Medical billing consultancy role in practices planning for ICD-10 conversion

The extent and scope of ICD-10’s clinical and operational impact is such that it is going to influence how functional departments coordinate and operate internally among themselves as well as with external entities such as payers and regulatory bodies. Therefore, it is imperative that providers migrate to clinical and operational practices that best endorse ICD-10 requirement. Hence practices are increasingly realizing the need to spruce up and better integrate the three important components: people, technology, and processes. While they may have the will and financial might to pay for elevating these three factors, they may still lack the requisite foresight and planning, which are the pre-requisites to a successful ICD-10 implementation. This is where, the external consultants – with a track record of delivering HIPAA 5010 and ICD-10 assessments, ICD-10 impact analysis, and ICD-10 implementation plans on time and on budget with excellent results – assume significance.

Having realized the importance of partnering with external consultants, practices have one more thing to evaluate: the process adopted by their prospective consultants. Ideally, the best consulting should comprise of:

• Business roadmap development
  As part of the comprehensive consulting plan, practices should insist on drawing a business roadmap development from their consultants. Such a business roadmap development need necessarily be backed by your desire to achieving organizational change. Further, it should pave way for forming a guiding coalition that can firm up the change vision, develop a roadmap of change initiatives and organize the teams of people responsible for getting the work done.
• Training
  A business roadmap development will never see the day of light unless and until it is backed by action in terms of training. Therefore, your prospective consultants training should necessarily involve key information about the ICD-10 code set, how to use it, how to benefit from it, and what the implementation steps are to be followed.
• High level review
  Early assessment helps you gain a strong understanding of how ICD-10 will impact your organization. Therefore, your consultants should focus on people, business processes and technology to assess the impact of ICD-10. It is a critical part of any ICD-10 initiative since ICD-10 has the potential to impact so much of your business, including programs and systems for claims, analytics fraud detection, enrollment, eligibility, benefits, pricing, sponsor contracting, medical management, provider electronic data interchange (EDI) transactions and other areas.
• In-depth assessment & gap analysis
  The success of ICD-10 consulting depends on how best consultants make an in-depth assessment and gap analysis of their clients’ (physician practices) clinical and operational practices vis-à-vis ICD-10 and HIPAA 5010 standards. An in-depth analysis of complex artifacts may include a review of underlying HIPAA 5010 EDI transactions, and ICD-10, trading partner coordination & testing plan review, and as–is & to–be process review. Such analysis is indispensable in measuring the extent of migration required to comply by ICD-10 and HIPAA 5010.
• Implementation planning and design
  Once your consultant establishes that extent of migration to be pursued, the next phase should involve pooling resources (strategic direction, high level review) to develop the detailed design. The design should necessarily focus on business processes that require modification and IT applications that require remediation and replacement.
• Implementation and ICD-10 compliance
  The final step in the ICD-10 conversion, the implementation and ICD-10 compliance should help physician practices achieve ICD-10 compliance and realize efficiencies while mitigating risk. During this phase, consultants should make necessary modifications to implementation plans based on recommendations from the planning and design phase.

As ICD-10 and HIPAA 5010 compliance is going impact on core clinical and operational functions, including patient care, drug administration, provider systems and reporting, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of competent understanding of the people and process changes needed to support ICD-10 implementations – can easily enable providers to evaluate the technical impact of the change and determine the best way to meet those changes.

Medicaid vs. Private Insurance: Providers’ Perspective

Medicaid not only plays a significant role in helping disabled and indigent people in the country but also provides important financial support for long term care patients. However, Medicaid also has a pivotal role to play in crowding-out private players in the insurance industry. Medicaid is essentially for poor people or indigent individuals and families and those with disabilities or people living with HIV/AIDS and since it is publicly funded, the reimbursement is on the lower side compared to other private health insurance payers.

The fact that private insurance is usually acquired by financially stable families and individuals is a vital point in favor of private insurance companies. However, one of the most palpable benefits of accepting Medicaid patients is the incentive provided by the government for ‘meaningful use’ of EMR/EHR systems which is higher compared to the incentive for accepting Medicare patients.

In relation to Medicaid, the law only covers low-income and indigent families and individuals but does not make it compulsory for providers to accept Medicaid patients. This creates further complications in the form of more and more Medicaid patients for those providers who do accept Medicaid. The distributions of disadvantages for physicians who accept Medicaid are geographic and differ from one state to another. Many states have not raised the reimbursement rates of providers for more than a decade and this has been a dampener for the expansion plans that were recently undertaken to improve Medicaid. The effect of the reluctance of providers to accept Medicaid patients is not just limited to the revenue of providers but also puts undue pressure on those who accept Medicaid plans by concentrating Medicaid patients to such providers.

