The Value of Outsourcing Cardiology Specialty Billing Amidst Changes to Medicare Reimbursement Rates

Any revision in Medicare reimbursement rates will have a direct impact on physicians’ medical billing, and cardiologists are not immune to the effects of frequent changes in Medicare reimbursement rates, announced by The Centers for Medicare and Medicaid Services (CMS) from time to time. While cardiologists or their billers could anticipate the extent of earlier revisions with a fair degree of accuracy, they might not have imagined what they would be encountering in 2013 – as per CMS would have to be prepared for a 2 percent cut over and above the possible 26.5 percent cut to fix Sustainable Growth Rate (SGR) formula. In addition to these general revisions, sweeping changes in rules governing evaluation of coders for certain high percentage cardio-vascular procedures, multiple procedure payment reduction, PQRS and e-prescribing, and value-based modifiers may potentially squeeze cardiologists’ revenues or operational margins.

One of the major changes that may hit cardiologists hard is the creation of new codes and payment levels for certain complex yet frequently encountered procedures. These new evaluation codes could potentially reduce payments from 20 to 27 percent depending on procedures. While representatives are negotiating with CMS for a more rational evaluation system, cardiologists or cardiology specialty billing will continue to be affected till such time when it may be revisited.

Another major concern comes from the CMS’ scheme for implementing a multiple procedure payment reduction to cardiovascular services. This could mean a reduction as high as 25 percent on the technical component of a service relatively less expensive than services performed on the same day. While this may not apply to office visits, most of the cardiovascular diagnostic and therapeutic services that happen to administer multiple services on the same day will certainly have to forgo a major chunk of their reimbursements.

As usual there would be bonus or penalty depending on compliance or non-compliance with PQRS and e-Prescribing – CMS has already made clear that cardiologists will receive 0.5 percent bonus for successfully participation in PQRS, and also be vulnerable to 1.5 percent penalty or reduction for non-compliance PQRS and e-Prescribing standards.

And, value-based modifier that adjusts payment for quality and cost of care could either enhance or decrease the eventual payouts to cardiology practices. While this system is not yet mandatory, you never cardiologists may soon be asked to be part of it under Account Care Organization (ACO) model.

Amidst these sweeping payments changes, cardiologists could be vulnerable to revenue losses, which in turn might jeopardize their sustenance and growth plans. This concern necessitates the significance of cardiology specialty billing that is competent enough to keep cardiologists’ revenue health positive despite the inevitable Medicare cuts.

Medicalbillersandcoders.com has successfully mediated physicians’ medical billing outsourcing decisions in the past; majority of Medical Billing Practices in varied disciplines across the 50 states in the U.S. have made use of our platform to source the right and competent medical billing professionals. Given our equally commendable cardiology-specific billing experience in the past during times of critical medical billing issues, cardiologists should be able to respond instantly and amicably to these Medicare-dictated billing challenges, and keep their practices clinically and operationally efficient.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Complications in Clinical Documentation Leading to Inaccurate Billing Codes

Clinical documentation is a need that threads through the entire lifecycle of an inpatient treatment episode. The clinical documentation specialist checks the documents of a patient before or within 24 to 28 hours of admission to assess various aspects of the patient’s condition, reviews documents every two to three days, during patient stay, to check their progress, accuracy and assign proper diagnosis related group (DRG). Based on assessment, the clinical documentation specialist also sends feedback to the physician who corrects things if necessary before the documentation is used for preparing reimbursement claims.

As is evident, clinical documentation requires extensive documentation of treatment procedures together with their relationship to be used for preparing reimbursement claims. Seen from a reimbursement claim standpoint, anything that’s not documented doesn’t exist and such are coding complexities that the presence or absence of any fact in documentation affects the choice of code later, making it either accurate or inaccurate. This has become more so since the expected implementation of ICD-10-CM.

ICD-10-CM is much more nuanced than ICD-9-CDM. Whereas ICD-9-CDM included 59 codes for diabetes, ICD-10-CM has more than 200 codes for it. Additionally, for diabetes, ICD-10-CM has added a new provision called ‘poorly controlled’ to the already existing provisions under ICD-9-CDM, controlled and uncontrolled. 

Similarly, ICD-10-CM has also increased the number of categories for injuries to cover a larger set of possibilities and arrest the nuances of a wider range of physical specifications of an injury. For example, apart from various details to ascertain the character of an encounter, the ICD-10-CM requires the coder to code the size and depth of an injury. Also, ICD-10-CM contains multiple combination codes to account for relationships between various conditions. After wading through these details, it is not very pleasant to be reminded that the source of these codes is clinical documentation.

Effective clinical documentation requires a grid-like structure underneath the day-to-day healthcare activities involved in an inpatient treatment episode which will arrest medical details, record them and pass them through various phases of the treatment terminating with the discharge of the patient. This process has to be a mix of human effort (to interact with various parties involved) and technology (to record details and facilitate coordination among various specialties – healthcare and otherwise – that interact during the course of a treatment).

MBC’s Revenue Management Consulting can help you with this by performing a thorough analysis of your revenue management cycle and lubricating various points of interaction it has with other areas of operation ensuring smooth flow of data. This involves identifying gaps in your process and addressing them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its Outsourced Billing and coding services which involve development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process - collectively resulting in reduced claim denials and enhanced core-business focus.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Tackling Reimbursement Challenges posed by Inpatient Coding with Professional Medical Billing and Coding!

Clinical documentation is a need that threads through the entire lifecycle of an inpatient treatment episode. The clinical documentation specialist checks the documents of a patient before or within 24 to 28 hours of admission to assess various aspects of the patient’s condition, reviews documents every two to three days, during patient stay, to check their progress, accuracy and assign proper diagnosis related group (DRG). Based on assessment, the clinical documentation specialist also sends feedback to the physician who corrects things if necessary before the documentation is used for preparing reimbursement claims.

As is evident, clinical documentation requires extensive documentation of treatment procedures together with their relationship to be used for preparing reimbursement claims. Seen from a reimbursement claim standpoint, anything that’s not documented doesn’t exist and such are coding complexities that the presence or absence of any fact in documentation affects the choice of code later, making it either accurate or inaccurate. This has become more so since the expected implementation of ICD-10-CM.

ICD-10-CM is much more nuanced than ICD-9-CDM. Whereas ICD-9-CDM included 59 codes for diabetes, ICD-10-CM has more than 200 codes for it. Additionally, for diabetes, ICD-10-CM has added a new provision called ‘poorly controlled’ to the already existing provisions under ICD-9-CDM, controlled and uncontrolled. 

