Physicians Shortage – Is there a perfect storm brewing in the healthcare industry?

There has been a rapid growth in the healthcare industry, more than any other industry, mostly in response to rapid growth in the elderly population. According to the Bureau of Labor Statistics, the healthcare industry will create 3.2 million new wage and salary jobs between 2008 and 2018. However, the American Association of Medical Colleges (AAMC) has released a report which states that physician shortage will quadruple after the full implementation of health reforms in the year 2015. The reimbursement cuts in Medicare are another factor that is impacting delivery of healthcare, physician revenues, and the shortage of providers in the country. Moreover along with the expected attrition in the healthcare industry due to the reforms, almost one third of physicians are set to retire in the next decade. The number of new physicians is not going to be enough unless the Congress ensures a 15 percent increase in residency training slots in the country.

The outlook for physicians remains bittersweet. On the bleaker side of things are the Medicare cuts, the new extensive guidelines to be followed under the health reforms, with scare time resources. However physicians who successfully demonstrate Meaningful Use and follow such other guidelines and who choose to work in Health Professional Shortage Areas are set to gain financially from health reforms.

The importance of revenue cycle management, payer interaction, and similar revenue related functions becomes accentuated in light of the changes taking place in the health care system.

The need for better interaction with payers, improved medical billing and coding, and revenue cycle management is being felt because of the increased volume of patients and the lesser time available for treating each patient. Errors in medical billing and coding and mistakes in related “back office” functions can negatively affect the revenue of providers, as providers face these challenges:

• With the increased number of patients due to universal insurance coverage, the number of denials by insurance companies would also increase necessitating constant interaction with insurance companies and payers
• Another unique challenge faced by providers is the increasing population of baby boomers in the country. High numbers of elderly patients would mean more physicians –patient encounters and lesser time to provide quality care

One of the better ways of managing such high volume of patients is to optimize revenue through various processes including efficient medical billing and coding process, so that there are no losses due to avoidable errors and to ensure that lesser amount of time is spent on managing denied claims.

Professionals at medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, not only provide effective medical billing and coding services but can also offer optimized revenue cycle management processes, better payer interaction, assistance in Meaningful Use implementation, and consultancy services for effectively dealing with challenges in the near future.

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.

Leverage your business with excellent medical billing services

When people go to hospitals or clinics for treatment or to doctors for consultation, they are expected to pay the medical bills after the procedure has been completed. However, billing services can be difficult if the staff has to do the billing statements for several people at the same time. In most instances, the patient wants to leave the hospital or clinic quickly upon release and does not want to wait for the billing statements. Letting the patient go and mailing the medical bills later on can lead to many errors, inaccurate bills and delays in transmittal to the patient, resulting in high accounts receivable problems. More so, if the doctor is not financially stable and needs the payments to sustain his daily operations. This and other related problems can be resolved through efficient electronic billing services. Some establishments implemented electronic systems within their premises with notable success. However, medical institutions found that keeping pace with the volume growth and new technology increased their operating costs significantly. Studies showed that it was more cost effective to pay for outsource billing services.

There are companies that specialize on medical billing services. The institution submits the transactions to the outsource company who transforms the information to electronic data by encoding. The data is then compiled and printed on an invoice, and given to the patient for payment.  If the patient was covered by medical insurance, a claim form would be prepared and submitted to the insurer for claims payment. This was the initial simplified approach. But as outsource companies became more proficient and experienced in medical billing services, with the help of advanced technology, they were able to improve their processes dramatically.

Outsource companies had to ensure 100% accuracy and completeness in the medical bills. If the bills contained too many errors, the medical institution would not be paid immediately. There would be a time delay while people remediated the errors and omissions. There had to be sufficient details in the statement so people could trace the transaction and verify its correctness. People have to be trained and educated on the encoding and transcription of data. This resulted in a highly trained and competent team of billers and encoders within the outsource company. Also, outsource companies had to ensure the personal and related medical information was present in the medical bills. Data such as patient’s name, address, physician’s name and the nature of illness had to be encoded and maintained in database repositories. In so doing, a medical history of the patient was achievable. This and other improvements can make outsource companies provide excellent medical billing services to help your business prosper.

Importance of Medical Billing and Coding for Physicians

The importance of medical billing and coding cannot be overemphasized in an era where health reforms are changing the face of the health care industry in the United States. Medical billers and coders not only ensure the accuracy of the billed amount but also simplify the process of how physicians are reimbursed. The job of medical billers and coders is not limited to just medical billing and coding. They also perform many other necessary functions such as interacting with payers, managing the revenue of physicians through a systematic approach towards revenue cycle management, managing denied claims effectively, and ensuring patient privacy.

