Employing Specialized Medical Billing to Maneuver Through Clinical and Operational Issues in 2013

The year 2013 is going to be quite significant to the U.S. health care industry in general and doctors in particular – it is the year when a host of health care reforms will be set in motion, and many clinical and operational experiments will get crystallized into norms to be complied with by the physician community. While they may have objectively been conceived to bring about transformational changes in clinical and operational spheres, the consensus amongst the doctors is that, along with noticeable clinical and operational efficiency, they may have to realign their medical billing practices to changing paradigm in order to remain operationally healthy.

Even as we start counting probable issues that can influence clinical sphere, cost of administering services, medical billing, and so forth, it is may be worthwhile having a glance at the watch list released by The Physicians Foundation, which is committed to focus on issues that surround physicians across the clinical destinations in the U.S. The watch list becomes credible in that it is derived from reliable reports, including the foundation’s 2012 Biennial Physician and Next Generation surveys.

One of the major issues that physicians will come to face in 2013 is the persistent apprehension with Affordable Care Act. While ACA may have been approved by the Federal Judiciary, and soon be mandatory in Medicare networks across the 50 states in the U.S., doctors are not still sure how they can operate under Accountable Care Organization model without having to compromise on their revenues as Medicare physician fee schedule is likely to be constricted and governed by independent payment advisory board.

Second, cost of medical care and patient distribution may get redefined from 2013 as smaller clinics are likely to become consolidated entities. Further, many independent doctors, in an effort to shield themselves from the impact of health care reforms, may even feel it worthwhile switching over large hospitals.  When such realignment starts dictating cost and patient distribution, many stand-alone practitioners may not be able carry on with constricted fees and patient visits.

Third, close on the heels is the possible induction of more than 30 million new patients into the nation’s healthcare systems. Doctors, whose volume is woefully short of the requisite, may still struggle more to provide quality care when the proposed new patients are accepted into health insurance backed (Medicare, Medicaid, and even private insurance policies) health care system.

Last, it is widely believed that doctors would lose the ability to independently decide on clinical & operational issues when they move into a consolidate system of health care delivery under ACO and other forms of shared models. It may not be an ideal scenario when doctors are deprived of their independent opinion on matters concerning clinical issues.

And, even if we are to believe that doctors will somehow navigate through clinical issues, administration and medical billing issues may not entirely be their known territories. That is why external medical billing intervention might just be the right injection. Medicalbillersandcoders.com has precisely been doing it admirably for more than a decade now. As physicians enter into a most momentous year in their professional experience, our resource-rich platform – known for facilitating instant, right, remedial, adaptive, and transformational medical billing solutions across the 50 states in U.S. – might just offer them the leverage to maneuver through the likely issues confronting them from 2013 onwards.

Will Outsourced Medical Billing Ease the Burden on Fewer Doctors Due to Healthcare Law?

The doctor-patient ratio has woefully been disproportionate across the 50 states in the U.S., and researchers believe that it may continue to be far from ideal and even worsen in the coming years:

Researchers have estimated that even in the absence of the health care reform law, the shortage of doctors would have exceeded 100,000 by 2025.

When the ACA is included, the Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed.

This figure is expected to double by 2025 when the retirement of the baby boomers and the implementation of the ACA are in full force.

And, when you consider the recommendation of the recent health care law authorizing the induction of 30 million Americans into the health insurance coverage, it may simply be an overwhelming proposition both clinically and operational. Majority of the new inductees are believed to be baby boomers, whose medical needs tend to be complex; Medicare officials predict that enrollment will surge to 73.2 million in 2025.

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While the patient population has constantly been increasing, there have not been enough doctors in the pool to respond to the clinical demand. Even though medical schools have seen a steady increase in enrollment, the problem of trained and job-ready graduates still persists. Moreover, younger doctors are more selective about their work-hours. And, the fact that about a third of the nation’s doctors are well beyond the age of 55 and fast approaching retirement has not helped the cause at all.

Another possible reason behind shortage of doctors could be disparity in compensation to physicians – a study by the Medical Group Management Association found primary care doctors make about $200,000 a year while specialists often earn twice as much. As a result, the proportion of medical students choosing to enter primary care has declined steadily in the past 15 years.

While The Obama Administration has pledged to ease the shortage, it may not entirely possible to respond to the demand of around 45,000 primary care doctors by the next decade; the proposed increase in Medicaid’s primary care payment rates in 2013 and 2014 may at best encourage an increase of around 5000 primary care doctors by 2020.

The trend is certainly bad from patients’ perspective as there may not be sufficient doctors around to deliver quality medical care. And, for doctors it could mean stretching the limits clinically, and submitting far too many medical claims with multiple health insurance carriers. While physicians should continue to shoulder unprecedented clinical responsibilities till such time when the doctor-patient ratio balance evens out, they can at least control and maximize their reimbursements with external medical billing.

