Coping with diverse medical billing challenges in different States

Like in any service sector, medical practitioners’ sustenance and growth has always hinged on their ability to adapt and reinvent themselves to the evolving market scenario.  While they have been quite enterprising enough to demonstrate the requisite character, the magnitude of healthcare reforms unleashed by the Federal Government, and its possible impact on their revenue generation has compelled them to add a new dimension to the usual scheme of adapting and reinventing.  And, majority of physician practices are beginning to realize that new dimension in business expansion – strategically expanding facilities to the areas that offer clinical and operational advantages.  While U.S. is abound with endless opportunities – the imminent expansion of Medicare population and an ever-growing demand for medical services in remote and sub-urban regions being the main source of opportunities, the physicians will have to contend with some unusual operational barriers. And, these operational barriers stem out of the diverse rules prevailing across the 50 states.

Amongst such heterogeneous rules, the regional modification of Medicare happens to be a significant one. Despite Federal Government’s universal Medicare scheme, states are privileged to modify Medicare and Medicaid rules pertaining to coverage, pre-existing condition, and fee-schedule as per their socio-economic conditions. In view of this scope for regional interpretation of Medicare and Medicaid rules, physicians are advised to be knowledgeable of them before they undertake expansion to multiple states or regions with heterogeneous interpretation of Medicare scheme.

Add caption

Complying with state-specific practice registration is another equally important issue when you contemplate on expanding your practice.  Although you carry a valid Federal license to practice medicine, yet you may still need to be registered separately in each of the Federal states you intend to practice. Otherwise, apart from facing legal hassles, you may not be eligible to any of the reimbursement schemes.

Adapting to regional billing demands is another challenge. Certain states have their own Medicare-specific rules, and they employ varying degree of audit intensity. Moreover, in every state the rules are different regarding fee-splitting, corporate practice of medicine, and scope of practice. As these things would have a direct bearing on the revenue, practices should be mindful of them before embarking on expansion.

The important issue that hospitals of group practices will have to contend with is the restriction on certain combinatorial practices in some of the states. Therefore, you may have to restructure your physician composition prior to expanding your hospital or group facilities to the regions with such imposition on certain combinatorial practices.

While you seek to avert and adapt to these operational issues through timely intervention of healthcare legal advisors and medical billing consultants, finding those that can effectively and efficiently match up to the region-specific challenges can be a daunting one. Therefore, it boils down to carefully choosing the one with diverse capabilities.

Medicalbillersandcoders.com – being a credible source for medical billing management and allied solutions across the 50 states in the U.S – stands up to be reckoned as the leading consortium for such interventional advice. Its diverse pool of competent medical billing professionals is strategically spread across all the clinical destinations so that you can have instant access to their expertise.

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.

Are you filing claims and have one in every three rejected!

• Filing claims has become more complicated as health insurers tighten eligibility requirements, and the chances of claims being denied have increased substantially
• Hence when a claim is filed, there is a fair possibility it will be denied and most providers are struggling to balance their busy time schedules to implement additional care while filing claims

Industry Standards say…

“Average rejected claim rate is reported at 30-33%”

According to top ten biller’s investigation on all Healthcare provider’s the claims rejections rate is: 30% with Federal Insurance Payers 33% with Commercial Payers

This rejection rate is observed in Podiatry, Pediatric, Allergy & Asthma, Dental and normally all specialties- if proper EDI or clearing house and payer set-up is not done

Why do claims get rejected?

Claims may get rejected for just a simple mistake like – Inaccurate coding errors by untrained staff, change of address not supplied to insurer to something complex like – Medical procedure ruled “experimental” and not covered.

Few reasons why claims get denied by insurance carriers:

Ailment not being covered in the health insurance policy

Procedure deemed medically unnecessary

Incomplete documentation

Improper claim form filled

Claim not filed in time

Pre existing disease which was not disclosed

How does it adversely affect your practice?

As far as possible steer clear of rejected claims as only one rejected claim can put your revenue behind, and bring on additional tasks like:

Reopening patient’s folder – second review & research of the notes

Claims to be compiled again

Double checking of codes again to ensure usage of the latest codes

Re- submission of claim

Insurance carrier may also need to be contacted

Solution – Reading between the lines to increase your bottom line and revenue!

According to most of the patient-advocacy organizations between 50 – 70% of disputes are resolved through initial appeals made directly to health insurers.

However this could be rather time consuming and opting for outsourcing your medical billing claims to a third party partner could help you get rid of the hassles that a rejected claim can cause.

Achieve the following benefits with MBC:

Considerable reduction in average rejection rate to less than 10%, due to reduced errors Efficient handling of claims resulting in increase of approximately 25% of your reimbursements In house staff is hassle free of all paper work involving medical billing and in turn able to assist you in managing your practice better

MBC’s expert Billing & Coding team will be able to efficiently handle your entire billing process, medical being their core process, besides providing updates about new rules and changes for each specialty.

