Spiraling Cost of Gastroenterology Services to Warrant Billing Partner!

Despite Gastroenterology being one of the high-yielding practices, practitioners’ revenues from reimbursements continue to remain below par. This can be a distressing trend considering the spiraling cost of administering gastroenterology services. While clinical and technological advancements have brought in unimaginable precision to care, billing requirements too have become more demanding than ever before. As a result, a considerable portion of gastroenterology bills are susceptible to delays and denials, most of which are never pursued owing to incompetent billing practices. With the combined cost of such unrealized claims amounting to almost 20% of the total bills submitted, gastroenterology practices would do well to find better billing alternatives. While internal billing resources may be brought up with training and orientation, its success rate has not been all that impressive. Moreover, it could prove costly.

In view of the uncertainty over internal billing capabilities, hiring or outsourcing the entire gastroenterology billing management could prove to be a wise decision.  While the quality of outsourced gastroenterology generally happens to be good, you may still have to assess your prospective billing partners’ competence and experience against your requirements and the prevailing gastroenterology billing complexities. Primarily, your gastroenterology billing partner needs to be proficient in:

• Complex gastroenterology billing codes and rules
• Gastroenterology-related terminology
• Office notes and operative notes, coding for surgical procedures
• Code variations related to multiple procedure rules
• Denial process and appeal denied claims quickly and efficiently to ensure speedy reimbursement

The advantage of evaluating your prospective Gastroenterology Billing partner against these requirements is that it make you believe that you will be assured of comprehensive billing, collections, and practice management services, interspersed with:

• Account receivables management
• Round-the-clock claims processing
• Checking system based eligibility
• Quarterly coding updates
• System-based claims scrubbing
• Comprehensive response to all billing calls
• Regular quality assurance checks
• Weekly meetings to discuss progress and go over reports
• Customized monthly reports

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Such proven gastroenterology billing practices would invariably facilitate:

• Improved collections and income
• Accelerated payments and reduced stress
• 24/7 accessibility to your patient data and financial information
• Transparency throughout the revenue cycle
• Full financial and practice management reporting

Even as you scout for your prospective gastroenterology billing partner, Medicalbillersandcoders.com – with impeccable success in deploying apt gastroenterology billing specialists for practices across the 50 states in the US – offers a chosen pool of gastroenterology billers, adept at coding, billing, payer relations, patient relations, collections, financial reporting, fee analysis, managed-care contracts.

Would Dwindling Medicare and Medicaid Payment Rates Turn Providers to Private Insurance Beneficiaries?

It is an irony that Medicare and Medicaid, which reimburse more than the half of the nation’s total health insurance, have come in for heavy flak by physicians, who claim to have lost considerable revenues that they could otherwise have rightfully earned had they avoided seeing Medicare and Medicaid beneficiaries and favored patients with private health insurance policies. The problem seems to originate from the sustainable growth rate (SGR) formula that has been proved unscientific against exponential growth in public health care beneficiaries and medical cost associated. Thus, physicians have constantly been put to Medicare and Medicaid cuts. And with Affordable Care Act recommending inclusion of millions of uninsured and baby boomers into the fold, physicians may get highly selective in admitting Medicare and Medicaid beneficiaries in an effort to save themselves from being affected with rather discouraging payments rates.

As a matter of fact these two popular government health schemes have been woefully behind payment rates offered by private insurance carriers. As a result, there has considerable shift in insurance pattern, which has resulted in escalation of the private health insurance cost by as much as 25 to 30 percent during the last 5 years. While private insurance beneficiaries have been fetching providers appreciably revenues well over their operational costs, Medicare and Medicaid have seemingly been returning revenues well below the operational costs. To be precise, doctor or hospital receives 10% less in Medicare and Medicaid umbrella as against 20% more on every dollar spent as clinical and operational cost on patients. What is even more worrying is that physicians have consistently been undergoing Medicare cuts, which now threatens to erode physicians’ revenues by as much as 25%.

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If Medicare reimbursements are staring at a monumental cut of 25%, Medicaid reimbursements too have not been that impressive either. Medicaid reimbursements have historically been varying from state to state. Moreover, Medicaid has traditionally been paying much less than Medicare. Although efforts are on to keep Medicaid reimbursements on par with Medicare’s, the expected inclusion of 15 million into Medicaid fold may not eventual allow it happen.