Similarly, ICD-10-CM has also increased the number of categories for injuries to cover a larger set of possibilities and arrest the nuances of a wider range of physical specifications of an injury. For example, apart from various details to ascertain the character of an encounter, the ICD-10-CM requires the coder to code the size and depth of an injury. Also, ICD-10-CM contains multiple combination codes to account for relationships between various conditions. After wading through these details, it is not very pleasant to be reminded that the source of these codes is clinical documentation.

Effective clinical documentation requires a grid-like structure underneath the day-to-day healthcare activities involved in an inpatient treatment episode which will arrest medical details, record them and pass them through various phases of the treatment terminating with the discharge of the patient. This process has to be a mix of human effort (to interact with various parties involved) and technology (to record details and facilitate coordination among various specialties – healthcare and otherwise – that interact during the course of a treatment).

MBC’s Revenue Management Consulting can help you with this by performing a thorough analysis of your revenue management cycle and lubricating various points of interaction it has with other areas of operation ensuring smooth flow of data. This involves identifying gaps in your process and addressing them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its Outsourced Billing and coding services which involve development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process - collectively resulting in reduced claim denials and enhanced core-business focus.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Solving the ‘Secondary Insurance’ puzzle at your medical practice

Care providers encounter patients with more than one level of health insurance coverage – a secondary insurance to complement primary insurance. While secondary insurance has considerably reduced patients’ out-of-pocket expenses and facilitated treatment plans outside primary coverage, billing for two-levels of insurance coverage has not been that easy. Even as certain secondaries to Medicare are enabled with automatic crossover to Blue Cross and Blue Shield and require no additional pursuance, majority of big and small private insurance plans continue to be unlinked with Medicare or Medicaid primary coverage. It is this isolation of secondary plans from primary that makes billing secondary insurance more difficult.

Irrespective of whether primary insurance is automatically linked to secondary insurance, it is the responsibility of care providers to arrange for co-ordination. Often, it is the insurance verification, billing, and follow up department that takes up the responsibility of coordination of benefits. Strangely, a large of proportion of relatively smaller secondary bills is never pursued or delayed till they become ineligible to be reimbursed. The collective value of such omitted secondary bills may be thousands of dollars per physicians. Therefore, with so much of hard-earned practice revenues going unrealized, physicians need to investigate and formulate corrective measures to follow up and realize secondary bills in time.

For more information visit : Medical Billing Blog

One of the primary steps to monitor secondary bills is to have access to your patient accounts and system reports that show balances and your aging out Secondary Insurance Account Receivables (A/Rs). If you see certain bills approaching or just about to cross 90-day limit, it should be alerted immediately to your billing department for immediate follow up with secondary insurance carriers. Second, more than alerting your billing coordinating department of aging secondary bills, you should try to extract reasons for delay in reimbursements, and advice your staff for corrective measures based on the facts responsible for such delay. Third, once you have found out aging secondary bills, and advised your billing department to follow up with requisite modification or proof, it is important that they are pursued within the stipulated time limit, usually within 90-days from the date of billing. Last, it is always good to have a periodic review of your billing practices, particularly secondary insurance bills. Periodicity may range depending on the volume of secondary bills or ideally once every month. Review is an apt way to monitor the progress on secondary claims, and keep your practice’s financials healthy. In addition to challenges mentioned above, secondary insurance may have policy-specific, provider-specific, and region-specific demands. And, if you happen to be a care provider dealing with multiple insurance networks and operating across multiple clinical destinations in the U.S., you may have to be conversant with these diverse requirements. It is these multiple challenges that warrant the intervention of an external medical agency in your internal medical billing practices.

Medicalbillersandcoders.com has traditionally been care providers’ first choice in medical billing and coding; care providers of varied sizes and disciplines across the 50 states in the U.S. have found our services catalytic to their clinical and operational efficiency. And, at a time when they need their secondary billing mediated more than ever before, our resourcefulness – competent billing professionals with credentials in maximizing secondary insurance reimbursements – in secondary billing should be comforting.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Pre-empting malpractice liability risk with superior EHR systems

Electronic Health Record system (EHRs), which is the next order in clinical and operational documentation, is perhaps one of the significant technology additions to have happened to the health care industry. While care providers seem to have been convinced of its ability to elevate clinical and operational efficiency to a new level, they may still be inheriting malpractice liability risk more than ever before. Amongst many things that are intrinsic to EHR system, transition, design, implementation, application, and control issues threaten physicians’ immunity against lawsuits with respect to breach of HIPAA-mandated patient privacy and security.

As physicians begin to transit from manual to EHR-managed data centers, patient-specific data may be vulnerable to proliferation, exclusion, or faulty conversion during the process of transfer from paper to electronic medium. As a result of this inappropriate conversion, patients’ clinical management may suffer from inaccurate clinical decisions. When patients’ care gets compromised on account of such inapt transition, physicians will certainly be held accountable legally. Therefore, it is important to undertake data transition comprehensively as well as have an EHR system that can entirely accommodate such data transfer.

More than being liable for lacking in data conversion, it is the choice your EHR design, customization, and implementation process that could either make or break your case – those EHR systems that tend to deviate from HIPAA’s requirements may spell trouble for physicians who happen to own them or may be opting for such EHR platforms without knowing the eventual consequences. Therefore, it is essential that you exercise caution before deciding on an EHR platform – it is not the price or somebody else’s provocation that should drive your decision but how far you can sustain integrity in clinical documentation.

Significantly, physicians may have to contend with control and security issues – with EHR systems chances of data proliferation, hacking, and unauthorized access are going to increase. Physicians – who are generally non-inquisitive of data coming in from EHR channels – may not entirely be informed of adverse happenings at their EHR systems. Therefore, more than being happy with implementation, it is important that you monitor the functioning of your EHR platform on an on-going-basis. It is also important that you commission a support staff that can conduct and protect EHR operations as required by HIPAA mandate.

Though a bill that protects providers from malpractice and other liability (if they happen to use certified EHRs) is being contemplated on, physicians would still have to continue to safeguard integrity and the accuracy of the patient’s medical record till then.

Medicalbillersandcoders.com is essentially helping out hospital management or physicians practices that may be vulnerable to EHR-specific malpractice liability risk. The significant advantage of partnering with us is our ability to leverage our tactical knowledge in EHR implementation with technology alliances with some of the best EHR manufacturers. More than getting your EHR systems customized, it is our catalytic role in assisting transition to EHR-enabled clinical and operational documentation that is instrumental in our being a leading consortium across the 50 states in the U.S.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Managing Variable Healthcare Data with the Help of a Medical Billing Service

Although healthcare data is presumably highly significant to clinical efficiency, its application is not limited to clinical circle alone – medical billing, operational efficiency, contribution to clinical research and macro healthcare policies are equally dependent on healthcare data. Therefore, the primary raw data collected needs to be processed and tailored-made to serve these diverse purposes. While we may have come a long way from what used be generic data computing systems to healthcare-centric data management systems of today, questions still remain as to their ability to retain, secure, and serve the purposes for which they are 

relied upon.