Medicalbillersandcoders.com has been physicians’ choice during times of clinical and operational crisis. Our nation-wide affiliation with expert medical billing resources help physicians chose and engage medical billers either on contingency or on-going basis. As the new health care law is likely to enhance clinical and operational responsibilities, physicians’ could easily off load their burden to our pool of credible and competent medical billers.

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How ‘Malpractice Insurance’ Can Save You From Drowning Financially During Malpractice Law Suits

Physicians, who are generally known for highest professional integrity, often have to live with the tag of ‘malpractice’ despite clinical errors being unintentional. While patients’ have every right to get indemnified for the grievance, physicians’ sole choice of protection against monetary liability – which may vary from few thousand to many thousand dollars depending on the severity of the clinical error – happens to be 'malpractice liability’. Thus, whether you like or not, malpractice insurance is now more a necessity than an option. Moreover, malpractice insurance often needs to chosen carefully depending on the context in which physicians find themselves in –  physicians employed in a hospital may need to be insured differently from those who may be operating their clinics. Because of these inherent priorities, physicians have to aware and knowledgeable of the malpractice insurance that best safeguards them against any eventuality. 

It may be remembered that professional liability insurance can be availed as either ‘occurrence’ or ‘claims-made’ policy. While most of the policies offered by the insurers are claims-made, you can still avail opt for occurrence policies, which are relatively costlier than claims-made policies.

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Claims-Made Policies

In claims-made insurance, carrier is obligated to provide coverage only for the incidents that occur and get reported during the time of your insurance being active. Therefore, it is necessary that both the incident and the filing of the claim happen while the policy is in effect.

Suppose you discontinue with a claims-made policy, and get sued for a malpractice during the time when your claims-made was still in force, you will not be covered against any such suit unless you have kept alive your original claim-made policy with ‘tail coverage’, the term used for extended reporting endorsement. Despite tail coverage being expensive – as far as three times the value of an annual premium – it is often recommended to be active with tail coverage for any claims that could be reported years after they first happened. Tail coverage is also beneficial to physicians who change over to private practice from hospital employment where employer may have been covering them with claims-made policies alone.

Occurrence Policies

On the other hand, occurrence policies are more protective in nature, offering lifetime coverage for the incidents the incidents gets reported long after the expiry of policies. Suppose, you are sued in 2013 for a malpractice that took five years earlier when you were covered under an occurrence policy, you still are entitled to be covered under the your erstwhile occurrence policy even though it has expired.  But a major drawback with occurrence insurance is that they are apparently too costly to be borne by smaller physicians.

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While physicians may possible chose among the forms of malpractice insurance, malpractice   liability is something that is quite inescapable. The alarming increase professional liability claims does quite vindicate the significance of having some form of malpractice insurance. While it may not restore the possible loss of credibility of goodwill of your clinical practices, it could surely prevent you from drowning financially. Therefore, your choice and quantum of malpractice insurance should necessarily be tailored to your practice specialty, practice location, ability to offer collateral security, and more importantly according to state legal requirements under which you are operating.

However, you may find it hard to reconcile these multiple considerations, and possible be better off with some external advice availing malpractice insurance. Medicalbillersandcoders.com, which holds the distinction of being a premier platform for sourcing medical billing solutions, is equally adept at suggesting and securing ‘malpractice insurance’ for physicians either employed in a hospital setting or practicing independently. Our broad base of experts, knowledgeable with various malpractice insurance policies and state-specific rules can be relied upon for implementing the insurance policies that best suit your need and capability.

The Significance of Responding to Cardiology Billing and Coding Dynamics

Cardiology is one those specialties that generally perform high-cost diagnostic and curative services, and getting reimbursed for such significant services means conclusive and convincing cardiology medical billing – adhering to cardiology codes, compliance standards and coding rules. Cardiologist, who used to be comfortable with a fewer codes and compliance standards and coding rules, are now required to be abreast with period changes in cardiology codes, compliance standards and coding rules. Amongst these evolving changes, cardiologists need to be aware of acceptability of the codes assigned, modifiers to be attached, medical necessity of performing and coding a procedure, component coding, and so on.

Acceptability of the codes assigned

Contrary to overlapping cardiology codes in the past, CMS has comes up with an exhaustive list of cardiology codes, meaning virtually an independent and appropriate code for every cardiology procedure. Therefore, Medicare, Medicaid, and private insurance companies can easily verify and ascertain whether or not you have aptly coded your procedures. Moreover, attaching a lower-paying code for a relatively costlier procedure does not make sense at all.

