In Search of Resources to Counter Radiology Billing and Compliance Challenges

Much like medical billing challenges faced by other practitioners, radiologists too will have challenges unique to their own profession. The general perception of billing being more complex than ever before and progressive fall in reimbursements seems to hold good to Radiology Billing as well. As a result, radiologists may see their revenues dropping considerably, which in turn could have disastrous impact on clinical and operational efficiency.   With possible threat to sustain diagnostic and radiologic quality amidst a host of clinical and Radiology medical billing challenges, radiologists will have to identify and address the key factors that may carry potentially greatest threats to their revenues, profitability, and more importantly the patient care.

• Foremost, bundling of services and codes could lead to significant decrease in reimbursement for radiologists.  It may be remembered that certain radiology codes are now modified into codes with lower RVUs. Moreover, The Medicare Payment Advisory Committee’s (MedPAC) inclination to reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for radiologists who both order and read images could severely hamper radiologists’ revenue prospects.

• Second, the enormity of radiology coding revisions will require radiologists to undergo training to comply with new coding order.  And, training for ICD-10 compliant radiology coding will not be all that easy simply because the electronic data standards and requirements, lengthy alpha-numeric codes, a whole set of new RVUs,   and the obligation to comply with PQRS standards for Radiology Billing and reimbursements.
  
  
• Most importantly, the new ICD-10 coding system could prove to be the most financially taxing of all that clinical and operational migrations that radiologists may have undertaken thus far – upgrading of technology that necessitates ICD-10 compliance is expected to cost radiologists as high as major capital investments. Coupled with this heavy financial expenditure, radiologists may be required to carry on with dual systems – both ICD-9 and ICD-10 – till such time when ICD-10 system becomes omnipresent. Thus, the duality of coding too will be more taxing both mentally as well as financially.

The enormity of these radiology billing challenges could throw radiologists into a phase of great uncertainty. Thus, it may require unusual acumen to respond to changing radiology coding and compliance requirements. And, who better to manage the business side of your practice than radiology specialists that possess the expertise to understand the dynamics of such radiology coding and billing compliance.

Quite aptly, Medicalbilllersandcoders.com happens to be the platform that can enable the deployment of such radiology billing specialists to practicing radiologists across the 50 states in the U.S.  Its affiliation with chosen pool of radiologists makes it the most reliable source for radiologic medical billing resources to counter radiology billing and compliance challenges. The service portfolio of these radiology billing experts include demographic/charge information, data accuracy verification, coding from physician reports, analysis of  billed charge fee schedule with recommendations, direct claims submission, revenue cycle management,  administration of patient payment plans, responding to patient and insurance inquiries, collecting, depositing payments and performing  refund reconciliation of overpayments, Medicaid pending account research, legal account follow up, carrier arbitration and government payor issue resolution, streamlined appeals process, monitoring accounts receivable, complete and detailed billing management reports.

How Healthcare Data Breaches Warrant the Intervention of Billing Specialists

Technology has really done wonders to the way doctors or hospitals document and exchange healthcare data across the clinical eco-system – with the digital mode, it is now finitely possible to record unimaginable volumes of data in miniature chips, and share them  instantly for collaborative clinical management, research, medical billing, and macro healthcare policy decisions. The negative side of this technology utility is that there has been alarming increase in healthcare data breaches that have threatened to jeopardize patients’ privacy and security as well as credibility of doctors/hospitals.

While most of the present-day Electronic Health Record Systems (EHRs) are amply protected against security threats, yet they are susceptible to unscrupulous manipulations. More over there are always possibilities like lost or stolen hard drives, laptop, PDA or thumb drive, human error, and network hacking.  With technology becoming more mobile than ever, chances of losing your healthcare data or being stolen while in transit may be too high.  Therefore, it comes as no surprise that 85% of healthcare providers have experienced a data breach of some kind or other in the recent past. While the new electronic medical record legislation seeks to put the onus on manufacturers or vendors, providers too will have significant role in preventing most of the data breaches that emanate on account of operator’s incompetence. In fact, the analysts have it that 86% of data breaches are not IT related and could be prevented through better policies and training.  Thus, may be increasingly necessary to have a multi-pronged strategy to avert data breaches:

• Prevention through sourcing industry-leading tools to stop identity theft and maintain legal compliance
• Education that seeks to impart best practices in protecting personal and highly sensitive clinical data
• Have a measured response to incidence of breaches and conduct scrutiny to seal off loopholes, and have a policy to monitor, avert and improve with evolving data security standards.
• Employing appropriate security and backup solutions to archive important files, and test frequently
• Devising two-factor authentication, such as strong user name and password, plus a token or one-time password
• Integrating information protection practices into businesses processes

In between these strategic measures, providers should necessarily be aware of the significance of full disk encryption (FDE) to nullify negative consequences when the device containing confidential patient information happens to be either stolen or lost. The advantage of full disk encryption (FDE) on devices such as desktops, laptops, data tapes, servers and removable media is that data continues to be safe and undisclosed.

