Simplify EHR Systems by Restructuring Your Medical Billing

EHR systems have changed over the last decade and the health reforms have given new meaning to such systems by making rules regarding ‘Meaningful Use” (MU) of such systems. Older versions of EHRs were simple digitized versions replacing paper based records and did not have the specific guidelines in MU to be implemented for the incentives. However, almost all EHR vendors now are MU compliant but only 10.1% of physicians in the country have a fully functional EHR system. This is due to the fact that those who have a basic system are not equipped with features to handle MU compliance along with the changing face of the health industry including the attitudes of payers towards billing processes.

A report prepared by the University of North Texas on providing – Guidance in Documentation, Coding, and Billing of Medical Services for Compliance-  clarifies the documentation and billing requirements and also the general rules to be followed while documenting. For instance – the medical record should be complete without any errors and the documentation of each patient should include the reason for encounter, relevant history, prior diagnostic test results, and physical examination findings. The past and present diagnoses should be accessible to the consulting or treating physician, the patients progress is to be documented and appropriate health risk factors identified. The code reported on the claim form or billing statement needs to be supported by documentation in the medial record.

Hence the requirement for a separate billing system can be felt and is one of the solutions for such complex compliance requirements and the above subset of information can be sent to a billing system designed to specifically handle such information. There are numerous other documentation standards that need to be observed and these standards are easily handled by EHRs and can be made to fit the billing system. The information corresponding to all the documentation standards mentioned above can be sent directly to the billing system at the time of the visit, making the whole process smoother. Moreover, HIPAA compliance can be easily observed because the medical documentation is stored in the billing system and does not require the clerical staff to access the actual EHR.

Billing and related processes need to be reorganized to fit the requirements of not just MU compliant EHR systems but also for accurate and timely reimbursements. These documentation standards and compliance are extremely important in light of the way in which payment models are changing in the industry. Physicians would be paid according to the quality of the service provided and the outcomes rather than the traditional per-patient method. For more information about medical billing processes and to restructure your billing and assistance with EHR implementation, visit www.medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States that also provides services such as revenue cycle management, denial management, and consultancy.

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.

Effects on Physicians reimbursements: Insurance Denials and uncertainty of health reforms

Insurance denials are one of the major factors that affect a physician’s revenue even though health reforms do address some issues faced by patients and physicians in dealing with insurance companies, the denial rate of claims has not significantly altered due to such reforms. These insurance denials are avoidable especially as they create problems for physicians and providers and delay or even eliminate the possibility of proper provider reimbursement. Dealing with insurance companies is tough enough for experienced physicians; it is even tougher for new physicians who have limited hands-on experience in such matters.

The reforms have played a significant role in reining in insurance companies and some of these policies may work but still remain to be fully tested. The survey conducted by The United States Department of Health and Human Services finds that the rate of denial is 19% but the denial rate increases with the age group of the patient. People who are older face more denials compared to young individuals and this is a worrying trend for a population which is continuously aging. The Government Accountability Office (GAO) has released a report on insurance denials which sheds some light on the nature of insurance denials- it states that in many cases the denied claim, if appealed, is often reversed. This survey also clarifies that the number of denials due to the inappropriateness of the service provided by the physician are less than those because of billing errors and eligibility issues.

The health reforms are going to  affect the insurance scenario in the sense that as now even people with pre-existing conditions can get insurance- this essentially means that physicians are more likely to see increased number of sick patients which in turn would increase the average physician-patient encounter time. The other aspects that will affect the insurance scenario in the country are that since there would be a large influx of consumers in the form of the previously uninsured 32 million Americans which would benefit the insurance companies to grow. However, initially insurance providers would see a drop in their revenue due to decreased profits and increasing number of claims.

Physicians and providers stand to gain from the health reforms in the long run and the way in which these new policies will affect payers even though some payers may decrease the Physician Reimbursement amount. Nevertheless, insurance denials are always going to be one of the major problems that providers will have to face in the future even after the implementation of reform policies.

The best way to deal with insurance denials is to ensure that denial management and payer interaction are performed by experienced professionals for better results. Such denial management and payer interaction can be performed in a professional and efficient manner by the largest consortium of medical billers and coders in the United States, medicalbillersandcoders.com Billers and coders in the consortium can not only assist in better Denial Management and payer interaction but also offer numerous other value added services such as revenue cycle management, research, and consultancy.

US Healthcare adapting to Reforms: Hospitals to Ease Physician Shortages

The health reforms have affected every aspect of the health care delivery system in the United States and smaller and solo practices in the country are finding it difficult to cope with the changes on almost every level of health care delivery. The changes in health IT sector, policies in government intervention, and changing reimbursement models are making it difficult for solo and small practices to cope with all these changes financially as well as functionally. Physicians as one of the options are turning towards hospitals and large group practices for better job prospects with reduced amount of responsibility.

The challenges faced by small and solo practices are not just limited to the core aspects of health care delivery. These challenges can range from functional impairments, workflow redesigns and other financial factors. The amount of work required to comply with the health reform guidelines is not just limited to implementation of EMRs and EHRs and ‘Meaningful Use’ objectives but also entails numerous other responsibilities in the form of maintenance of such EHR systems and changes in various departmental processes that are essential for boosting revenues. Increasingly physicians are struggling to find a holistic approach towards the practice and succeed due to the new reform guidelines that are complex and exhaustive in nature.

