‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system. 

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true. 

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position. 

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.

The growing emphasis on Medicare-specific medical billing services

Medicare, which continues to remain as the nation’s largest public health insurance scheme covering nearly half the United States’ population in its health insurance ambit, has gone through considerable reforms over the years. In fact, the evolution of Medicare can be defined as:

1. Phase-I when it actually used to reimburse physicians the actual cost of medical services
2. Phase- II when it introduced Fee Schedule formula to marginally discount the reimbursements
3. Now when it is linking reimbursements to the level of Physician Quality Reporting System (PQRS) adopted by physicians

While the Federal Government believes that Physician Quality Reporting System (PQRS) will complement its endeavor to curb the sky-rocketing Medicare expenditure, which has already overshot the Sustainable Growth Rate (SGR) by nearly 25%, the response from the physician community has been a mixed one.

• A recent report by the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures
• More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria
• More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum

Judging by these statistics, PQRS is still a long way from witnessing cent percent voluntary participation from the physicians across the nation.

Inevitably, the CMS (Center for Medicare Services), which happens to be the governing body in the US, has made it clear that it will introduce penalties (along with the current system of incentivizing physicians meeting and surpassing the PQRS) beginning with 2013.  Consequently, physician community – which looked encouraged by Federal Government’s recent announcement of extending Medicare to every citizen – will have to contend with mandatory PQRS compliance to avoid getting penalized.

One of the first steps to comply by PQRS mandate is the implementation of an effective and efficient EHR implementation for clinical and operational excellence. Furthermore, such EHR implementation should be customized in a way that responds to Medicare’s PQRS requirement. Physicians, who are already faced with the monumental task of transiting to ICD-10 and HIPAA 5010 clinical and operational functioning, will surely be overwhelmed by the PQRS burden.

Therefore, in view of these inherent demands, physicians would do well to collaborate with service providers who not only specialize PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. Such collaboration with credible service providers would necessarily yield multiple results:

• Frees physicians from the burden of attending to non-core activities
• Qualifies their practices for incentives and bonuses along with maximizing their Medicare revenue generation
• Above all improves their goodwill, which might pave way for further expansion of medical services across multiple locations

As physicians seek to collaborate with external service providers for PQRS-specific EHR implementation, and ICD-10 & HIPAA 5010 compliant clinical documentation needs, Medicalbillersandcoders.com – with the requisite technical competence and professional excellence – should not only be able to ensure PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. The combination of strategic partnership with leading EHR vendors, a dedicated a team of Medicare billing & coding professionals, and a rapport with Medicare makes it the most sought-after Medicare billing service provider in the U.S.

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.

Leverage your business with excellent medical billing services

When people go to hospitals or clinics for treatment or to doctors for consultation, they are expected to pay the medical bills after the procedure has been completed. However, billing services can be difficult if the staff has to do the billing statements for several people at the same time. In most instances, the patient wants to leave the hospital or clinic quickly upon release and does not want to wait for the billing statements. Letting the patient go and mailing the medical bills later on can lead to many errors, inaccurate bills and delays in transmittal to the patient, resulting in high accounts receivable problems. More so, if the doctor is not financially stable and needs the payments to sustain his daily operations. This and other related problems can be resolved through efficient electronic billing services. Some establishments implemented electronic systems within their premises with notable success. However, medical institutions found that keeping pace with the volume growth and new technology increased their operating costs significantly. Studies showed that it was more cost effective to pay for outsource billing services.

There are companies that specialize on medical billing services. The institution submits the transactions to the outsource company who transforms the information to electronic data by encoding. The data is then compiled and printed on an invoice, and given to the patient for payment.  If the patient was covered by medical insurance, a claim form would be prepared and submitted to the insurer for claims payment. This was the initial simplified approach. But as outsource companies became more proficient and experienced in medical billing services, with the help of advanced technology, they were able to improve their processes dramatically.

Outsource companies had to ensure 100% accuracy and completeness in the medical bills. If the bills contained too many errors, the medical institution would not be paid immediately. There would be a time delay while people remediated the errors and omissions. There had to be sufficient details in the statement so people could trace the transaction and verify its correctness. People have to be trained and educated on the encoding and transcription of data. This resulted in a highly trained and competent team of billers and encoders within the outsource company. Also, outsource companies had to ensure the personal and related medical information was present in the medical bills. Data such as patient’s name, address, physician’s name and the nature of illness had to be encoded and maintained in database repositories. In so doing, a medical history of the patient was achievable. This and other improvements can make outsource companies provide excellent medical billing services to help your business prosper.

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The Increasing Interest In Medical Billing From Home

In addition a medical biller will work from the other finish – at insurance policy providers. Here the biller tends to make confident that an insured has paid out his or her part of the value for medical provider (i.e. the deductible), and that the total medical invoice is thus taken care of. Typically there are disputes as to what an insured really should pay vs . what the insurance policy company is responsible for, and the medical biller will work to kind out these problems and collect payments

Kaplan University s persevering with schooling method. This on the web method is meant for those with a high college diploma or GED. Medical Billing And Coding Salary College students getting into this method must demonstrate primary computer system capabilities with a challenge exam or proof of systematically finishing a college-degree computer system course. An Introduction to Laptop or computer Abilities course is offered for those college students getting into the medical coding method who require computer system schooling.

