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

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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.

The Value of Accurate Documentation in Medical Bill Reimbursement

Medical documentation has myriad applications in today’s health care administration – being reference-source for future encounters; enabling coordinated care, both within and across the clinical network; contributing to macro health care planning and reforms; ensuring clinical data privacy and security as per HIPAA norms; and ensuring flawless medical billing. Notwithstanding providers’ effort to document as best as they can, “accuracy” continues to be a matter of great concern. While inaccuracies in medical documentation can lead to lapse in medical care quality and breach of trust, it is the reimbursement that will be most affected.

Every reimbursement starts with medical billing, which is calculating the cost of administering medical services. Clinical documentation – which contains physicians’ narration of entire course of medical management – is the source on which billers rely upon in assigning monetary value to medical services. Because most of the physician documentation is supposed to be true, medical billing is as good as your clinical documentation. But, physicians, with all their good intention and focus, may not always be expected to document without omission or error. And any omission or error may either correspondingly reduce reimbursement or expose your bills to chances of denial or delay.

One way to do away with omission or error is to encourage doctors to check back on every chart before they move on to the next patient. But doctors are seemingly busy, and may not wish to keep the next patient waiting or compromise on clinical priorities. In such cases, internal staff may be assigned with the job of elaborating the doctor’s notes into comprehensive charge sheets or case summary. Training and orienting the so deputed staff is crucial before they take over the charge and start feeding medical billers with charge notes.

Clinical documentation has undergone remarkable changes recently – paper-based charts have given way to automated documentation. Medical practitioners are lot happier with pace and ease with which modern-day systems can generate voluminous reports that can easily be exchange across the health care network system. But, automated documentation is also inherent with investment, implementation, and training issues. Moreover, patient security and privacy may be at a higher risk from hacking concerns. All these issues may prompt the intervention of competent medical billing service providers who know how to upgrade providers’ internal clinical documentation in sync with medical billing and coding.

Medicalbillersandcoders.com – known for its catalytic role in clinical and operational management of a majority of medical practices across the 50 states – is prepared for the next challenge: changing face of clinical documentation in ICD-10 and HIPAA 5010. With the entire provider-fraternity transiting to a more robust, comprehensive, and technology-driven clinical documentation environment, it hopes to own up the responsibility of transformation. It is well-served by its core group, comprising clinical documentation specialist, expert medical billers and coders, and strategic partnership with best-known vendors of automated documentation systems. The fact that it has already executed documentation upgrading as part of its comprehensive RCM services is a testimony to its credential and competence.

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.

It Pays To Be a Medical Billing and Coding Specialist

Choice of a profession is determined by its stability against job market fluctuation, potential growth and monetary rewards. Medical billing and coding profession seem to be one those few professions that possess all these attributes. While professionals in other spheres are fighting lay-offs and salary cuts, medical billers and coders’ present and future looks highly secure. And it pays to be a medical billing and coding profession!

The primary reason behind this optimism is that care providers’ reliance on medical billers and coders will increase further. As the recent reform foretell major overhaul in coding and billing practices, providers may see it worthwhile to entrust an activity that is not their specialty. This shift in strategy could further increase the demand for qualified and competent medical billers and coders. It is worth remembering the U.S. Bureau of Labor Statistics (BLS) reports, which forecast a 20% growth in demand for medical and billing professionals between 2008 and 2018.

Second, the payback time for a medical billing and coding specialist is faster – it takes less than a year to complete a formal training, or about a year-and-a-half for an associate degree.  Therefore, you can expect to be industry-ready or certified professional within your budget. Moreover, with certainty of being employed in a secure and stable profession, you can easily recoup your investment in few months.

Third, training and education is unbelievably convenient – online medical billing and coding degree and diploma programs have virtually removed barriers of time and place. All you need to do is to select a credible source of training and education based your specialization. With so much convenience around, you should save considerable amount of time and money that would otherwise be spent conventional mode of training and education.

Fourth, medical billing and coding profession is not physically exhausting – most of your work is conducted through a computer, and it usually involves helping out your physicians and patient to avail the best possible medical reimbursements. Therefore, medical billers and coders are better off when compared with other healthcare personnel who usually work long hours and are required to move patients, stand or walk for long periods of time, clean up after patients and so on.

More importantly, profession in medical and billing offers flexibility to schedule your work hours based on your convenience. As providers are more inclined to outsource medical billing and coding from external consultants, there is an upsurge in home-based billers and coders, who seem more than pleased with the prospect of operating from the comfort of their homes, having a perfect balance between their personal and professional lives.

