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

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

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

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

How to make it happen?

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

Is AR management and medical billing restricting you?

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

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

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

Providers Acquiring Medical Billing Services To Handle the ACA Impact on Revenue

The Affordable Care Act has left the healthcare providers in the US worried. A survey conducted sometime back reported that 55% of hospitals expect a dip in their revenue while only 28% think that there would be an increase in revenue. But the survey also revealed that a considerable number of those who are informed about the impact of the healthcare reform (about 58 %) plan to become accountable care organization to reap financial benefit of the reform and improve the quality of care.

The 58 percent that revealed their plan to become ACO organization are well informed about the finer points of The Affordable Care Act as the law aims to set up a national pilot program to encourage care providers of various stripes (doctors, physicians etc) to coordinate and work together to improve quality of care so that they can be reimbursed through a flat fee (bundled payment) for a singular episode of care which the law supposes will lower expense and promote quality of care.

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However, the concerns of the 55% hospitals that expect a dip in revenue can’t be dismissed either. The insurance authorities propose to pay a flat payment to healthcare providers of different stripes who have come together and formed an ACO. The problem with this model is that it requires sound coordination among the various providers involved in a treatment episode to ensure a centralized collation of medical data which would be used to prepare claims and appropriate codes assigned to them.

Another concern that has worried healthcare providers is that this reform has a punitive nature to it. Millions of tax paying Americans eligible for government-subsidized healthcare coverage but without government-mandated health insurance coverage will be penalized with higher taxes unless they get an insurance policy within a year.

This is indeed good because it will induce more and more Americans to get health insurance bringing them into the net of national healthcare security. Albeit, the problem is this will require healthcare providers to assess insurance eligibility accurately, handle instances of unrealized partial payments where the patient’s bill exceeded his/her coverage, and of course a phenomenal increase in non-medical activities for healthcare providers to handle. Additionally, under ACA insurance providers will provide more coverage for preventive services and these services would have to be coded using separate CPT codes with enrollee-costs waived.

These concerns have sparked a trend where healthcare organizations that were handling their billing and coding responsibilities themselves until now are hiring the services of professional billers and coders. However, it’s important to remember that to handle the above challenges brought by ACA, a billing and coding organization needs to be familiar with the current procedures; be able to handle medical details coming from varied medical practices for preparing claims for bundled payments; be able to negotiate the additional red-tapism in submitting claims; and ensure timely payment of claims through post submission follow-ups.

MBC’s revenue management consulting has been helping physicians by performing a thorough analysis of the Revenue Management Cycle and ensuring that there is sound coordination between various components of healthcare leading to smooth flow of medical data. Our RCM services also involve identifying gaps in the process and addressing them by advising physicians while replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several small to medium size healthcare providers with its Outsourcing services. MBC handles the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups, along with regularly updating themselves about the changing healthcare industry trends.

Protecting Your Practice Against RAC Audits With the Help of Efficient Medical Billing Practices

Efficient medical billing practices can make or break your medical practice and if anything can verify this statement, it is an RAC audit. RAC audits of Recovery Audit Contractor audits are nothing short of a nightmare for any healthcare provider.

Medicare and Medicaid are two healthcare carriers that provide coverage and reimburse physicians and hospitals for the services they provide to patients covered under these carriers. However, medical practitioners are known to receive over-ayments due to incorrect claims or erroneous coding at the time of medical billing. In essence, government tries to ensure patients’ best interest and control the rate of fraud, error or wastage by putting RAC audits in place. But the resultant inconvenience caused to a medical practice in the event of an RAC audit is nothing short of disastrous.

Not only is error-free coding and meticulous book keeping of paramount importance, subsequent adjustment of office accounts can play an important role in case an RAC audit actually happens. To protect your practice against RAC audits, you must put efficient medical billing practices in place –

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• Follow correct coding for services –If a medical service is incorrectly coded for the sake of avoiding internal confusion or due to oversight and the incorrectly coded service is reimbursed by Medicare or Medicaid; then your practice can be in for an RAC audit. Transparent and efficient medical billing practices help you monitor coding of services on a regular basis and avoid simple yet latent disasters, hence with a little more attention, you can save your practice a lot of money and hassle.
  
• File claims for correct payment amounts – Scrutinizing the final claim statement filed with healthcare carriers is of paramount importance. If the government settled an incorrect payment amount to your practice, as long as five years ago (as per recent healthcare reforms, the RAC audit period for overpayment has been extended from three years to five years) then your current financials can suffer drastically. Diligent book-keeping is a medical billing practice that can help you avoid this scenario altogether.
  
• Avoid duplicate services – It may not be fraud at all, but mention of duplicate services is rarely ever seen as an honest human error by an auditor. A prudent medical billing practice is installing audit software or enlisting the service of a compliance auditor, to fix your errors before an actual audit.
  