In examining this exciting occupation route, the largest concern is do I require to be accredited? A single of the superior things to know is that if you do come to be accredited, a higher starting off wage, than those who are not, usually generally follows. Outlines of raises and bonuses, as properly as, a positive aspects package such as wellness insurance policy, sick pay, holidays and holidays.

Medical coding and billing is a single of the quickest increasing occupation possibilities in the U.S. medical billing and coding training these days. People in the medical coding and billing trade use a universally recognized coding technique to support medical professionals, and insurers, hold monitor of affected person information and facts for a assortment of utilizes, such as billing, and monitoring research in the wellness care trade. The wage assortment for medical coding and billing expert is in between $36,000-45,000.00 per 12 months. Teaching for careers in medical billing and coding can consider anyplace from 2 months to 2 a long time, depending on the place you decide to go to courses, and irrespective of whether you select to go for a certificate or degree. After you end your schooling you will require to consider the Accredited Qualified Coding exam (CPC). This is supplied through the American Academy of Qualified Coding (AAPC). Though conventional brick and mortar schools are offered to study medical billing and coding, a single of the quickest methods to accomplish this is to go to an on the web college.

Hold in brain these vital things when looking for on line schools giving medical billing and coding course and you will in no way go incorrect. It is suggested that you search for schools that are accredited and gives a confirmed method that is geared towards you reaching personalized achievements.

AAPC gives equally a CPC Preparing course and a CPC-H Preparing course. The CPC Prep course teaches medical doctor office coding and will help to prepare a scholar for the CPC certification exam. The CPC-H Prep course teaches coding for an outpatient hospital/facility setting and will help to prepare a scholar for the CPC-H certification exam. These are self-review courses in which college students work at their private pace, from residence, to full every course within a 4-month timeframe. For college students who have a preference for to consider a classroom based course, a lot of PMCC instructors train during the US.

Medical billing is a job which is not thoroughly wellness care relevant. Alongside with some medical factors, it does affiliate to an office job of getting into knowledge into the computer system for precise functions. Medical billing and coding is a practice which involves the knowledge entry of wellness care records into techniques. This is executed for the reason of submitting statements for wellness insurance policy to providers or even to the Medicare scheme supplied by the federal government. A individual who is responsible for medical billing companies is referred to as a medical billing and coding expert. This skilled plays a incredibly essential position in the managing of the medical facility, considering the fact that they support in availing insurance policy for the charges incurred by the clinical setting. In the subsequent, you will get to know about the job description of a medical biller and coder.

Size of Teaching Course. Most schooling courses necessitate that entrants have an associates degree. Teaching programs consist of course work in medical terminology, legal factors of wellness information and facts, coding and billing, database conduite, and superior advancement strategies. College students are educated on the techniques of coding such as the International Classification of Disorder (ICD-nine) and Present-day Procedural Terminology (CPT-4). career in medical coding Teaching courses prepare college students for certification in medical information and facts conduite.

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How do modifiers increase your AR by more than 60 days?

The number of days a physician’s takes to collect their receivables is a good indicator of how well the physician’s clinic is collecting its accounts receivables.

Industry standards state that organizations which were considered as “better-performing medical practices” – excelled in four performance management categories, one of which were Accounts Receivable and Collections. Depicting that strong cash flow is crucial to the success of any practice; in the AR category high-performing groups reported collecting their receivables in lesser number of days than their peers:

High-performing mental health groups’–7 – 10% of their Total A/R collected in 120+ days Other mental health groups- about 19 – 35% of their Total A/R collected in 120+ days

Modifiers key to reducing your AR days!

Getting the revenue your practice truly deserves requires using appropriate modifiers-

Usage of proper modifiers leads to:

• Improved Collections & Reduced Time in AR
• Enhances  staff and practice productivity
• Decreases cost of revenue management
• Add accuracy and detail to the record of the encounter

On the other hand incorrect modifiers lead to:

• Denials, payer audits, investigations, refunds and fines
• Loss of revenue to the healthcare organization
• Delay in Account Receivable (AR) Collection days, pushing them up by 47- 60+ days

Getting your practice the right revenue…

A medical billing service whose main concern is the billing and coding transactions of a practice will assist and benefit your practice to achieve the revenue it deserves.

Track your modifier with MBC …

Steps applied by MBC	Pertaining to modifiers application in the RCM process
List common procedures	Medicare & other major private insurance payer do not reimburse.
Quick reference & analysis	Collate payers’ write-off codes into the management system
Monthly reports	Denied/reduced claims due to a missing /incorrect modifier.
Modifiers information	Included in payer contract with clear definitions in contracts.
Track changes	How payers handle and reimburse modifiers.
Contract management software	Keeps a tab on payments & compares to contract- allowable.

MBC’s expert Research & Billing team will keep track of the appropriate modifiers to be applied providing updates about new rules, changes for each specialty. Medicalbillersandcoders.com has been assisting in revenue maximization for healthcare organizations by billing and coding for:

• Over a decade now for physicians across the 50 US States and across varied specialties
• Our team is constantly training and updating themselves about industry requisites
• MBC also provides consultancy right from the best EHR– to data analytics

Additionally MBC’s customized reporting along with a dedicated account manager assures regular, accurate and detailed modifier checks. MBC is constantly striving to update and improve the RCM cycle in turn reducing AR to achieve the right revenue for your organization.

For More Information Visit : Medical Billing Companies