Medicalbillersandcoders.com – which has successfully orchestrated training and placement of a majority of medical billers and coders across 50 states – hopes to play a bigger catalytic role. Its core team of expert billers and coders, affinity with leading knowledge sources, and partnership with prospective employers will essentially be responsible for providing aspirants with a jump start to their career in medical and coding.

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.

Life as Medical Billers & Coders in Today’s Economy

The world’s largest economy has had to weather one of the worst recessions in the recent times. Not too long ago U.S. GDP hit the rock-bottom (at -8.9 in the middle of 2009). While it has slowly been coming out of the depths, the growth is not enough to bring down unemployment rate, which is hovering around 7.9% as of October, 2012. While most of the service sectors seem to have been affected uniformly, health care sector has remained an exception. And, medical billers and coders, being integral to health care industry, too have benefited from this. While, they have not been totally immune to lay-offs or salary cuts, at least percentage wise they are the least affected, with only 3-4% of the certified billers and coders being unable to find jobs.

The reason why medical billers & coders are least affected is health care is something indispensible – whether a positive GDP or negative, health care spending continues as usual, and providers’ reliance on billers and coders remains unaffected. The 3-4% unemployment is largely because of those billers losing jobs on account of being tied with lone-standing or small practices who may have decided to wind up operations. Otherwise, qualified and experienced professionals continue their lucrative association with clinics, hospitals, and group practices.

Being in a protective industry has surely helped them to be immune to the impact of the current economic scenario. But what is truly remarkable is the kind of flexibility and adaptation that these professionals exhibit in coping with adverse conditions.

What primarily stands out is their commitment to remain as competent as ever. Employers are increasingly growing quality conscious, and medical billers and coders are required to be as seamless as possible. Billers and coders are proving their mettle by undergoing refresher courses that keep them abreast with latest developments.

Networking with peers too is proving to be ingenious way to getting employed or reemployed. As per reliable statistics, over 38% of aspirants and professionals are known have followed networking as a means of finding employment opportunities.

Some professionals devised work-hour adjustment to adapt to these testing times. It is believed that currently there are two categories of professionals – one working an average of 31 to 40 hours per week, the other devoting an average of 41 to 71 hours per week. The former accounts for nearly 38% of the total medical billers and coders, and the latter constitutes 58% of the total medical billers and coders. Together, they have found a way out to remain active without being unemployed or unpaid.

There have also been instances of medical billers exhibiting extraordinary capacity for excellence, which have been suitable rewarded with health insurance & dental insurance through employer, sick leave from employer, and prompt benefits & incentives.

Therefore, it is apt to say that medical billers and coders have not been comforting under health care security, but responding creatively to evolving economic conditions. As a result, they have been able to remain least affected in terms of being unemployed or unpaid. It seems brighter days are ahead of them. In fact, The Bureau of Labor Statistics (BLS) reports that medical billing and coding will grow by 20% between 2008 and 2018, which is enough incentive for billers and coders to remain focused and optimistic.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – being a leading platform for provider-biller interface – is committed to help billers and coders maneuver through these testing times. Over the years, we have helped a majority of professionals connect with their true calling across 50 states in the US.  And, as we enter into a time of great transition, we are even more focused on facilitating right employee-employer connection, enriching professional experience, and more importantly promoting service excellence.

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.

Forecasting the Future of Medical Billing and Coding Post ICD-10

United States is on the verge of a major billing and coding reform – the introduction of ICD-10 in particular marks the beginning of the most robust, effective and efficient system of billing and coding ever to have been followed. While providers and payers will benefit from progressive changes, medical billers and coders will have the onus of keeping their expertise renewed from time to time. One of the best ways to be ready for future challenges is through preparedness based on forecast for a certain milestone period. 2020 happens to be that immediate milestone period.

Medical billing and coding will have undergone considerably sophistication by 2020. Amongst a number changes to impact billers and coders, following happen to be on top of the agenda:

• Progressive coding specificity
• Billing automation
• Career requirements

ICD-10 currently has 70,000 odd codes. And, given the progressive nature of ICD-10 coding system, it may have added a few more by 2020. All this extension means that coders will have to be conversant of codes as and when they added. Therefore, coders need to have access to such information from reliable sources.

Billing automation is another area that billers and coders need to watch out for. It is expected that the industry will have reached maximum automated billing and coding by 2020; paper medium will more or less have lost its edge. Therefore, professionals should continually seek upgrading their knowledge on billing and coding software. More importantly, they would be required to mediate EHR practices between providers and payers. Their employability will primarily decided by their technical competence.