Private insurance providers and Medicare are faring much better since Medicare laws do not vary by state and private insurers pay more compared to Medicaid plans. Moreover, many physicians end up accepting Medicare patients since it pays better for the same services rendered in Medicaid. The irony is not just the fact that many physicians want to accept low-income indigent individuals but are not able to do so due to the lower reimbursement, but also the fact that even though the laws for Medicaid vary by state, the willingness (or reluctance) to accept Medicaid patients has almost remained the same across various states.

The health reforms have improved the outlook for Medicaid and physician revenue due to the incentives provided, but there are numerous challenges for physicians when it comes to managing their revenue in such a dynamic payer environment. The growing need for better interaction with payers and a scientific and professional approach towards managing the revenue is being felt in contemporary medicine due to the recent reforms and the challenges faced by both publicly funded insurance plans as well as private payers.

For more information about Medicare and Medicaid reimbursement plans, revenue cycle management, EMR/EHR implementation, consultancy, medical billing and coding, and other related 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.

Practicing Medicine in Multiple States: Inherent medical billing challenges

Contrary to single-location practices that were the norms during olden days, the recent trend has been the exploring of practice opportunities in multiple locations. It is not strange for a medical practice/clinic/hospital to expand its operations beyond the original location once it has built up a considerable reputation. Moreover, multiple-location operation has its own advantages: economies of large-scale operations, regional advantages, off-setting adverse practice results in some dormant locations against the profitable locations, and above all nurturing the vision of nation-wide presence.

While some of these expansions are well-planned, often there have been cases that emerge as reflexive actions to situations or circumstances. And these circumstantial expansions are the ones that will be vulnerable to regional rules and regulations. Although, the U.S. healthcare norms generally tend to be rationalized, yet each of the Federal states does exercise some degree of authority when it comes to governing certain clinical and operational functions. Therefore, it is imperative that physicians/clinics/hospitals on the verge of expansion plans realize, anticipate, and respond positively to the advantages and restrictions in the states in which they embark on clinical practices desire to have a presence.

• One of the foremost issues associated with multiple-location operations is the registration. Although, your practice, clinic or practice is licensed to be clinical operational entity, yet you still require to be registered in each of the states you intend to expand yours operations to. Failure to comply with this norm will be deemed as violation of the law, and state will have every right to expel your operations from the state/s concerned.
• Rules regarding fee-splitting, corporate practice of medicine and scope of practice vary from state to state. As these diverse rules directly impact your contracts and compensation methodologies, it is important to be mindful of diverse rules prior to foraying into multiple-location practice.
• Insurance agreement regarding employees and contractors are governed differently across the states. Therefore, it is necessary to get your agreements tailor-made to the governing rules of the state/s you intend to open your practice.
• Medicare billing requirements too vary across the states. Therefore, it is crucial to adapt to the requirements of the state with regard to local coverage decisions and other factors. Certain states may audit more than others or have other unfamiliar requirements to which you will need to adapt.
• Certain states do not encourage professionals with multiple operating licenses. Therefore, it is important verify your physicians’ operating license before taking them on board while expanding your business operations to multiple states or states with such restrictions.
• Certain states have their own policies when it comes to monitoring marketing communication associated with healthcare. Therefore, it is important you know what is allowed to be communicated and what is not.
• There are also state-specific laws that govern practices operating over the internet or telecommunication medium. Therefore, it is important that you know and respect the laws that govern dissemination or exchange of healthcare data over this medium.

While these are apparent issues associated with operating in multiple locations, there could be more that are often elusive but pertinent to physicians/hospitals’ clinical and operational excellence. Moreover, negligent attitude to them can adversely impact both clinical and operational efficiency. Physicians, who may not be in a position to track such elusive factors, need necessarily have to solicit expert advice from competent and credible sources. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – providing medical billing services across all 50 US states, being the largest consortium of medical billers and coders competent to advice on diverse clinical and operational rules prevalent in diverse states across the U.S – comes across a preferential name in the healthcare services outsourcing industry.

Driving patient engagement through healthcare-based social media

From seemingly innocuous platforms for personal interaction amongst registered community members, social media (comprising Face Book, Twitter, and other interactive sites) has emerged as a powerful channel for marketing. In fact, its business-utility has grown to so much that it has evolved to be a parallel channel to the traditional mode of advertising of products and services. And, with healthcare being no exception, has slowly but surely embracing it in what has come to be recognized as “healthcare-based social media”.

