Managing Payer Denials, Cuts & Delays at Your Practice with a Medical Billing Service

An increasing cause of worry for almost every doctor in USA is payer denials and delays which invariably result in potential loss of revenue for the physicians. With the introduction of reimbursement cuts in medical bills, physicians and medical practitioners now face various payment challenges and a more uncertain future. Considering the increasing expenses acquired with the recent health reforms, it is important for physicians to receive payments on time, so as to cover their expenses and also be able to efficiently provide necessary services to their patients.

Conversely, as health insurers tighten eligibility requirement, filing claims have become more complicated and the chance of claims being denied have increased substantially, consequently claims are filed with high possibility of being denied, with increased providers struggling to balance patient care and billing. Industry standards state that high performing practices depicted denial rates are below 5%; while other practices denial rates were between 10%-20%, reducing denials by 5% can increase a practice’s revenue tremendously.

The current economic climate in healthcare is that of ambiguity and uncertainty. The economic cuts proposed under the Medicare system by Congress is leading to economic crunches have forced such doctors to carry on their medical practice at the cost of their personal assets. On an average, one third of the patients who come to a clinic are on Medicare, in addition private insurers who follow Medicare rates prove to be plummeting further. This situation makes it very difficult for an independent practice to survive and may even result in closing down of clinics along with causing shortage of medical resources.

Additionally various documentation issues like -  incorrect patient details, inaccurate coding, incomplete claims, lack of communication, submitting claims to wrong insurer or not following up due to lack of AR process can lead to claim delays and denials. In the face of these numerous challenges large numbers of physicians to increase their bottom line are turning towards the facility of medical billing service. Being specialists in their field medical billing companies provide a safe and secure way to overcome all these issue and guarantee timely payments.

Hence outsourcing the denial process successfully creates a unique and safe platform for doctors as well as medical institutes to manage their billing cycles, and also allows practitioners to concentrate on their responsibility of providing healthcare. Industry experts believe that up to 40% of the costs of payments to hospital and physicians can be saved by using medical billing companies.

Medicalbillersandcoders.com serving healthcare community for more than a decade now across all 50 US states provides the advantages of medical billing services by offering a dedicated and specialised team of experts who excel in the denial management, along with coding specialists who ensure correct coding of claims in compliance with HIPAA norms. MBC’s specific billing model uses planned billing software and methods which are fast and accurate so as to deploy claims within a short span of time with minimum possibility of errors.

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.

Things to Consider When Outsourcing to a Medical Billing Company

Choosing a medical billing company is a big decision, as it plays a vital role in the efficient management of records as well as submission of claims. With outsourced medical billing services, you can gain maximum reimbursement from your medical billing. As there are a number of medical billing service providers in the market, it is quite challenging for you to choose the one that best fits your need. This article will guide you in selecting a reliable medical billing outsourcing firm that can ideally meet your needs.

Some Important Tips

You have to carry out a complete evaluation in order to locate reliable Medical Billing Companies. The following tips will help you identify the right medical billing provider.

• Ensure that the firm has enough years of experience to meet the requirements of your medical facility.
• Evaluate the number of employees who support the account.
• The practice management system provided by the company must be useful and user-friendly.
• Check whether they provide a comprehensive medical billing package
• The company must provide easy access to information such as outstanding claims, charge data, user notes, follow-up information, and payments.
• Check whether they use the most up-to-date software such as NextGen, IDX, Medisoft, Inception, and Lytec.
• In addition, assess the security features the firm us
• Make sure that the billing company you approach will provide you the maximum returns.
• Check whether they follow HIPAA regulations and ensure strict confidentiality of data.
• Ensure whether the service provider provides timely billing.
• Ensure custom medical billing solution is available.
• Reports should be provided on a daily, weekly or monthly basis.
• Ensure that there are no hidden charges
• Figure out the quality of service
• Check for the provider's obligation to regulatory compliance
• Confirm the file transfer is done securely

Choosing the right firm based on the above factors will help you find the right billing partner for your service.

A medical billing company will work for any type of practice no matter what specialty in medicine you practice. Physician groups, individual physicians, free standing diagnostic facilities, clinics, long term care facilities, acute care facilities, multi specialty groups, hospitals and many others can benefit from Medical Billing Services.

Outsource your medical billing requirements to a reliable and professional medical billing company. Having the support of a professional medical billing outsourcing firm will not only reduce operating costs, simplify workload, cut down denials, increase reimbursement, save your valuable time and enhance your office efficiency but will also help you maintain a strong relationship with the clients and insurance companies.

