How Can Outsourcing Help Better Position Your Practice for Pay-for-Performance?

Pay-for-performance programs are a great way of rewarding health care providers but do you have the time and resources to make your medical practice eligible for such rewards?
There is no doubt that these programs provide encouragement to doctors and better services to patients but several challenges are also related to pay-for-performance-

• In order to become eligible for these programs, you will be required to reduce variation in your clinical practice
  
• You will have to reduce errors by promoting effective medical safety practice and offering best care to chronically ill patients
  
• As per the present system for Pay-for-performance, factor like reduction in glycohemoglobin for diabetic patients is also a scale on which your performance will be measured
  
• Whether or not your practice will become eligible for P4P also depends on your patient’s hospital stay and emergency room visits. Care co-ordination of patients suffering from chronic diseases between home, hospital and office is also a criteria for rewards
  
• If you happen to use health information technology for improving health of your chronically ill Medicare patient, you will be rewarded under these programs. You will also have to devote enough time and energy to ensure that patients coming at your clinic are well-informed and empowered
  
• In case you don’t participate in P4P programs, you will not only lose patients but also your market share

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How can pay-for-performance benefit you?
If your practice gets to win an incentive award under pay-for-performance program, it will give you an edge over other health care providers. This will result in increased flow of patients at your clinic which will eventually add to your income.

How to make it happen?

At a time when the US healthcare system is facing strain on finance and healthcare delivery due to inflation of medical cost, it has become imperative to offer high quality medical services at an attractive cost. This can happen only when you make your practice eligible for these P4P program by concentrating more on patient care rather than billing and account receivables.

Is AR management and medical billing restricting you?

You may have the capability to offer enhanced medical care to the patients and tackle P4P challenges but tasks like medical billing and account receivable management can eat up all your precious time that can be otherwise devoted in best medical care facilities.

Taking into consideration the complexities of healthcare industry in the US, many physicians are outsourcing these services and buying precious time to prepare their practices for pay-for-performance programs. So, if you also want to improve your services and get the competitive edge, why not make use of increased time and look into patient care?

Medicalbillerandcoder.com has been offering outsourced billing and AR management services to physicians across 50 states in the US. The expert team at MBC also provides consultancy to help doctors enhance their in-house practices and improve health care services to their patients.

Physicians Realign Their Strategies to Meet the Challenges of Healthcare Reform

After reforms, the American healthcare industry is seeing a curious change: healthcare providers are adjusting their practice models to suit the needs of Affordable Care Act. A quick look at some of the factors that are provoking these changes will bring about how the changes have not left (or will not leave) any aspect of healthcare operations untouched.

The reforms will completely alter the mode of payment in which healthcare providers are paid by insurance authorities. The mode of payment will go from pay-per-service to per-visit or per service mode. Additionally, the provider will be paid in the form of bundled payments so that there is scope for promoting quality even as costs are driven down.

As far back you can see Medicare’s Physicians’ Quality Reporting System (PQRS) was around as a quality reporting standard which laid down quality parameters for physicians to report on. Albeit, now this reporting is going to become more rigorous: unlike until recently when physicians used to report only on data, now their reports would have to show that they meet each quality metric.

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Bundled payment is perhaps the biggest change driver of the reform. Because bundled payments require coordination among various care disciplines involved in providing care, the reform gives the physician’s role prominence over that of the hospital.

As a result of this, surveys have revealed, 70% of hospitals are expanding the number of physicians on their staff to position themselves such that they can handle any initiatives resulting from the reform law. Additionally, bundled payment is also making care providers to either join or set up their own Accountable Care Organizations (ACOs).

Whether it is the mode of payment, the reporting methods, expansion of physician employment in hospitals, the singular area that the changes seem to gravitate towards is insurance reimbursement – how claims are made, medical data gathered to make them, codes (CDT) used, insurance claims paid, etc. And this is not a surprise as the reforms are focused towards bringing down the cost of care; promoting the number of people insured, and improving quality of care.

So equally unsurprising is the fact that the last few months have seen an increase in the number of care providers approaching professional billers and coders to help them sort out their post-reform concerns. However, you would require billing and coding organizations that can combine traditional knowledge with keen awareness of the current changes and how they affect the billing and coding processes and practices.