Apart from learning evolving coding numbers and their correct assignment, cardiologists should also familiar with changes that have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic changes. As of now, while billing for cardiology procedures:

• Cardiologists are required report most non-congenital procedures with a single code
• Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
• Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
• Cardiology-specific codes such as 93451, 93456, and 93503 are not allowed to be attached with modifier 51.

Medical necessity of performing and medical necessity of performing and coding a procedure

In certain cases, insurance payors may contest the medical necessity of certain procedures undertaken by cardiologists. Therefore, it crucial that cardiologists substantiate the necessity of those procedures that have sent coded. Otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.

Component Coding 

 

Cardiologists’ services may often involve certain technical components, and there are specific coding ruling depending on the criticality of each of such technical components. A higher technical component should always be accompanied by a higher value code so as to maximize the eventual reimbursement. In cases where there are several technical components involved on the same, the lowest component should be singled out to prevent the mandatory 25 percent deduction being charged to any other higher paying technical components.

All of these evolving cardiology codes, standards, and rules may limit cardiologists’ ability to realize their reimbursement in full. Therefore, irrespective of you being interventional cardiologists, diagnostic cardiologists, electro-physiologists, nuclear cardiologists or cardiovascular/ cardiothoracic physicians, you may eventually need an effective revenue cycle management solution in place that is integrated with the right technology, processes and people to respond to Cardiology Billing and Coding dynamics.

Medicalbillersandcoders.com offers and mediates resource deployment for integrated solutions in medical billing Revenue Cycle Management to diverse medical practices across the 50 states in the U.S. Our capability in cardiology medical billing is driven by a nation-wide resource base of expert cardiology medical billers and coders familiar with cardiology-specific medical billing, technology, and processes. With access to such talent-pool of professionals, cardiologists across the U.S. should be able to respond to cardiology billing and coding dynamics.

Ascertaining Cardiologists’ Medical Billing Needs Even as They Migrate From Private Practices to Hospitals

Till recently, cardiologists who were happy with their private practices have suddenly started exploring avenues to align themselves with hospitals. The change has been so dramatic that already around 15 percent of cardiologists across the U.S. have left their private practices in search of more secure positions in large clinics and hospitals. As per reliable industry sources, the exodus might well cross 70 percent in a couple of years. This shift may have not come about without valid reasons – increased regulations on private practices, stricter reimbursement environment, and a series of healthcare reforms calling for healthcare to be made more affordable may have triggered the swift turn of events.

Impact of revised cardiology fee schedules Like in other clinical disciplines, cardiologists too are feeling the heat of significant cuts in their fee schedules. The recent revision to cardiology fee schedule is so hard on cardiologists that it is virtually difficult even to operate on minimal operational margins. While a certain double digit cut to reimbursement from Medicare is expected, there is also apprehension that private payors may also follow suit. The consolation from the likely swell in patient numbers may not still be able to off-set revenues losses completely.

Stricter federal regulations on private practices Although the recent health care reforms are generally aimed at optimizing the quality of medical care across the nation, private practices may feel rules and regulation emanating from such reforms to be rather harsh or difficult to comply with. Affordable care model, mandatory EHR compliance, and the ensuing ICD-10 billing regime may be both exhausting and expensive. Therefore, cardiologists in private practice may deem it apt to mitigate such burden by abandoning their private practices, and practice in hospitals where they focus solely on cardiology efficiency.

Lure of hospitals Certain hospitals too are laying out baits to cardiologists with promise of lucrative benefits and vertical promotions. Hospitals feel that they can improve the quality with a large pool of experts under one umbrella. And, as for the cardiologists, it may be an opportunity to expand their professional expertise without additional overheads.

Immunity from administration burden One of the significant reasons behind cardiologists opting for larger clinics and hospitals is the perceived burden of administration, which is likely to be even more laborious in the aftermath of the recent health care reforms and the ensuing ICD-10 billing regime

While this migration may clinically and operationally be prudent for cardiologists who do not want to risk practicing amidst volatile conditions, it may not be good for the industry which has always thrived on proper mix of sole practitioners, clinics, and large cardiology specialty hospitals. The fear with this unprecedented exodus is that it may deprive instant access to primary cardiology points. Therefore, cardiologists need to be assured of operationally viable practices. And, there is no better way of doing this than easing cardiology medical billing burden of their shoulders.

Medicalbillersandcoders.com has been a premier source for medical billing, coding, and revenue cycle management services. Practices of varied sizes and disciplines across the 50 states in the U.S. have found our services to be reassuring at times of major operational dilemma. And, now at a time, when cardiologist across the U.S. are losing faith in private practices, our cardiology-specific billing, coding, and RCM solutions may just help them focus on their clinical priorities without being unduly worried about operational issues.