The Primary Barriers in Physician Billing and HIT Adoption

Physicians and healthcare provides across the country are slowly but surely adopting EHRs or Electronic Health Records as a part of the recent health reforms in the United States. Moreover, it has been reported by the Centers for Disease Control and Prevention (CDC) that there has been a substantial increase in the adoption rates across the country and this trend is gaining momentum as the financial and health benefits of Health IT are understood and implemented successfully however some states still lag behind in “Basic” EHR adoption. 

The adoption of EHRs may be increasing but some of the statistics are misleading. “Basic” adoption of EHRs is not considered as qualified for the ‘Meaningful Use’ (MU) incentives, there are time restrictions and this was apparent in the Stage 1 of MU when a lease was given to numerous physicians to fully start implementing their EHR systems. Moreover, the costs of implementing a fully functional EHR or EMR System is so high that it is financially cumbersome for providers and staff to handle their core job aspects as well as train on EHRs and maintain these systems. 

The cost of IT services can be very high and since it is a recurring fixed cost, it can form a dent in a physician’s revenue. The stage 2 timelines are also of concern since those who do not implement Health IT would fall behind and find financial as well as policy hurdles. However, this can be counterbalanced by the incentives offered in the long run due to increased revenue because of EHRs and HIT implementation. The costs of IT in health care come in the form of continuous IT support for services not just in the core aspects of the medicine but also in the other departmental processes involved in getting paid. However, some relief in the form of incentives is providing financial relief to private practices as well as hospitals. 

The deadlines for the implementation of Stage 2 of MU have also been extended to the year 2014 instead of 2013 due to hurdles such as costs and the skill required along with the learning curve to fully implement both the stages of MU. The need to cope with such costs and pressures is not limited to the core aspects of medicine. The effect of exhaustive changes in Medical Billing and coding procedures, handling the costs associated with IT maintenance, dramatically increased interaction with payers, and increasing your revenue at the same time is a process that needs dedicated professionals who are not just HIPAA compliant but also ensure the accurate and timely delivery of reimbursement for providers. Medicalbillersandcoders.com is the largest consortium of medical billers and coders in the United States that can carry out all these departmental processes in an efficient and timely manner. 

The services delivered by this largest consortium include revenue cycle management (RCM), denial management, extensive and fruitful co-ordination with payers, and streamlining of these processes to integrate with EHRs.


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Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion. 

Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation for meeting Medicaid expenditure as soon as the Federal Government’s ceases to support Medicaid related expenditure, it is imperative that, in a Federal Setup, states follow certain measures as dictated by the Federal mandate. Moreover, Medicaid, expansion, being a pro-healthcare measure, is destined to elevate the quality of public healthcare across the country in tandem with Medicare reforms. 

Coming to the composition of the Medicaid expansion, the proposed scheme opens up health insurance eligibility to all people with household incomes up to 133 percent of the Federal poverty level. Irrespective of whether you are unemployed or the so-called working poor – there can be no denial of Medicaid coverage from January 2014. This is going to be a significant shift from the current coverage which covers only low-income parents and children, and the frail elderly and the disabled. Therefore, when it comes to pro-societal issue, quality healthcare should take precedence over the rest. Quite encouragingly, some states – California, Connecticut, Minnesota, New Jersey and Washington have already started with the expansion of Medicaid programs. 

While Medicare expansion is going to bring an unprecedented population under the ambit of Medicaid, physicians will have a hard time in coping up with sudden influx of patients. The situation is going to even more serious if the patients happen to be in need of specialty services as there is already a dearth of specialty-specific physicians across the state. And, with the situation requiring sometime to become ideal, the existing physicians will have to bear the additional brunt. Although the additional workload would also bring in additional revenues from Medicaid reimbursements, their Medical Billing Practices would be put to test as Medicaid reimbursement environment has progressively become more stringent over the years. When you consider dealing with such stringent environment along with the mandatory EHR compliance that support ICD-10 and HIPAA 5010 practices, you might get apprehensive of physicians’ ability to devote quality time to patient care.

