Protect Your Medical Practice in Uncertain Times with a Medical Billing Specialist

The healthcare reforms brought by the Obama administration have in many ways been an industry-churning affair. They have changed the number of patients the healthcare centers receive today, affected the administrative activities that revolve around a typical treatment episode, shifted the professional location of several medical practitioners (independent physicians aligning with hospitals) etc.

These changes have caused severe hurt to small healthcare centers and left the big ones financially ruffled, leaving organizations ill-equipped to meet their future goals leaving them far behind organizational aspirations.  

If we look at the changes triggered by reforms as separate facts without any connecting link between them, the situation will look irretrievable. But if we look a little closer to find out that link which unites them, what will spring to our attention is the fact that all of them have a revenue impact on a healthcare organization.

For example, a healthcare organization receiving more patients stems from the fact that the reforms have widened the healthcare security net to include more people than before. It is commendable but more patients may lead to more rejection of reimbursement claims if their insurance eligibility and extent of insurance coverage are not properly checked and proper codes not assigned while preparing their claims, not to mention the fact that more volume causes oversight of minor details.

The second example pertains to administrative responsibilities. While administrative responsibilities were always part of a treatment episode, they have become a concern today as the new changes brought by reforms need a greater collaboration among medical and nonmedical (billing and coding) sections of a healthcare organization to ensure a steady flow of medical information between them based on which decisions will be made. A point in case is the Medicare frauds coming to light in case of E&M coding where the choice of appropriate codes is done by the coder based on medical inputs he/she receives. 

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There is also a need to understand the medical information (about procedures and diagnoses) passed on to billers and coders accurately so that proper coding choices can be made preventing making under-claims and over-claims, especially the latter as it can lead to security by Medicare authorities, now overly sensitized by rising insurance frauds. Similarly, there are other operational challenges brought in by reforms.

Independent physicians aligning with hospital is not a very old phenomenon and one that had been sparked by healthcare reforms – because, to transfer cost benefit to the patient, reimbursement requires services to be bundled up, which has forced hospitals to align with independent physicians to offer varied medical services under one roof, begetting a new set of problems for in-house billing and coding and administrative teams to contend with.

And the impacts of these challenges accumulated over a period of time starts showing on the financial performance of a healthcare organization leading to a situation where yearly financial targets missed by small margins each year adds up to form a big lag after the lapse of a passage of time, sapping vigor and life out of the organization. 

Medicalbillersandcoders.com the largest billing and coding consortium in the US has helped both small and big healthcare centers to avoid this scenario by offering billing and coding service modules that are flexible and can be adjusted to fit the billing and coding needs of any healthcare organization regardless of size.

If you are a large medical outfit with an in-house team of billers and coders to handle claims, as part of our Revenue Management Consulting services, we can prune up your revenue management system by advising you about software applications suiting your purpose and environment, sprucing up your lengthy processes or replacing them with new ones if required and training people in new billing and coding techniques and methodologies.

However, if you neither have an in-house team of billers and coders nor any reason to have one, you can outsource your entire billing and coding process to us and nullify your claim rejection rates and boost your revenues.

The Significance of HIPAA Compliant Medical Billing Services for Gastroenterologists

Gastroenterologists trade patient-centric information for a variety of purposes, and Medical Billing is one of them. While physicians clinical notes on gastroenterology procedures are made use of by coding and billing staff, there may be possibility, intentionally or accidentally, that vital patient-centric information being exposed to security and privacy breach in the form of theft or hacking.  As we know that any compromise with patients’ data security and privacy could lead to monetary as well criminal penalties. Therefore, with gastroenterologists’ practice credibility and reimbursements at stake, it is inevitable that Gastroenterology Billing partners or service providers become HIPAA compliant.

Fundamentally, HIPAA compliant Gastroenterology Billing services are required to be  integrated with various advanced systems to protect all health information that can identify a patient including name, dates, zip code, e-mail ID, telephone or fax numbers, medical record information, health plan and social security information, license numbers, and photographs. Gastroenterologists who happen to source HIPAA compliant medical billing services would invariably be assured of:

• Requirement-specific application of medical billing software
  
  
• Web based medical billing software with EMR solutions
  
  
• High security measures
  
  
• VPN system
  
  
• Frequent reports
  
  
• Insurance authorization
  
  
• AR follow-up
  
  
• Higher confidentiality
  
  
• Anti-virus and firewall software on each computer
  
  
• 24/7 response management

While gastroenterologists’ medical billing staff may have been using HIPAA 4010 platform until now, they certainly need to migrate to HIPPA 5010 in view of ICD-10 coding replacing the erstwhile ICD-9 system. ICD-10 being more specific and alphanumeric, HIPAA 4010 software platforms would certainly not support ICD-10 compliant gastroenterology coding and billing. Therefore, HIPAA 5010 version would invariably have to be introduced, and aligned with advanced billing software such as Lytec, Medic, Misys, Medisoft, Inception, IDX, and NextGen. Such monumental system-change can only be achieved with highly efficient workforce that is conversant with electronic medical records (EMR) and electronic practice management (EPM) systems – believed to be crucial in providing a complete and quality medical billing service as per the requirements of gastroenterology clinics, hospitals, and practitioners.

