What does the latest ICD-10 delay mean to your medical practices?

The persistent appeal for pushing back the ICD-10 compliance date has finally paid off for physicians; the US Department of Health and Human Services (HHS) has made it official that physicians would have time till October1, 2014 (revised from the current deadline of October1, 2013) to comply with ICD-10 system of medical coding. The decision to extend the deadline is seen as a positive response to a majority of physicians who felt the original deadline too narrow to comply by voluminous and complex coding system.

While the latest revision would no doubt give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets, it would also delay stage 2 implementation, which requires medical practices to have demonstrated minimum duration of compliance in stage 1. Consequently, those physicians who started with the preparation as early as 2011 will get to progress to the stage 2 earlier than those who start with the stage 1 as late as October 1, 2014.

Along with this differential in progressing to the stage 2 of ICD-10 compliance, it is also important to know how this delay is going to play out in detecting the pace of ICD-10 implementation by physicians. While the one-year delay comes as a much needed relief for those practices that are yet to embark on the transition, it is also a sort of cushion for those who have actually started with the process and are on course to be ready by previous deadline.

The early adapters can use this opportunity to identify and focus on areas where they may have some weaknesses. The advice holds good even for those medical practices that are moving along nicely:

• This unique scenario gives them enough time to streamline areas of their program that were potentially weak
• Create a create a truly robust approach to test the company under ICD-10
• Leverage trading partners in a pilot environment and focus on the risky areas that require time and attention

Conversely, the late adapters – those physicians that are not on course for the compliance by the October 2013 date– would do well not to procrastinate further but use this leeway for earnestly training on ICD-10 compliant medical coding. While they are numerous sources that offer ICD-10 training programs, physicians would do well to trust the proven credentials of Medicalbilliersandcoders.com (www.medicalbillersandcoders.com), which has rightfully earned their name as the leading consortium of medical billers and coders in the U.S.

Specifically designed to address challenges in ICD-10 implementation, its ICD-10 Compliance Training Program should come handy for both early adapters as well as late adapters.  Spread over two phases of intense training – phase 1 comprises updates sharing & building base for latest coding updates in about 35 weeks, and phase 2 covers the real ICD-10 Training – the program seeks to enrich participants’ knowledge base through a value-combination: transition tips from ICD9 to ICD 10, problem solving webinars, weekly updates on ICD implementation, FAQ documents on ICD 10, coding practices forum with other experts and participants.

Practice Owners face challenges with EHR adoption: Possible Solutions

The adoption of Electronic Health Records (EHRs) presents numerous challenges for physicians and many practices are finding it difficult to successfully adopt EHRs. The data released by the Center for Disease Control and Prevention about EHR adoption rates in the country bears witness to the fact that adoption rates are not what they need to be in order to have a positive effect on the health industry. Although more than 50% of office based physicians in the country have some type of EMR/EHR, only about 10% of office based physicians in the country have a fully functional EMR/EHR system. 

Originally EHRs were designed for hospitals and smaller practices and practice owners have found it difficult to adopt such system due to many reasons. The resources required for successful implementation of EHRs are easily available for big hospitals compared to smaller practices. These resources usually include a trained staff for operation of EHRs/EMRs, IT consultants, and maintenance of such systems which requires finances that are easily obtainable in a hospital setting but become difficult to obtain in a small practice. Practice Owners are struggling to meet the ‘Meaningful Use’ (MU) criteria and even though more than half the office based physicians in the country have some sort of EHR/EMR, they do not meet the criteria required for enjoying the incentives through MU. 

Additionally Practices Owners already possessing a basic EHR system are facing challenges in scrapping the old system and starting with a certified new EHR – as certification itself is confusing and upgrading to a certified EHR and scrapping the older system is a costly and cumbersome process. Besides the maintenance and upkeep of the system is also costly and requires skilled resources to work in an efficient manner. The adoption of EHR also entails redesigning the workflow of a practice and this too is a difficult task in both small as well as bigger settings. For instance, physicians would need more time to comply with the MU policies by entering various observations and facts in the system which would require rescheduling of the way in which a practice works. Complying with MU guidelines for all specialties in a similar manner is also not easy as many specialties need to modify these guidelines to suit their line of work. 

There are numerous other challenges in adopting an efficient and MU compliant EHR system and the increasing number of patients due to the newly insured 31 million citizens is compounding the adoption problems. Physicians need to start addressing these problems not just to qualify for the incentives but also to escape the penalties imposed for non-adoption of EHRs. Successful adoption of EHRs can be made feasible by hiring professionals who have experience in this field and can assist in streamlining all the departmental processes in order to optimally utilize such systems. Medical billers at www.medialbillersandcoders.com can not only provide billing and coding services but also the latest in certified EHR technology along with optimization of other processes such as Revenue Cycle Management and denial management along with other value added services to boost the performance of your practice.

