Forecasting the Future of Medical Billing and Coding Post ICD-10

United States is on the verge of a major billing and coding reform – the introduction of ICD-10 in particular marks the beginning of the most robust, effective and efficient system of billing and coding ever to have been followed. While providers and payers will benefit from progressive changes, medical billers and coders will have the onus of keeping their expertise renewed from time to time. One of the best ways to be ready for future challenges is through preparedness based on forecast for a certain milestone period. 2020 happens to be that immediate milestone period.

Medical billing and coding will have undergone considerably sophistication by 2020. Amongst a number changes to impact billers and coders, following happen to be on top of the agenda:

• Progressive coding specificity
• Billing automation
• Career requirements

ICD-10 currently has 70,000 odd codes. And, given the progressive nature of ICD-10 coding system, it may have added a few more by 2020. All this extension means that coders will have to be conversant of codes as and when they added. Therefore, coders need to have access to such information from reliable sources.

Billing automation is another area that billers and coders need to watch out for. It is expected that the industry will have reached maximum automated billing and coding by 2020; paper medium will more or less have lost its edge. Therefore, professionals should continually seek upgrading their knowledge on billing and coding software. More importantly, they would be required to mediate EHR practices between providers and payers. Their employability will primarily decided by their technical competence.

While career opportunities will have risen considerable by 2O10, the skill-level too will have grown equally demanding. Among other professional traits, billers and coders ability to promote patients’ privacy and safety through confidential clinical documentation will have received utmost prominence. Therefore, it is crucial that aspiring professionals keep on conforming to evolving privacy and safety rules under HIPAA 5010. These fundamental requirements should not seem difficult given the prospects of rewarding career – The U.S. Bureau of Labor Statistics expects the growth to be around 16% till 2020, with an entry level salary of $35,010.

Billers and coders will continue to have a bright and promising future well beyond 2020. Even though technology will take-over manual operations, billers and coders’ personal touch will still be indispensable to efficient and effective medical billing management. This is precisely the reason to believe that they will have a secure future despite the accompanying challenges. Therefore, professionals should continue to be optimistic of the future.

As medical billers and coders look forward to a future of hope, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – the largest platform for career aspiration in medical billing and coding – is committed to help them navigate to successful career paths. While our core team of expert billers and coders helps improve your competence, our extensive network with employers facilitates compatible placement.

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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.

Does a Medical Coding & Billing Job Offer You Healthcare’s Security from an Office Setting?

Career in health care industry has rarely been unsecure. While professionals in other sectors have had to undergo turbulent times recently, people in this priority sector have maintained steady progress despite economic reversals. And there are reasons to it: first, health care is indispensable; more significantly, it is supported by world’s largest public insurance schemes – Medicare and Medicaid; and the contribution of private insurance players is also noteworthy. This remarkable story of sustenance and growth does not end here. With the Federal Government extending public health insurance to every American, care providers, support staff, payers, and everyone related directly or indirectly to health care will have their future protected.

Amongst those who have been benefited most by the string of recent health care reforms are medical billing and coding professionals. While these reforms have made clinical documentation and operational management more complex for providers, they have opened up myriad of career opportunities for medical billers and coders. Providers now consider it impossible to manage mandatory EHR compliance and ICD-10 transition without the intervention of external billing and coding consultants. With so much of reliance, it is only fair to say that profession in medical billing and coding offers the most of the health care’s security.

Unlike most medical jobs, profession in medical billing and coding is easy to start off. Any graduate can aspire to become one. Financially too it is less burdensome – a qualification can be achieved with as less as $2,600. Aspirants can enroll themselves with Federal Government approved institutes for a formal certification program in medical billing and coding. With a few years of on-field experience, they can expect to be approached by leading hospitals, clinics, and physicians practices.

Medical coding and billing is equally rewarding too – an entry level salary is $35, 920, which can rise to $58,150 with a few years of experience. As for the opportunities and growth, medical billing and coding is expected to register 21% growth between 2010 and 2020, which is an unprecedented record.

Judging by the exponential growth in health care spending, providers’ shift to outsourced billing and coding operations, and an increasingly stringent multi-payer reimbursement environment, medical billers and coders’ significance will only increase further. According to the World Health Organization (WHO), total health care spending in the U.S. is the highest in the world. With the Health and Human Services (HHS) Department expecting health share of GDP to be at a historical high of 19.5% by 2017, medical billers and coders will be greatly required to mediate providers’ RCM process with payers.