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Even as gastroenterologists try to bring about these HIPAA compliant gastroenterology billing changes, the extent of system upgrading and staff orientation may be too much to take in. As a result, they would have to depend on outsourced HIPAA compliant gastroenterology billing services that:

• Ensure periodic backup of data and critical facilities accessibility
  
  
• Are fortified with secure workstations, storage facility and authorized access
  
  
• See Firewalls and antivirus software on all systems are updated frequently
  
  
• Ensure technical evaluations are performed on a routine basis
  
  
• Come with affordable pricing: with 30 to 40% cost savings
  
  
• Provide free billing analysis
  
  
• Employ password protected lockers

Medicalbillersandcoders.com – by virtue of having nation-wide affiliation with a chosen pool of gastroenterology billing professionals attuned to HIPAA compliant Gastroenterology medical billing practices – can help gastroenterologists reap the benefits of HIPAA compliant  medical coding, medical insurance collection, medical paper and insurance electronic billing, charge entry, cash posting and reconciliation, management of old accounts receivable collections, and insurance verification and authorization.

Demand for Gastroenterology Services to Impact Medical Billing in Clinics and Hospitals?

The consistent rise in demand for Gastroenterology services has really been a boon for clinics and hospitals. But the growth has been so overwhelming that it started affecting their reimbursements in a big way. While practitioners have generally been preoccupied with clinical duties, their medical billing staff have found the voluminous growth simply hard to cope with. As a result, there may been considerable delay in processing claims, leaving physicians’ bills to pile up as ‘account receivables’. The situation is likely to be even more demanding as a large percentage of population is going to be brought under Medicare and other insurance schemes. As per the reliable industry sources, Gastroenterology specialty alone will see 20 to 25 percent growth over the next five years or so.

Fortunately, Gastroenterology practices can replace or ease medical billing woes with outsourced Gastroenterology medical billing solutions. The quality of services offered is generally good across the US, but it is still advisable to gauge your prospective service providers’ credentials before taking them onboard. Amongst many parameters against which you may judge your prospective Gastroenterology Billing partners’ competence, following assume more significance than the rest:

History of your prospective Gastroenterology billing partners: It is always safe and prudent to engage with billing partners with considerable and demonstrated ability to handle medical claims with Medicare, Medicaid and commercial carriers.

Staff’s experience and credentials: It is the billing professionals’ experience and credentials that translate into tangible benefits for you. Thus, it is important to verify your prospective billing company’s staff’s experience and credentials such as being certified billers and coders from authorized institutes.

Timeliness and accuracy of service: Notwithstanding your Gastroenterology billing company’s credentials, it all the more important that they deliver on-time and accurate billing services.

Being compliant with Federal as well as state-specific Gastroenterology regulatory compliance: Outsourced billing service providers are bound by the regulatory compliance standards, either Federal or state-specific. As outsourced service providers, it is imperative that your prospective Gastroenterology billing partners comply with either of the two

Competitive cost: With other things being equal, you should insist on those partners whose prices are relatively less.

Inclusiveness of services: While you may be availing Gastroenterology billing solutions, yet your billing partners should be judged for their ability to offer inclusive set of services, such as the entire process of Gastroenterology Revenue Cycle Management (RCM).

The advantage of this fact-checking is that it you can be sure of the following benefits from your billing partners:

Timely Processing and Submission of Claims: Once you have chosen Gastroenterology billing company against the parameters listed above, it is more or less guaranteed that your claims will be processed and submitted in time either through paper or electronically. The timeliness and accuracy of submission will go a long way in fast realization of your Gastroenterology claims with Medicare or commercial carriers.

Follow up with payors: Follow up, being an integral component of your billing providers’ services, will help isolate partially paid or unpaid claims and entitle you to the amount due to you.

Report Generation: The utility of having an inclusive Gastroenterology billing service partner is that you can expect to be fed with reports that can be used to bring about clinical and operational improvement.

As you begin your search for inclusive Gastroenterology Billing service providers, you may find the selection a bit tricky. That is precisely why we, at Medicalbillersandcoders.com, are committed to mediate the deployment of Gastroenterology billing resources chosen from a talent-pool of Gastroenterology billers across the 50 states in the U.S.

Spiraling Cost of Gastroenterology Services to Warrant Billing Partner!

Despite Gastroenterology being one of the high-yielding practices, practitioners’ revenues from reimbursements continue to remain below par. This can be a distressing trend considering the spiraling cost of administering gastroenterology services. While clinical and technological advancements have brought in unimaginable precision to care, billing requirements too have become more demanding than ever before. As a result, a considerable portion of gastroenterology bills are susceptible to delays and denials, most of which are never pursued owing to incompetent billing practices. With the combined cost of such unrealized claims amounting to almost 20% of the total bills submitted, gastroenterology practices would do well to find better billing alternatives. While internal billing resources may be brought up with training and orientation, its success rate has not been all that impressive. Moreover, it could prove costly.