This primary concern brings us to contemplate on data warehousing techniques that can necessitate the broad range of data-related utilities, such as tracking orders, recording vital signs, admitting/discharging/transferring patients, aiding reference, sending bills, and helping in collaborative exchange of healthcare data across clinical and operational eco-system – care providers, patients, insurance carriers, research bodies, and the Federal Government. While technology vendors have made available multiple versions of data warehousing models, care providers and all the external stakeholders still doubtful of them being fully responsive to ‘Meaningful Use’ of healthcare data.

Even as the problem persists with understanding variable healthcare data, care providers can still persuade manufacturers, vendors, and implementing agencies to evolve technology platforms that best serve providers’ internal data requirements as well contribute to external stakeholders’ data necessities. More than the mere architecture of the platforms, it is the utility-factor that needs to be well-defined and agreed upon before engaging with your prospective manufacturers or vendor. While we emphasize the need for customizing healthcare data centers’ architecture and delivery in sync with variable health care data utilities, current EHR platforms available in the market offer somewhat near-perfect options – today’s EHR platforms are believed to enable variable health care data utilities such as electronic medical records generation, billing, coding, operational functions, e-prescriptions, and a host of clinical and operational utilities.

While care providers may be able to better understand and manage variable health care data demands with these latest EHR platforms, they may still need to assess their prospective vendors’ ability to come up with customization that best supports their unique data needs. Notwithstanding their ability to assess intrinsic and potential data requirements, they, being physicians with essentially clinical care as their focus, may be well advised to avail services of medical agencies that best understand such critical healthcare data issues.

Medicalbillersandcoders.com has a tradition of mediating clinical and operational transformation on behalf of care providers. And, at a time when variable healthcare data management has become critical to clinical and operational efficiency, our broad resource-base of medical billing experts across the 50 states and their substantial experience in managing healthcare data centers for practices of varied sizes and disciplines should augur well for the future of variable healthcare data management in particular, and the nation’s healthcare delivery at large.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

EHR As a Means to Better Co-Ordinate and Control Care Processes

The success of health care has always been determined by how best care providers are able to coordinate the care processes across the clinical cycle – right from the time patients are admitted till they are pronounced cured. While clinical decision often lies with the primary physicians, clinical management may be divided among several departments or intervening specialists depending upon the complexities of clinical cases. Each clinical constituent may have specific, limited interactions with the patient and, depending on his/her area of expertise, may come up with his/her own view of the patient. While each of such views contribute to the ultimate clinical outcome, they information largely remains fragmented into disconnected facts and clusters of symptoms. As a result, clinical decision-makers are increasingly reliant on systems that keep disjointed clinical views into a cohesive clinical data.

Just as internet and web medium continues to evolve newer systems of care co-ordination, EHR is thought upon as the best technology system ever. While there could be arguments in favor of or against EHR as means to control clinical process, there is little doubt as to its ability to decrease the fragmentation of care by improving care coordination. EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care. With a well-networked EHR across the clinical continuum, care provider can expect:

superior integration among providers by improved information sharing to monitor and control the effect of medication to seek entry at point of care or off-site consistency of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine gain access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine, have population management trended data and treatment and outcome studies, be armed with more convenient, faster, and simpler disease management

These multiple utilities promise to be a positive influence on health care quality and convenience. Amongst a series of EHR-enables advantages, providers will primarily be benefited with

Instant access to patient records from inpatient and remote locations for more coordinated, efficient care Superior decision support, clinical alerts, reminders, and medical information Performance-improving tools, real-time quality reporting Clear, complete documentation that facilitates accurate coding and billing Ready interfaces with labs, registries, and other EHRs Improved, safer, and more reliable prescribing

Providers, who are always dictated by clinical excellence, should welcome EHR as a means to enhance primarily clinical efficiency as well as operational efficiency at large. While internal staff can be acquainted with the functioning of EHR, implementation of EHR need necessarily be done by experts. Medicalbillersandcoders.com – who has been the first to mediate with critical processes and systems on behalf of care providers – have the experience and expertise to enable care providers with decision-supportive EHR systems. Our resource base, spread across the 50 states in the U.S., is capable of customizing EHR systems in sync with your practice sizes and disciplines.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Does Expanding Outpatient Physicians Really Help Stabilize Your Hospital Revenues?

Hospitals that hitherto have been troubled with in-patient operational losses may just have found a solution in outpatient mode. Contrary to stagnant inpatient volumes and revenues, outpatient volumes seem to have picked up in recent years. As a result operational revenues at hospitals seem to be firming up. It is also worthwhile to be informed of some interesting statistics unearthed by the research agencies – Fitch’s research has found the average operating margin to have shifted from 2.6% in 2010 to 2.7% in 2011 while Moody’s have estimated it to be hovering around 2.5%.

While outpatient mode may have marginally helped offset inpatient downturn, it is expected that hospitals’ outpatient windows will further gain from steady decline in inpatient cases – the decline in patient volumes, which previously was in sub-decimal, seems to be heading towards double-digit figure (prominent research agencies currently estimate it to be around 9%). Coupled with this dip in inpatient volumes, the recent health care reforms may force hospitals to operate at negligible profit margins. With so much pressure behind, hospitals should look at outpatient mode not as an option but necessity to sustain and grow.

But expanding outpatient windows has its own challenges – finding competent physicians or doctors, cost associated with their overheads, deciding on disciplines to be more aggressively followed under ‘outpatient’ category, and not but not the least the likely billing challenges on account of expanding outpatient services.

Recruiting physicians for outpatient services will be a primary challenge. As every hospital begins to scout for talents from a limited pool, the aspirants may begin to command higher price. The initial cost of hiring may temporarily be result in negative revenues. Therefore, hospitals should be prepared for such scenario and be optimistic of eventual turn around in revenue margins.

Second, it may not be viable to pursue every discipline under ‘outpatient’ category – hospitals should explore their intrinsic competence and decide on disciplines that are demanded most in their location of operation.

Browse All: Medical Billing Services

Last, the shift to outpatient services may give rise to unprecedented increase in billing activities. The sudden increase in billing may prove to be unbearable or burdensome to in-house or the billing services provider. Unless it is eased by a superior billing intervention, it may prove to be responsible for delay or denial of claims.