Accurate Medical Billing and Coding

The job of a medical biller and coder requires specialized and thorough training since errors can cost physicians heavily in terms of provider revenue and the way in which healthcare is delivered. Errors in medical billing and coding impact physicians negatively, in some cases the physician may be denied participation in any government affiliate program such as Medicare or Medicaid under the False Claims Act due to errors in medical billing and coding. The responsibility of ensuring accuracy and thus protecting the revenue of the physician lies with the medical biller and coder. The learning curve accompanying the health reforms is not just limited to physicians but is also encountered by their staff, including medical billers and coders.

Medical Billing and Coding Post-Reforms

The possibility of errors in the medical billing and coding industry has increased due to the migration from ICD-9 to ICD-10 codes. The latter are more complicated and expansive compared to ICD-9 codes, thus increasing possibility of errors. With almost 19% of claims being denied due to errors by insurance companies, the handling of these ‘mistakenly’ denied claims falls upon medical billers and coders who have to extensively interact with the payers in order to correct these errors.

Revenue Cycle Management

Another important task of medical billing and coding companies is revenue cycle management. The revenue cycle management process entails functions such as clinical care documentation, charge capture, coding and utilization review, billing, collections and follow-up, denial management, and data warehousing and analytics. However, there are many other pre-visit tasks that are part of the revenue cycle management that is the responsibility of medical billing and coding companies. These tasks include administrative functions, patient scheduling, checking medical eligibility, benefits verification, registration, and point of service collections.

The role of medical billers and coders in assisting providers to receive timely and accurate reimbursements has definitely increased after the reforms. The need for better medical billing and coding is being felt since a solid platform in the form of better departmental processes is needed for the higher or core objectives of the reforms to work in favor of physicians. The largest consortium of medical billers and coders in the United States, medicalbillersandcoders.com, can provide such professional departmental solutions to almost all the processes involved in medical billing and coding, revenue cycle management, EMR/EHR implementation, 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

Workers compensation claims boon or bane? – Medical Billing process of filing these claims

Workers’ compensation has been a much debated subject and has been traditionally viewed as a liability for the company. However new ways of filing claims and with streamlining of various medical billing processes for such claims, it can be an asset which can boost employee morale and thus increase the productivity along with assistance in cutting costs incurred due to cumbersome administrative processes involving the payer and the medical provider.

Reduction of costs in Workers’ compensation claims incurred during the process of medical billing and coding and improving the revenue cycle management process of physicians has shown to have a positive impact on the finances of the concerned physician & company. The American Medical Association also supports the Model Rule to streamline the medical billing for workers’ compensation which will be crucial in saving money on workers’ compensation claims and help in preventing delays in compensation for workers who have filed legitimate claims.

While filing these claims, use of electronic medical records, scientific approaches, and aggressive collection policies based on proven data can benefit all the parties involved. State regulators in Texas, California, and Minnesota have already adopted the Model Rule to streamline medical billing for workers’ compensation insurance which is developed by the International Association of Industrial Accident Boards and Commissions (IAIABC).

The benefits of electronic billing or ebilling, according to a report by the International Association of Industrial Accident Boards and Commissions (IAIABC), go beyond “getting rid of paper”. This procedure assists in eliminating the need for tedious interaction between the payer and the medical provider which can relieve the pecuniary pressures generated due to lags in workers’ compensation.

The health reforms have provided a new momentum to the process of eliminating unnecessary delays in workers’ compensation claims and have provided various guidelines to help pave the way for speedy compensations and settlement. Moreover, many medical billing and coding companies have adapted to these changes in laws and regulations and have successfully assisted almost all the parties involved in such claims.

Medical billers and coders at Medicalbillersandcoders.com form the largest consortium of medical billers and coders in the United States and provide numerous value added services such as research, consultancy, better revenue cycle management (RCM), efficient payer interaction, and expertise in use of cutting edge technology along with HIPAA compliance. The combination of all these services along with an aggressive albeit scientific approach towards collections ensure that all the parties involved in workers compensation claims receive optimized solutions for various situations that have been traditionally considered expensive and time consuming.

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.

Medical Billing Companies Must Use the Clean Claim Laws

Clean Claim Laws are currently in place in every state. The assistance provided by the laws ranges from states like South Dakota which has no economic penalty to Texas where the payer sometimes is required to pay billed charges

The basic idea of the law is that a payer has to respond to a clean claim within a set time (usually around 30 days for electronic claims). In order to utilize the clean claim law effectively you must have a tracking system built into your medical billing process that flags:

1. Which payers must abide by the clean a claim law (the laws do not apply to all payers),
2. The date the clean claim “clock” begins (i.e., the claims submission date),
3. Events that stop the clean claim clock (e.g., an information request from the payer),
4. When your practice has taken actions in response to payer requests;
5. When you received a payment or denial.

Planning and constructing the monitoring system can be difficult, but it can have a significant impact on how quickly your claims are paid cleanly. Aggressive users of clean claim laws have actually received calls from payers assuring them that their claims will be process quickly and requesting that complaints be held to give the payer a chance to prove itself.

Source By: ArticleDistribution.Org

If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state’s guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.

For more information visit to Medical Billing Companies.