Practicing Medicine in Multiple States: Inherent medical billing challenges

Contrary to single-location practices that were the norms during olden days, the recent trend has been the exploring of practice opportunities in multiple locations. It is not strange for a medical practice/clinic/hospital to expand its operations beyond the original location once it has built up a considerable reputation. Moreover, multiple-location operation has its own advantages: economies of large-scale operations, regional advantages, off-setting adverse practice results in some dormant locations against the profitable locations, and above all nurturing the vision of nation-wide presence.

While some of these expansions are well-planned, often there have been cases that emerge as reflexive actions to situations or circumstances. And these circumstantial expansions are the ones that will be vulnerable to regional rules and regulations. Although, the U.S. healthcare norms generally tend to be rationalized, yet each of the Federal states does exercise some degree of authority when it comes to governing certain clinical and operational functions. Therefore, it is imperative that physicians/clinics/hospitals on the verge of expansion plans realize, anticipate, and respond positively to the advantages and restrictions in the states in which they embark on clinical practices desire to have a presence.

• One of the foremost issues associated with multiple-location operations is the registration. Although, your practice, clinic or practice is licensed to be clinical operational entity, yet you still require to be registered in each of the states you intend to expand yours operations to. Failure to comply with this norm will be deemed as violation of the law, and state will have every right to expel your operations from the state/s concerned.
• Rules regarding fee-splitting, corporate practice of medicine and scope of practice vary from state to state. As these diverse rules directly impact your contracts and compensation methodologies, it is important to be mindful of diverse rules prior to foraying into multiple-location practice.
• Insurance agreement regarding employees and contractors are governed differently across the states. Therefore, it is necessary to get your agreements tailor-made to the governing rules of the state/s you intend to open your practice.
• Medicare billing requirements too vary across the states. Therefore, it is crucial to adapt to the requirements of the state with regard to local coverage decisions and other factors. Certain states may audit more than others or have other unfamiliar requirements to which you will need to adapt.
• Certain states do not encourage professionals with multiple operating licenses. Therefore, it is important verify your physicians’ operating license before taking them on board while expanding your business operations to multiple states or states with such restrictions.
• Certain states have their own policies when it comes to monitoring marketing communication associated with healthcare. Therefore, it is important you know what is allowed to be communicated and what is not.
• There are also state-specific laws that govern practices operating over the internet or telecommunication medium. Therefore, it is important that you know and respect the laws that govern dissemination or exchange of healthcare data over this medium.

While these are apparent issues associated with operating in multiple locations, there could be more that are often elusive but pertinent to physicians/hospitals’ clinical and operational excellence. Moreover, negligent attitude to them can adversely impact both clinical and operational efficiency. Physicians, who may not be in a position to track such elusive factors, need necessarily have to solicit expert advice from competent and credible sources. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – providing medical billing services across all 50 US states, being the largest consortium of medical billers and coders competent to advice on diverse clinical and operational rules prevalent in diverse states across the U.S – comes across a preferential name in the healthcare services outsourcing industry.

Driving patient engagement through healthcare-based social media

From seemingly innocuous platforms for personal interaction amongst registered community members, social media (comprising Face Book, Twitter, and other interactive sites) has emerged as a powerful channel for marketing. In fact, its business-utility has grown to so much that it has evolved to be a parallel channel to the traditional mode of advertising of products and services. And, with healthcare being no exception, has slowly but surely embracing it in what has come to be recognized as “healthcare-based social media”.

As healthcare-base social media has the potential not only to drive stakeholders’ (providers, payers, and pharmaceutical companies) offers to the target population (patient community), but also encourage patient engagement through interactive communication, there is a growing realization that social media needs to implemented in such that best serves both business as well as welfare of the patient community at large. While stakeholders devise unique social media strategies for attracting substantial healthcare market for their products and service offers, the response from the patient community seems to be quite encouraging. According to a recent study from PwC’s Health Research Institute, 40 percent of the sample population has been found to be using social media to find health-related consumer reviews. Twenty-five percent have been found to use social media for “posting” about their health experience; and 20 percent have joined a health forum or community. Forty-one percent of the respondents have confessed that social media would affect their choice of a specific doctor, hospital or medical facility, while forty-five percent of them have even said it would affect their decision to get a second opinion.