Notwithstanding hospitals’ capacity to alternate to outpatient mode with larger physician base, it is advisable to be mediated by people who are sensible in clinical and operational issues. Medicalbillersandcodes.com has time and again proved to be an able ally in times of clinical and operational crisis. Our resource base spread across 50 states in the U.S. offer instant remediation for billing, coding, RCM, AR Management, and a host of clinical and operational issues. At a time when hospitals’ stand on the verge of a major shift from inpatient to outpatient mode, MBC may well be your platform for prosperity.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Keeping your Clinical Focus Intact with Analysis-Backed AR Management Solutions

Every year physicians in the U.S. lose thousands of dollars in the form bad debts. These so called bad debts are Account Receivables that have surpassed the admissible time limit or deemed impossible to be followed up. Once Account Receivables are allowed to languish for more than 120 days, it is difficult, if not impossible, to get them followed up and claimed. It really requires a dedicated AR management practices to monitor and keep ARs active. While care providers’ internal billing staff may be relied upon to a certain extent, they have often been found to be limited in their ability to analyze the reasons behind pending reimbursements, devise strategies to reduce AR days, and speed up realization of claims. But, because these tasks essentially decide the providers’ financial health and progress, they need to be arranged somehow or sourced from somewhere. Therefore, outsourced AR management services seem to be the only way out.

While outsourced AR management services could have right answers to solving AR puzzle, you certainly need to judge your prospective AR management service providers’ credentials on certain parameters:

Ability to analyze long-pending ARs: AR analysis is believed to extract reasons for delay, denial, or long-pending ARs. The reasons so extracted are supposed to be vital leads in resubmitting, following up, modifying, or adjudicating long-pending ARs. Amongst several possible reasons, your AR management partner should be able to cull out reasons such as:

• Claim denial occurring due to patient’s non-eligibility of the insurance
  
• delays due to adjudication issues
  
• pending for request of clarification or documents
  
• denials due to errors in coding and charge entry
  
• delay in payment due to insufficient funds with government aided insurance carriers
  
• filing of the claims beyond the claims filing limit

Ability to devise systematic corrective measures: Reasoning alone will not suffice; your ARs will be converted into real revenues only when they are backed up with instant, effective, and corrective measures. While most of the AR management providers are generally believed to knowledgeable, it is always safe to be informed of their ability to:

• Process and systematically follow up with the insurance carrier for paper as well as electronic claims to improve reimbursements.
  
• be conversant with knowledge about the insurance companies’ policies and procedures that help process claims
  
• Keep records of past AR events that may come useful in dealing with similar future events.
  
• maintain good rapport with the insurance company will help the physicians’ office or the physician billing company in solving the issues more effectively
  
• handle major rejections and in prioritizing claims
  
• verify explanation of benefits, and preserve final payment documents for future use

While ascertaining your prospective AR management service provider is inevitable, you being care providers may not want to be distracted from your primary focus: clinical excellence. Medicalbillersandcoders.com has precisely been an operational partner for medical billing and allied services. With a resource-network across the 50 states in the U.S., we promise to keep your clinical focus intact with some of the best analysis-backed AR management solutions. While our AR management solutions have been inclusive in our total RCM solutions, you can also get them customized exclusively to your practice needs. 

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Negotiating Justifiable Contract with Health Insurance Companies

Care providers operate in an environment characterized by multiple payors – Medicare, Medicaid, and a host of private health plans. The prevalence of such multi-payer is reason enough for differences in rates at which care providers are reimbursed despite the clinical procedures more or less being the same. Adding to this heterogeneous payor-environment is the regional differences wherein a physician practicing in an urban state gets reimbursed more than its counterpart in a rural state.  Are we simply to believe that these are irreversible factors, and physicians are left with no avenues but to accept what is offered?

Certainly, multi-payor system and regional factors should never hold you from claiming what you really deserve. If you happen to be as good a care provider as your counterpart in a metropolis, you are entitled to be reimbursed on par with the best rates. This is where your negotiation skills come into the fore – convincing you’re your payors as to why they should reimburse you at the rates given in the fee schedule, equivalent to the CPT codes, and to the maximum extent possible.

The extent to which you can negotiate is often decided by your being in a particular network – HMO or PPO. If you are a HMO provider, your negotiation is limited to Medicare or Medicaid fee schedule.  Medicare, being public plan, reimburses you at a rate which is comparatively less than a physician gets by being a provider in PPO. At best you can insist on getting reimbursed on par with what the admissible CPTs deserve.  But, to insist on being paid at CPT-equated level, you will certainly need to back up with clinical and quality credentials – care excellence, EHR implementation, and compliant coding and billing practices.

Browse All: Medical Billing Services

If you happen to PPO provider, being supported mostly by private carriers, can expect variable and maximum scope for negotiation – by being in the PPO network, you can expect to be paid at rates higher than in Medicare fee schedule.  But your payors are not going to be convinced unless you support you claim with valid reasons and proof. Amongst many ways through which you can negotiate better deals with your payors are:

• Keeping track of history of your claim submission and eventual realization:
This will provide with variance in your expectation and eventual pay out. When such variance are brought to the notice of your contracted payors, payors may be inclined to have a relook at the existing reimbursements, and may even amend with higher rates.

• Being aware of the rates offered by other plans:
This will help you compare your reimbursements with what your counterparts in the similar field are paid by other plans elsewhere. When these differential rates are brought to your payors notice, they may be inclined to revise to higher rates provided your quality of health care is as good as it is elsewhere.

• Being aware of geographic advantage:
If you happen to practice in an area that distinctively know for medical care quality, you try to force this into your advantage; payors are generally convinced of relatively higher level of quality care in urban and metropolis.

• By threatening to walk out temporarily:
If your payor is not open to the idea of negotiating, you may consider coming out of the contract. And when you start billing 100% to your patients, patients in turn may switch sides to payors that offer maximum coverage. This may force your original payor reconsider his original stance.

All these seemingly possible tactics would have to be carefully implemented. Care providers, who are primarily focused on clinical job, may be found wanting tactically. This is where medical billers would be sorely required. Medicalbillersandcoders.com – with a thorough understanding of multi-payer reimbursement environment – continues to mediate justifiable contract with health insurance companies across the 50 states in the U.S. Irrespective of your being HMO or PPO, our expert team of insurance contract negotiation is essentially driven by the motto: “maximizing your reimbursements”.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

What makes Outsourced DME Billing Superior?

Physicians who are part of DME services now face an important operational decision: whether to persist with in-house billing staff or entrust to external sources. The long-held belief that in-house billing staff would manage DME-related billing complexities seems to have failed them recently – most of the in-house-staff-managed DME billing are reported to have high incidence denial, delay, or under realization of DME bills from Medicare, Medicaid, and private DME health plans.  And, now that physicians strongly feel the reason to replace in-house DME billing, should they be embracing outsourced DME billing straight away? Yes, but not before they have debated pros and cons of DME billing outsourcing.