• Don’t claim for non covered services – Services that are not necessary and reasonable under section 1862(a) (1) (A) of the social security act are not meant to be reimbursed by Medicare or Medicaid. Avoiding inclusion of the same in your claim amount can save you from a potential audit.

Medicalbillersandcoders.com an expert in medical billing and coding serving the healthcare industry for more than decade now can help protect your practice from potential RAC audits by offering immaculate medical billing consultancy and services.

RAC auditors conduct audits on providers in response to insider information or complaints, upon diagnosing irregularities in billing and coding practices as per the CERT or other CMS analysis. With comprehensive and efficient medical billing practices in place with the help of our experienced medical billers and coders, our client’s practices are well equipped with all the required defenses in place to protect themselves against an RAC audit.

Inevitability of the Electronic Radiology Practice and Its Effect on Radiology Billing

The advent of digital technology has been quite a boon to healthcare industry, more so to radiology, whose role in clinical diagnosis and planning the right course of medical intervention continues to be more critical than ever before. Physicians and patients’ reliance on digital or electronic radiology interpretation is so much that it is virtually impossible to practice radiology without a full-pledged digital or electronic radiology infrastructure. As a result, PACS and other web-based technology have become indispensable part of every radiology practice. While electronic radiology medium considerably reduces turnaround time and greatly enhances quality of image interpretation, radiologists may have to find ways to deal with its impact on Radiology Billing on account of:

• Rules governing billing of electronic radiology services,
• Complexities involved in billing, coding, and realization of radiology claims, and
• Voluminous increase in electronic radiology cases.

In view of these intervening factors, electronic radiology practices may well have to devise billing system that is web-enabled, allowing them to print statements, view accounts and even view radiology transcription reports on-line. Moreover, they would need to get their billing system, custom-designed to have full access to every component of billing data. Within this broader operational frame-work, they should have a team of coders, A/R managers, accountants, radiology practice managers, and data processors to work collectively to ensure that each charge is captured and billed accurately and on-time. These staff should be encouraged to monitor and update collection protocols to keep pace with the shifting regulatory conditions. While contract negotiations remain a paramount concern, it is imperative that your billing is complete with:

Best practices related to procedural codes, including HCPCS and modifiers, to ensure that you are coding for the highest revenue.

Understanding of payer rules, including medical necessity and NCCI rules, to help minimize chances of an audit.

Sophisticated medical billing system/electronic health record with advanced claim scrubbing capability

Facility for submitting both UB04 and CMS-1500 claims.

Facility to follow on denials or delinquent claims

The benefits of having such a well-rounded Medical Billing system is that it

Can enable HIPAA compliant clinical and operational practices

Generates monthly reports specific to radiologists’ needs

Helps retrieve the required reports and demographic data computer system.

Enables electronic billing to Medicare or commercial radiology insurance payers

Can confirm receipt of all electronic claims and produce error reports to identify claims that are incomplete

Can correct claims immediately and resubmits them for processing.

Facilitates scanning all demographic data, charge and payment data and other correspondence into the system to help in efficient follow up, thereby creating a paperless system.

And more importantly, helps in implementing strong denial management systems to resolve the pending claims.

While it may seem a daunting task to have such a comprehensive billing mechanism in place to counter the demands of billing electronic Radiology Services, outsourcing should make it a lot easier. And, when it comes to outsourcing medical billing and allied services, Medicalbillersandcoders.com has stood out to be a reliable platform for sourcing competent and experienced billing professionals. With a nation-wide affiliation with radiology billers, we look forward to arm radiology practices across the 50 states in the U.S. with exemplary radiology billing solutions.

Billing Specialists to Look After Major Billing Issues Likely to Be Faced By Radiologists in 2013

Radiologists, who have been striving to maintain a balance between diagnostic priorities and operational compliance, may well find pulled further into a host of billing and compliance issues throughout 2013:

To begin with, they will have to discern the vital connect between diagnosis coding and procedural coding systems and the systems that have evolved to provide a common method of describing diseases, diagnoses, and procedures.

Second, like in other disciplines, they may be bound by the medical necessity clause while diagnosing high-cost tests. In fact, Medicare requires that the medical necessity of high-cost diagnostic radiology tests be proved and the extent to which they may be prescribed for beneficiaries by either primary care physicians or physician specialists. Therefore, radiologists need to be aware of both the medical necessity as well as the extent to which beneficiaries are entitled for radiology reimbursement under Medicare, Medicaid, or commercial health insurance plans.

Third, admissible radiologic expenses for Part B imaging services may be rationalized on par with industry standards. As a result, radiologists may see their reimbursements dropping or appreciation depending on where they stand vis-à-vis industry standards.

