The Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

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.

The Changing Face of Primary Care: An Overview

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

Is Medicare and Medicaid Reimbursements fairer than Private Insurers: a Brief Comparison

Various providers despite being paid lesser by government than by commercial insurers believe that Medicare and Medicaid reimburse more fairly than commercial payers. Findings from a recent survey depicted that 93% of respondents feel that Medicare is fair always or frequently while 62% felt the same about Medicaid, whereas 62% were of the view that commercial plans are not fair in all or most cases; and 49% said commercials are fair sometimes. One of the factors in assessing fairness can be speed –approximately two-thirds of respondents said Medicare pays the fastest, 26% said Medicaid and only 9% opted for commercial payers.

The differences between Medicare, Medicaid and private insurers is not limited to the reimbursements but are also observed in various other fiscal features such as the overheads where private insurance companies have more overheads in the form of administrative costs, overhead for Medicare – approximately 2-3% whereas for private payers – 12%. This comparison sheds some light on the way government and private payers operate as far as their fiscal policies are concerned. However the looming Medicare cuts though postponed by the Congress time and again will affect physician perspective towards government payers.

The Committee on Ways and Means (US Congress) in its latest efforts in the health reforms regarding payments from private payers and its implementation in Medicare has started to explore how private payers are rewarding physicians who provide high quality and efficient care. The report released by the cites the Sustainable Growth Rate (SGR) formula in Medicare Fee-for-service (FFS) as lacking in recognizing the quality of care that is offered by the provider. A report by the U.S National Institute of Health clarifies that in 2004 31% of all outpatient physician income was derived from government sources and this number is set to rise as the reforms ensure health insurance for the remaining 32 million uninsured in the country. This essentially implies that even if Medicare and Medicaid pay a less amount per claim compared to private insurers, more than one-third of physician income is set to come from such government sources.

The inherent advantage that government payers seem to possess is the trust that the government enjoys from the public as well as from beneficiaries such as physicians. Private players bear more risks in terms of bankruptcy and losses compared to government payers. Moreover, Medicare historically accounts for more than 50% of total public spending by the government for US healthcare; this implies that the option of dropping Medicare patients due to any reason does not seem practical financial prudence. Another advantage of Medicare for physicians is that it pays providers roughly the same amount throughout the country regardless of the consumer’s socioeconomic status. Therefore, even though Medicare and Medicaid are faltering, they are still viewed as trustworthy services.

On the other hand Private payers have traditionally created numerous problems for physicians and patients in the form of errors in claim processing, delays in payment, incorrect payments and excessive denial of claims. Private payers at times deliberately commit errors in claims and such errors amount to almost 19% of the claims that are denied for no reason after submission. These claims need to be filed again which takes considerable departmental work and invariably increases costs and delays reimbursements. To deal with both upcoming healthcare reforms affecting government payers and policies of private payers, physicians require assistance of professional departmental processes. Medial billers and coders at medicalbillersandcoders.com not only offer such professional services in the form of denial management and revenue cycle management but also offer traditional medical billing and coding services for better returns.

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.

The Financial Importance of Timely Medical Claim Submission

The importance of timely claims submission is not lost on physicians or their staff and is an integral part of the revenue cycle management (RCM). The dynamic nature of the health industry and the reforms has further exacerbated the already volatile situation when it comes to claim submission, denials, and re-submissions. There are numerous factors that affect the efficiency of the claim submission process and these may range from type-o errors to other issues regarding medical billing and coding or policy matters. Moreover, the tendency to deny or reject claims based on simple errors seems to be the unwritten principle of most of the insurance companies in the market which further hampers the whole RCM process, thus affecting physician revenue and patient satisfaction.