While career opportunities will have risen considerable by 2O10, the skill-level too will have grown equally demanding. Among other professional traits, billers and coders ability to promote patients’ privacy and safety through confidential clinical documentation will have received utmost prominence. Therefore, it is crucial that aspiring professionals keep on conforming to evolving privacy and safety rules under HIPAA 5010. These fundamental requirements should not seem difficult given the prospects of rewarding career – The U.S. Bureau of Labor Statistics expects the growth to be around 16% till 2020, with an entry level salary of $35,010.

Billers and coders will continue to have a bright and promising future well beyond 2020. Even though technology will take-over manual operations, billers and coders’ personal touch will still be indispensable to efficient and effective medical billing management. This is precisely the reason to believe that they will have a secure future despite the accompanying challenges. Therefore, professionals should continue to be optimistic of the future.

As medical billers and coders look forward to a future of hope, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – the largest platform for career aspiration in medical billing and coding – is committed to help them navigate to successful career paths. While our core team of expert billers and coders helps improve your competence, our extensive network with employers facilitates compatible placement.

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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 a Medical Coding & Billing Job Offer You Healthcare’s Security from an Office Setting?

Career in health care industry has rarely been unsecure. While professionals in other sectors have had to undergo turbulent times recently, people in this priority sector have maintained steady progress despite economic reversals. And there are reasons to it: first, health care is indispensable; more significantly, it is supported by world’s largest public insurance schemes – Medicare and Medicaid; and the contribution of private insurance players is also noteworthy. This remarkable story of sustenance and growth does not end here. With the Federal Government extending public health insurance to every American, care providers, support staff, payers, and everyone related directly or indirectly to health care will have their future protected.

Amongst those who have been benefited most by the string of recent health care reforms are medical billing and coding professionals. While these reforms have made clinical documentation and operational management more complex for providers, they have opened up myriad of career opportunities for medical billers and coders. Providers now consider it impossible to manage mandatory EHR compliance and ICD-10 transition without the intervention of external billing and coding consultants. With so much of reliance, it is only fair to say that profession in medical billing and coding offers the most of the health care’s security.

Unlike most medical jobs, profession in medical billing and coding is easy to start off. Any graduate can aspire to become one. Financially too it is less burdensome – a qualification can be achieved with as less as $2,600. Aspirants can enroll themselves with Federal Government approved institutes for a formal certification program in medical billing and coding. With a few years of on-field experience, they can expect to be approached by leading hospitals, clinics, and physicians practices.

Medical coding and billing is equally rewarding too – an entry level salary is $35, 920, which can rise to $58,150 with a few years of experience. As for the opportunities and growth, medical billing and coding is expected to register 21% growth between 2010 and 2020, which is an unprecedented record.

Judging by the exponential growth in health care spending, providers’ shift to outsourced billing and coding operations, and an increasingly stringent multi-payer reimbursement environment, medical billers and coders’ significance will only increase further. According to the World Health Organization (WHO), total health care spending in the U.S. is the highest in the world. With the Health and Human Services (HHS) Department expecting health share of GDP to be at a historical high of 19.5% by 2017, medical billers and coders will be greatly required to mediate providers’ RCM process with payers.

With so much of growth potential around, aspiring professionals should be eying on their share of apple pie. Medicalbillersandcoders.com – which has been a leading launching platform for career in medical billing and coding – hopes to complement aspirants’ efforts with learning and employment resources. The fact that it mediates majority of provider-biller engagements is ample testimony of its credentials.

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 can Physicians Balance Roles at Work to Increase Medical Billing Efficiency of Their Clinic?

Over the last few years the healthcare system in the United States has witnessed modifications in policies and regulations, in order to make healthcare facilities cost effective and accessible to people from all income groups. However, a substantial percentage of the population still remains uninsured and the introduction of the Patient Protection & Affordable Care Act in 2010, aims to increase the number of people insured and make healthcare more patient friendly.

Doctors need sufficient face-to-face time with their patients to provide the best possible medical care. Changes in healthcare regulations and rise in the number of patients have raised the bar for services provided by physicians, hospitals as well as insurance companies. For instance, in the coming months, the insurance companies are obligated to cover sicker patients without asking for higher premiums and must cover preventive screening services for certain diseases. The physicians are expected to adopt health information technology; databases like EMR/EHR (for patient records), dealing with the insurance claims; billing details, coding, follow up on the claims and other technical responsibilities. They are also expected to be compliant with the regulations of HIPAA, CPT and the upcoming ICD-10 coding system.