In view of the uncertainty over internal billing capabilities, hiring or outsourcing the entire gastroenterology billing management could prove to be a wise decision.  While the quality of outsourced gastroenterology generally happens to be good, you may still have to assess your prospective billing partners’ competence and experience against your requirements and the prevailing gastroenterology billing complexities. Primarily, your gastroenterology billing partner needs to be proficient in:

• Complex gastroenterology billing codes and rules
• Gastroenterology-related terminology
• Office notes and operative notes, coding for surgical procedures
• Code variations related to multiple procedure rules
• Denial process and appeal denied claims quickly and efficiently to ensure speedy reimbursement

The advantage of evaluating your prospective Gastroenterology Billing partner against these requirements is that it make you believe that you will be assured of comprehensive billing, collections, and practice management services, interspersed with:

• Account receivables management
• Round-the-clock claims processing
• Checking system based eligibility
• Quarterly coding updates
• System-based claims scrubbing
• Comprehensive response to all billing calls
• Regular quality assurance checks
• Weekly meetings to discuss progress and go over reports
• Customized monthly reports

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Such proven gastroenterology billing practices would invariably facilitate:

• Improved collections and income
• Accelerated payments and reduced stress
• 24/7 accessibility to your patient data and financial information
• Transparency throughout the revenue cycle
• Full financial and practice management reporting

Even as you scout for your prospective gastroenterology billing partner, Medicalbillersandcoders.com – with impeccable success in deploying apt gastroenterology billing specialists for practices across the 50 states in the US – offers a chosen pool of gastroenterology billers, adept at coding, billing, payer relations, patient relations, collections, financial reporting, fee analysis, managed-care contracts.

Would Dwindling Medicare and Medicaid Payment Rates Turn Providers to Private Insurance Beneficiaries?

It is an irony that Medicare and Medicaid, which reimburse more than the half of the nation’s total health insurance, have come in for heavy flak by physicians, who claim to have lost considerable revenues that they could otherwise have rightfully earned had they avoided seeing Medicare and Medicaid beneficiaries and favored patients with private health insurance policies. The problem seems to originate from the sustainable growth rate (SGR) formula that has been proved unscientific against exponential growth in public health care beneficiaries and medical cost associated. Thus, physicians have constantly been put to Medicare and Medicaid cuts. And with Affordable Care Act recommending inclusion of millions of uninsured and baby boomers into the fold, physicians may get highly selective in admitting Medicare and Medicaid beneficiaries in an effort to save themselves from being affected with rather discouraging payments rates.

As a matter of fact these two popular government health schemes have been woefully behind payment rates offered by private insurance carriers. As a result, there has considerable shift in insurance pattern, which has resulted in escalation of the private health insurance cost by as much as 25 to 30 percent during the last 5 years. While private insurance beneficiaries have been fetching providers appreciably revenues well over their operational costs, Medicare and Medicaid have seemingly been returning revenues well below the operational costs. To be precise, doctor or hospital receives 10% less in Medicare and Medicaid umbrella as against 20% more on every dollar spent as clinical and operational cost on patients. What is even more worrying is that physicians have consistently been undergoing Medicare cuts, which now threatens to erode physicians’ revenues by as much as 25%.

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If Medicare reimbursements are staring at a monumental cut of 25%, Medicaid reimbursements too have not been that impressive either. Medicaid reimbursements have historically been varying from state to state. Moreover, Medicaid has traditionally been paying much less than Medicare. Although efforts are on to keep Medicaid reimbursements on par with Medicare’s, the expected inclusion of 15 million into Medicaid fold may not eventual allow it happen.

While the inclusion of 77 million baby boomers into the public insurance ambit may provide voluminous clinical opportunities to doctors, the proposed cut to Medicare spending by as much as $426 billion over the next decade could drastically spoil their revenue prospects. With reimbursements revenues expected to decrease even further, physicians or hospitals may not be inclined to seeing more of Medicare and Medicaid beneficiaries. Thus, they may have to substitute their portfolio with more and more private health insurance beneficiaries. While patients with private health insurance policies may be more lucrative, there would always be the risk of dealing with private insurance carriers, who are seemingly more vigilant and stricter when it comes to reimbursements. Given the challenges of private insurance reimbursement environment, it may require an external medical billing mediation to orchestrate the entire process of billing, submitting and realizing the claims to their fullest.

Medicalbillersandcoders.com has considerable experience in deploying medical billing resources as demanded by unique operational challenges. As providers shift their preference towards private health insurance beneficiaries, our nation-wide affiliation with medical billing specialists that are versatile enough to deal with heterogeneous payers should offer them the requisite leverage to manage their medical billing process as efficiently as possible.