing process as efficiently as possible.

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.

Employing Specialized Medical Billing to Maneuver Through Clinical and Operational Issues in 2013

The year 2013 is going to be quite significant to the U.S. health care industry in general and doctors in particular – it is the year when a host of health care reforms will be set in motion, and many clinical and operational experiments will get crystallized into norms to be complied with by the physician community. While they may have objectively been conceived to bring about transformational changes in clinical and operational spheres, the consensus amongst the doctors is that, along with noticeable clinical and operational efficiency, they may have to realign their medical billing practices to changing paradigm in order to remain operationally healthy.

Even as we start counting probable issues that can influence clinical sphere, cost of administering services, medical billing, and so forth, it is may be worthwhile having a glance at the watch list released by The Physicians Foundation, which is committed to focus on issues that surround physicians across the clinical destinations in the U.S. The watch list becomes credible in that it is derived from reliable reports, including the foundation’s 2012 Biennial Physician and Next Generation surveys.

One of the major issues that physicians will come to face in 2013 is the persistent apprehension with Affordable Care Act. While ACA may have been approved by the Federal Judiciary, and soon be mandatory in Medicare networks across the 50 states in the U.S., doctors are not still sure how they can operate under Accountable Care Organization model without having to compromise on their revenues as Medicare physician fee schedule is likely to be constricted and governed by independent payment advisory board.

Second, cost of medical care and patient distribution may get redefined from 2013 as smaller clinics are likely to become consolidated entities. Further, many independent doctors, in an effort to shield themselves from the impact of health care reforms, may even feel it worthwhile switching over large hospitals.  When such realignment starts dictating cost and patient distribution, many stand-alone practitioners may not be able carry on with constricted fees and patient visits.

Third, close on the heels is the possible induction of more than 30 million new patients into the nation’s healthcare systems. Doctors, whose volume is woefully short of the requisite, may still struggle more to provide quality care when the proposed new patients are accepted into health insurance backed (Medicare, Medicaid, and even private insurance policies) health care system.

Last, it is widely believed that doctors would lose the ability to independently decide on clinical & operational issues when they move into a consolidate system of health care delivery under ACO and other forms of shared models. It may not be an ideal scenario when doctors are deprived of their independent opinion on matters concerning clinical issues.

And, even if we are to believe that doctors will somehow navigate through clinical issues, administration and medical billing issues may not entirely be their known territories. That is why external medical billing intervention might just be the right injection. Medicalbillersandcoders.com has precisely been doing it admirably for more than a decade now. As physicians enter into a most momentous year in their professional experience, our resource-rich platform – known for facilitating instant, right, remedial, adaptive, and transformational medical billing solutions across the 50 states in U.S. – might just offer them the leverage to maneuver through the likely issues confronting them from 2013 onwards.

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.

The Significance of Responding to Cardiology Billing and Coding Dynamics

Cardiology is one those specialties that generally perform high-cost diagnostic and curative services, and getting reimbursed for such significant services means conclusive and convincing cardiology medical billing – adhering to cardiology codes, compliance standards and coding rules. Cardiologist, who used to be comfortable with a fewer codes and compliance standards and coding rules, are now required to be abreast with period changes in cardiology codes, compliance standards and coding rules. Amongst these evolving changes, cardiologists need to be aware of acceptability of the codes assigned, modifiers to be attached, medical necessity of performing and coding a procedure, component coding, and so on.

Acceptability of the codes assigned

Contrary to overlapping cardiology codes in the past, CMS has comes up with an exhaustive list of cardiology codes, meaning virtually an independent and appropriate code for every cardiology procedure. Therefore, Medicare, Medicaid, and private insurance companies can easily verify and ascertain whether or not you have aptly coded your procedures. Moreover, attaching a lower-paying code for a relatively costlier procedure does not make sense at all.

Apart from learning evolving coding numbers and their correct assignment, cardiologists should also familiar with changes that have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic changes. As of now, while billing for cardiology procedures:

• Cardiologists are required report most non-congenital procedures with a single code
• Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
• Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
• Cardiology-specific codes such as 93451, 93456, and 93503 are not allowed to be attached with modifier 51.

Medical necessity of performing and medical necessity of performing and coding a procedure

In certain cases, insurance payors may contest the medical necessity of certain procedures undertaken by cardiologists. Therefore, it crucial that cardiologists substantiate the necessity of those procedures that have sent coded. Otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.

Component Coding 

 

Cardiologists’ services may often involve certain technical components, and there are specific coding ruling depending on the criticality of each of such technical components. A higher technical component should always be accompanied by a higher value code so as to maximize the eventual reimbursement. In cases where there are several technical components involved on the same, the lowest component should be singled out to prevent the mandatory 25 percent deduction being charged to any other higher paying technical components.

