Tackling Reimbursement Challenges posed by Inpatient Coding with Professional Medical Billing and Coding!

Clinical documentation is a need that threads through the entire lifecycle of an inpatient treatment episode. The clinical documentation specialist checks the documents of a patient before or within 24 to 28 hours of admission to assess various aspects of the patient’s condition, reviews documents every two to three days, during patient stay, to check their progress, accuracy and assign proper diagnosis related group (DRG). Based on assessment, the clinical documentation specialist also sends feedback to the physician who corrects things if necessary before the documentation is used for preparing reimbursement claims.

As is evident, clinical documentation requires extensive documentation of treatment procedures together with their relationship to be used for preparing reimbursement claims. Seen from a reimbursement claim standpoint, anything that’s not documented doesn’t exist and such are coding complexities that the presence or absence of any fact in documentation affects the choice of code later, making it either accurate or inaccurate. This has become more so since the expected implementation of ICD-10-CM.

ICD-10-CM is much more nuanced than ICD-9-CDM. Whereas ICD-9-CDM included 59 codes for diabetes, ICD-10-CM has more than 200 codes for it. Additionally, for diabetes, ICD-10-CM has added a new provision called ‘poorly controlled’ to the already existing provisions under ICD-9-CDM, controlled and uncontrolled. 

Similarly, ICD-10-CM has also increased the number of categories for injuries to cover a larger set of possibilities and arrest the nuances of a wider range of physical specifications of an injury. For example, apart from various details to ascertain the character of an encounter, the ICD-10-CM requires the coder to code the size and depth of an injury. Also, ICD-10-CM contains multiple combination codes to account for relationships between various conditions. After wading through these details, it is not very pleasant to be reminded that the source of these codes is clinical documentation.

Effective clinical documentation requires a grid-like structure underneath the day-to-day healthcare activities involved in an inpatient treatment episode which will arrest medical details, record them and pass them through various phases of the treatment terminating with the discharge of the patient. This process has to be a mix of human effort (to interact with various parties involved) and technology (to record details and facilitate coordination among various specialties – healthcare and otherwise – that interact during the course of a treatment).

MBC’s Revenue Management Consulting can help you with this by performing a thorough analysis of your revenue management cycle and lubricating various points of interaction it has with other areas of operation ensuring smooth flow of data. This involves identifying gaps in your process and addressing them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has helped medical practices improve their finances by its Outsourced Billing and coding services which involve development of accurate electronic billing, intricate procedure coding, electronic filling of claims and a multi-layered application process - collectively resulting in reduced claim denials and enhanced core-business focus.

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.

Solving the ‘Secondary Insurance’ puzzle at your medical practice

Care providers encounter patients with more than one level of health insurance coverage – a secondary insurance to complement primary insurance. While secondary insurance has considerably reduced patients’ out-of-pocket expenses and facilitated treatment plans outside primary coverage, billing for two-levels of insurance coverage has not been that easy. Even as certain secondaries to Medicare are enabled with automatic crossover to Blue Cross and Blue Shield and require no additional pursuance, majority of big and small private insurance plans continue to be unlinked with Medicare or Medicaid primary coverage. It is this isolation of secondary plans from primary that makes billing secondary insurance more difficult.

Irrespective of whether primary insurance is automatically linked to secondary insurance, it is the responsibility of care providers to arrange for co-ordination. Often, it is the insurance verification, billing, and follow up department that takes up the responsibility of coordination of benefits. Strangely, a large of proportion of relatively smaller secondary bills is never pursued or delayed till they become ineligible to be reimbursed. The collective value of such omitted secondary bills may be thousands of dollars per physicians. Therefore, with so much of hard-earned practice revenues going unrealized, physicians need to investigate and formulate corrective measures to follow up and realize secondary bills in time.