While the inclusion of 77 million baby boomers into the public insurance ambit may provide voluminous clinical opportunities to doctors, the proposed cut to Medicare spending by as much as $426 billion over the next decade could drastically spoil their revenue prospects. With reimbursements revenues expected to decrease even further, physicians or hospitals may not be inclined to seeing more of Medicare and Medicaid beneficiaries. Thus, they may have to substitute their portfolio with more and more private health insurance beneficiaries. While patients with private health insurance policies may be more lucrative, there would always be the risk of dealing with private insurance carriers, who are seemingly more vigilant and stricter when it comes to reimbursements. Given the challenges of private insurance reimbursement environment, it may require an external medical billing mediation to orchestrate the entire process of billing, submitting and realizing the claims to their fullest.

Medicalbillersandcoders.com has considerable experience in deploying medical billing resources as demanded by unique operational challenges. As providers shift their preference towards private health insurance beneficiaries, our nation-wide affiliation with medical billing specialists that are versatile enough to deal with heterogeneous payers should offer them the requisite leverage to manage their medical billing process as efficiently as possible.

What Implication Will Reimbursement Cuts For 2013 Have on Radiology Collections?

Radiology collections, which have been far from being impressive in the recent years, may further go down amidst a host of issues likely to surface throughout 2013. Significant of those issues is the reimbursement cuts, which is supposed to lead to a reduction of almost 19% in the collections of radiology practices. Further, a 25% cut in payments for imaging services has not gone down well with providers, who may eventually be discouraged to comply and continue with revised guidelines.

Closely on the heels of this monumental cut in reimbursements, radiologists seem to be overwhelmed by the demands of Meaningful Use (MU) requirements. While the stage 2 of ‘meaningful use’ promises to be lot easier to comply by, it is highly impossible to predict whole-hearted participation – as much as 40% of radiologists are reported to have stayed from the MU bandwagon, citing reasons such as lack clarity in the program and seemingly unbearable costs associated with it. Therefore, we might as well see radiologists losing collections on account being non-compliant with MU requirements. While the absence of mandatory penalties might seem to be reason for their reluctance, other priority tasks too may have limited their financial and entrepreneurial abilities.

Other than these compliance, lowered payments and Radiology Billing issues, the core clinical issues often seem to consume most of radiologists’ time and resources. As a result, despite the heavy investments, they may continue to have reduced radiology collections. Therefore, it is important that radiologists have or source the expertise to balance clinical as well business side of their practices. The utility of having such expertise is that radiologists will be able to:

• Successfully adapt to meaningful use guidelines
  
  
• Better appreciate changing regulations
  
  
• Manage radiology collections better despite the reimbursement cuts, and
  
  
• Qualify for financial incentives under Meaningful Use criterion and PQRS reporting standards

If the expertise is hard to come by internally, Radiology Billing Outsourcing may possible have answers to every clinical and operational issue, and save radiology practices going into further clinical and financial crisis. The significant advantage of outsourcing is that they come at a price far less than what they would cost if carried out internally. Moreover, it gives ample scope for concentrating on more important aspect – evolving with clinical standards for diagnostic and imaging services. With financial incentive schemes not likely to be stretched beyond 2016, time may be running out for radiologists who have not preparation as yet.

And, those radiology practices that are willing try out Outsourced Radiology Billing Practices to offset the implication of reform measures, Medicalbillersandcoders.com offers the right platform to source radiology billing services from chosen pool of radiology billing specialists. With an in-depth expertise and substantial experience in mediating change-over and adaptation to clinical and operational reforms, these experts may well be crucial in keeping your radiology collections as healthy as possible.

In Search of Resources to Counter Radiology Billing and Compliance Challenges

Much like medical billing challenges faced by other practitioners, radiologists too will have challenges unique to their own profession. The general perception of billing being more complex than ever before and progressive fall in reimbursements seems to hold good to Radiology Billing as well. As a result, radiologists may see their revenues dropping considerably, which in turn could have disastrous impact on clinical and operational efficiency.   With possible threat to sustain diagnostic and radiologic quality amidst a host of clinical and Radiology medical billing challenges, radiologists will have to identify and address the key factors that may carry potentially greatest threats to their revenues, profitability, and more importantly the patient care.

• Foremost, bundling of services and codes could lead to significant decrease in reimbursement for radiologists.  It may be remembered that certain radiology codes are now modified into codes with lower RVUs. Moreover, The Medicare Payment Advisory Committee’s (MedPAC) inclination to reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for radiologists who both order and read images could severely hamper radiologists’ revenue prospects.

• Second, the enormity of radiology coding revisions will require radiologists to undergo training to comply with new coding order.  And, training for ICD-10 compliant radiology coding will not be all that easy simply because the electronic data standards and requirements, lengthy alpha-numeric codes, a whole set of new RVUs,   and the obligation to comply with PQRS standards for Radiology Billing and reimbursements.
  