Irrespective of operational sizes, there are enough technology versions to avert data loss or incidence of data breaches. Given the larger implications of healthcare data breaches – hefty penalties from HHS, it may be safer and rather more economical to implement HIPAA compliant EHR systems that are built against threats of data theft, hacking, or operational error.

And, to those practitioners who do not want risk experimenting with too many options, Medicalbillersandcoders.com offers to implement HIPAA compliant and secure healthcare data management platforms (EHRs) as part its comprehensive medical billing solutions. Our affiliation with health care data specialists – who are adept at sourcing, implementing, and conducting healthcare data centers as per your unique clinical and operational demands – should help them remain resolute against healthcare-data-related threats.

It Is Worth Paying for Medical Billing Services Than Be Affected with Suspended Reimbursements

Affordable Care Act, along with a few other pro-beneficiary health care policies, may have helped rationalize cost of health care as well as cost of health care insurance across the broad spectrum – Medicare, Medicaid, and a variety of private insurance plans offered across the U.S. Beneficiaries could even benefit from lesser co-payment obligations and deductibles. However, it may not be said with any certainty that their woes with delay and denial would come to end. If the recent reactions are any indicators, medical practitioners may well see denials and A/R days going up more than they used to be earlier – there have already been instances wherein physicians’ reimbursements have been held up for as long as 60 days and even more. Just, imagine the kind of negative impact it could have had on their clinical and operational efficiency!

With health insurance premiums reaching lowest levels, payors have resorted to various contingency strategies – abandoning their services altogether, restructuring their portfolios, and of course withholding reimbursements till they are pursued aggressively by the medical practitioners concerned. While payors are within their right to safeguard their financial and business interests, medical practitioners could do better with Medical Billing Practices that are better tuned to expedite A/Rs before they become impossible to be follow-up and may even have to be written off as bad debts.

When it is obvious that such A/R delays will become more common in the coming days, medical practitioners would be left with no alternative but to spruce up their A/R management beyond the routine Medical Coding and Billing exercises. As soon as your bills cross the permissible time, your A/R management team should take over the process of finding out the reason for delay, following up with possible remedial measures, and expediting the process of realization. Operating under multi-payer reimbursement environment, you may have entered into contracts with Medicare, Medicaid, and a host of private health insurance agencies. Therefore, you A/R management team need necessarily have to be versatile enough to deal with multiple payors.

While your A/R Management team is doing what it is entrusted with, coding and billing efforts need to be equally supportive with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards. Although every medical practitioner aspires to be equipped with as comprehensive a medical billing as possible, he may be limited by time and financial factors. Hence, you may be required outsource your entire process of medical billing from patient enrollment, scheduling insurance verification, insurance authorizations, scheduling and re-scheduling, coding, billing and reconciling of accounts, collections, AR collections, to denial management & appeals. One big advantage from outsourcing is that billing companies can be expected to deliver services at a price that is within your budgetary constraints. Moreover, they are invariably versatile enough to deal with complex medical billing issues. 

As you begin to preempt the possibility of undue delay of A/Rs with external billing mediation, Medicalbillersandcoders.com may just be the platform for complete, flexible, affordable, and more importantly tailor-made to the critical situation when your claims are likely to run the risk of being held up far in excess of admissible period of time.  Our credibility is essentially built around chosen billing affiliates (across the 50 states in the U.S.), who are versatile enough to monitor, follow-up, and expedite claim realization when you seem be giving up on your aging or withheld Account Receivables.

How Crucial are Cardiology Billing Specialists during Reporting and Following-Up Cardiology Medical Bills?

In the last few years, cardiology has had to manage with negligible fee increase while having to cope up with numerous coding and billing changes. While cardiologists may have seen an increase of 1 to 2 percent increase in Medicare’s fees, they have had put up with reduction in medical reimbursements beyond permissible limits. To a large extent, these practice-related medical reimbursements reductions could have been triggered by a series of relentless medical billing and coding changes that have seemingly been more challenging than ever before.

It all began around 2009 when codes for implanted devices were replaced with an entire set of new codes. Notable among such revolutionary codes were the ones that would be applied specifically to internet (remote) device checks, codes for devices with leads in 3 chambers, ICM device follow-up codes, and codes for per procedural checks. While this coding overhaul may have helped streamline Cardiology Billing, cardiologists’ medical billing has not been fully able to decipher them to their best advantage.