More importantly, radiologists may be under increased monitoring for billing errors, and irregularities. It could even lead to being black-listed for repeated history of billing malfunction. Therefore, it may require a concerted effort to stay clear of being guilty under Medicare, Medicaid, and other HHS programs or commercial health insurance plans.

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These ensuing operational issues may prompt radiologists to:

Screen medical necessity and ask for advanced beneficiary notices (ABNs) on Medicare patients. This could require radiologists to function in tandem with the facility staff at the patient’s hospital to ensure the ABNs are accompanied by component fee as well.

Be prepared for Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs), which are integral to standard scrutinizing. This would call for tactical and shrewd documentation and explanation of the radiologic services billed for claiming.

Evaluate templates and exam titles in accordance with the prevailing standard of equipment, technique or procedure, and the admissible CPT codes as amended from time to time.

Establish smooth communication with billing processes during revision to equipment, techniques or procedures. This would ensure that the modifications are adequately reflected in coding and billing, and claims are devoid of either under-coding or up-coding.

Make provision for reporting discrepancies, such as number of views or extent of technical complexity. This could help radiologists recover maximum claims as well as minimize the chance of denials and auditing issues

Even as radiologists seek to implement tactical moves to counter the impact of billing issues, they may find themselves swayed more towards clinical focus. That is why it makes sense to hire Radiology Billing specialists for the purpose. Medicalbillersandcoders.com – having nation-wide affiliation with a chosen pool of radiology billing specialists – offers to deploy billing resources that are competent and experienced to address and maneuver radiologists through the billing issues likely to surface in 2013.

How Radiologists Can Refine Their Revenue Cycle Management (RCM) With Radiology Billing Specialists

The emphasis on Revenue Cycle Management could never have been so high as it is now – as radiologists begin to comply with of the Affordable Care Act’s (ACA) requirements, they would realize the importance of reinvent their billing and revenue cycle management process to suit the bundled care, shared risk, and quality-driven reimbursement models. With fee-for-service likely to be phased out in favor of value-based service model, radiologists’ revenues may be vulnerable to reductions or long hold-up at the hands of either public plans such as Medicare, Medicaid, or commercial payors. In fact, the population health management requires diagnostic radiologists to adopt shared-risk model with in a period of five years or so. Therefore, radiologists will be under the obligation to coordinate and conform to performance standards for diagnostic services, rendered to both Medicare-supported beneficiaries as well as commercial insurance beneficiaries.

While displaying the requisite level of diagnostic competence may qualify them for value-based reimbursements and incentives, it is no guarantee that they automatically get converted to monetary returns unless they have substantially modified their medical billing and RCM process to the demands of value-based reimbursement model. Notwithstanding radiologists’ internal billing resources, it may not be possible to maneuver through a more regulatory payment environment without an exclusive third party diagnostic radiology Revenue Cycle Management specialist or specialists. The advantage of having such specialists onboard your Radiology Billing and RCM is that they prove catalytic in the entire process of RCM cycle, comprising:

Credentialing with inclusion of turnkey services, payer enrollment and contracting, credentialing and verification services, state medical licensing services, and personalized attention for individuals or group radiologists

Patient Access with key demographic patient information – including name, social security number, and insurance coverage – to serves as the foundation for payment of services. It is critical that this information be accurate, and linked to other billing functions from centralized registration or pre-registration systems.

Accurate and timely charge capture to make sure that all radiology services produce payable claims; it may be remembered that reconciliation of procedures-to-charges will help confirm that an accurate number of claims have been generated.

Coding powered by automatic and electronic coding of ICD-9 and ICD-10 codes, supervised by trained coders that specialize in CPT, ER and E&M coding

Billing, complete with electronic claim submission, posting denials and aggressive follow up of delays and denials

Collection with emphasis on conversion of older account receivables first and within the permissible time limit.

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As radiologists seek to uplift their revenue fortunes with Radiology Billing Specialists, Medicablbillersandcoders.com offers to mediate the employment of radiology billing specialists, who are capable of:

• Keeping reimbursements as per negotiated fee schedules with Medicare, Medicaid, or commercial health insurance carriers
• Guaranteeing payment contracts as per prevailing market
• Minimizing A/R days through complete and timely charge capture
• Enhancing payment accuracy with line-item posting of charges and payments
• Averting risk through the industry’s most comprehensive compliance program

What Do Stage 2 Meaningful Use Guidelines Have in Store for Radiologists?

Stage 2 meaningful use guidelines are finally out, and radiologists may heave a sigh of relief since most of the ambiguity that existed in Stage 1 about their eligibility and the ways to approach the qualification criterion seem to have been made amply clear by CMS and the Office of the National Coordinator (ONC). The American College of Radiology (ACR) needs word praise for its relentless effort in getting most of the necessary changes made to radiology guidelines before the Stage 2 meaningful compliance regime comes into force.  While it is not before 2014 that radiologists should complying with newly laid out guidelines, it may still require some crucial adjustments in processes and technology to be fully ready for compliance and qualification under State 2 of meaningful use criterion.