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One of the primary steps to monitor secondary bills is to have access to your patient accounts and system reports that show balances and your aging out Secondary Insurance Account Receivables (A/Rs). If you see certain bills approaching or just about to cross 90-day limit, it should be alerted immediately to your billing department for immediate follow up with secondary insurance carriers. Second, more than alerting your billing coordinating department of aging secondary bills, you should try to extract reasons for delay in reimbursements, and advice your staff for corrective measures based on the facts responsible for such delay. Third, once you have found out aging secondary bills, and advised your billing department to follow up with requisite modification or proof, it is important that they are pursued within the stipulated time limit, usually within 90-days from the date of billing. Last, it is always good to have a periodic review of your billing practices, particularly secondary insurance bills. Periodicity may range depending on the volume of secondary bills or ideally once every month. Review is an apt way to monitor the progress on secondary claims, and keep your practice’s financials healthy. In addition to challenges mentioned above, secondary insurance may have policy-specific, provider-specific, and region-specific demands. And, if you happen to be a care provider dealing with multiple insurance networks and operating across multiple clinical destinations in the U.S., you may have to be conversant with these diverse requirements. It is these multiple challenges that warrant the intervention of an external medical agency in your internal medical billing practices.

Medicalbillersandcoders.com has traditionally been care providers’ first choice in medical billing and coding; care providers of varied sizes and disciplines across the 50 states in the U.S. have found our services catalytic to their clinical and operational efficiency. And, at a time when they need their secondary billing mediated more than ever before, our resourcefulness – competent billing professionals with credentials in maximizing secondary insurance reimbursements – in secondary billing should be comforting.

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.

Pre-empting malpractice liability risk with superior EHR systems

Electronic Health Record system (EHRs), which is the next order in clinical and operational documentation, is perhaps one of the significant technology additions to have happened to the health care industry. While care providers seem to have been convinced of its ability to elevate clinical and operational efficiency to a new level, they may still be inheriting malpractice liability risk more than ever before. Amongst many things that are intrinsic to EHR system, transition, design, implementation, application, and control issues threaten physicians’ immunity against lawsuits with respect to breach of HIPAA-mandated patient privacy and security.

As physicians begin to transit from manual to EHR-managed data centers, patient-specific data may be vulnerable to proliferation, exclusion, or faulty conversion during the process of transfer from paper to electronic medium. As a result of this inappropriate conversion, patients’ clinical management may suffer from inaccurate clinical decisions. When patients’ care gets compromised on account of such inapt transition, physicians will certainly be held accountable legally. Therefore, it is important to undertake data transition comprehensively as well as have an EHR system that can entirely accommodate such data transfer.

More than being liable for lacking in data conversion, it is the choice your EHR design, customization, and implementation process that could either make or break your case – those EHR systems that tend to deviate from HIPAA’s requirements may spell trouble for physicians who happen to own them or may be opting for such EHR platforms without knowing the eventual consequences. Therefore, it is essential that you exercise caution before deciding on an EHR platform – it is not the price or somebody else’s provocation that should drive your decision but how far you can sustain integrity in clinical documentation.

Significantly, physicians may have to contend with control and security issues – with EHR systems chances of data proliferation, hacking, and unauthorized access are going to increase. Physicians – who are generally non-inquisitive of data coming in from EHR channels – may not entirely be informed of adverse happenings at their EHR systems. Therefore, more than being happy with implementation, it is important that you monitor the functioning of your EHR platform on an on-going-basis. It is also important that you commission a support staff that can conduct and protect EHR operations as required by HIPAA mandate.

Though a bill that protects providers from malpractice and other liability (if they happen to use certified EHRs) is being contemplated on, physicians would still have to continue to safeguard integrity and the accuracy of the patient’s medical record till then.

Medicalbillersandcoders.com is essentially helping out hospital management or physicians practices that may be vulnerable to EHR-specific malpractice liability risk. The significant advantage of partnering with us is our ability to leverage our tactical knowledge in EHR implementation with technology alliances with some of the best EHR manufacturers. More than getting your EHR systems customized, it is our catalytic role in assisting transition to EHR-enabled clinical and operational documentation that is instrumental in our being a leading consortium across the 50 states in the U.S.

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.

Managing Variable Healthcare Data with the Help of a Medical Billing Service

Although healthcare data is presumably highly significant to clinical efficiency, its application is not limited to clinical circle alone – medical billing, operational efficiency, contribution to clinical research and macro healthcare policies are equally dependent on healthcare data. Therefore, the primary raw data collected needs to be processed and tailored-made to serve these diverse purposes. While we may have come a long way from what used be generic data computing systems to healthcare-centric data management systems of today, questions still remain as to their ability to retain, secure, and serve the purposes for which they are 

relied upon.