Quite parallel to these intermittent cardiology coding revisions, 30 and 90 day global periods too have been active for follow-up for certain devices. What is more, the new codes are specific to either an interrogation evaluation or a reprogramming evaluation without being inquisitive of the happening of reprogramming. It is quite possible that cardiology practices may have found cardiology coding and billing rather difficult.

Interestingly, wearable cardiac telemetry devices too have been assigned specific codes, and it is impossible to assign unlisted codes that previously could be applied with slight modification. Moreover, these wearable cardiac telemetry devices are equally susceptible to complication of global periods as in the case of certain other cardiac devices. Yet again, cardiologists’ medical billing and coding may have found this coding-specificity an unusual thing.

Not least of them all, bundling multiple procedures under a single has limited cardiologists’ ability to breakdown a larger service into smaller components. As a result, insurance payors can now insist on bundling an echo with both a Doppler and color flow and a stress flow into a single and comprehensive CPT code. While this may have reduced multiple coding and billing, it certainly has limited cardiologists’ ability to maximize revenues from breaking down larger services into smaller components.

While Cardiology Medical Billing has already been affected by these monumental changes, cardiologists may still face harder challenges during reporting and insurance follow-up under the ensuing ICD-10 billing and coding regime. With the possibility of coding specificity, bundling, and billing and coding restrictions getting magnified even more, cardiologists may well have look beyond conservative cardiology medical billing practices. Hence, cardiology medical coding and billing, integrated with enhanced coding compliance, electronic processes, and competent billing practices could help measure up to challenges in insurance reporting and follow-up.

Medicalbillersandcoders.com has verifiable success as a leading and progressive medical billing consortium, more so for cardiology billing. Our cardiology medical billing mediation has been backed with deployment of experienced, techno-savvy, and competent medical billing specialists. As a result cardiologists across the 50 states in the U.S. can look forward to engaging medical specialists who have evolved with cardiology medical billing challenges.

How to Prevent Shrinking Bottom-Line with Streamlined Cardiology Billing Process?

Cardiologists are reported to have been writing off a considerable chunk of medical bills that could otherwise have been realized if they had a more responsible cardiology medical billing in place. If the industry sources are to be believed, over 20 percent of claims are left unrealized. What is even more worrying is that Account Receivables too are languishing in the basket for more than 60 days! As a result, cardiologists bottom-line has constantly been sinking, making it hard to sustain effective and efficient cardiology services. While cardiology billing requirements may have more demanding, they are not something that cannot be overcome with streamlined Cardiology Billing Process. And, when we mean streamlined billing process, there ought to be an ideal integration of cardiology medical billing specialists, technologies, processes and RCM solutions aimed at bringing down revenues losses to negligible percentage.

• Educating Cardiology Billers
  
  Significant advances have been made in cardiology billing system in the recent, and it is possible that your cardiology medical billing staff may not be knowledgeable of current billing system. Hence, educating cardiology medical billing specialists with latest billing system is the primary step in streamlining cardiology billing process.
  
• Adapting to technologic advancements
  
  Second, you have the privileges of technologic advancements in cardiology coding and billing. It is remarkable how these technologic advancements have redefined cardiology billing – automation of routine tasks, and reminders when follow-ups are required; time management in resolving complex billing cases and denials; enabling collection improvement and reduction in A/R. Therefore, coding and billing software built on ASP model may possible accomplish such critical tasks.


• Improving processes
  Third, processes to ensure:
  
  
  • Claims are submitted the same day of charge entry is entered; applying payments fast: electronically for carriers with automatic reconciliation and, for others, using procedures optimized for each payer.
  • Filing secondary claims—with electronic EOB attached—on the same day payments are applied from the primary payer.
  • Queuing up denials and other payer responses to be followed up automatically by A/R team
  • Electronic monitoring of  patient and procedure data, eligibility, specifics of coverage, submitted claims, electronic adjudication of  claims, negotiation of electronic remittance, and automated posting to line items on the original claim submission
• Devising Revenue Cycle Management
  
  Last, Revenue Cycle Management integrated with complete revenue cycle process could go a long way in ensuring increased collections, minimize A/R days, and more importantly control and enhance clinical and operational efficiency.

This entire act of streamlining cardiology medical billing may require considerable time and resources. And cardiologists, who are already hit by revenue erosions, may be low in morale. That is why it is advisable to leverage with external billing companies that can transform or streamline your entire cardiology billing within your budgetary constraints. 

Medicalbillersandcoders.com has a credible history of sourcing and deploying medical billing resources within the budgetary constraints of diverse health care disciplines across the 50 states in the U.S. And, at time when streamlining cardiology medical billing is high on the minds of every cardiologist, we promise to leverage and streamline their cardiology coding, billing, and follow-up with our broad  resource-base, who are trained and acquainted with the most modern cardiology billing practices, systems, and processes.