Article Source: http://bill.ezinemark.com/things-to-consider-when-outsourcing-to-a-medical-billing-company-7d35c1a6ae03.html

ICD-10 codes and its Impact on Denial Management

The transition from ICD-9 codes to ICD-10 codes presents a huge challenge for medical billers and also affects health care delivery system and physicians’ revenues. The staggering number of additional codes makes the learning process complex. Moreover, the scope for error increases which is exacerbated by a harder denial management process. Insurers have a distinct opportunity to target the increased volume of ICD-10 codes for finding ample mistakes to postpone payment.

Here are some of the basic  impacts of the transition from ICD-9 to ICD-10 codes pertaining to denials:

Basic Difference

The basic difference between ICD-9 codes and ICD-10 codes is that they are more compact even when carrying in-depth information about the case. This helps in identifying the correct rules to be applied as far as reimbursement and insurance policies are concerned. Quantitatively there are more ICD-10 Codes compared to ICD-9 and this also means that the newer codes help in further clarifying the information at hand. However, denial management would face problems due to the increased scope of errors by insurance companies due to the new codes.

Insurance Companies

Claims and reimbursements may be delayed or rejected due to several reasons by insurers due to – differences in the codes sets that cannot be accounted for because of unavoidable compromises in the conversion, conscious efforts to take advantage of the more precise ICD-10 code set; hence Physician practices will be wise to include ICD-10 in their payer agreement negotiation discussions to decrease their risks concerning compliance errors and claims denials.

The Time Factor

The time factor can play a crucial role in deciphering the codes since the volume of ICD-10 codes is high compared to ICD-9 codes. This might mean longer waiting periods for reimbursements and more number crunching for medical billing and coding companies. Another hurdle facing a clinic or a provider is that medical billing and coding is a highly demanded profession and this transition of codes would make it more competitive, making it costlier than before.

The Impact on Patients

ICD-10 codes have been used in numerous countries and the United States was one of the few developed countries to use ICD-9 medical coding system. Although denial management consists of correcting errors and other important functions, the new health care reform has almost ensured that insurance companies and payers cannot deny claims on the basis of errors which can reach a staggering 19.7% out of total claims submitted. This high percentage of denial of claims is one of the biggest hurdles in denial management and it is difficult to predict whether ICD-10 codes would work in favor of denial management and if it would impact patients favorably.

For more information about denial management, EMR and EHR implementation, consultancy, revenue cycle management, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States. Medicalbillersandcoders.com billing and coding professionals are charged up for the change and to further this trend Medicalbillersandcoders.com is offering a training program to all medical billers and coders through this platform to a career revamp ensuring transition to ICD-10 with confidence.

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.

Advocating and Practicing Best Practices in Medical Billing

For years, Medicalbillersandcoders.com has been synonymous with medical billing management – helping medical practitioners not only realize their medical reimbursements fully but also optimize their clinical and operational efficiency. While the medical billing complexities have consistently been escalating – owing to unprecedented increase in insured population and the risk associated with managing insurance reimbursements – we have been able to off-set its effect through consistently remodeling our medical billing Revenue Cycle Management (RCM) to the benchmarked industry standards. As a result, time and again, our ingenious medical billing processes have come to fore in mitigating adverse impact on our clients’ medical bill reimbursement, and ensuring optimal realization of reimbursements, clinical and operational efficiency.

Here is a rundown of the “Best Practices in Medical Billing” that we have been advocating and practicing in ensuring optimal realization of reimbursements, clinical and operational efficiency, and compliant processing of medical claims as per the Federal Healthcare norms:

• Eligibility Verification or Pre-Screening is the foremost on list of Best Practices in Medical Billing; the objective is to determine the patients’ eligibility for the insurance coverage for which the medical intervention is sought. Further, it also ensures knowing in advance what is covered or what in not before a patient is registered and admitted for clinical management.
• Understanding Coverage:  Understanding how the respective insurance carrier would reimburse the eventual cost of medical services is as important as verifying the patient’s eligibility for the insurance coverage for which the medical intervention is sought. As it is the insurance company that ensures the reimbursement on behalf of the patient, there should be clear communication and clearance from the respective insurance bearer.
• Billing Competence: Often medical coding and claim submission can go wrong owing to inherent errors while preparing medical bills for the medical services concerned. Therefore, due vigil needs to exercised while preparing bills that form the basis for eventual coding and claim submission.
• Coding Compliance and Competence: As much as billing competence, coding too hold its importance in flawless claim submission and realization. As the outcome of a medical bill largely hinges on coding compliance and competence, medical bills should invariably accompany ICD and HIPAA compliant coding procedure for medical procedures.
• Electronic Claim Submission and Follow up: As the system of IT-enabled claim submission and follow up becomes more common, medical claims submission need to be managed through electronic medium for seamless and faster realization.
• Managing the Revenue Cycle: As the incidence of claim submission become too voluminous, your claims may take a little while for realization. But, as the sustenance and growth of your practice largely hinges on your ability to minimize the Accountable Receivable days as less possible, an effective and efficient Revenue Cycle Managementbecomes inevitable. Medicalbillersandcoders.com’s (www.medicalbillersandcoders.com) ingenious and credible RCM – comprising Adjudication, Follow Up, Re-submittals, Payments, Adjustments, Secondary Claims, Denials and Appeals – invariably proves to be indispensable to successful Revenue Cycle Management.