Following reforms, MBC has helped several healthcare providers to be equipped to face the challenges of reforms either by strengthening their internal operations or by handling their complete billing and coding responsibilities.

MBC’s Revenue Management Consulting services helps providers by assessing their in-house revenue management cycle and ensuring that there is sound coordination between various components of healthcare facilitating smooth flow of medical data for ACO operations and otherwise. We also identify gaps in your process and address them if necessary.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, are constantly updating themselves with current healthcare industry trends. In addition serving all 50 US states across varied specialties for more than a decade, MBC experts have the required expertise and experience in Medical Billing and Coding to help clients handle the upcoming reform challenges effectively.

Providers Acquiring Medical Billing Services To Handle the ACA Impact on Revenue

The Affordable Care Act has left the healthcare providers in the US worried. A survey conducted sometime back reported that 55% of hospitals expect a dip in their revenue while only 28% think that there would be an increase in revenue. But the survey also revealed that a considerable number of those who are informed about the impact of the healthcare reform (about 58 %) plan to become accountable care organization to reap financial benefit of the reform and improve the quality of care.

The 58 percent that revealed their plan to become ACO organization are well informed about the finer points of The Affordable Care Act as the law aims to set up a national pilot program to encourage care providers of various stripes (doctors, physicians etc) to coordinate and work together to improve quality of care so that they can be reimbursed through a flat fee (bundled payment) for a singular episode of care which the law supposes will lower expense and promote quality of care.

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However, the concerns of the 55% hospitals that expect a dip in revenue can’t be dismissed either. The insurance authorities propose to pay a flat payment to healthcare providers of different stripes who have come together and formed an ACO. The problem with this model is that it requires sound coordination among the various providers involved in a treatment episode to ensure a centralized collation of medical data which would be used to prepare claims and appropriate codes assigned to them.

Another concern that has worried healthcare providers is that this reform has a punitive nature to it. Millions of tax paying Americans eligible for government-subsidized healthcare coverage but without government-mandated health insurance coverage will be penalized with higher taxes unless they get an insurance policy within a year.

This is indeed good because it will induce more and more Americans to get health insurance bringing them into the net of national healthcare security. Albeit, the problem is this will require healthcare providers to assess insurance eligibility accurately, handle instances of unrealized partial payments where the patient’s bill exceeded his/her coverage, and of course a phenomenal increase in non-medical activities for healthcare providers to handle. Additionally, under ACA insurance providers will provide more coverage for preventive services and these services would have to be coded using separate CPT codes with enrollee-costs waived.

These concerns have sparked a trend where healthcare organizations that were handling their billing and coding responsibilities themselves until now are hiring the services of professional billers and coders. However, it’s important to remember that to handle the above challenges brought by ACA, a billing and coding organization needs to be familiar with the current procedures; be able to handle medical details coming from varied medical practices for preparing claims for bundled payments; be able to negotiate the additional red-tapism in submitting claims; and ensure timely payment of claims through post submission follow-ups.

MBC’s revenue management consulting has been helping physicians by performing a thorough analysis of the Revenue Management Cycle and ensuring that there is sound coordination between various components of healthcare leading to smooth flow of medical data. Our RCM services also involve identifying gaps in the process and addressing them by advising physicians while 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 also been helping several small to medium size healthcare providers with its Outsourcing services. MBC handles the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups, along with regularly updating themselves about the changing healthcare industry trends.

Improving your AR by Switching to a Billing Service for Your Medical Practice

One of the most frustrating issues for a physician is delivering quality medical services and not getting paid for it. Your practice can become successful only when the receivables are captured at all times. In absence of follow ups, you will not be able to recover the deserved amount as the recovery process becomes close to impossible once the account receivables reach 120 days.

What causes long-pending account receivables?

If your staff is not efficient in monitoring and keeping the account receivables of your practice active, it can become extremely difficult to retrieve the amount after a certain period of time. Usually, the entire process of finding out reasons behind delays, claim denials, following up with insurance companies, resubmitting the claims is extremely tedious due to which a significant number of physicians in the US lose thousands of dollars in the form of long-pending account receivables.

