Does Expanding Outpatient Physicians Really Help Stabilize Your Hospital Revenues?

Hospitals that hitherto have been troubled with in-patient operational losses may just have found a solution in outpatient mode. Contrary to stagnant inpatient volumes and revenues, outpatient volumes seem to have picked up in recent years. As a result operational revenues at hospitals seem to be firming up. It is also worthwhile to be informed of some interesting statistics unearthed by the research agencies – Fitch’s research has found the average operating margin to have shifted from 2.6% in 2010 to 2.7% in 2011 while Moody’s have estimated it to be hovering around 2.5%.

While outpatient mode may have marginally helped offset inpatient downturn, it is expected that hospitals’ outpatient windows will further gain from steady decline in inpatient cases – the decline in patient volumes, which previously was in sub-decimal, seems to be heading towards double-digit figure (prominent research agencies currently estimate it to be around 9%). Coupled with this dip in inpatient volumes, the recent health care reforms may force hospitals to operate at negligible profit margins. With so much pressure behind, hospitals should look at outpatient mode not as an option but necessity to sustain and grow.

But expanding outpatient windows has its own challenges – finding competent physicians or doctors, cost associated with their overheads, deciding on disciplines to be more aggressively followed under ‘outpatient’ category, and not but not the least the likely billing challenges on account of expanding outpatient services.

Recruiting physicians for outpatient services will be a primary challenge. As every hospital begins to scout for talents from a limited pool, the aspirants may begin to command higher price. The initial cost of hiring may temporarily be result in negative revenues. Therefore, hospitals should be prepared for such scenario and be optimistic of eventual turn around in revenue margins.

Second, it may not be viable to pursue every discipline under ‘outpatient’ category – hospitals should explore their intrinsic competence and decide on disciplines that are demanded most in their location of operation.

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Last, the shift to outpatient services may give rise to unprecedented increase in billing activities. The sudden increase in billing may prove to be unbearable or burdensome to in-house or the billing services provider. Unless it is eased by a superior billing intervention, it may prove to be responsible for delay or denial of claims.

Notwithstanding hospitals’ capacity to alternate to outpatient mode with larger physician base, it is advisable to be mediated by people who are sensible in clinical and operational issues. Medicalbillersandcodes.com has time and again proved to be an able ally in times of clinical and operational crisis. Our resource base spread across 50 states in the U.S. offer instant remediation for billing, coding, RCM, AR Management, and a host of clinical and operational issues. At a time when hospitals’ stand on the verge of a major shift from inpatient to outpatient mode, MBC may well be your platform for prosperity.

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.

Keeping your Clinical Focus Intact with Analysis-Backed AR Management Solutions

Every year physicians in the U.S. lose thousands of dollars in the form bad debts. These so called bad debts are Account Receivables that have surpassed the admissible time limit or deemed impossible to be followed up. Once Account Receivables are allowed to languish for more than 120 days, it is difficult, if not impossible, to get them followed up and claimed. It really requires a dedicated AR management practices to monitor and keep ARs active. While care providers’ internal billing staff may be relied upon to a certain extent, they have often been found to be limited in their ability to analyze the reasons behind pending reimbursements, devise strategies to reduce AR days, and speed up realization of claims. But, because these tasks essentially decide the providers’ financial health and progress, they need to be arranged somehow or sourced from somewhere. Therefore, outsourced AR management services seem to be the only way out.

While outsourced AR management services could have right answers to solving AR puzzle, you certainly need to judge your prospective AR management service providers’ credentials on certain parameters:

Ability to analyze long-pending ARs: AR analysis is believed to extract reasons for delay, denial, or long-pending ARs. The reasons so extracted are supposed to be vital leads in resubmitting, following up, modifying, or adjudicating long-pending ARs. Amongst several possible reasons, your AR management partner should be able to cull out reasons such as:

• Claim denial occurring due to patient’s non-eligibility of the insurance
  
• delays due to adjudication issues
  
• pending for request of clarification or documents
  
• denials due to errors in coding and charge entry
  
• delay in payment due to insufficient funds with government aided insurance carriers
  
• filing of the claims beyond the claims filing limit

Ability to devise systematic corrective measures: Reasoning alone will not suffice; your ARs will be converted into real revenues only when they are backed up with instant, effective, and corrective measures. While most of the AR management providers are generally believed to knowledgeable, it is always safe to be informed of their ability to:

• Process and systematically follow up with the insurance carrier for paper as well as electronic claims to improve reimbursements.
  
• be conversant with knowledge about the insurance companies’ policies and procedures that help process claims
  
• Keep records of past AR events that may come useful in dealing with similar future events.
  