As healthcare-base social media has the potential not only to drive stakeholders’ (providers, payers, and pharmaceutical companies) offers to the target population (patient community), but also encourage patient engagement through interactive communication, there is a growing realization that social media needs to implemented in such that best serves both business as well as welfare of the patient community at large. While stakeholders devise unique social media strategies for attracting substantial healthcare market for their products and service offers, the response from the patient community seems to be quite encouraging. According to a recent study from PwC’s Health Research Institute, 40 percent of the sample population has been found to be using social media to find health-related consumer reviews. Twenty-five percent have been found to use social media for “posting” about their health experience; and 20 percent have joined a health forum or community. Forty-one percent of the respondents have confessed that social media would affect their choice of a specific doctor, hospital or medical facility, while forty-five percent of them have even said it would affect their decision to get a second opinion.

The survey results are sure indicator of growing interest from patients in using social media platforms, such as Face book, Twitter or a patient-based community site like Patients Like Me, to share and engage in their experiences. Now the only it is imperative that providers, payers, and even pharmaceutical companies put themselves in position where they can listen to the conversation that is happening in social media, decipher patients’ expectations, and engage them with amicable solutions. The initiative of some organizations in devising unique social media initiatives should instill others to follow. These leaders have developed both internal and external media platforms – the internal system allows for knowledge sharing, innovation, and communication across their wide spectrum, while the external platform allows for patients to create communities and find legitimate medical information.

Therefore, there is really shift from using social media as a mere marketing tool to being a patient-engagement tool. The fact that the PwC survey found 80% of the 124 members (comprising providers, payers, and pharmaceutical organizations) is itself is an endorsement of this shift towards engagement model of service through social media platforms.

While there can be no denying as to social media’s potential to impact patient engagement and involvement, connectivity between individuals, and flow of information across the macro healthcare continuum, there is always an undercurrent of it being susceptible to privacy concerns. As more physicians and healthcare organizations move to social media, its misuse will increase the exposure of Protected Healthcare Information (PHI).  Consequently, they may have to face the wrath of the governing body, such as HIPAA, which restricts and prohibits the circulation of clinical information that infringes patients’ privacy norms. Therefore, providers, payers, and pharmaceutical companies need to get their social media platforms customized and run in congruence with HIPAA mandate to avoid being dragged into any legal issue.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long standing reputation for credible and comprehensive solutions comprising the entire gamut of clinical and operational management – is poised to play a catalyst-role for those embracing social media as a channel for offering their healthcare products and services.

For More Information Regarding medical billing Or Even Medical Billing Companies.

Exodus to hospital-based employment and its effect on healthcare industry

While the recent healthcare reforms ushered in by the Federal Government promises to elevate clinical and operational efficiency across the nation’s healthcare continuum, it is also going to induce physicians into a more accountable and responsible quality clinical regime. The imminent Accountable Care Organization Model, Medicare cuts, the fear of Sustainable Growth Rate (SGR) backlash, the compulsory implementation of EHR, coupled with the monumental shift to ICD-10 and HIPAA 5010 compliant medical billing and coding have begun to take heavy toll of lone-standing clinical practices. The effective influence of these factors is showing up in an unprecedented exodus to hospital-based employment by both new entrants as well as those that have been practicing for a considerable period of time.

A recent study by the Medical Group Management Association (MGMA) quite endorses this shift to hospital-based employment: 65% of physicians that changed jobs recently have all moved into a hospital employment model. What is more interesting is that the propensity to this model is more common amongst new entrants – almost half of new fellows across all specialties are in favor of hospital-based employment. The shift has really assumed a gigantic proportion. And, when we begin to trace the reasons behind this radical shift, we are invariably led to the following interesting factors:

• The new entrants may not be in a position to match up to the administrative challenges associated with running a medical practice; whereas seasoned practitioners seem to have had enough of their share of administrative challenges
• Many associate hospital employment with a source of secure salary, which might take years in private practice. Therefore, most of the entrants view hospital employment as a safer bet
• Hospitals provide resources such as advanced technology and electronic medical records that small practices might find financially taxing to acquire
• The imminent cuts to Medicare and Medicaid reimbursement rates also happen to be a major discouragement to own private practices as majority of U.S. population is supported by either Medicare or Medicaid
• The monumental shift to ICD-10 and HIPAA 5010 compliant coding, which requires considerable resource allocation on training and system implementation

While physicians are justified in their decision to safeguard their professional interest, this trend of increasing hospital employment may well jeopardize the remote clinical access to millions of people residing in the remote areas where private practices have been the only source of medical care. Moreover, there is a growing apprehension of this exodus making way for monopoly in clinical care. Either way, there needs to be some kind of balance between hospital-based employment and private practices in the nation’s macro healthcare well-being. Yet again, medical billing and coding specialists, who hold the crucial to this restoring this balance through off-loading the administration task off physicians, come to the fore.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long-standing reputation of being the credible source for medical billing management comprising streamlined medical billing practices, such as 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, A/R management, and financial management reporting – is poised to play an important role in this direction.