Medicalbillersandcoders.com has been assisting in revenue maximization for healthcare organizations through their revenue management model encompassing: 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. All this along with weekly reporting and consultancy ensures our physicians receive the revenue they deserve.

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.

Challenges Faced by Physicians in 2012: An Overview

The hurdles faced by physicians in 2012 are not just limited to core medical issues but are also spread across almost all the facets of the health care delivery system. The changing nature of medical practices, changes in Information Technology and in other departmental processes is changing the face of the healthcare industry. Here are some of the major issues and challenges faced by physicians and their staffs in the year 2012.

Physician Shortage

Physician shortage is one of the most challenging aspects of the health reforms since almost 32 million newly insured Americans would worsen the already present scarcity of physicians in the country. Moreover, since the process of implementation of EMR/EHR is time consuming, the amount of time spent with patients would increase, putting even more pressure on limited resources such as the available time and finances. Baby boomers are also playing an active role in reducing physician supply in the country as the population becomes older. Physician shortage is going to get worse in the coming years and the shortage would be about 65,000 physicians in the year 2015, according to a report released by AAMC Center for Workforce Studies. Although there are no quick-fix solutions to these problems of shortages, better management of various processes involved in the delivery of health care has the scope to bring about positive outcomes for the revenue and for the quality of the service.

IT Challenges

The most complex IT challenges faced by physicians are EMR implementation, ‘Meaningful Use’, ICD-10 transition, HIPAA compliance, maintaining IT systems, and financing the support required for management of these IT systems and functions. Health Information Exchanges also put forward significant challenges such as data management, interoperability, connectivity, and security issues. In order to carry out such new and complex tasks, physicians need skilled IT staff and professional support for better departmental processes. Finding such skilled workers is another challenge that is faced by physicians due to changes in Health IT.

Decreased Return on Investments

The healthcare reforms have changed the way in which physicians are paid and even though these changes are positive, physicians would be spending more time, effort, and finances in order to meet the reform guidelines. Increased burden and decreased returns in terms of time and effort put into the practice is a problem that would be faced by physicians and hospitals alike. Increasing amount of administrative work, complex back-office processes, and the changing attitude of insurance companies has forced many physicians to rethink their departmental outsourcing strategies since mistakes in such processes could mean huge revenue losses for physicians.

Medical Billing and Coding

Medical billing and coding has also changed dramatically after the reforms and some of the changes include migration from ICD-9 to ICD-10 codes, 5010 platform adoption, and changes in the way denial management and revenue cycle management are handled. Reforms have enacted stricter guidelines for insurance companies but the rate of denial has not changed considerably. The need for better interaction with payers is being felt due to the reforms and this has also affected revenue cycle management processes. The largest consortium of medical billers and coders at medicalbillersandcoders.com can provide solutions to various challenges ranging from Health IT solutions to better revenue cycle and denial management.

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.

Physicians Shortage – Is there a perfect storm brewing in the healthcare industry?

There has been a rapid growth in the healthcare industry, more than any other industry, mostly in response to rapid growth in the elderly population. According to the Bureau of Labor Statistics, the healthcare industry will create 3.2 million new wage and salary jobs between 2008 and 2018. However, the American Association of Medical Colleges (AAMC) has released a report which states that physician shortage will quadruple after the full implementation of health reforms in the year 2015. The reimbursement cuts in Medicare are another factor that is impacting delivery of healthcare, physician revenues, and the shortage of providers in the country. Moreover along with the expected attrition in the healthcare industry due to the reforms, almost one third of physicians are set to retire in the next decade. The number of new physicians is not going to be enough unless the Congress ensures a 15 percent increase in residency training slots in the country.

The outlook for physicians remains bittersweet. On the bleaker side of things are the Medicare cuts, the new extensive guidelines to be followed under the health reforms, with scare time resources. However physicians who successfully demonstrate Meaningful Use and follow such other guidelines and who choose to work in Health Professional Shortage Areas are set to gain financially from health reforms.

The importance of revenue cycle management, payer interaction, and similar revenue related functions becomes accentuated in light of the changes taking place in the health care system.

The need for better interaction with payers, improved medical billing and coding, and revenue cycle management is being felt because of the increased volume of patients and the lesser time available for treating each patient. Errors in medical billing and coding and mistakes in related “back office” functions can negatively affect the revenue of providers, as providers face these challenges:

• With the increased number of patients due to universal insurance coverage, the number of denials by insurance companies would also increase necessitating constant interaction with insurance companies and payers
• Another unique challenge faced by providers is the increasing population of baby boomers in the country. High numbers of elderly patients would mean more physicians –patient encounters and lesser time to provide quality care

One of the better ways of managing such high volume of patients is to optimize revenue through various processes including efficient medical billing and coding process, so that there are no losses due to avoidable errors and to ensure that lesser amount of time is spent on managing denied claims.

Professionals at medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, not only provide effective medical billing and coding services but can also offer optimized revenue cycle management processes, better payer interaction, assistance in Meaningful Use implementation, and consultancy services for effectively dealing with challenges in the near future.

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.