This primary concern brings us to contemplate on data warehousing techniques that can necessitate the broad range of data-related utilities, such as tracking orders, recording vital signs, admitting/discharging/transferring patients, aiding reference, sending bills, and helping in collaborative exchange of healthcare data across clinical and operational eco-system – care providers, patients, insurance carriers, research bodies, and the Federal Government. While technology vendors have made available multiple versions of data warehousing models, care providers and all the external stakeholders still doubtful of them being fully responsive to ‘Meaningful Use’ of healthcare data.

Even as the problem persists with understanding variable healthcare data, care providers can still persuade manufacturers, vendors, and implementing agencies to evolve technology platforms that best serve providers’ internal data requirements as well contribute to external stakeholders’ data necessities. More than the mere architecture of the platforms, it is the utility-factor that needs to be well-defined and agreed upon before engaging with your prospective manufacturers or vendor. While we emphasize the need for customizing healthcare data centers’ architecture and delivery in sync with variable health care data utilities, current EHR platforms available in the market offer somewhat near-perfect options – today’s EHR platforms are believed to enable variable health care data utilities such as electronic medical records generation, billing, coding, operational functions, e-prescriptions, and a host of clinical and operational utilities.

While care providers may be able to better understand and manage variable health care data demands with these latest EHR platforms, they may still need to assess their prospective vendors’ ability to come up with customization that best supports their unique data needs. Notwithstanding their ability to assess intrinsic and potential data requirements, they, being physicians with essentially clinical care as their focus, may be well advised to avail services of medical agencies that best understand such critical healthcare data issues.

Medicalbillersandcoders.com has a tradition of mediating clinical and operational transformation on behalf of care providers. And, at a time when variable healthcare data management has become critical to clinical and operational efficiency, our broad resource-base of medical billing experts across the 50 states and their substantial experience in managing healthcare data centers for practices of varied sizes and disciplines should augur well for the future of variable healthcare data management in particular, and the nation’s healthcare delivery at large.

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.

EHR As a Means to Better Co-Ordinate and Control Care Processes

The success of health care has always been determined by how best care providers are able to coordinate the care processes across the clinical cycle – right from the time patients are admitted till they are pronounced cured. While clinical decision often lies with the primary physicians, clinical management may be divided among several departments or intervening specialists depending upon the complexities of clinical cases. Each clinical constituent may have specific, limited interactions with the patient and, depending on his/her area of expertise, may come up with his/her own view of the patient. While each of such views contribute to the ultimate clinical outcome, they information largely remains fragmented into disconnected facts and clusters of symptoms. As a result, clinical decision-makers are increasingly reliant on systems that keep disjointed clinical views into a cohesive clinical data.

Just as internet and web medium continues to evolve newer systems of care co-ordination, EHR is thought upon as the best technology system ever. While there could be arguments in favor of or against EHR as means to control clinical process, there is little doubt as to its ability to decrease the fragmentation of care by improving care coordination. EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care. With a well-networked EHR across the clinical continuum, care provider can expect:

superior integration among providers by improved information sharing to monitor and control the effect of medication to seek entry at point of care or off-site consistency of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine gain access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine, have population management trended data and treatment and outcome studies, be armed with more convenient, faster, and simpler disease management

These multiple utilities promise to be a positive influence on health care quality and convenience. Amongst a series of EHR-enables advantages, providers will primarily be benefited with

Instant access to patient records from inpatient and remote locations for more coordinated, efficient care Superior decision support, clinical alerts, reminders, and medical information Performance-improving tools, real-time quality reporting Clear, complete documentation that facilitates accurate coding and billing Ready interfaces with labs, registries, and other EHRs Improved, safer, and more reliable prescribing

Providers, who are always dictated by clinical excellence, should welcome EHR as a means to enhance primarily clinical efficiency as well as operational efficiency at large. While internal staff can be acquainted with the functioning of EHR, implementation of EHR need necessarily be done by experts. Medicalbillersandcoders.com – who has been the first to mediate with critical processes and systems on behalf of care providers – have the experience and expertise to enable care providers with decision-supportive EHR systems. Our resource base, spread across the 50 states in the U.S., is capable of customizing EHR systems in sync with your practice sizes and disciplines.

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.