• maintain good rapport with the insurance company will help the physicians’ office or the physician billing company in solving the issues more effectively
  
• handle major rejections and in prioritizing claims
  
• verify explanation of benefits, and preserve final payment documents for future use

While ascertaining your prospective AR management service provider is inevitable, you being care providers may not want to be distracted from your primary focus: clinical excellence. Medicalbillersandcoders.com has precisely been an operational partner for medical billing and allied services. With a resource-network across the 50 states in the U.S., we promise to keep your clinical focus intact with some of the best analysis-backed AR management solutions. While our AR management solutions have been inclusive in our total RCM solutions, you can also get them customized exclusively to your practice needs. 

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.

Transforming Your Data Centers into Secure, Instant, and HIPAA-Compliant

Medical data has significant utilities – as vital source of reference for subsequent follow-ups, collaborative clinical management across the clinical network, Medical Billing, information bank for clinical research, and macro health care policies. While most of the practitioners may have a system for storing, retrieving, and sharing the data across the health care eco-system, they are increasingly susceptible to natural disasters, system-related snag, and hacking from unscrupulous sources. And data lost – either to natural disasters, system-related snag, or hacking – can have wide repercussions:

• It may hamper your ability to coordinate your patients’ clinical administration
  
• It may hold you back from contributing to collaborative clinical management
• It may leave you without evidence while audit inspection, follow ups, or resubmission of your medical bills with Medicare or private health plans
• It may project you as non-contributory to clinical research, and above all
  
• It may depict you as non-participatory in macro health care policy missions

Because of these likely consequences, not only are physicians obligated to have their medical data stored but also have them secured from the threats mentioned earlier.

Most of the medical data these days are managed on EHR – which is a comprehensive platform for storing, retrieving, and sharing clinical and operational data. While an EHR can integrate clinical and operational functions with unbelievable ease, it is by no means guaranteed that it will stand the test of the threats highlighted earlier. As responsible care providers, it becomes your priority to have backup facilities for data stored in your EHR systems. One easy way to ensure data-readiness is to copy them from your EHR sources to portable USB drives that can be preserved securely elsewhere.

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An important thing to remember while converting or transferring medical data into portable USB drives is that care should be taken to encrypt the so transferred data. The significance of encryption is that it will save your stored medical data from being easily decoded by hackers. With HIPAA being severe on breach of patient privacy and safety clause, protecting data privacy has become more than a mere necessity. HIPAA’s security rule comprises required and recommended actions to ensure the security of protected patient health information. Moreover, the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009, supports HIPAA by imposing stiff penalties on healthcare organizations found guilty of data breaches. Among the penalties: fines up to $1.5 million and the burden of notifying the media (as well as patients) if the breach involves more than 500 records.

Along with this data-back plan and adherence to HIPAA’s privacy and safety norm, medical data should also be made available just in time – power outages should not an excuse as any data not available just in time may well be deemed as data denied. Therefore, physician facilities should have USP facilities to run data centers interrupted.

Managing medical data management as per HIPAA’s directive could be an extended burden to physicians, who are centrally focused on clinical care. This is where experts may have an interventional role in transforming care providers’ facilities into secure, instant, and HIPAA-compliant data centers. We, Medicalbillersandcoders.com, have been a responsible partner to care providers seeking data-related advice; practices of varied sizes and disciplines across the 50 states in the U.S. have stood to gain from our data backup plans & advice, and been able to respond to HIPAA’s safety and security norms positively. As medical data management continues to influence clinical and operational efficiency, our team of experts in data management is committed to transform your data centers into secure, instant, and HIPAA-compliant.

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.

Negotiating Justifiable Contract with Health Insurance Companies

Care providers operate in an environment characterized by multiple payors – Medicare, Medicaid, and a host of private health plans. The prevalence of such multi-payer is reason enough for differences in rates at which care providers are reimbursed despite the clinical procedures more or less being the same. Adding to this heterogeneous payor-environment is the regional differences wherein a physician practicing in an urban state gets reimbursed more than its counterpart in a rural state.  Are we simply to believe that these are irreversible factors, and physicians are left with no avenues but to accept what is offered?

Certainly, multi-payor system and regional factors should never hold you from claiming what you really deserve. If you happen to be as good a care provider as your counterpart in a metropolis, you are entitled to be reimbursed on par with the best rates. This is where your negotiation skills come into the fore – convincing you’re your payors as to why they should reimburse you at the rates given in the fee schedule, equivalent to the CPT codes, and to the maximum extent possible.

The extent to which you can negotiate is often decided by your being in a particular network – HMO or PPO. If you are a HMO provider, your negotiation is limited to Medicare or Medicaid fee schedule.  Medicare, being public plan, reimburses you at a rate which is comparatively less than a physician gets by being a provider in PPO. At best you can insist on getting reimbursed on par with what the admissible CPTs deserve.  But, to insist on being paid at CPT-equated level, you will certainly need to back up with clinical and quality credentials – care excellence, EHR implementation, and compliant coding and billing practices.