With so much of growth potential around, aspiring professionals should be eying on their share of apple pie. Medicalbillersandcoders.com – which has been a leading launching platform for career in medical billing and coding – hopes to complement aspirants’ efforts with learning and employment resources. The fact that it mediates majority of provider-biller engagements is ample testimony of its credentials.

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.

How can Physicians Balance Roles at Work to Increase Medical Billing Efficiency of Their Clinic?

Over the last few years the healthcare system in the United States has witnessed modifications in policies and regulations, in order to make healthcare facilities cost effective and accessible to people from all income groups. However, a substantial percentage of the population still remains uninsured and the introduction of the Patient Protection & Affordable Care Act in 2010, aims to increase the number of people insured and make healthcare more patient friendly.

Doctors need sufficient face-to-face time with their patients to provide the best possible medical care. Changes in healthcare regulations and rise in the number of patients have raised the bar for services provided by physicians, hospitals as well as insurance companies. For instance, in the coming months, the insurance companies are obligated to cover sicker patients without asking for higher premiums and must cover preventive screening services for certain diseases. The physicians are expected to adopt health information technology; databases like EMR/EHR (for patient records), dealing with the insurance claims; billing details, coding, follow up on the claims and other technical responsibilities. They are also expected to be compliant with the regulations of HIPAA, CPT and the upcoming ICD-10 coding system.

Hence as healthcare providers get increasingly burdened with these challenging technical activities which require time and proper training to perform, physicians and other medical staff spend more than half of their time dealing with billing and insurance formalities when the same could be spent diagnosing & treating patients. However as physician’s core activity being patient care they are finding it increasingly difficult to balance their roles at work to increase revenue generation.

Inevitably lack of time and increased regulations can cause inaccurate coding, errors in patient records, failure to comply with the regulatory standards which are some of the issues faced by the physicians. In this scenario more and more physicians are facing delays in claims processing, rejection of claims, increased penalties etc. Moreover, incorporating IT systems for medical billing along with trained personnel can be a costly affair.

One of the most favorable solutions to this problem lies in – physicians outsourcing their paperwork requirements to medical billing companies – while they solely concentrate on patient care. Being specialists in medical billing the billing company’s support staffs are certified, up-to-date and have better infrastructure hence are able to easily manage the entire Revenue Cycle Management (RCM) along with denial management and appeals while conforming to patient confidentiality, offering physicians the balance required in their work.

MedicalBillersAndCoders.com has been providing assistance to physicians and healthcare organizations across 50 states in the United States to receive timely reimbursements for over a decade now. We have certified billers and coders who are well versed in handling all sorts of discrepancies & situations. We also provide professional solutions in medical billing, coding, RCM, denial management, along with regulatory compliance helping  physicians to balance their roles and concentrate mainly on patient care while we strive to achieve maximum & timely revenues for our physicians.

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.

Denial Management – Integral to Physicians’ Conquering Reimbursement Challenges While Medical Billing

Denials are responsible for major erosion of practice revenues, and, despite the best efforts, denials continue to assume monstrous proportions. The situation has grown so alarming that:

• Medical practices fail to collect 25% of the money they are owed
• $125 billion is left in the bag as unpaid claims
  
• Only 70% of claims are paid the first time they are submitted
  
• Of those denied claims, 60% are never resubmitted to payers
  
• Medical practices never pursue 18% of claims at all

While payers (whether Medicare, Medicaid or private health insurance companies) are justified in denying claims with inherent errors, it is physicians who are responsible for not pursuing with resubmission and intensified efforts. This is where Denial Management becomes significant.

Denial Management comprises thorough analysis of denials and ways to convert denials into reimbursements. The crucial part of an efficient denial management practice is re-appealing with substantial proof.But the actual process of your denial management starts with knowing the reasons for denials.
Over a period of time, it has been seen that payers base their rejections on the following:

• Registration inaccuracies, wherein either patient’s insurance is not verified or a wrong payer is mentioned or it is difficult decipher patient’s identity
  
• Charge Entry with unacceptable procedure or diagnosis codes
  
• Lack of referrals & pre-authorizations
• Inadequate information about patient
• Claims with code duplication for the same procedure
  
• Lack of substantial proof for medical necessity of a procedure
  
• Inaccuracies in clinical documentation
• Bundling non-allowable items or applying modifiers where they are not permissible
  
• Lack of credentialing

 Once you have known the root causes for denials, it should lead you to analyze the extent of denials as against the actual submission. Practice Management System (PMS) makes it easy for you to track down denied claims. The advantage of having a PMS in your practice is that it reflects the exact payment posting against each of the submitted claims making it easy to identify the under realized or denied claims.