Hence as healthcare providers get increasingly burdened with these challenging technical activities which require time and proper training to perform, physicians and other medical staff spend more than half of their time dealing with billing and insurance formalities when the same could be spent diagnosing & treating patients. However as physician’s core activity being patient care they are finding it increasingly difficult to balance their roles at work to increase revenue generation.

Inevitably lack of time and increased regulations can cause inaccurate coding, errors in patient records, failure to comply with the regulatory standards which are some of the issues faced by the physicians. In this scenario more and more physicians are facing delays in claims processing, rejection of claims, increased penalties etc. Moreover, incorporating IT systems for medical billing along with trained personnel can be a costly affair.

One of the most favorable solutions to this problem lies in – physicians outsourcing their paperwork requirements to medical billing companies – while they solely concentrate on patient care. Being specialists in medical billing the billing company’s support staffs are certified, up-to-date and have better infrastructure hence are able to easily manage the entire Revenue Cycle Management (RCM) along with denial management and appeals while conforming to patient confidentiality, offering physicians the balance required in their work.

MedicalBillersAndCoders.com has been providing assistance to physicians and healthcare organizations across 50 states in the United States to receive timely reimbursements for over a decade now. We have certified billers and coders who are well versed in handling all sorts of discrepancies & situations. We also provide professional solutions in medical billing, coding, RCM, denial management, along with regulatory compliance helping  physicians to balance their roles and concentrate mainly on patient care while we strive to achieve maximum & timely revenues for our physicians.

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 can A Medical Billing Service Help in Increasing Revenue at Your Practice?

Quality and cost have been inseparable. And, as U.S. health care industry is defined by new quality benchmarks, cost of administering medical services too seems be rising proportionately. While physicians continue to respond with appreciable clinical efficiency, they seem to have lost ways to find sustainable existence and growth. The existence of intense competition has forced them to operate at the most competitive prices, and off-set with volume. But, volume has failed to generate real revenues due to several reasons. As a result, many practices have either been forced to wind up operations or sell off.

One of the primary reasons for disproportionate revenues vis-à-vis actual volume is failed medical billing practices. Physician practices are either incompetent or lack the requisite infrastructure to take on the challenges of medical billing. The presence of multi-payer system too has not helped their cause. Medicare, Medicaid, and private payer environments pose unique challenges, which can be handled only by experts.

Sweeping health care reforms too have contributed to physicians’ billing woes. While reforms have generally been promulgated to streamline health care delivery and billing, physicians have found it tough to adapt to monumental transitions such as mandatory EHR compliance, ICD-10 coding, and performance-linked reimbursement regime or ACOs. There have also been instances of failed experiments on account of lack of expert or outside billing consultancy. The impact of these reasons is reflected in under-realization of claims, denials, and undesirable A/R days.

The solution to these inherent challenges lies in a full-pledged Revenue Cycle Management that can effectively mitigate under-realization of claims, denials, and undesirable A/R days. Physician practices that have been or likely to be impacted with revenue issues on account of internal billing incompetence and Federal Government’s clinical and operational reforms would do well to engage RCM consultancy that:

• Increases revenue collections by ensuring patients are eligible for medical services and verifying pre-authorization prior to the examination
• Allows tracking each stage of a claim or batch from first logged to posted payment
• Vigorously follows up with unresolved claims issues and diligently appeals denied claims
• Evaluates denial rationales and coding errors in order to establish follow-up procedures that maximize recovery rate
• Employs predictive modeling to forecast future revenue streams and support cash flow
• Is compliant with Medicare and HIPAA 5010 norms, and operates on certified EMR platform that satisfies HITECH requirements, qualifying physicians for performance incentives
• Provides unparalleled transparency through comprehensive reporting and web-based tools that let you manage performance

It is also imperative that your Revenue Cycle Management (RCM) provider follows the tried and tested process, which comprises orderly execution of patient pre-authorization, eligibility and benefits verification, claim submission, payment posting, denial management, A/R follow up, reporting, and litigation management.

Medicalbillersandcoders.com – with credentials and expertise in managing revenue cycle processes for physician practices of varying sizes across the 50 states in the United States – holds the reputation of being a leading RCM provider with a comprehensive approach, encompassing  patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices), insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), AR management (insurance and patient), and financial management reporting.