For More Information Visit : Medical Billing Companies

How crucial are certain adjustments while posting payments?

While it is true that payment posting is merely an exercise of recording the actual claim realized against patient account concerned, in reality its scope extends beyond that.  Far from just being an accounting exercise, payment posting has evolved into an indispensable tool for analyzing and augmenting revenue generation from medical claim realization from medical insurance providers. Today, the quality of payment posting exercise can either make or break your final financial report. Therefore, medical practitioners across the healthcare continuum are beginning to lay emphasis on this pivotal component more than ever before. Consequently, the cash posting or payment entry department if yours is an in-house medical billing practice, or your medical billing service provider if yours is an outsourced medical billing practice should view payment posting not merely as posting of the details contained in the explanation of benefits (EOB) from the health insurance providers, but also charging the appropriate patient’s account and initiate the process for denied claims if the actual claim happens to be far below the expected one. 

But before your medical billing and coding department or service provider can embark on the process of appealing against delay or denial, it is imperative that they look into certain adjustments that are integral to any medical billing fee reimbursements. This could save you from being embarrassed when you actually come to know that you have compared the explanation of benefits (EOB) from the health insurance providers in isolation of certain out-of-pockets expenses, co-payments, deductible, allowable limit, etc. Therefore, it becomes inevitable that medical practitioners heed to following adjustments before they can actually make qualms against under realized claims: 

• Billed Amount, the amount which the physician charges for his medical services.

• Allowed Amount, the amount that insurance company agrees to bear for medical  services availed by its beneficiary.

• Write-off, the difference between the billed amount and the actual amount allowed by the insurance company.

• Participating/Non-participating, being participatory a physician accepts whatever the insurance company offers as payment for his medical services. Whereas, in non-participatory role he can bill the patient for the difference between the allowable and the billed.

• Deductible, the amount borne by the beneficiary before his coverage actually gets effective.

• Co-insurance/co-payment, wherein a primary insurance company shares a part of the payment with the secondary insurance company.

• Balance bill, where in a non-participating primary insurance company pays a part of a claim, allowing the balance on the claim to be billed to the patient or secondary insurance company.

• Out-of-pocket expenses, wherein patient himself meets certain medical-related expenditure – deductible, co-pay, co-insurance and balance bills happen to be “out of pocket expenses”.

• Contract Maximum, wherein  insurance companies earmark the maximum payable amount on certain illness or policies.

• Offset, wherein insurance company recovers previously allowed excess EOB  from subsequent payments. 

When one considers these incidental factors that have a direct impact on the quality of payment posting, which in turn has a direct bearing on the financial reporting, it is obvious that physicians would do well with tried and tested payment posting practices. Medicalbillersandcoders.com (www.medicalbillersandcoders.com), whose payment posting practices are part of its credible medical billing Revenue Cycle Management (RCM) services, should amicably address inherent challenges in payment posting.

For More Visit :  Medical Billing Companies

How aging reports aid in realizing Account Receivables

Notwithstanding the importance of flawless coding in maximizing healthcare insurance reimbursements from insurance carriers, it is the Account Receivable (A/R) Management that proves decisive in either making or breaking your chances of mitigating denial or delay of your medical bill claims. Most of the physicians, whose primary focus happens to be quality medical care to their patients, never bother to look into this aspect as long as their revenues are not affecting their operational margins. They kind of trust their medical billing department or outsourced Revenue Cycle Management (RCM) service provider. But, despite their best practices, your medical bills are vulnerable to being trashed in Account Receivables for too long; in fact, so long that you may have to relinquish your chances of resubmission. 

This is precisely where you are drawn to keep vigilance on Account Receivables (A/R) so that your Account Receivables are kept within the 120-day-limit.   The best way to keep track on the age of your Account Receivables is to demand a monthly report from your medical billing department or outsourced Revenue Cycle Management (RCM) service provider. Such monthly reports should aid you in knowing how long your claims are languishing in A/R bracket – 30, 60, 90, 120, or more days. But, having access to aging reports does not mean that they are reliable and acted upon for augmenting the process of claim realization. A good aging report need necessarily exhibit how your Medical Billing revenue management services are matching up to the challenges in follow-up on patient accounts and insurance claims. 

Then, how do you ensure that the reports that you avail of are genuine? Is it practical for you to periodical monitor aging-reports on your Account Receivables? If so how often you need to draw on those reports. Well, the answer is definitely ‘yes’, but not on a weekly or monthly basis for it might impede your clinical efficiency if you are drawn into too much of operational issues. Therefore, ideally you can look to draw on these aging reports at the middle of the year when you can actually track what Account Receivables are slipping into expiry bracket, and speed up the follow-up process on first-come-first-out (FIFO) basis. The significance of FIFO is that it kind of minimizes the chances of your Account Receivables falling into ‘bad debts’ category. 