Arguments in favor of DME Billing Outsourcing

Primary argument in favor of outsourcing DME billing is that it will bring a fresh perspective to hitherto stereotype practices – outsourced DME billing providers, with their specialization, could iron out deficiencies, and improve realization. The in-house staff, on their part, will be able to concentrate on clinical priorities, and prepare reliable data for DME billing and coding.

Second, care providers need not worry about capital investment associated with training people and installing system for DME billing; an outsourced service comes with a ready-combination of trained people and systems. Moreover, with a large clientele, it will be easy for your prospective service provider to pass on the economies of scale.

Third, outsourced DME billing providers are supposed to have good terms with payers and agencies. Their being well-acquainted with Medicaid, Medicare, and private health plans should help care providers in knowing, negotiating, and responding better to dynamics of DME billing. Likewise, DME billing providers can save you from accepting health plans that are either operationally non-profitable or non-supportive of DME services.

Last but not the least, DME billing providers can be relied upon to keep A/R days within the permissible limit – with supposedly superior expertise in ICD and HCPCS coding, there should be little need for Decreased denials and/or front end rejections: as a result of expertise in ICD-9 and HCPCS coding, for re-filing, rebilling or appeal.

Arguments against DME Billing Outsourcing

Primary argument against outsourcing DME billing is that it involves lot of deliberation while selecting a prospective service provider from so many operating in the market – the chosen provider may or may not turn out to be a suitable one; sometimes, it may turn out to be inferior to your in-house DME billing.

Second, outsourced DME billing may initially need to be synchronized with your operational environment. And, when DME billing needs to be customized to your requirement, there will be likelihood of DME billing cost being escalated.

Last, mobility may sometimes be an issue – your outsourced DME billing provider may not be logistically near your clinical facility. Therefore, there could be considerable time gap between what you need and what you eventually get from your DME biller.

Because pros outnumber cons, physicians should consider it operationally viable and profitable to entrust their DME billing to outside service provider. With operational burden taken out of their minds, they can focus on clinical priorities, which essentially decide their competitiveness. Medicalbillersandcoders.com has veritable success as leading DME billing service provider; a great majority of care providers across 50 states in the U.S. have benefited from our specialized, economical, and collaborative DME billing services. And, as the demand for outsourced DME billing services is likely to increase in coming days, we hope to leverage on our nationwide DME billing specialists in bringing you operationally profitable billing solutions.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Challenges and Opportunities of Durable Medical Equipment Practice (DME)

The necessity of Durable Medical Equipments (DMEs) had never been so high – in U.S. 30% to 54% of those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of DME to keep them mobile or enabled. It is also estimated that around 1.5 million people are currently in need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity to people involved in Durable Medical Equipment services: physicians, pharmacies, and manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in how physicians themselves can recommend, source, and administer DMEs.

While physicians can benefit immensely from an integrated DME management, there are challenges on way – being equipped with a Medicare enrolled and recognized pharmacy, sourcing supplies from bidders authorized by CMS, and showing up as participating supplier, who accept Medicare approved fees on DMEs.

Physicians who are willing to have pharmacies attached with Medicare Part B approval need to have a full-pledged Medicare Part B recognized DME supplies. The importance of having Medicare approved DMEs at your pharmacy is that it enables patients to have access to DMEs that are fully covered and reimbursed from Medicare Part B.

DMEs cannot be freely traded at your pharmacy; you need to apply for authorization from CMS. First, you need to apply by filling up Form CMS-855S for all likely suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Applications are verified by National Supplier Clearinghouse (NSC) before being certified for compliance with DMEPOS Supplier Standards, as set forth in 42 CFR 424.57

Physicians in DME services are expected to be responsible – being responsible means agreeing to accept Medicare-approved amount as full payment. Physicians that accept this clause will stand to collect only 20% of the approved amount after the patient has paid the part B deductible. Though not mandatory, being partner in sharing monetary responsibility may have disguised benefits, such as goodwill and patient-initiated referrals.

While suppliers recognized by CMS are generally dependable, there have also been cases of sub-standard supplies. Accepting any supplies without thorough inspection may prove to be clinically inapt or underperforming. Therefore, physicians from time to time need to verify suppliers’ credentials and report cards as and when they are published by CMS.

Notwithstanding these possible challenges ahead, physicians in DME services should have ample scope for revenue generation. Consider the scenario when Medicare will be extended to every U.S. citizen – with a majority of current Medicare beneficiaries yet to utilize DME benefits, DME practice itself will be a major attraction amongst practitioners. And, with strategic partnership with medical billing providers, physicians can expect to overcome these incumbent challenges, and become more than being just survivors.

Medicalbillersandcoders.com has always responded positively to every clinical and operational challenge. Whether it is billing and coding, EHR implementation, or ICD-10 transition, we have been the first to assume responsibility. Medical practices of varied sizes and disciplines across the 50 states in the U.S. would readily endorse us as most dynamic and comprehensive source for overcoming clinical and operational challenges. And, at a time when DME practitioners find themselves in between opportunities and challenges, we are hopeful of helping them overcome challenges and realize opportunities.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Overcoming DME Billing Challenges with a Medical Billing Service

There is a distinctive difference between billing for Durable Medical Equipment (DME) services and other clinical procedures – durable medical equipment services are ancillary to the primary clinical purpose, and their admissibility is subject to certain conditions.  Physicians since long have found these conditions tricky and challenging to understand, and often either been denied or underpaid for DME services, which may either have been

• Deemed medical unnecessary,
• Uncertified by Medicare/Medicaid/private health insurers,
• Beyond the permissible reimbursement level
• Lack of solid grounding in the Healthcare Common Procedure Coding System (HCPCS), which governs level II codes designated for DME equipment and supplies

While physicians have the right to recommend DMEs as part of a clinical treatment, they will have to back their recommendation with sufficient proof of them being medical necessary. Proving medical necessary alone will not suffice; it is equally important to know whether or not patient’s health insurance coverage supports DME services. With Medicare, Medicaid, and even certain private insurance schemes cautious about supporting exorbitant DMEs, physicians would do well to be verify whether or not patients’ health plans support DMEs.

Reimbursements are subject to the condition that physicians or patients source the admissible DMEs from payer-recognized vendors or manufacturers. While this condition may endorse payers’ commitment toward quality DMEs that last long and are competitively priced, physicians will certainly be put through the process of identifying Medicare/Medicaid/private insurer recognized vendors or manufacturers.  What is more interesting is that Medicare has designated certain pharmacies that can only supply admissible DMEs. Therefore, physicians’ task of identifying and sourcing DMEs has certainly become more complex than ever.