Therefore, it becomes inevitable that they seek Medical Billing and Revenue Cycle Management Services (RCM) that would not only ensure maximization of their revenues but also elevate their clinical efficiency. Care should also be taken to analyze your prospective service providers’ credibility and competence for Medicaid-related reimbursement practices. 

While you embark on seeking a suitable medical billing and Revenue Cycle Management Services (RCM) provider, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of long-standing reputation as a credible and competent source for Medicaid-related billing and Revenue Cycle Management Services (RCM) comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – may well prove to be your preferential recourse. 

For more information visit: Medical Billing Services

EHR Adoption gains popularity with Oregon, Georgia, Washington and Virginia leading the trend

The EHR adoption rates in the United States are definitely increasing and this fact is corroborated by a report released by the CDC (Centers for Disease Control and Prevention) which states that – “American Hospital Association’s Survey of IT adoption, 15.1 percent of acute care non-federal hospitals have adopted at least a “basic” EHR. Moreover, according to the report 24.9% of office-based physicians have implemented at least a “basic” EHR. This figure is twice what it was in 2008 depicting an increase in the adoption rates by almost 50% as far as office based physicians are concerned and this trend is observed in almost all health provider settings such as various hospitals and private practices. The survey also shows that 79% of intended applicants are in the process of preparation to apply for adoption in the year 2011 or in 2012. 

Oregon, Georgia, and Washington among some others are some of the States that are leading in the adoption of EHRs due to this national trend. The data released by researchers from the Doctors Company gives a state wise adoption percentage of physicians in the country. According to the report, Forty-one percent of Oregon’s physicians have adopted electronic health records, following Oregon for physician adoption are Georgia at 39 percent, Florida at 37 percent, Washington at 35 percent and Virginia at 34 percent. 

The repercussions of such increases in the adoption of EHRs in hospitals and by physicians are not just limited to positive outcomes related to the health of the population and the efficiency of the hospital, provider, or practice but also have an excellent impact on the revenue of providers. This is not just because of the increased work and thus revenue but also due to the incentives provided by the Government. The adoption of EHRs usually brings profits and revenues in the long run but it is not surprising that a certain period of time passes before you see positive financial outcomes. This is due to the fact that EHR adoption can be a little cumbersome, has a steep learning curve, and is being implemented for the first time on a national level. 

The successful adoption of EHRs is only possible if all the processes involved in the delivery of healthcare are streamlined and integrated with EHRs. The other departmental processes have also undergone changes and the staff also has to learn these new IT innovations in the industry for increasing the revenue of providers. With new polices implemented by the government concerning not just insurance but also Medical Billing and coding and such other processes, reform is seen in all processes involved in the ”back-office” functions. 

Changes need to be taken place in many processes such as Revenue Cycle Management, insurance interaction, billing codes, and denial management. We at Medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, not only provide these services but are also aware of the latest changes in policies such as HIPAA compliance and billing issues among many others to provide optimization of revenue and better quality of service to providers. 

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.

For more information visit: Medical Billing Services

Specialty EMR Market not completely tapped

Recent estimates conclude there are various specialists in the EMR market who rather than using specialty EMR, usually follow the trend of using a general EMR which has a few extra functions; however user views suggest that general EMRs with extra functions/templates are usually not sufficient for many specialists. 

The U.S. EMR market space is highly fragmented with more than 1000 players in the market with the EMR market expected to grow to $6,054 million in 2015 at an estimated CAGR of 18.1%. Most doctors recognize that EMR adoption is inevitable and are willing to invest in a good EMR, but specialists find it difficult to access a broad range of options when they want a system tailored to their needs. Various EMRs lack the sophistication needed to be effective in specialized medical environments and if an EMR has been designed for everyone, for every specialty, it has in reality very little value. 

There is a wide disconnecting between futurist visions and current EMR implementation rates amongst medical specialists, such as otolaryngologists and orthopedic surgeons. But generally EMR vendors provide solutions that are designed for generalized medical fields, rather than specialties as they focus their R&D efforts and finances on solving the needs of physicians such as family practitioners or pediatricians. Furthermore certain manufacturers choose an even wider approach and attempt to build systems that suit the needs of physicians across today’s very broad medical spectrum. 