Once you have decided on drawing on aging Account Receivables in the middle of the financial year, and found out those A/Rs that need immediate attention, it is imperative that you follow up with a comprehensive AR Management for augmenting the process of realizing the A/Rs as early as possible. Usually such A/R Management calls for inclusive approach comprising: 

• Insurance follow up, where in your unpaid and underpaid claims are analyzed and promptly followed up with insurance companies for speedier realization. Every effort should be made to substantiate your claims as genuine and worthy of being realized fully.

• Denial Management, wherein, based on the reasons for denial, your denied claims are taken up for resubmission or appealing with the respective attorneys if the insurance companies concerned refuse to entertain the resubmission.

• Patients follow up, wherein outstanding bills from patients are pursued through individualized tracking of patients’ accounts.

• Reconciliation of credit balance, wherein accumulated revenue is taken for audit to see that every account-related revenue is identified and not duplicated.

• Resolving accumulated and unresolved A/Rs, wherein files are taken up for possible redemption through strategic follow up with insurance companies. 

As these functions would invariably seem monumental to physicians, it is prudent to avail tried and tested medical billing management services from credible outsourced service providers. Medicalbillers andcoders.com (www.medicalbillersandcoders.com) – by virtue of leading Revenue Cycle Management (RCM) provider with an array of RCM services comprising patient scheduling and reminders, patient enrollment (demographics and charges), insurance enrollment (for physicians and offices), insurance verification, insurance authorizations, coding and audits, billing and reconciling of accounts (payment posting), account analysis and denial management (EOB analysis), A/R management (insurance and patient), and financial management reporting – may well be your preferential choice.

Towards honest Medicare billing practices

In an industry characterized by the highest level of professional integrity and honesty, it is strange yet true that health insurance related fraud and abuse have reached alarming heights. While the incidence of fraud and abuse are equally spread across the health insurance continuum, it’s more intense in Medicare. In fact, a reliable survey (by the American Society of Business & Behavioral Sciences) puts the cost of such Medicare fraud and abuse at a staggering $700 billion annually, which is close to one third of the total healthcare spend. What is even more frightening is that that 80 percent of healthcare fraud is committed by hospitals, clinics and medical providers themselves! While the Federal Government has set up a recovery mechanism, the percentage of recovery against the eroded Medicare expenditure has been rather dismal – roughly about 5% of the expenditure lost to Medicare fraud and abuse is recovered annually.

While the unscrupulous hands have stood to gain (rather dishonesty), it is the Medicare that has to bear the brunt – the Sustainable Growth Rate (SGR) has grown so monstrous that the Federal Government is on the brink of introducing cuts to Medicare reimbursements. To compound the matter even further, the mandated transition from ICD-9 to ICD 10 could make Medicare even more prone to fraud and abuse. As diagnostic codes will increase from 14,000 to 69,000 and procedure codes will increase from 3,800 to 72,000, there is an undercurrent that more complex the coding system, the greater the opportunity for fraud & abuse.

Although the Federal Government has a stringent policy in place for penalizing unscrupulous intentions, yet the duality of the menace – wherein beneficiaries and providers contribute equally to fraud and abuse – and the unholy nexus between them – wherein they collude for unholy gains – have rather been tougher challenges.

Duality of fraud and abuse of health insurance schemes
Fraud by healthcare providers	Fraud by health insurance beneficiaries
Billing for services that were not provided	Using a member ID card that does not belong to that person
Duplicate submission of a claim for the same service	Adding someone to a policy that is not eligible for coverage
Misrepresenting the service provided	Failing to remove someone from a policy when that person is no longer eligible
Upcoding – charging for a more complex or expensive service than was actually provided	Doctor Shopping – visiting several doctors to obtain multiple prescriptions
Billing for a covered service when the service actually provided was not covered

Left with no alternative, Medicare has introduced radical measures to detect, investigate, prevent, prosecute, and recover the loss from fraudulent and abusive actions committed by providers, members, groups, brokers, and others. Although RAC audits have been able to recover a substantial amount of fraudulently claimed reimbursements, still, a considerable cases find ways to sneak under their nose; the high cost of appointing Recovery Audit Contractors (RACs) – nearly ¼ of the total reimbursement to be audited for fraudulent realization is not helping the cause either. Therefore, suspension and cancellation of practice license and Medicare benefits, legal prosecution have become more viable options.

As Medicare fraud and abuse can land beneficiaries and providers in the legal binds, it is high time that they scrupulously avoid such unholy habits or seek professional advice in case their cases are unintentional. This is where medical billers and coders’ competence will come to fore in aiding them to practice honest Medical Billing Practices. Medicalbillersandcoders.com – by virtue of a long-standing credibility as the leading consortium of medical billing for Medicare-related reimbursements and Revenue Cycle Management (RCM) services – may well be your preferential partner for being immune to legal implications surrounding Medicare fraud and abuse.