All of these evolving cardiology codes, standards, and rules may limit cardiologists’ ability to realize their reimbursement in full. Therefore, irrespective of you being interventional cardiologists, diagnostic cardiologists, electro-physiologists, nuclear cardiologists or cardiovascular/ cardiothoracic physicians, you may eventually need an effective revenue cycle management solution in place that is integrated with the right technology, processes and people to respond to Cardiology Billing and Coding dynamics.

Medicalbillersandcoders.com offers and mediates resource deployment for integrated solutions in medical billing Revenue Cycle Management to diverse medical practices across the 50 states in the U.S. Our capability in cardiology medical billing is driven by a nation-wide resource base of expert cardiology medical billers and coders familiar with cardiology-specific medical billing, technology, and processes. With access to such talent-pool of professionals, cardiologists across the U.S. should be able to respond to cardiology billing and coding dynamics.

Ascertaining Cardiologists’ Medical Billing Needs Even as They Migrate From Private Practices to Hospitals

Till recently, cardiologists who were happy with their private practices have suddenly started exploring avenues to align themselves with hospitals. The change has been so dramatic that already around 15 percent of cardiologists across the U.S. have left their private practices in search of more secure positions in large clinics and hospitals. As per reliable industry sources, the exodus might well cross 70 percent in a couple of years. This shift may have not come about without valid reasons – increased regulations on private practices, stricter reimbursement environment, and a series of healthcare reforms calling for healthcare to be made more affordable may have triggered the swift turn of events.

Impact of revised cardiology fee schedules Like in other clinical disciplines, cardiologists too are feeling the heat of significant cuts in their fee schedules. The recent revision to cardiology fee schedule is so hard on cardiologists that it is virtually difficult even to operate on minimal operational margins. While a certain double digit cut to reimbursement from Medicare is expected, there is also apprehension that private payors may also follow suit. The consolation from the likely swell in patient numbers may not still be able to off-set revenues losses completely.

Stricter federal regulations on private practices Although the recent health care reforms are generally aimed at optimizing the quality of medical care across the nation, private practices may feel rules and regulation emanating from such reforms to be rather harsh or difficult to comply with. Affordable care model, mandatory EHR compliance, and the ensuing ICD-10 billing regime may be both exhausting and expensive. Therefore, cardiologists in private practice may deem it apt to mitigate such burden by abandoning their private practices, and practice in hospitals where they focus solely on cardiology efficiency.

Lure of hospitals Certain hospitals too are laying out baits to cardiologists with promise of lucrative benefits and vertical promotions. Hospitals feel that they can improve the quality with a large pool of experts under one umbrella. And, as for the cardiologists, it may be an opportunity to expand their professional expertise without additional overheads.

Immunity from administration burden One of the significant reasons behind cardiologists opting for larger clinics and hospitals is the perceived burden of administration, which is likely to be even more laborious in the aftermath of the recent health care reforms and the ensuing ICD-10 billing regime

While this migration may clinically and operationally be prudent for cardiologists who do not want to risk practicing amidst volatile conditions, it may not be good for the industry which has always thrived on proper mix of sole practitioners, clinics, and large cardiology specialty hospitals. The fear with this unprecedented exodus is that it may deprive instant access to primary cardiology points. Therefore, cardiologists need to be assured of operationally viable practices. And, there is no better way of doing this than easing cardiology medical billing burden of their shoulders.

Medicalbillersandcoders.com has been a premier source for medical billing, coding, and revenue cycle management services. Practices of varied sizes and disciplines across the 50 states in the U.S. have found our services to be reassuring at times of major operational dilemma. And, now at a time, when cardiologist across the U.S. are losing faith in private practices, our cardiology-specific billing, coding, and RCM solutions may just help them focus on their clinical priorities without being unduly worried about operational issues.

Eliminating Skilled Nursing Facilities’ (snfs) Medical Billing Complication

Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services that are administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring a Medicare beneficiary.

While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time in understanding:

What services are covered under consolidated billing What is billable under Medicare Part A What is billable under Medicare Part B State-specific Medicaid protocols and methodologies for SNFs Medical Billing Commercial health insurance plans and their dynamics

Though most the services offered to a resident under Medicare Part A are allowed to be included in the consolidated billing, certain services deemed costly or requiring specialization must not be appended with the consolidated billing. Generally, physician's professional services; certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services; certain ambulance services, including transporting the beneficiary to the SNF initially, transporting from the SNF at the end of the stay (other than when involving transfer to another SNF), and transporting round-trip during the stay temporarily offsite to receive dialysis or certain types of intensive or emergency outpatient hospital services; erythropoietin for certain dialysis patients; certain chemotherapy drugs; certain chemotherapy administration services; radioisotope services; and customized prosthetic devices are excluded.