The credibility earned from being perpetually committed to “Best Practices in Medical Billing” has been instrumental in expanding our reach to the length and breadth of U.S. Our diverse pool of qualified and competent medical billing professionals has been able offer result-oriented medical billing practices to diverse clientele (ranging from small practices to multi-specialty groups) in varied specialties including Allergy & Immunology, Ambulance Transportation, Anesthesiology, Behavioral Health, Cardiology,  Chiropractic, Dental, Dermatology, Family Practice, Gastroenterology, General Surgery, Hospitalist Billing.

As the success of investing in any business turnaround exercise is measured by the degree of its impact clients’ cost-optimization and revenue maximization, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) too had to verify its executed solutions against actual benefits for its client. Remarkably, the transformation made by our “best practices” has been quite impressive with:

• HIPAA compliant medical coding ensuring highest authenticity
• Reduced operating costs
• Regular monitoring and auditing
• High accuracy in coding
• Feedback & custom reports
• Multi-level quality assurance
• Quick turnaround
• Reduced claim denials
• Faster reimbursement
• Accelerated revenue generation
• Ample scope for intensive focus on medical care

Therefore, if you are a medical practitioner seeking to turnaround your practice’s clinical and operational efficiency, Medicalbillersandcoders.com may well be your source.

Coping with diverse medical billing challenges in different States

Like in any service sector, medical practitioners’ sustenance and growth has always hinged on their ability to adapt and reinvent themselves to the evolving market scenario.  While they have been quite enterprising enough to demonstrate the requisite character, the magnitude of healthcare reforms unleashed by the Federal Government, and its possible impact on their revenue generation has compelled them to add a new dimension to the usual scheme of adapting and reinventing.  And, majority of physician practices are beginning to realize that new dimension in business expansion – strategically expanding facilities to the areas that offer clinical and operational advantages.  While U.S. is abound with endless opportunities – the imminent expansion of Medicare population and an ever-growing demand for medical services in remote and sub-urban regions being the main source of opportunities, the physicians will have to contend with some unusual operational barriers. And, these operational barriers stem out of the diverse rules prevailing across the 50 states.

Amongst such heterogeneous rules, the regional modification of Medicare happens to be a significant one. Despite Federal Government’s universal Medicare scheme, states are privileged to modify Medicare and Medicaid rules pertaining to coverage, pre-existing condition, and fee-schedule as per their socio-economic conditions. In view of this scope for regional interpretation of Medicare and Medicaid rules, physicians are advised to be knowledgeable of them before they undertake expansion to multiple states or regions with heterogeneous interpretation of Medicare scheme.

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Complying with state-specific practice registration is another equally important issue when you contemplate on expanding your practice.  Although you carry a valid Federal license to practice medicine, yet you may still need to be registered separately in each of the Federal states you intend to practice. Otherwise, apart from facing legal hassles, you may not be eligible to any of the reimbursement schemes.

Adapting to regional billing demands is another challenge. Certain states have their own Medicare-specific rules, and they employ varying degree of audit intensity. Moreover, in every state the rules are different regarding fee-splitting, corporate practice of medicine, and scope of practice. As these things would have a direct bearing on the revenue, practices should be mindful of them before embarking on expansion.

The important issue that hospitals of group practices will have to contend with is the restriction on certain combinatorial practices in some of the states. Therefore, you may have to restructure your physician composition prior to expanding your hospital or group facilities to the regions with such imposition on certain combinatorial practices.

While you seek to avert and adapt to these operational issues through timely intervention of healthcare legal advisors and medical billing consultants, finding those that can effectively and efficiently match up to the region-specific challenges can be a daunting one. Therefore, it boils down to carefully choosing the one with diverse capabilities.

Medicalbillersandcoders.com – being a credible source for medical billing management and allied solutions across the 50 states in the U.S – stands up to be reckoned as the leading consortium for such interventional advice. Its diverse pool of competent medical billing professionals is strategically spread across all the clinical destinations so that you can have instant access to their expertise.

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.