DMEs have grown to be clinically superior and functionally perfect these days. While appreciation in quality has facilitated clinical efficiency and patient well-being, price has been a major issue. Payers have not been all that receptive to the idea of supporting DMEs that are not operationally viable. Medicare/Medicaid too has its own reservations against highly-priced DMEs, and has put a ceiling on DMEs reimbursements.  Physicians, therefore, need to be aware of these restrictions while encountering patients that require DMEs well beyond their insurance eligibility.

Lack of solid grounding in the Healthcare Common Procedure Coding System (HCPCS), which governs level II codes designated for DME equipment and supplies, has largely been responsible for physicians’ below par realization of DME bills. In fact, if we revisit payer reports, wrong codes, absence of modifiers and insufficient narration seem to have contributed to drastic fall in reimbursement of DME bills. With care providers transiting to a more streamlined coding practice in ICD-10, DME-relevant codes will further get emphasized.

But for physicians, who are already reeling under a series of health care reforms, DME-related challenges may prove to be simply unbearable.  In-house staff, who are generally tied with clinical duties, may not be able to stretch beyond their general billing capability. The situation prompts an external medical billing intervention that can offer DME billing as part its comprehensive medical billing services.

Medicalbillersandcoders.com has verifiable success in DME billing services for practices across the 50 states in the U.S. The experience of negotiating DME claims with state-specific Medicaid policies, Medicare, and a host of private health plans is itself proof of our competence. With a team of DME billing experts at your service, challenges associated with ascertaining DME necessity, Medicare/Medicaid/private health insurers’ approval, permissible reimbursement level, and Healthcare Common Procedure Coding System (HCPCS) might just be the thing of the past!

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Managing Holiday Season Resource-Crunch with the Help of a Medical Billing Company

Healthcare is perhaps one of those few professions which are exception to the general rule of eight hour-a-day duty – professionals are required to stretch beyond their usual duty hours, and may even have to be on a 24×7 vigil. As a result work-related fatigue has been more common, which is undesirable from clinical point of view. Fortunately, holidays offer welcome-break from the rigors of work, and help professionals revitalize their mind and body. Generally, holidays in U.S. are season-driven – most professionals opt for holidays during Christmas.

While professionals can look forward to a long-awaited break this Christmas season, there is something whose rhythm cannot simply be ignored – medical billing, processing and claim realization. But, when the majority of resources – either internal staff or external resources – are expected to be on leave for a considerable period,  a large portion of medical practitioners’ bills may remain unprocessed, unrealized or piled up as account receivables, which are potentially detrimental to financially viable clinical operations.

During such resource-crunch times, medical billing companies – with enormous, flexible and agile resource base – should keep your reimbursements unaffected. While you may have conceded to the idea of outsourcing from medical billing company, you should still arrive upon the best source among many billing companies offering their services. The following factors should help you determine whether or not the medical billing company in question is credible and competent enough to fit into your requirements:

Is the company open to the idea of risk-sharing? Many companies are open to the idea of operating on a risk-sharing model – being able to share operational profit or loss equally with their clients, i.e. medical practitioners. Therefore, it is better your prospective medical billing company is comfortable with this clause.

Will the billing company earmark a separate account representative? Medical billing company manages many portfolios, and a single-contact may not be able to answer queries from multiple clients. Therefore, it is better to know if your prospective medical billing company will be able to appoint an account representative exclusively to look after the affairs of your medical billing process.

Will your billing company pursue denials astutely? Denials if not pursued may end up as irrecoverable. Therefore, it is necessary to know in advance whether or not your prospective medical billing company is credited with astute denial management.

Will your filing be on time? Claim submission if not done on time may well get rejected. It is the responsibility of your medical billing company to keep you alerted about filing deadlines, and knowing that your prospective billing partner is sensitive to filing deadlines really helps.

Will my Practice Management be integrated with EHR? The success rate of reimbursement is often decided by how best your PMS is integrated with EHR system. Therefore, your prospective medical billing partner should be capable of implementing a single and integrated platform comprising both PMS as well as EHR.

Will it offer customization? Outsourcing an entire range of general solutions may not make sense – few processes may be irrelevant or may have to be customized to your billing needs. Therefore, it is crucial to know whether or not your prospective billing company can offer the right mix of services to your practice.

What about its success rate with A/Rs? The credibility and competence of a medically billing company is built around its ability to reduce its clients’ A/R days to permissible limit. Verify your prospective biller’s credentials in A/R management before entrusting your billing management.

Is it familiar with technology demands? Medical billing is increasingly being managed by technology – clinical documentation, billing, coding, claim submission, realization, and reporting are all serially managed over a well-networked real time computing. Therefore, it is important to know whether or not your prospective billing company is sufficiently equipped with these technology demands.

Medicalbillersandcoders.com – being the largest consortium for medical billing services – has demonstrated its worth as reliable, broad-based, and flexible medical billing partner for practices of varied sizes and disciplines. Our intense resource-deployment during times of resource-scarcity has helped practices to keep their reimbursements and revenues unaffected even during holiday season. As practices are about to enter another holiday season, we assure them of everything that they anticipate from an ideal billing partner.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Physicians to Manage Revenues amidst the Impending 26.5% Medicare Cut with a Medical Billing Service

Ever since Sustainable Growth Rate (SGR) began overshooting budgeted Medicare spend, physicians have been under the constant threat of Medicare cut. While Congress’ intervention has delayed the inevitable thus far, it may be a little tougher this time – Centre for Medicare Services (CMS) has already indicated that its fee schedule for 2013 is designed to initiate 26.5% Medicare cut if the Congress fails to intervene before Jan. 1, 2013. While physicians may still be optimistic of a breakthrough in their favor, they still need to be prepared for any eventuality. And if 26.5 Medicare cut is indeed set in motion, it would have a debilitating effect on physicians’ clinical and operational efficiency – practices may not be able to support operational expenditure, leave alone the thought of ‘profit’.

Despite the looming fear, practices can still find ways to off-set the impact of Medicare cut – transition to new payment and delivery models will help meeting the primary objective of improving patient care as well as moving to a higher-performing Medicare program.

Accountable Care Organization (ACO) is one such care model, which will increasingly become mandatory for care providers in the Medicare network. ACO requires physicians to form a clinical network that can achieve optimum clinical efficiency at minimum cost to patients. ACO works on the formula that a clinical network with A-Z medical services can considerably bring down patients’ medical expenditure. While physicians in an ACO get to be recognized for high performance, they also stand to benefit from shared-savings. Moreover, being in an ACO is indeed helpful in building credibility among patients.

The provision of Affordable Care will also help physicians counter the impact of Medicare cut. The significant thing about this reform is that it extends Medicare to every uninsured citizen in U.S. With roughly one-third of population expected to be Medicare beneficiaries, physicians can look forward to off-set Medicare cut with operational volumes from Affordable Care provision.