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The services that are excluded under Medicare Part A should be billed under Medicare Part B, which allows medically necessary services to be reimbursed under ‘Fee For Service’ (FFS) system. It is possible that SNFs may have not entirely been thorough with these procedures, resulting in billing inefficiencies.

Even as most of the SNFs need to bill Medicare Part A and Part B, there could be SNFs that operate under state-specific Medicaid ambit. And, because each of the 50 states in the U.S. may its own Medicaid program, SNFs should invariably have to bill under their state-specific Medicaid rules and regulations. This regions-specific compliance too may have had a considerable impact on SNFs billing.

Outside the public health insurance plans, SNFs encounter the second largest health insurance providers in commercial health insurance carriers. While CMS has set a uniform standard for reimbursements across the board, commercial plays may still have their own individualistic methods of SNF reimbursement. Thus, SNFs medical billing may have suffered from having to adapt to these multi-payer dynamics.

These SNF-related medical billing concerns necessitate the significance of SNF medical billing specialists that certified and competent to maneuver SNF medical billing executions under Medicare Part A, Part B, state-specific Medicaid programs, and commercial health insurance environment. Medicalbillersandcoders.com has been versatile enough to solve medical billing issues regardless of location, size, or medical disciplines; practices across the 50 states in the U.S. continue to rely on us for remedial and transformational medical billing services. With our nation-wide resource-base adept at multi-component and multi-payer health insurance environment, SNFs should be able to put their medical billing complication to rest.

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Reforming Nursing Facilities Medical Billing Amidst Dwindling Reimbursements

Nursing facilities across the U.S. have somehow endured a series of Medicare/Medicaid cuts thus far, but the latest move by CMS to reduce reimbursement for so-called Medicare “bad debt” – Medicare co-payments not made by beneficiaries or state Medicaid programs – may bring them on the threshold of a major operational crisis. The new legislation has effectively brought down reimbursement rate for bad debts to 65 percent from what used to be 100 percent of unpaid co-payments under dual-eligible beneficiaries, and 70 percent for other Medicare bad debts. With most of the nursing facilities encountering dual-eligibles (Medicare & Medicaid beneficiaries), and federal law allowing Medicaid programs to opt out of making co-payments in most cases, it may be difficult to sustain quality and operationally viable nursing services amidst shrinking Medicare and Medicaid reimbursement rates.

Therefore, it is not unusual for nursing facilities adopting contingency plans to safeguard their operational viability. Amongst several options available to nursing facilities, the following seem to have been deemed strategically more sensible:

Laying off direct service staff Many nursing facilities operators believe that they would be able to off-set the effect of irrevocable bad debts with a reduction in their direct service staff. While they may be able to save considerable overheads, they may also be limiting their ability to sustain service quality. Putting new hiring on hold With limited scope for generating or increasing practice revenues, it may be difficult for nursing facilities operators expand their staff beyond their capacity. That is why most of them are inclined to putting new hiring on hold, and optimize operational efficiency with existing capacity. Here again, they may either be limiting their scope of operation or quality against a likely increase in Medicare or Medicaid patients. Pruning benefits Another plan that may increasingly be adopted is ‘pruning employment-related benefits’ – bonus, increments, promotion, and other amenities. While it may help substantially reduce cost, you could be harming staff’s morale and motivation. Deferring or cancelling expansion plans Reduction in reimbursements may curtail nursing facilities ability to expand with new ventures, and be forced to continue with current capacities despite demand generated by growing Medicare or Medicaid population.

While these plans may be effective to a certain extent, they will certainly be limiting nursing facilities’ ability to sustain quality, motive staff, and look beyond myopic operational strategies. That is why, rather than protective plans, operators would do well to explore alternatives that can keep their facilities responsive to quality and growth demands. Medical Billing is the area which has answers to most of the operational issues. Therefore, operators should look at making their nursing facility medical billing as effective and efficient as possible. Significantly, operators will need to align their billing practices to Medicare/Medicaid’s policy on reimbursing bad debts from disowned co-payments or deductibles.

Medicalbillingandcoders.com remains the most comprehensive source for medical billing solutions, more so for Medicare and Medicaid billing. With a resource base of medical billing experts spread across the 50 states in the U.S., nursing facilities can look forward to instant, effective, and efficient nursing facilities medical billing that can help them sustain quality and grow with evolving demand for nursing facilities.

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