Even as the Stage 2 requirements offer clarity for how computerized physician order entry (CPOE) will impact radiology, providers would still be required to use CPOE to order more than 30 percent — instead of the 60 percent CMS originally proposed — of radiology procedures during an EHR reporting period in order to qualify for MU incentive payments. Therefore, the necessity of having an efficient and effective computerized physician order entry (CPOE) would still be there.

As regards the problem of complying with the MU requirements on account of rarity of face-to-face contact with patients, radiologists and other providers may get reprieve from noncompliance penalties, but still they would be required to be versatile with specialty codes use in the Provider Enrollment Chain and Ownership System (PECOS). And this proficiency in using the Provider Enrollment Chain and Ownership System (PECOS) would definitely require specialized training or they might have to appoint external coding specialists for the purpose.

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While Stage 2 rules do not require an EHR to store images, providers or radiologist would still be required to ensure that they an active link to the images. Despite the initially proposed linkage of 40% being brought down to 10% finally, it would still be quite a task to keep those 10% active as and when required for clinical study, interpretation, or sought by patients for various documentation needs.

Along with these inherent challenges, providers or radiologists may still have to sort out the issue with employing clinical decision support (CDS) as The Stage 2 rules to do not expand the definition of CPOE to include computerized decision support (CDS). Also, there may be issues with transporting images in the absence of clear cut rules even in Stage 2. While DICOM mode can be relied upon for secure encoding images,   IHE profiles, such as XDS-I and XDR-I would still have to be sent via secure email, which may sometimes be vulnerable to security and privacy threats. Therefore, it could require a dedicated monitoring to see that such files are not exposed to threats.

Amidst managing as critical a practice as radiology, complying with these set of Stage 2 guidelines for meaningful use might either be too demanding or detrimental to the very purpose of diagnostic or imaging excellence.  Medicalbillersandcoders.com – with an objective to ensure diagnostic or imaging excellence unaffected by Stage 2 demands – has offered to mediate the deployment of Radiology Billing specialists that have the requisite competence and experience to implement processes and technology on behalf of radiologists, seeking to comply with the Stage 2 guidelines, and qualify for incentives.

What Implication Will Reimbursement Cuts For 2013 Have on Radiology Collections?

Radiology collections, which have been far from being impressive in the recent years, may further go down amidst a host of issues likely to surface throughout 2013. Significant of those issues is the reimbursement cuts, which is supposed to lead to a reduction of almost 19% in the collections of radiology practices. Further, a 25% cut in payments for imaging services has not gone down well with providers, who may eventually be discouraged to comply and continue with revised guidelines.

Closely on the heels of this monumental cut in reimbursements, radiologists seem to be overwhelmed by the demands of Meaningful Use (MU) requirements. While the stage 2 of ‘meaningful use’ promises to be lot easier to comply by, it is highly impossible to predict whole-hearted participation – as much as 40% of radiologists are reported to have stayed from the MU bandwagon, citing reasons such as lack clarity in the program and seemingly unbearable costs associated with it. Therefore, we might as well see radiologists losing collections on account being non-compliant with MU requirements. While the absence of mandatory penalties might seem to be reason for their reluctance, other priority tasks too may have limited their financial and entrepreneurial abilities.

Other than these compliance, lowered payments and Radiology Billing issues, the core clinical issues often seem to consume most of radiologists’ time and resources. As a result, despite the heavy investments, they may continue to have reduced radiology collections. Therefore, it is important that radiologists have or source the expertise to balance clinical as well business side of their practices. The utility of having such expertise is that radiologists will be able to:

• Successfully adapt to meaningful use guidelines
  
  
• Better appreciate changing regulations
  
  
• Manage radiology collections better despite the reimbursement cuts, and
  
  
• Qualify for financial incentives under Meaningful Use criterion and PQRS reporting standards

If the expertise is hard to come by internally, Radiology Billing Outsourcing may possible have answers to every clinical and operational issue, and save radiology practices going into further clinical and financial crisis. The significant advantage of outsourcing is that they come at a price far less than what they would cost if carried out internally. Moreover, it gives ample scope for concentrating on more important aspect – evolving with clinical standards for diagnostic and imaging services. With financial incentive schemes not likely to be stretched beyond 2016, time may be running out for radiologists who have not preparation as yet.

And, those radiology practices that are willing try out Outsourced Radiology Billing Practices to offset the implication of reform measures, Medicalbillersandcoders.com offers the right platform to source radiology billing services from chosen pool of radiology billing specialists. With an in-depth expertise and substantial experience in mediating change-over and adaptation to clinical and operational reforms, these experts may well be crucial in keeping your radiology collections as healthy as possible.

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.