But transiting to these novel care models may be seemingly difficult for physicians who have been used to protective health care models. Amongst possible challenges, understanding fee schedule, negotiating and renewing payer contracts, being conversant with multiple payer policies, and striking beneficial deal with payers will be more important. Moreover, a proper mix of public-private payers is more than advisable.

And, amidst these Medicare-cut-generated challenges, mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding too will add to the burden, which may be far too much to bear for physicians. With the in-house staff incapacitated to take responsibility of this enormity, outsourced medical billing services seem to be the only way out. Medical billing companies – with experience and competence in stage-managing transformation to high-performance Medicare models, managing mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding on behalf of physicians who are essentially focused on clinical efficiency – could provide helping hand.

Medicalbillersandcoders.com has time and again demonstrated its worth as being most reliable, flexible and transformation source for physicians’ billing and operational issues. Over the years, we have successfully helped practices of varied sizes and disciplines ease through operational hurdles. And, at a time when physicians are confronted with the impending 26.5% Medicare cut, we are committed to help them counter the impact with alternative and profitable operational practices. Our broad-base of resources – comprising competent medical billing professionals, who are conversant with dynamics of Medicare and other payer systems – essentially drives our mission across all the 50 states in U.S.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Correlation between Practice Revenue and Operational Documentation

Documentation holds special significance in clinical care – care coordination, easy reference, clinical research, and clinical certification are all made possible by well-documented clinical encounters. But documentation got a new dimension when fee-for-service was first replaced by Medicare-supported reimbursements. And, with the gradual inclusion of private players in health insurance, the significant of documentation is felt operationally too – documentation is the single-most source for billing, coding, and verifying the accuracy of claim submission.

Over the years, there has been considerable increase in both incidence and volume of documentation – increase in insurance-backed patients has largely been responsible for this. As a result, staff’s documentation responsibilities too have gone up. What used to a few demographic entries, insurance eligibility verifications, charge entries, billing, coding, submission and follow ups, has suddenly assumed gigantic proportions. And, when internal staff is forced to manage beyond their capacity, issues such as delay, denial, resubmission, audit, and arbitration are bound to be common. The fact that physicians find themselves in multi-payer system – which continues to be tougher by the day – is reason enough to practice accurate documentation so as to be operationally viable.

EHR provides the right platform needed to respond with operational documentation as required by your payers. As an EHR is capable of integrating clinical documentation with Practice Management System (PMS), billing and coding errors will be more unlikely. Further, with the capacity for large data base, EHR can be relied upon for any future reference or audit verification from payer side. Significantly, EHR is supposed to be a primary requirement for ensuring patients’ privacy and security as mandated by HIPAA 5010.

EHR-enabled documentation will be more than just a requirement as practices continue to negotiate economic uncertainty, declining reimbursements, healthcare reform and an increasing emphasis on performance improvement. While the imminent ICD-10 regime promises streamlined billing practices, physicians will have to do whatever best they can to have a documentation system that is consistent, comprehensive, and accurate enough to be translated into ICD-10 compliant billing and coding. Practices that lack the will and resources to adopt progressive EHR-enabled documentation may well lose considerable chunk of patients as well as practice revenues.

Therefore, medical practices have the ominous task of either find the solution themselves or with an external intervention – billing consultants or companies. The complexities involved in customizing operational documentation as demanded by individual practice structures make it apt to outsource from credible and competent sources. Medical billing service providers with strategic partnership with leading EHR vendors may just be the people to bank upon.

Medicalbillersandcoders.com is known to have implemented customized EHR systems as part of its comprehensive RCM services. Practices of varied sizes and disciplines across the 50 in U.S. have experienced clinical and operational utilities from our EHR implementation. And, at a time when medical documentation has begun to impact operational revenues, we are leveraging our internal competence (experts in EHR implementation) with external collaboration (leading EHR vendors or manufacturers) to set up revenue-promoting documentation systems.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Financial Stability from Collaborative Partnership with Billing Companies

Business acumen is something that is generally lacking amongst health care professionals, particularly doctors or physicians. Physicians are primarily driven by clinical excellence, which they believe it to be pivotal to their existence, growth and credibility amongst the patient community. True, clinical excellence continues to be decisive factor even today. But, in a free economy where quality is generally standardized, practitioners’ financial stability and growth is not determined by clinical excellence alone, but innovative care, strategic expansion, and more importantly effective & efficient medical billing as well.

U.S. health care sector has always been at the fore-front of clinical innovations – adoption of improved clinical practices and technologies continue to enrich clinical experience and outcome. It is unquestionably true that patients are increasingly drawn towards practitioners with innovative attitude. As a result, many practices that are incompetent to reinvent themselves may slowly be on their way out.

Medical Billing

Browse All: Medical Billing Articles

Practice expansion too is something that is generally neglected by physicians – many are happy with single-outlet practice. But it is quite possible that competition may gradually reduce what once used to be profitable practice to a loss-making one. To offset such adverse impact, it is prudent to think of expanding your practice base to regions with positive growth prospects.

Billing complexity is a major reason for practices’ financial woes. With fee-for-service completed replaced by health insurance reimbursements, physicians have entered a multi-payer environment characterized by region-specific rules on Medicare and Medicaid, diverse fee-schedules, and overtly strict reimbursement policies. As a result, delay and denials continue to pile up account receivables and erode practice revenues. The situation has grown so alarming that medical practices fail to collect 25% of the money they are owed; $125 billion is left in the bag as unpaid claims; Only 70% of claims are paid the first time they are submitted; of those denied claims, 60% are never resubmitted to payers; and medical practices never pursue 18% of claims at all. While payers (whether Medicare, Medicaid or private health insurance companies) are justified in refusing or withholding claims with inherent billing and coding errrors, physicians could still have averted revenue loss of this magnitude with collaborative partnership with billing companies.

Maintaining financial stability will be even more challenging post the series of recent health care reforms – Medicare cuts, affordable & ACO model of care, mandatory EHR compliance, HIPAA 5010 compliant patient privacy and security, and ICD-10 based billing & coding.  If Medicare cuts are indeed brought on, physicians will have to forego a considerable portion of their reimbursement.  ACO model of care too is designed to rationalize reimbursement. While mandatory EHR compliance, HIPAA 5010 compliant patient privacy and security, and ICD-10 based billing & coding all promise to streamline medical billing practices, compliance will not come about without investing on people and technology.