  
• Most importantly, the new ICD-10 coding system could prove to be the most financially taxing of all that clinical and operational migrations that radiologists may have undertaken thus far – upgrading of technology that necessitates ICD-10 compliance is expected to cost radiologists as high as major capital investments. Coupled with this heavy financial expenditure, radiologists may be required to carry on with dual systems – both ICD-9 and ICD-10 – till such time when ICD-10 system becomes omnipresent. Thus, the duality of coding too will be more taxing both mentally as well as financially.

The enormity of these radiology billing challenges could throw radiologists into a phase of great uncertainty. Thus, it may require unusual acumen to respond to changing radiology coding and compliance requirements. And, who better to manage the business side of your practice than radiology specialists that possess the expertise to understand the dynamics of such radiology coding and billing compliance.

Quite aptly, Medicalbilllersandcoders.com happens to be the platform that can enable the deployment of such radiology billing specialists to practicing radiologists across the 50 states in the U.S.  Its affiliation with chosen pool of radiologists makes it the most reliable source for radiologic medical billing resources to counter radiology billing and compliance challenges. The service portfolio of these radiology billing experts include demographic/charge information, data accuracy verification, coding from physician reports, analysis of  billed charge fee schedule with recommendations, direct claims submission, revenue cycle management,  administration of patient payment plans, responding to patient and insurance inquiries, collecting, depositing payments and performing  refund reconciliation of overpayments, Medicaid pending account research, legal account follow up, carrier arbitration and government payor issue resolution, streamlined appeals process, monitoring accounts receivable, complete and detailed billing management reports.

How Healthcare Data Breaches Warrant the Intervention of Billing Specialists

Technology has really done wonders to the way doctors or hospitals document and exchange healthcare data across the clinical eco-system – with the digital mode, it is now finitely possible to record unimaginable volumes of data in miniature chips, and share them  instantly for collaborative clinical management, research, medical billing, and macro healthcare policy decisions. The negative side of this technology utility is that there has been alarming increase in healthcare data breaches that have threatened to jeopardize patients’ privacy and security as well as credibility of doctors/hospitals.

While most of the present-day Electronic Health Record Systems (EHRs) are amply protected against security threats, yet they are susceptible to unscrupulous manipulations. More over there are always possibilities like lost or stolen hard drives, laptop, PDA or thumb drive, human error, and network hacking.  With technology becoming more mobile than ever, chances of losing your healthcare data or being stolen while in transit may be too high.  Therefore, it comes as no surprise that 85% of healthcare providers have experienced a data breach of some kind or other in the recent past. While the new electronic medical record legislation seeks to put the onus on manufacturers or vendors, providers too will have significant role in preventing most of the data breaches that emanate on account of operator’s incompetence. In fact, the analysts have it that 86% of data breaches are not IT related and could be prevented through better policies and training.  Thus, may be increasingly necessary to have a multi-pronged strategy to avert data breaches:

• Prevention through sourcing industry-leading tools to stop identity theft and maintain legal compliance
• Education that seeks to impart best practices in protecting personal and highly sensitive clinical data
• Have a measured response to incidence of breaches and conduct scrutiny to seal off loopholes, and have a policy to monitor, avert and improve with evolving data security standards.
• Employing appropriate security and backup solutions to archive important files, and test frequently
• Devising two-factor authentication, such as strong user name and password, plus a token or one-time password
• Integrating information protection practices into businesses processes

In between these strategic measures, providers should necessarily be aware of the significance of full disk encryption (FDE) to nullify negative consequences when the device containing confidential patient information happens to be either stolen or lost. The advantage of full disk encryption (FDE) on devices such as desktops, laptops, data tapes, servers and removable media is that data continues to be safe and undisclosed.

Irrespective of operational sizes, there are enough technology versions to avert data loss or incidence of data breaches. Given the larger implications of healthcare data breaches – hefty penalties from HHS, it may be safer and rather more economical to implement HIPAA compliant EHR systems that are built against threats of data theft, hacking, or operational error.

And, to those practitioners who do not want risk experimenting with too many options, Medicalbillersandcoders.com offers to implement HIPAA compliant and secure healthcare data management platforms (EHRs) as part its comprehensive medical billing solutions. Our affiliation with health care data specialists – who are adept at sourcing, implementing, and conducting healthcare data centers as per your unique clinical and operational demands – should help them remain resolute against healthcare-data-related threats.