Multi specialties can do well by choosing generically built EMR if they suit their purpose, however it suits a specialist more to use specialty EMR’s to avoid higher costs and implementation. Physicians aware of this can definitely benefit from the right EMR. 

Certain Advantages for a specialist of a customizable specialty EMR system over a generic system: 

• Specialty EMR takes less time to implement and adopt 

• Customized with the library of required forms and templates which helps the user to focus on quality of care rather than writing templates 

• Generalized EMR’s could take a month to work properly and user has higher chance of making errors while preparing templates. Specialized EMR’s leave little room or no room for errors and omissions 

• A specialty EMR is designed according to the workflow of a particular practice 

• A general EMR system comes loaded with all types of features and functionalities whether a user needs it or not leading in distracting the user’s attention and efficient workflow 

• Specialty EMR helps to improve competence through the accuracy of medical decisions 

Hence it is evident that there is a large market for EMRs that specialize by practice type and gradually there is developing a trend amongst smaller EMR vendors who are trying to carve out their niche in the EMR market by focusing on certain specialties, but the market for specialty EMRs has a long way to go before it matures. Moreover doctors while choosing their EMR have an option of choosing from more than 300 EMR companies. 

Balancing their act between healthcare reforms demands and patient care physicians can do well by partnering with a Medical Billing Consultant who can guide them and give them advice on the right EMR after studying their practice medical billing process completely. 

MedicalBilersandCoders.com is offering a wide array of EMR’s for them to choose from besides providing consultation in selection of the right EMR which generate records through successful implementation in the healthcare practices which are eventually used by the practice for various purposes such as patient care, administration, research, healthcare quality improvement, and processing of 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.

Increasing Impetus on Physician Reimbursements becoming value-based

Both federal and private payers are shifting compensation from volume to value of services. According to American Medical News one of such payers is UnitedHealth Group who is to start offering approximately 50- 70% of its physician’s bonuses for reaching cost and quality targets and/or participating in new care models. 

Increased numbers of physician practices are likely to experience this shift soon with other large health plans, like Aetna and WellPoint, already using the value-based incentives model. In addition Medicare’s shared savings program is also offering “shared savings” to the pioneers of Accountable Care Organization (ACO) who are improving quality of care and reducing costs. Overall the shift to value is not a passing trend states American Medical News especially with UnitedHealth Group US’s largest health plan, with physicians in every state, also adopting this trend. 

Shift putting physicians at risk for lower reimbursements? 

As of now as a majority of insurers shift reimbursements towards value, are not yet putting their physicians at risk for lower reimbursements. Nevertheless this is likely to change soon- with physicians who do not meet quality outcome requirements and lower readmissions will in most probability begin experiencing reimbursement reductions. 

Medicare and other payers are expected to continue taking steps to encourage increased number of medical groups to concentrate on the outcome rather than volume consequently in this scenario practices need to start gearing up and adjusting themselves accordingly for a shift from volume to value to assure smooth revenue generation. 

Physicians get geared 

Contrary to what some entities may feel physicians can do well in areas of both quality and productivity at the same time, but for that physicians will need to apply best practices for streamlining care, learn from other successful practices and understand resources needed to track quality and cost indicators. Outlined below are some measures Physicians may find necessary to take to help in value based reimbursements: 

• Proof: physicians may need to establish that they are providing quality care at reduced cost 

• Documents: fully utilize EHR to document patient information and be able to quickly share patient information with other providers due to increased care coordination 

• Data Analysis: analyze data generated through EHR to help determine performance 

• Patient engagement:  soon to become an increasing factor related to payments 

Though the shift from volume to value is stressful, it has potential for physicians as if it is successful they may see higher reimbursements, for which they need to spend  good quality time with patients, but may be pressed for time to address the other measures mentioned earlier. As physicians move towards a value based system of healthcare delivery, they would be well-off having an advisory from experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization. 

Medicalbillersandcoders.com besides managing your practice’s Medical Billing our medical billers and coders can guide the practice right from the EHR best suited for your practice to data analysis and assist in incentive maximization contributing towards the healthcare goal of providing quality and cost‐effective healthcare services. 

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