Hospitals are also taking steps in order to boost the revenue and streamline various processes by forming tie-ups with other group of physicians and hospitals. This not only encourages innovation but also cuts costs and saves time. This can also be a solution for reducing the shortages of physicians by giving an opportunity to those physicians who would have failed in Meaningful Use implementation or had decided to stop practicing due to the complex guidelines of the health reforms. Moreover, the implementation of successful Meaningful Use is carried by more physicians since they have the support of hospitals and larger clinics to comply with reform guidelines.

Due to the many reasons cited above, hospitals are starting to recruit physicians who are finding it very challenging to cope with the recent changes in the health industry. This can obviously help in relieving the pressures in big and medium sized hospitals and give an opportunity for better health outcomes. Such services backed up by departmental processes such as medical billing and coding, revenue cycle management, better accounts receivable handling, active interaction with payers offered by www.medicalbillersandcoders.com can assist any hospital in properly handing the financial side of the health care delivery.

What does the latest ICD-10 delay mean to your medical practices?

The persistent appeal for pushing back the ICD-10 compliance date has finally paid off for physicians; the US Department of Health and Human Services (HHS) has made it official that physicians would have time till October1, 2014 (revised from the current deadline of October1, 2013) to comply with ICD-10 system of medical coding. The decision to extend the deadline is seen as a positive response to a majority of physicians who felt the original deadline too narrow to comply by voluminous and complex coding system.

While the latest revision would no doubt give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets, it would also delay stage 2 implementation, which requires medical practices to have demonstrated minimum duration of compliance in stage 1. Consequently, those physicians who started with the preparation as early as 2011 will get to progress to the stage 2 earlier than those who start with the stage 1 as late as October 1, 2014.

Along with this differential in progressing to the stage 2 of ICD-10 compliance, it is also important to know how this delay is going to play out in detecting the pace of ICD-10 implementation by physicians. While the one-year delay comes as a much needed relief for those practices that are yet to embark on the transition, it is also a sort of cushion for those who have actually started with the process and are on course to be ready by previous deadline.

The early adapters can use this opportunity to identify and focus on areas where they may have some weaknesses. The advice holds good even for those medical practices that are moving along nicely:

• This unique scenario gives them enough time to streamline areas of their program that were potentially weak
• Create a create a truly robust approach to test the company under ICD-10
• Leverage trading partners in a pilot environment and focus on the risky areas that require time and attention

Conversely, the late adapters – those physicians that are not on course for the compliance by the October 2013 date– would do well not to procrastinate further but use this leeway for earnestly training on ICD-10 compliant medical coding. While they are numerous sources that offer ICD-10 training programs, physicians would do well to trust the proven credentials of Medicalbilliersandcoders.com (www.medicalbillersandcoders.com), which has rightfully earned their name as the leading consortium of medical billers and coders in the U.S.

Specifically designed to address challenges in ICD-10 implementation, its ICD-10 Compliance Training Program should come handy for both early adapters as well as late adapters.  Spread over two phases of intense training – phase 1 comprises updates sharing & building base for latest coding updates in about 35 weeks, and phase 2 covers the real ICD-10 Training – the program seeks to enrich participants’ knowledge base through a value-combination: transition tips from ICD9 to ICD 10, problem solving webinars, weekly updates on ICD implementation, FAQ documents on ICD 10, coding practices forum with other experts and participants.

Practice Owners face challenges with EHR adoption: Possible Solutions

The adoption of Electronic Health Records (EHRs) presents numerous challenges for physicians and many practices are finding it difficult to successfully adopt EHRs. The data released by the Center for Disease Control and Prevention about EHR adoption rates in the country bears witness to the fact that adoption rates are not what they need to be in order to have a positive effect on the health industry. Although more than 50% of office based physicians in the country have some type of EMR/EHR, only about 10% of office based physicians in the country have a fully functional EMR/EHR system. 

Originally EHRs were designed for hospitals and smaller practices and practice owners have found it difficult to adopt such system due to many reasons. The resources required for successful implementation of EHRs are easily available for big hospitals compared to smaller practices. These resources usually include a trained staff for operation of EHRs/EMRs, IT consultants, and maintenance of such systems which requires finances that are easily obtainable in a hospital setting but become difficult to obtain in a small practice. Practice Owners are struggling to meet the ‘Meaningful Use’ (MU) criteria and even though more than half the office based physicians in the country have some sort of EHR/EMR, they do not meet the criteria required for enjoying the incentives through MU. 

Additionally Practices Owners already possessing a basic EHR system are facing challenges in scrapping the old system and starting with a certified new EHR – as certification itself is confusing and upgrading to a certified EHR and scrapping the older system is a costly and cumbersome process. Besides the maintenance and upkeep of the system is also costly and requires skilled resources to work in an efficient manner. The adoption of EHR also entails redesigning the workflow of a practice and this too is a difficult task in both small as well as bigger settings. For instance, physicians would need more time to comply with the MU policies by entering various observations and facts in the system which would require rescheduling of the way in which a practice works. Complying with MU guidelines for all specialties in a similar manner is also not easy as many specialties need to modify these guidelines to suit their line of work. 

There are numerous other challenges in adopting an efficient and MU compliant EHR system and the increasing number of patients due to the newly insured 31 million citizens is compounding the adoption problems. Physicians need to start addressing these problems not just to qualify for the incentives but also to escape the penalties imposed for non-adoption of EHRs. Successful adoption of EHRs can be made feasible by hiring professionals who have experience in this field and can assist in streamlining all the departmental processes in order to optimally utilize such systems. Medical billers at www.medialbillersandcoders.com can not only provide billing and coding services but also the latest in certified EHR technology along with optimization of other processes such as Revenue Cycle Management and denial management along with other value added services to boost the performance of your practice.

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