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If you happen to PPO provider, being supported mostly by private carriers, can expect variable and maximum scope for negotiation – by being in the PPO network, you can expect to be paid at rates higher than in Medicare fee schedule.  But your payors are not going to be convinced unless you support you claim with valid reasons and proof. Amongst many ways through which you can negotiate better deals with your payors are:

• Keeping track of history of your claim submission and eventual realization:
This will provide with variance in your expectation and eventual pay out. When such variance are brought to the notice of your contracted payors, payors may be inclined to have a relook at the existing reimbursements, and may even amend with higher rates.

• Being aware of the rates offered by other plans:
This will help you compare your reimbursements with what your counterparts in the similar field are paid by other plans elsewhere. When these differential rates are brought to your payors notice, they may be inclined to revise to higher rates provided your quality of health care is as good as it is elsewhere.

• Being aware of geographic advantage:
If you happen to practice in an area that distinctively know for medical care quality, you try to force this into your advantage; payors are generally convinced of relatively higher level of quality care in urban and metropolis.

• By threatening to walk out temporarily:
If your payor is not open to the idea of negotiating, you may consider coming out of the contract. And when you start billing 100% to your patients, patients in turn may switch sides to payors that offer maximum coverage. This may force your original payor reconsider his original stance.

All these seemingly possible tactics would have to be carefully implemented. Care providers, who are primarily focused on clinical job, may be found wanting tactically. This is where medical billers would be sorely required. Medicalbillersandcoders.com – with a thorough understanding of multi-payer reimbursement environment – continues to mediate justifiable contract with health insurance companies across the 50 states in the U.S. Irrespective of your being HMO or PPO, our expert team of insurance contract negotiation is essentially driven by the motto: “maximizing your reimbursements”.

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.

What makes Outsourced DME Billing Superior?

Physicians who are part of DME services now face an important operational decision: whether to persist with in-house billing staff or entrust to external sources. The long-held belief that in-house billing staff would manage DME-related billing complexities seems to have failed them recently – most of the in-house-staff-managed DME billing are reported to have high incidence denial, delay, or under realization of DME bills from Medicare, Medicaid, and private DME health plans.  And, now that physicians strongly feel the reason to replace in-house DME billing, should they be embracing outsourced DME billing straight away? Yes, but not before they have debated pros and cons of DME billing outsourcing.

Arguments in favor of DME Billing Outsourcing

Primary argument in favor of outsourcing DME billing is that it will bring a fresh perspective to hitherto stereotype practices – outsourced DME billing providers, with their specialization, could iron out deficiencies, and improve realization. The in-house staff, on their part, will be able to concentrate on clinical priorities, and prepare reliable data for DME billing and coding.

Second, care providers need not worry about capital investment associated with training people and installing system for DME billing; an outsourced service comes with a ready-combination of trained people and systems. Moreover, with a large clientele, it will be easy for your prospective service provider to pass on the economies of scale.

Third, outsourced DME billing providers are supposed to have good terms with payers and agencies. Their being well-acquainted with Medicaid, Medicare, and private health plans should help care providers in knowing, negotiating, and responding better to dynamics of DME billing. Likewise, DME billing providers can save you from accepting health plans that are either operationally non-profitable or non-supportive of DME services.

Last but not the least, DME billing providers can be relied upon to keep A/R days within the permissible limit – with supposedly superior expertise in ICD and HCPCS coding, there should be little need for Decreased denials and/or front end rejections: as a result of expertise in ICD-9 and HCPCS coding, for re-filing, rebilling or appeal.

Arguments against DME Billing Outsourcing

Primary argument against outsourcing DME billing is that it involves lot of deliberation while selecting a prospective service provider from so many operating in the market – the chosen provider may or may not turn out to be a suitable one; sometimes, it may turn out to be inferior to your in-house DME billing.

Second, outsourced DME billing may initially need to be synchronized with your operational environment. And, when DME billing needs to be customized to your requirement, there will be likelihood of DME billing cost being escalated.

Last, mobility may sometimes be an issue – your outsourced DME billing provider may not be logistically near your clinical facility. Therefore, there could be considerable time gap between what you need and what you eventually get from your DME biller.

Because pros outnumber cons, physicians should consider it operationally viable and profitable to entrust their DME billing to outside service provider. With operational burden taken out of their minds, they can focus on clinical priorities, which essentially decide their competitiveness. Medicalbillersandcoders.com has veritable success as leading DME billing service provider; a great majority of care providers across 50 states in the U.S. have benefited from our specialized, economical, and collaborative DME billing services. And, as the demand for outsourced DME billing services is likely to increase in coming days, we hope to leverage on our nationwide DME billing specialists in bringing you operationally profitable billing solutions.

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.