The survey results are sure indicator of growing interest from patients in using social media platforms, such as Face book, Twitter or a patient-based community site like Patients Like Me, to share and engage in their experiences. Now the only it is imperative that providers, payers, and even pharmaceutical companies put themselves in position where they can listen to the conversation that is happening in social media, decipher patients’ expectations, and engage them with amicable solutions. The initiative of some organizations in devising unique social media initiatives should instill others to follow. These leaders have developed both internal and external media platforms – the internal system allows for knowledge sharing, innovation, and communication across their wide spectrum, while the external platform allows for patients to create communities and find legitimate medical information.

Therefore, there is really shift from using social media as a mere marketing tool to being a patient-engagement tool. The fact that the PwC survey found 80% of the 124 members (comprising providers, payers, and pharmaceutical organizations) is itself is an endorsement of this shift towards engagement model of service through social media platforms.

While there can be no denying as to social media’s potential to impact patient engagement and involvement, connectivity between individuals, and flow of information across the macro healthcare continuum, there is always an undercurrent of it being susceptible to privacy concerns. As more physicians and healthcare organizations move to social media, its misuse will increase the exposure of Protected Healthcare Information (PHI).  Consequently, they may have to face the wrath of the governing body, such as HIPAA, which restricts and prohibits the circulation of clinical information that infringes patients’ privacy norms. Therefore, providers, payers, and pharmaceutical companies need to get their social media platforms customized and run in congruence with HIPAA mandate to avoid being dragged into any legal issue.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long standing reputation for credible and comprehensive solutions comprising the entire gamut of clinical and operational management – is poised to play a catalyst-role for those embracing social media as a channel for offering their healthcare products and services.

For More Information Regarding medical billing Or Even Medical Billing Companies.

Exodus to hospital-based employment and its effect on healthcare industry

While the recent healthcare reforms ushered in by the Federal Government promises to elevate clinical and operational efficiency across the nation’s healthcare continuum, it is also going to induce physicians into a more accountable and responsible quality clinical regime. The imminent Accountable Care Organization Model, Medicare cuts, the fear of Sustainable Growth Rate (SGR) backlash, the compulsory implementation of EHR, coupled with the monumental shift to ICD-10 and HIPAA 5010 compliant medical billing and coding have begun to take heavy toll of lone-standing clinical practices. The effective influence of these factors is showing up in an unprecedented exodus to hospital-based employment by both new entrants as well as those that have been practicing for a considerable period of time.

A recent study by the Medical Group Management Association (MGMA) quite endorses this shift to hospital-based employment: 65% of physicians that changed jobs recently have all moved into a hospital employment model. What is more interesting is that the propensity to this model is more common amongst new entrants – almost half of new fellows across all specialties are in favor of hospital-based employment. The shift has really assumed a gigantic proportion. And, when we begin to trace the reasons behind this radical shift, we are invariably led to the following interesting factors:

• The new entrants may not be in a position to match up to the administrative challenges associated with running a medical practice; whereas seasoned practitioners seem to have had enough of their share of administrative challenges
• Many associate hospital employment with a source of secure salary, which might take years in private practice. Therefore, most of the entrants view hospital employment as a safer bet
• Hospitals provide resources such as advanced technology and electronic medical records that small practices might find financially taxing to acquire
• The imminent cuts to Medicare and Medicaid reimbursement rates also happen to be a major discouragement to own private practices as majority of U.S. population is supported by either Medicare or Medicaid
• The monumental shift to ICD-10 and HIPAA 5010 compliant coding, which requires considerable resource allocation on training and system implementation

While physicians are justified in their decision to safeguard their professional interest, this trend of increasing hospital employment may well jeopardize the remote clinical access to millions of people residing in the remote areas where private practices have been the only source of medical care. Moreover, there is a growing apprehension of this exodus making way for monopoly in clinical care. Either way, there needs to be some kind of balance between hospital-based employment and private practices in the nation’s macro healthcare well-being. Yet again, medical billing and coding specialists, who hold the crucial to this restoring this balance through off-loading the administration task off physicians, come to the fore.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long-standing reputation of being the credible source for medical billing management comprising streamlined medical billing practices, such as patient scheduling and reminders, patient enrollment, insurance enrollment, insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts, account analysis and denial management, A/R management, and financial management reporting – is poised to play an important role in this direction.

The Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

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 Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.