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.

Monitoring Potential for Up-Coding Errors in EHR with the Help of a Medical Billing Service

There has been considerable resolve and persuasion from the Federal Government to introduce Electronic Health Record System across the health care continuum. The Health Information Technology for Economic and Clinical Health (HITECH) Act has indeed given much impetus to pace of conversion from paper to electronic medium. The bait of financial incentives and penalties for complying with ‘Meaningful Use Criterion’ or otherwise has done wonders to the overall macro clinical efficiency as well physicians’ operational efficiency. In fact, no one would have foreseen the extent of transformation when the Federal Government first announced its major IT reform in 2009.

One of the significant advantages of EHR is that it has enormously simplified complex documenting during the billing process. As a result physician practices have been able manage higher level coding with far more degree of confidence than before. But, amidst all these catalytic effects of EHR, EHR is also known to have paved for errors that had not been possible with paper documentation. While EHR’s ‘cloning feature’ allows one to copy previous notes to current notes, it could also inherit errors in the previous notes or be filled with information that may not be pertinent to the current visit.

The consequence of such cloning is that it may promote coding inconsistencies or up-coding. While physicians may benefit initially with inflated reimbursements, they may be susceptible to audit later. Therefore, with their credibility at stake, they should see that EHR is utilized for the purpose it is meant for: safe and efficient patient care. Whether EHR errors come from system inadequacies or personnel incompetence during billing, physicians should actively involve themselves in resolving them through:

• Charting reviews while processing bills through electronic systems
• Sourcing EHR systems from vendors who promise what is right for you
• Generating baseline CPT frequency report of your E&M services for each provider before you adopt an EHR
• Evaluating variations in coding patterns
• Reviewing your practice records and looking for evidence of cloning or carrying forward notes on physical exams and patient histories
• Shutting down “auto-coder” if your EHR has one

Practically, it may seem too much to ask of physicians who are primarily motivated by clinical focus. The best recourse is to engage competent EHR consultants or medical billers and coders who offer EHR consultancy as an extended service. Medicalbillersandcoders.com– with an extended capability for EHR sourcing, implementing and monitoring for physician practices of varying sizes and specialties – should practically solve all of your EHR related woes. Our strategic alliance with leading EHR vendors will help you find custom-made EHR systems that make it easy to find out cloning and up-coding even before the claim is submitted to the payers or Medicare/Medicaid.

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.

Combining Medical Billing and Coding to Deliver Maximum Physician Revenue

'Medical billing’ and ‘Medical coding’ may have sometimes been used interchangeably to mean the act of claiming reimbursement from insurance payers, but essentially they are two separate and specialized jobs. Medical coding precedes medical billing, and it is irreversible. While a medical biller is entrusted with far more task than a coder, it is the quality of coding that largely decides the success of medical billing. That is why medical coding is often termed as a ‘specialty’ by itself while medical billing, its ‘sub-specialty’.

Medical coding is based on the descriptive narration of the medical services or procedures done by physicians. The coder assigns appropriate codes based on the physicians’ clinical summaries. Here, he may have to verify with diverse source points to validate the correctness of the physician summaries. Typically, he may have to rely on the transcription of the doctor’s notes, ordered laboratory tests, requested imaging studies and other sources. Such verification is necessary in avoiding denial, delay or exposure of claims to payer audit remarks.

Coder’s general responsibility is restricted to assigning CPT codes, ICD codes and HCPCS codes to both report the procedures that were performed and to provide the medical biller with the information necessary to process a claim for reimbursement by the appropriate insurance agency/s. But he may also be required to audit and re-file appeals of denied claims. In certain cases, coder may also educate providers and recommend the appropriate application of federal mandates and compliance that require providers to use specific coding and billing standards through chart audits.

Medical billing, on the other hand, is a series of activities culminating in ensuring maximum reimbursement for physicians. A medical biller job begins with filing insurance forms in the admissible formats with the payers. He may be required to clarify diagnoses or to obtain additional information so as to substantiate physician claims for reimbursement from payers. Like coder, he should also be familiar with CPT; HCPCS Level II and ICD CM codes to help him better understand the clinical summaries.

Apart from preparing invoices, medical biller may even be involved in rectifying past error on account of coding discrepancies. Collecting payments, making adjustments, interpreting Explanation of Benefits (EOBs), and handling denied claims, and processing appeals are all part and parcel of a biller’s routine.