Having known the reason and the extent of denial, it is now time to put your denial management skills into practice. While coding revision and modification set the things in motion, it is the relationship with the payers and adjudicating agencies that would eventually tilt the balance in your favor.

But it has been found out the physicians are either reluctant or do not have time to focus on these denial management skills amidst their busy clinical schedule. The fact that their internal staff too lacks these skills has not helped their cause. Therefore, medical billing consultancies that offer to integrate denial management processes into your medical billing practices should offer the much needed relief.

Medical billers and coders – being a proven medical billing consortium offering quality and result-driven medical billing services – across all 50 states for over a decade with experience in handling a varied payer mix – are known for elevating practice revenues through integrated denial management. To substantiate our denial analysis, we follow these steps carefully:

• Figure out specific causes for the accumulation of the denied receivables. Such denial analysis provides us the characteristics of the denials, and an opportunity to get them resolved comprehensively
• Analyze the financial impact of the denials; our team of expert medical billing professionals is adept at identifying the general pattern and stake of the denials to evaluate its impact on financial returns
• Provide feedback to improve the efficiency through root-cause analysis and financial impact analysis of denials

MBC’s unique integrated approach has helped physicians of varying sizes & specialties by interpreting the reasons for denials, increasing resubmission and realization through instant denial analysis and management process.

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How can A Medical Billing Service Help in Increasing Revenue at Your Practice?

Quality and cost have been inseparable. And, as U.S. health care industry is defined by new quality benchmarks, cost of administering medical services too seems be rising proportionately. While physicians continue to respond with appreciable clinical efficiency, they seem to have lost ways to find sustainable existence and growth. The existence of intense competition has forced them to operate at the most competitive prices, and off-set with volume. But, volume has failed to generate real revenues due to several reasons. As a result, many practices have either been forced to wind up operations or sell off.

One of the primary reasons for disproportionate revenues vis-à-vis actual volume is failed medical billing practices. Physician practices are either incompetent or lack the requisite infrastructure to take on the challenges of medical billing. The presence of multi-payer system too has not helped their cause. Medicare, Medicaid, and private payer environments pose unique challenges, which can be handled only by experts.

Sweeping health care reforms too have contributed to physicians’ billing woes. While reforms have generally been promulgated to streamline health care delivery and billing, physicians have found it tough to adapt to monumental transitions such as mandatory EHR compliance, ICD-10 coding, and performance-linked reimbursement regime or ACOs. There have also been instances of failed experiments on account of lack of expert or outside billing consultancy. The impact of these reasons is reflected in under-realization of claims, denials, and undesirable A/R days.

The solution to these inherent challenges lies in a full-pledged Revenue Cycle Management that can effectively mitigate under-realization of claims, denials, and undesirable A/R days. Physician practices that have been or likely to be impacted with revenue issues on account of internal billing incompetence and Federal Government’s clinical and operational reforms would do well to engage RCM consultancy that:

• Increases revenue collections by ensuring patients are eligible for medical services and verifying pre-authorization prior to the examination
• Allows tracking each stage of a claim or batch from first logged to posted payment
• Vigorously follows up with unresolved claims issues and diligently appeals denied claims
• Evaluates denial rationales and coding errors in order to establish follow-up procedures that maximize recovery rate
• Employs predictive modeling to forecast future revenue streams and support cash flow
• Is compliant with Medicare and HIPAA 5010 norms, and operates on certified EMR platform that satisfies HITECH requirements, qualifying physicians for performance incentives
• Provides unparalleled transparency through comprehensive reporting and web-based tools that let you manage performance

It is also imperative that your Revenue Cycle Management (RCM) provider follows the tried and tested process, which comprises orderly execution of patient pre-authorization, eligibility and benefits verification, claim submission, payment posting, denial management, A/R follow up, reporting, and litigation management.

Medicalbillersandcoders.com – with credentials and expertise in managing revenue cycle processes for physician practices of varying sizes across the 50 states in the United States – holds the reputation of being a leading RCM provider with a comprehensive approach, encompassing  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), AR management (insurance and patient), and financial management reporting.

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.