The most important aspect in RCM is the timely filing of claims that has an undeniable impact on how much and when the providers get paid. There are, however, numerous hurdles in timely filing of claims that can be encountered in a clinic and by their staff or even medical billers and coders:

• One of the most common hurdles in timely filing of claims is the fact that simple errors can and do occur while submission and this rate is even higher for an in-house staff that juggles with numerous issues and interacts with numerous payers
• The biggest hurdle in timely filing is resubmission which is when the claim is denied and filed again due to some error or incompetence on the part of insurance companies
• However, there are other more practical hurdles such as unavailability of time, work pressure on staff, increased demand, and other pecuniary factors that influence the timely filing of the claim

The most important factor that affects the timely filing or submission of claim is whether the in-house staff is handling claim submission or interaction with payers or if the complete RCM process has been outsourced to a professional billing company that not only has competency and professionalism but is also professional and scientific in its approach. The dynamic insurance market also plays a role in the timely submission of medical claims and the rules and regulations governing various providers are also responsible for influencing the way in which claims are filed. Usually claims should be filed within 30 days of the day when the service(s) was provided; however, this may differ according to the provider policies and government guidelines.

There are many ways of dealing with the issue of untimely claims submission and its inevitable negative repercussions. However, the most important method of ensuring that claims are filed on a timely basis is to analyze the whole process of RCM so that the lacunae and repeated errors can be isolated and corrected. For instance, if a provider is denying more claims or is denying claims even when filed in a timely manner, then such situations need to be analyzed and resolved immediately. This process of finding habitual and regular errors in the process of timely submission can be easily handled by a medical billing specialist in a better manner compared to a novice or an in-house staff member.

The inevitable impact of the health reforms on claim submission and RCM is palpable in the form of adoption of 5010 platforms, Electronic Health Records (EHRs) and numerous other factors and requires specialized training and skill that can only be achieved by dedicated professionals who are capable of submitting claims in a timely manner. Moreover, recent issues such as the rapid changes in legislation, intervention of the Supreme court, legal, financial, and administrative issues surrounding ‘Obamacare’ have made it necessary to have specialized professionals who can keep up with the changes and assist in timely submission of medical claims.

Medical billers and coders at www.medicalbillersandcoders.com are not just HIPAA compliant and legally updated but also perform research and analysis of claims and strive to achieve the maximum efficiency through a scientific approach, be it claims submission or accounts receivables. To find more information and for consultancy as well as other medical billing and coding services.

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.

Predicting the scope of medical billing consultants after 2014 and beyond

Although it has been quite a while since the Federal Government announced a series of far-reaching healthcare reforms, we are yet to experience their full impact across the healthcare continuum. And, with the Senate bill deferring a major chunk of the reforms further, it is expected that we may have to wait as late as 2014 to witness their full impact.

Amongst a string of reforms that will take effect from 2014 are the ones emanating from the Patient Protection and Affordable Care Act, which will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act:

• Access to affordable coverage for the uninsured with pre-existing conditions, which means the act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions

• Re-insurance for Retiree Health Benefit Plans, wherein the act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees

• Closing the Coverage Gap in the Medicare (Part D) Drug Benefit, under which the act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500. There would also be guarantee of 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap

• Extension of dependent coverage for young adults, wherein act requires insurers to permit children to stay on family policies until age 26

Coupled with this set of reforms, which are believed to improve physicians’ revenues, there are also reforms that are likely to test their ability to practice delay-and-denial-free reimbursement practices:

• The Accountable Care Organization Model, which requires physicians to realign their practices in congruence with Medicare incentive framework

• The ghost of Sustainable Growth Rate (SGR) fix, which threatens to substantially erode physicians’ share of Medicare reimbursements

• Last but not the least, the radical ICD-10 and HIPAA 5010 compliant clinical and coding practices, which, though indispensable to reduce healthcare fraud and abuse, are going to force medical practices into a more stringent reimbursement environment than ever

While the impact of the ensuing healthcare reforms are going to be felt across the whole healthcare continuum, it is the medical billing practices that would be most affected. Therefore, it is going to be crucial that medical billers and coders respond with highest degree of professional dynamism to mitigate the chances of physicians’ medical claims running the risk of denial or delay. When one thinks of the possible areas that medical billers and coders would be addressing post 2014, the following come up to the fore:

1. Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
2. Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
3. Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
4. Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physicians’ medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
5. Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
6. Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s Medical Billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

As physicians, in the wake of these sweeping healthcare reforms, look to elevate their billing and coding practices through outsourced Medical Billing Services, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – should be a preferential choice for streamlined medical billing practices.