The possible loss from Medicare cuts will have to be off-set with increase in volumes or being eligible for lion’s share in incentives from ACO model.  More importantly the capital investment on people and technology needs to be recouped as early as possible if practices wish to remain profitable. All these finer aspects of financial management may prove to be beyond physicians’ capability, whose scope is limited to clinical management. Therefore, medical billing companies – with experience and competence in advising physicians of profitable practices, negotiating higher fees schedule with payers, setting up contract with multiple payers, and more importantly streamlining business practices with coding & billing accuracy – should assume the mantle of financial management.

Medicalbillersandcoders.com has already proved its worth as a reliable medical billing and financial management partner to practices of varied size and specialization across the 50 states in the U.S. We are well-served by a team of expert medical billing professionals with expertise in finer aspects of financial management for care providers. Their familiarity with multiple payers, government agencies, and prominent knowledge & technology sources gives us a distinctive edge when it comes to managing practices’ financial aspect.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

Recognizing Value in Healthcare Reforms with the Help of a Billing Service

U.S. health care industry is characterized by multiple stakeholders – patients, care providers, and payers. The Federal Government, being the custodian of this priority sector, has had to keep each of these stakeholders in good humor. But, during the recent, there have been a multitude of reforms which have sought “quality medical care at affordable price”. And, if there is one group that is little apprehensive about these seemingly patient-centric reforms is the “care providers”. Care providers’ fear is based on the premise that the proposed cuts to Medicare – which is still the largest player in the multi-payer system – would force them to forgo a major portion of their practice revenues. Incentive-based reimbursements (ACOs), mandatory EHR implementation, and ICD-10 too may have further escalated the apprehension. But, providers may have actually missed to discern “the value” residing deep inside these seemingly pro-patient reforms.

The Patient Protection and Affordable Care Act (PPACA), which was one of the earliest of the recent health care reforms, promises to generate ample scope for practice growth and expansion. Even if it is certain that fees or cost of medical services would further get rationalized, providers would still be able to off-set or even make surplus revenues with Affordable Care’s ambitious plan for extending Medical insurance to every uninsured U.S. citizen.

Accountable Care Organization Model of Care, which seeks to incentivize providers on shared quality medical care, would help grow providers into more credible and competent. And, credibility and competence would essentially drive up practice volumes and revenues.

The purpose behind EHR compliance is to document and exchange and clinical data in sync with privacy and security norms under HIPAA. By attesting to these norms, providers will be able to project themselves as responsible, and avoid violation of privacy and security norms. Moreover, “Meaningful Use of EHR” could further qualify them for incentives under EHR Stimulus Package Scheme. Therefore, the cost of implementing EHR would prove to be less than its eventual returns.

ICD-10, with all the hype surrounding its scope, has evoked a sense of great awe amongst a majority of providers. No doubt, ICD-10 require complete overhaul of billing and coding. Upgrading systems and training staff as per the new coding system would involve considerable expenditure; sourcing right knowledge and system provider would be even more challenging. But, despite these inherent challenges, ICD-10 promises to be the most efficient coding system ever. When coding efficiency is destined to be the best, it should mean fewer denials and rejections. Therefore, providers should be able to recoup the investment faster than they actually estimate.

But maneuvering through reforms of this magnitude would require external intervention, and it is the medical billing service providers who are likely to help realize the value that potentially reside inside these reforms. Medicalbillersandcoders.com – which has time and again demonstrated their ability to mediate providers’ clinical and operational challenges – is confident of convincing providers’ of the efficacy of the recent healthcare reforms. Our core group of expert medical billing professionals – adept at transforming mandates into providers’ advantages – continues to lead our charge as a leading consortium for medical billing and allied services across the 50 states in the U.S.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.

How Medical Billing Consortiums Are Superior to Medical Billing Companies

The origin of medical billing practices in the U.S. can be traced back to the 1960s when Medicare was introduced as a parallel to cash-based medical services. Since then, insurance-backed medical service has grown enormously, and two-third of the total physicians’ fees is routed through insurance of some form or the other. This shift in compensating physicians has made medical billing more complex than ever before. While medical practices initially tried to manage with in-house medical billing practices, they gradually had to give up because of internal incompetence and escalating cost of training and system deployment. As a result, outsourced medical billing practices have become the order of the day.

Outsourced medical billing practices come in various forms – freelance consultants offering billing services, dedicated medical billing companies providing comprehensive billing services, and billing consortiums with differentiated billing practices. While practices can choose the one that best suits their budget and expectation, there is an over-whelming inclination towards Medical Billing Consortium.

Medical Billing Consortiums versus Medical Billing Companies

Cost is a major factor that has made medical billing consortium more popular than medical billing company. Medical billing companies operate from a pre-determined location, which may be far away from care providers’ facilities. As movement of resources involves considerable expenditure, physicians feel burdened with inclusion of such expenditure in fees payable to medical billing companies. Whereas billing consortiums, with affiliates across major clinical destinations, provide economies of mobile resources.

U.S. health care reimbursement environment is characterized by multi-payer system – Medicare, Medicaid, and a host of prominent private payers. Moreover, these health insurance schemes are governed and get modified according to state-specific laws. A medical billing company may not be conversant with region-specific variations prevailing in all of the 50 states. But a billing consortium, with affiliates drawn across the states, can be relied upon to deal with such variations.

Comprehensiveness is another trait lacking in most of the medical billing companies. While there are certain companies that are highly specialized in billing select-few disciplines, billing companies with competence for the entire range of medical disciplines is a rarity these days. Large hospitals that require billing services for the entire range of medical disciplines may not like the idea of dealing with too many service providers. Medical billing consortiums, which normally comprise professionals of diverse billing specializations, are preferred for their inclusive medical billing practices.

Care providers’ are put through a host of healthcare reforms – Medicare cuts, mandatory EHR compliance, possible shift to ACO model, and ICD-10. While opting for outsourced mediation from medical billing companies may seem an instant justification, billing companies too are restricted by geographical confinement, resource constraints, and limited competence. Consortiums, on the other hand, are agile, resource-rich, and infinitely competent with their vast and varied professional base.

Medical billing companies may be susceptible to resource-crunch during times of attrition or turnover of professionals, which is likely to affect practices’ clinical and operational rhythm. Conversely, medical consortiums rarely face such adverse times due to their vast affiliation. With readily available reserve-pool of resources, consortium can ensure that practices’ do not experience cluttered service flow.

Medicalbillersandcoders.com is a leading billing consortium with a professional base across the 50 states in the U.S. Over the years, practices of varied size and specialization have tried, tested, and endorsed our billing services as comprehensive, practical, and transformational. With a credible history and agile, resource-rich and infinitely competent affiliations across the 50 states, we are confident of transforming the recent health care directives into opportunities for care providers.

Medical Billers and coders (MBC) is one of the leading Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies, Medical Billing Services according to their preferences of specialty, city, software and services performed.