Irrespective of whether coding and billing are done separately or by the same individual/s, the success of physician reimbursements depends on how best they complement each other. While medical practices used to manage coding and billing as a comprehensive internal function, it later started impacting their core function – clinical efficiency. Therefore, outsourced coding and billing became the accepted practice. And, with the US health care industry embracing its biggest billing and coding transition (ICD-10), along with the other reforms affecting the industry physicians’ reimbursement rates may further be impacted. Therefore, finding competent billing and RCM service providers makes much more sense than embarking on costly in-house practices, which may or may not yield the desired results.

Medicalbillersandcoders.com – with demonstrated ability in ensuring maximum reimbursement for a large pool of physician practices across the 50 states in the US – should be your first choice of billing and RCM services. Capable of maneuvering through multi-payer and ICD-10 environment, our billing services live up to being the most comprehensive with Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing services.

For more information visit : Medical Billing Blog

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.

Navigating through Regulatory Changes that Dramatically Affect Medical Billing

The limited reach of US healthcare network leaves a large part of American population outside the net of healthcare. This problem has stalked US governments traditionally and to expand the reach of healthcare to make healthcare available to a larger part of US population, successive governments (in varying degrees and as suited their political beliefs) have introduced regulations to make healthcare cheaper for and easily accessible to the care receiver.

In continuity of this tradition, the last few years under Obama administration have been witness to a flurry of regulations. Whilst one can argue that they have addressed the traditional concerns and empowered US healthcare to stand up to the challenges of technology and needs of modern day healthcare, the regulations have also affected the day-to-day healthcare operations carried out by medical practitioners coiling up every treatment procedure with regulatory activities burdening care providers with activities they neither have time nor qualification to perform.

The Affordable Care Act will expand the number of insured people by more than 30 million people. To restrict the increasing cost of Medicare, the act will create a panel of experts to prevent reimbursing for treatments not found effective and create incentives for healthcare providers to offer bundled payment modules to care receivers.

These are indeed very effective measures to take healthcare to lower income groups in the US and reduce healthcare costs, but they throw considerable operational challenges to healthcare operators. The effect of increase in number of insured Americans from a care provider standpoint is quite simple to understand: it will mean more regulatory responsibilities for care providers in way of having to deal with technical details related to billing and coding, using codes appropriately, etc., leading to not just time spent by them on nonmedical activities but also exposing them to the prospect of inaccuracies in preparing insurance claims resulting in claim denials.

However, the bundled payment aspect warrants a deeper look to understand the impact of regulations on day-to-day healthcare operations. A treatment episode is a sprawling affair. It includes various phases of treatment an individual goes through from pre-hospitalization diagnosis through hospitalization to post hospitalization care. Each one is a distinct healthcare activity and traditionally has had separate healthcare fees. Bundled payments club together the different fees associated with each phase of a treatment episode and offer the care receiver one fee for the entire treatment life-cycle, saving him money.

Albeit, this everything-rolled-together approach requires sound coordination among various specialties involved in a treatment episode for data sharing and final pulling together of medical information to prepare claims using appropriate codes for each phase of treatment. Big healthcare bodies have addressed some of these concerns (like internal coordination and easy availability of medical data while preparing claims) by making all the services available under one roof but are struggling with others, like using appropriate codes and spending resources (time and money) on non-medical activities, all leading to low rates of claim reimbursement and revenue leakage. Finding it difficult to withstand the financial onslaught wrought by denied claims and losing patients to big care providers, small operators have aligned themselves with big care providers losing their entrepreneurial independence.

Coping with the changes caused to medical billing:

The irony of this whole US healthcare industry saga is that what has caused this is not a healthcare issue but an administrative one. To handle this issue, a care provider either needs an in-house setup with a strong revenue management system staffed by well-trained billers and coders to handle the entire claim preparation process using appropriate codes and medical details where necessary and knowledge of software platforms to submit the claims electronically to ensure HIPPA compliance or needs to outsource the entire claim administration process to a biller and coder.

Medical Billers and Coders, the largest billing and coding consortium in the US,  has helped care providers in all 50 states of rural and urban US to address these issues helping them to save time and cost, an advantage they can divert to their core business, healthcare, and also share with the customer. MBC’s experienced billers and coders are familiar with all regulatory details and prepare claims with high degree of accuracy ensuring low rejection rates.

MBC can also spruce up your revenue management cycle by pruning up your processes, replacing your old software platforms with new and appropriate ones and training your staff in administrative details as also cross-functional competencies thus reducing your downtime and ensuring the continuity of your billing process in the absence of a staff.