Predicting the scope of medical billing consultants after 2014 and beyond

Although it has been quite a while since the Federal Government announced a series of far-reaching healthcare reforms, we are yet to experience their full impact across the healthcare continuum. And, with the Senate bill deferring a major chunk of the reforms further, it is expected that we may have to wait as late as 2014 to witness their full impact.

Amongst a string of reforms that will take effect from 2014 are the ones emanating from the Patient Protection and Affordable Care Act, which will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act:

• Access to affordable coverage for the uninsured with pre-existing conditions, which means the act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions

• Re-insurance for Retiree Health Benefit Plans, wherein the act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees

• Closing the Coverage Gap in the Medicare (Part D) Drug Benefit, under which the act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500. There would also be guarantee of 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap

• Extension of dependent coverage for young adults, wherein act requires insurers to permit children to stay on family policies until age 26

Coupled with this set of reforms, which are believed to improve physicians’ revenues, there are also reforms that are likely to test their ability to practice delay-and-denial-free reimbursement practices:

• The Accountable Care Organization Model, which requires physicians to realign their practices in congruence with Medicare incentive framework

• The ghost of Sustainable Growth Rate (SGR) fix, which threatens to substantially erode physicians’ share of Medicare reimbursements

• Last but not the least, the radical ICD-10 and HIPAA 5010 compliant clinical and coding practices, which, though indispensable to reduce healthcare fraud and abuse, are going to force medical practices into a more stringent reimbursement environment than ever

While the impact of the ensuing healthcare reforms are going to be felt across the whole healthcare continuum, it is the medical billing practices that would be most affected. Therefore, it is going to be crucial that medical billers and coders respond with highest degree of professional dynamism to mitigate the chances of physicians’ medical claims running the risk of denial or delay. When one thinks of the possible areas that medical billers and coders would be addressing post 2014, the following come up to the fore:

1. Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
2. Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
3. Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
4. Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physicians’ medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
5. Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
6. Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s Medical Billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

As physicians, in the wake of these sweeping healthcare reforms, look to elevate their billing and coding practices through outsourced Medical Billing Services, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – should be a preferential choice for streamlined medical billing practices.

HIPAA 5010 enforcement delayed to ensure doctors & entities complete transition

Enforcement of HIPAA 5010 transactions on March 15, 2012, was delayed for the second time for another 3 months by the government, with the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) pushing the date further to June 30, 2012, in order to not compromise physician cash flow. Physicians have previously communicated to AMA significant cash flow problems they encountered associated with the transition to HIPAA Version 5010. Essentially the rule called for compliance by January 1, 2012, however earlier on November 17, 2011 OESS announced its first enforcement delay of three months, referring to the move as “enforcement discretion”.

OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format

Commercial plans are reporting similar numbers

State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

How are States retaining physicians in times of shortage?

Physician shortages is a growing concern and is pushing various states to keep doctors trained in medical schools and residency programs from crossing state lines to practice medicine. According to new statistics from the Assn. of American Medical Colleges- nationwide, there were 258.7 active physicians per 100,000 people and in individual states, ratios range from a high of 415.5 physicians per 100,000 people in Massachusetts to a low of 176.4 per 100,000 in Mississippi. 

In this scenario medical school, hospitals, medical societies and state legislatures are increasingly taking a practical approach to retain the physicians and doctors-in-training in their state. According to a report by AAMC Center for Workforce Studies on average: 

39% of U.S. physicians practice	State where they went to medical school
48% of U.S. physicians practice	State where they completed graduate medical education

Methods adopted by states to retain physicians 

AAMC projections depict that physician shortages nationwide are projected to reach 62,900 doctors by 2015 and 91,500 by 2020 and several states to retain physicians have: 

• Opened new medical schools or expanded existing ones 

• Are offering incentives such as bonuses, scholarships or loan repayment programs to physicians 

• Communities are developing new residency programs with the aim that physicians will develop long-term professional and personal relationships during GME training and keep them from moving out 

• Certain schools’ mission is to train physicians from their states to practice in their states. However states need enough GME training positions else this efforts are wasted as then physicians will shift to another state 

Iowa is below national average retaining 22% of its medical school graduates and 37% of physicians who complete GME training in the state and several efforts in Iowa have been designed to attract physicians to stay in the state. Several other states including Kansas, Mississippi and Alabama offer loan repayment programs for doctors to practice locally. 

In Oklahoma, the state offers scholarships and loans to medical students and residents who agree to practice in rural Oklahoma for a set amount of time. Hence Oklahoma is above national averages, retaining 48% of its medical school graduates and 52% of physicians who complete residency training. 

Physician adapting to this shortage 

Higher revenues and incentives would attract more physicians to the profession and also keep doctors from moving out from states. Healthcare reforms are striving to improve quality of care and physician incentives, to entice more doctors to stay in the profession; but this leaves doctors with little time to balance both patient care and Revenue Cycle Management. As physicians move towards a value based system of healthcare delivery, they would be well-off by partnering with experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization. 

Medicalbillersandcoders.com experienced in offering cost-optimizing and revenue-maximizing Medical Billing Revenue Cycle Management in tandem with their goal to assist healthcare should be able to play an essential role in making physicians’ transition towards a value based model easier and profitable, hence also helping towards eliminating physician shortage in the long term.

Medical Billing Companies: Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Medical Billing Companies: Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Electronic Health Records spurring hiring of staff besides adding to costs at physicians practice

Electronic Health Records (EHRs) are complex systems and a dedicated team of professionals are required for handling and maintaining these systems for smooth operation of such records. The drawbacks of paper based records, the projected advantages of EHRs, and the incentives offered along with the penalties for non-adoption of EHRs are driving hospitals and small practices towards implementing EHR related policies. There are numerous reasons for the slow rate of adoption of EHRs and range from reluctance to accept new technology, the changes brought about by government intervention and practical causes such as financial burdens, increased amount of work and shortage of time. 

Although there are challenges in the initial stages of implementing EHRs, the benefits in the long run are holistic in nature and can benefit physicians as well as consumers. One of the important aspects of the financial and professional growth of the practice is the maintenance of the viability of the equipment and the resources available for efficient operation. One of the important steps in ensuring such efficient operation is the hiring of reliable staff that are not only educated in their own profession  but are also computer savvy and familiar with EHRs and such other systems required for everyday activities. 

Some other factors that may add to the costs are health IT services which are a recurring one along with some other costs such as upgrading the system and keeping the systems secure as per HIPAA guidelines. However, the fact that the initial cost of EHR would be offset due to the incentives provided and the benefits in the long run, financially or otherwise, cannot be denied. The costs of EMR or EHR implementation and maintenance can be reduced by using various methods to streamline the departmental processes by optimizing services such as revenue cycle management and denial management along with numerous other services. These processes require accuracy in order to reduce duplication and rejection of claims, and errors while billing and coding. 

Professional medical billing and coding companies can provide dedicated services such as payment posting, where accurate comprehension of Explanation of benefits (EOB) is required, and accounts receivable where time is the most crucial factor in receipt of accurate reimbursement. Moreover, the advent of EHRs and numerous new polices, physicians are trying to hire more staff for health IT support which is in short supply. Costs of health IT services for upkeep of successful EHRs are rising and some of the ways of cutting costs is to outsource as many departmental processes as possible in order to find relief from some financial burden. 

Medical billing and coding companies that offer specialized services in this field not just cater to physicians’ billing and coding needs but also provide numerous other services. Medical billers and coders at www.medicalbillersandcoders.com offer other value added services such as physician credentialing, consultancy and denial management.