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.

Improving your AR by Switching to a Billing Service for Your Medical Practice

One of the most frustrating issues for a physician is delivering quality medical services and not getting paid for it. Your practice can become successful only when the receivables are captured at all times. In absence of follow ups, you will not be able to recover the deserved amount as the recovery process becomes close to impossible once the account receivables reach 120 days.

What causes long-pending account receivables?

If your staff is not efficient in monitoring and keeping the account receivables of your practice active, it can become extremely difficult to retrieve the amount after a certain period of time. Usually, the entire process of finding out reasons behind delays, claim denials, following up with insurance companies, resubmitting the claims is extremely tedious due to which a significant number of physicians in the US lose thousands of dollars in the form of long-pending account receivables.

Some of the challenges you might face with account receivables are:

• Denial of an insurance claim-
  If your patient is considered non-eligible by the insurance company, the claim will be denied and your payment will get delayed. In this case, claim (paper or electronic) will have to be resubmitted and regular following up will have to be done every time the claim is denied. If you file the claims beyond the claim filing limit, your account receivable will become next to impossible
  
  
• Coding errors-
  Revisions are being done to CPT and HCPCS Level II codes annually and with the growing number of patients, and in this scenario your staff happens to make any coding error, AR will get delayed till the matter isn’t resolved
  
  
• Delayed payments-
  Sometimes government aided insurance companies don’t make the payment on time which again delays the payment process for physicians. In this case, too much time goes in constant follow up with the payers
  
  
• Adjudication issues and documentation-
  There can be certain adjudication issues and requirement of additional documents or clarification for patients that needs to be catered in time to ensure that AR doesn’t get delayed

For more information visit : http://www.medicalbillersandcoders.com/

How can you improve your account receivable?

Account receivables will get converted in revenue only when you are dedicating enough time and resources into follow-ups, error-free claim resubmission, analysis of denials, maintaining past AR records, staying updated with new policies and procedures and so on.

To manage account receivables, you will have to perform:

• Timely follow-ups with patients as well as insurance companies
• Analyse the reasons for claim denials, fill the claims forms again without errors and submit them
• Keep updating the list of long-pending ARs and work towards getting the revenue

The entire AR cycle management demands substantial amount time which can distract physicians from offering quality patient care which very few can afford currently. Medicalbillersandcoder.com has been offering effective AR management services to physicians across 50 US states. We offer in-dept analysis-backed AR management solutions or customize parts of it to your practice needs so that while we help retrieve your revenue you can concentrate on offering medical services.

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

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

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

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

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

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

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

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

In Search of Resources to Counter Radiology Billing and Compliance Challenges

Much like medical billing challenges faced by other practitioners, radiologists too will have challenges unique to their own profession. The general perception of billing being more complex than ever before and progressive fall in reimbursements seems to hold good to Radiology Billing as well. As a result, radiologists may see their revenues dropping considerably, which in turn could have disastrous impact on clinical and operational efficiency.   With possible threat to sustain diagnostic and radiologic quality amidst a host of clinical and Radiology medical billing challenges, radiologists will have to identify and address the key factors that may carry potentially greatest threats to their revenues, profitability, and more importantly the patient care.

• Foremost, bundling of services and codes could lead to significant decrease in reimbursement for radiologists.  It may be remembered that certain radiology codes are now modified into codes with lower RVUs. Moreover, The Medicare Payment Advisory Committee’s (MedPAC) inclination to reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for radiologists who both order and read images could severely hamper radiologists’ revenue prospects.

• Second, the enormity of radiology coding revisions will require radiologists to undergo training to comply with new coding order.  And, training for ICD-10 compliant radiology coding will not be all that easy simply because the electronic data standards and requirements, lengthy alpha-numeric codes, a whole set of new RVUs,   and the obligation to comply with PQRS standards for Radiology Billing and reimbursements.
  
  
• Most importantly, the new ICD-10 coding system could prove to be the most financially taxing of all that clinical and operational migrations that radiologists may have undertaken thus far – upgrading of technology that necessitates ICD-10 compliance is expected to cost radiologists as high as major capital investments. Coupled with this heavy financial expenditure, radiologists may be required to carry on with dual systems – both ICD-9 and ICD-10 – till such time when ICD-10 system becomes omnipresent. Thus, the duality of coding too will be more taxing both mentally as well as financially.

The enormity of these radiology billing challenges could throw radiologists into a phase of great uncertainty. Thus, it may require unusual acumen to respond to changing radiology coding and compliance requirements. And, who better to manage the business side of your practice than radiology specialists that possess the expertise to understand the dynamics of such radiology coding and billing compliance.

Quite aptly, Medicalbilllersandcoders.com happens to be the platform that can enable the deployment of such radiology billing specialists to practicing radiologists across the 50 states in the U.S.  Its affiliation with chosen pool of radiologists makes it the most reliable source for radiologic medical billing resources to counter radiology billing and compliance challenges. The service portfolio of these radiology billing experts include demographic/charge information, data accuracy verification, coding from physician reports, analysis of  billed charge fee schedule with recommendations, direct claims submission, revenue cycle management,  administration of patient payment plans, responding to patient and insurance inquiries, collecting, depositing payments and performing  refund reconciliation of overpayments, Medicaid pending account research, legal account follow up, carrier arbitration and government payor issue resolution, streamlined appeals process, monitoring accounts receivable, complete and detailed billing management reports.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Improved and Advanced Billing Processes Help in Increasing Physicians’ Revenue

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

How do advanced billing processes help in improving revenue?

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

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

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

The Prominence of Health Records in Clinical and Medical Billing Efficiency

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

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

 

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

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

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

For more information visit : Medical Billing Services

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.