Some of the challenges you might face with account receivables are:

• Denial of an insurance claim-
  If your patient is considered non-eligible by the insurance company, the claim will be denied and your payment will get delayed. In this case, claim (paper or electronic) will have to be resubmitted and regular following up will have to be done every time the claim is denied. If you file the claims beyond the claim filing limit, your account receivable will become next to impossible
  
  
• Coding errors-
  Revisions are being done to CPT and HCPCS Level II codes annually and with the growing number of patients, and in this scenario your staff happens to make any coding error, AR will get delayed till the matter isn’t resolved
  
  
• Delayed payments-
  Sometimes government aided insurance companies don’t make the payment on time which again delays the payment process for physicians. In this case, too much time goes in constant follow up with the payers
  
  
• Adjudication issues and documentation-
  There can be certain adjudication issues and requirement of additional documents or clarification for patients that needs to be catered in time to ensure that AR doesn’t get delayed

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How can you improve your account receivable?

Account receivables will get converted in revenue only when you are dedicating enough time and resources into follow-ups, error-free claim resubmission, analysis of denials, maintaining past AR records, staying updated with new policies and procedures and so on.

To manage account receivables, you will have to perform:

• Timely follow-ups with patients as well as insurance companies
• Analyse the reasons for claim denials, fill the claims forms again without errors and submit them
• Keep updating the list of long-pending ARs and work towards getting the revenue

The entire AR cycle management demands substantial amount time which can distract physicians from offering quality patient care which very few can afford currently. Medicalbillersandcoder.com has been offering effective AR management services to physicians across 50 US states. We offer in-dept analysis-backed AR management solutions or customize parts of it to your practice needs so that while we help retrieve your revenue you can concentrate on offering medical services.

Aligning your medical billing goals with your Practice’s Goals!

A truly successful medical practice in today’s evolving healthcare industry is one that has its goals aligned with its medical billing goals. To a physician, however, it may seem like yet another time consuming task, but well determined objectives of a medical practice, if successfully translated into billing and coding practices can result in enhanced efficiency and greater profitability.

Many practices outsource their medical billing functions to third party experts, who work on pay-for-performance principle. This in-turn ensures that the billing experts work in sync with the revenue goals of the practice, for they get paid only when you get paid. Another way to go about medical billing is enhancing the in-house function; along with implementing performance based compensation to in-house staff may help do justice to your revenue goals.

Goal alignment has become the need of the hour for maintaining the competitiveness of your practice. The following steps can assist you in effective definition of practice goals and alignment of the same with medical billing goals –

• Identify your primary goals – Medical practice is built around the primary goals of patient care and service, which can resultantly improve revenues. Although profits and revenue are not primary goals, they are essential elements of every practice. Thus, it is crucial to write down goals in clear statements such as – “our goal is to maximize revenue while delivering unmatched healthcare and medical service to each and every patient” or “Assist patients in accessing healthcare service at reasonable costs and without wastage of time.”
  
  
• Communicate these goals to the medical billing staff – Once your goals are defined, make sure to discuss the same with your billing staff. Many physicians deign to indulge in the financial aspect of their practice and thereby lose out on a big chunk of their revenues. Medical billing goals are primarily focused on payment collection, correct coding, claim filing and reimbursements. Each activity takes new meaning if only practice goals are communicated well to the billing experts, whether external or internal.
  
  
• Monitor the gap in understanding and training – Keeping a track of staff activities and billing reports can effectively prove if medical billing goals and practice goals are aligned or if there is some gap in staff or consultant understanding. Regular interactions and consultations will lead to clearer goals and efficient achievement of the same.

• Update goals as per the changing industry scenario – HIPAA and HITECH guidelines, in addition to EHR regulations and RAC procedures have necessitated extreme caution and care to be applied while handling with patient data. Medical billing and coding goals are required to be more data and revenue centric rather than service oriented. However, a balance can always be established between conflicting goals.

Medicalbillersandcoders.com can help you define your practice goals and align them with medical billing goals. We can facilitate you in achievement of your financial and service objectives on a continual basis by understanding your practice objectives and applying them to your billing practices.

Our billing experts have been serving healthcare specialists in varied domains across all 50 US States for more than a decade now. We help physicians concentrate on patient care as we handle their entire revenue cycle process in line with their medical billing goal; along with assisting them in aligning their practice goals with the help of our experts’ in-dept healthcare industry knowledge.