What Do Stage 2 Meaningful Use Guidelines Have in Store for Radiologists?

Stage 2 meaningful use guidelines are finally out, and radiologists may heave a sigh of relief since most of the ambiguity that existed in Stage 1 about their eligibility and the ways to approach the qualification criterion seem to have been made amply clear by CMS and the Office of the National Coordinator (ONC). The American College of Radiology (ACR) needs word praise for its relentless effort in getting most of the necessary changes made to radiology guidelines before the Stage 2 meaningful compliance regime comes into force.  While it is not before 2014 that radiologists should complying with newly laid out guidelines, it may still require some crucial adjustments in processes and technology to be fully ready for compliance and qualification under State 2 of meaningful use criterion.

Even as the Stage 2 requirements offer clarity for how computerized physician order entry (CPOE) will impact radiology, providers would still be required to use CPOE to order more than 30 percent — instead of the 60 percent CMS originally proposed — of radiology procedures during an EHR reporting period in order to qualify for MU incentive payments. Therefore, the necessity of having an efficient and effective computerized physician order entry (CPOE) would still be there.

As regards the problem of complying with the MU requirements on account of rarity of face-to-face contact with patients, radiologists and other providers may get reprieve from noncompliance penalties, but still they would be required to be versatile with specialty codes use in the Provider Enrollment Chain and Ownership System (PECOS). And this proficiency in using the Provider Enrollment Chain and Ownership System (PECOS) would definitely require specialized training or they might have to appoint external coding specialists for the purpose.

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While Stage 2 rules do not require an EHR to store images, providers or radiologist would still be required to ensure that they an active link to the images. Despite the initially proposed linkage of 40% being brought down to 10% finally, it would still be quite a task to keep those 10% active as and when required for clinical study, interpretation, or sought by patients for various documentation needs.

Along with these inherent challenges, providers or radiologists may still have to sort out the issue with employing clinical decision support (CDS) as The Stage 2 rules to do not expand the definition of CPOE to include computerized decision support (CDS). Also, there may be issues with transporting images in the absence of clear cut rules even in Stage 2. While DICOM mode can be relied upon for secure encoding images,   IHE profiles, such as XDS-I and XDR-I would still have to be sent via secure email, which may sometimes be vulnerable to security and privacy threats. Therefore, it could require a dedicated monitoring to see that such files are not exposed to threats.

Amidst managing as critical a practice as radiology, complying with these set of Stage 2 guidelines for meaningful use might either be too demanding or detrimental to the very purpose of diagnostic or imaging excellence.  Medicalbillersandcoders.com – with an objective to ensure diagnostic or imaging excellence unaffected by Stage 2 demands – has offered to mediate the deployment of Radiology Billing specialists that have the requisite competence and experience to implement processes and technology on behalf of radiologists, seeking to comply with the Stage 2 guidelines, and qualify for incentives.

Medicare Fraud Claims, A New Challenge Even For Honest US Physicians – is Competent Billing and Coding A Way Out?

In 2010, Medicare improper payment amounted to $47.9 billion. Human and Health Services, in 2011, recovered $4.1 billion paid through reimbursements as a result of ‘fraudulent’ or ‘improper’ claims. You may be right if you think you won’t ever be among the fraudulent care practitioners who contributed to these figures because you are scrupulous.

But being scrupulous can’t prevent you from being suspected by federal authorities, thanks to the profusion of fraudulent cases – because bizarrely all some care providers have had to do to attract the scrutiny of federal authorities is over use a billing code, regardless of whether they did it for right or wrong reasons.

Why guard against Medicare fraud claims?

What federal authorities track is which codes are being used the most in terms of charges and unit volume at a national level. And then monitors the use of these codes by care practitioners. Currently E&M codes, for instance, have been found to be high in terms of charges and unit volume at a national level and are expected to be a potential target. It means merely using E&M codes can actually expose physician centers to scrutiny by Medicare authorities.

However, to negotiate this situation, you have to understand why it’s happening. And to understand this phenomenon, let us use E&M codes as an example to see how they actually can become subjects of potential abuse. (Remember, it could be any codes; E&M has just been used as an example here.) E&M services are ones provided by physicians and non-physician practitioners to assess patients and manage their care – and the code to get reimbursement is chosen based on the location where the service is performed, medical history, examination and medical decision making.

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As is evident, while some of the bases of choosing E&M codes are objective and straightforward, others are subjective in nature and dependent on availability of information (medical decision making, medical history etc) to the coder who is making the choice. This leaves a scope for human error (both deliberate and otherwise) and misjudgment.

The problems physician practices face today are in the subjective areas. Their in-house billers and coders mostly contend with ineffective in-house coordination between billing and coding and medical processes leading to inadequate medical information based on which coding judgments are made. Even if medical information is available, billers and coders are sometimes beset by lack of sound-enough familiarity with complex medical procedures where diagnoses may often overlap making it difficult to decipher where one ends and another starts leading to wrong assignment of codes and overbilling through coding of diagnoses not covered by Medicare.

With most physician centers the concern is not intended fraud but misinformation and inaccuracy in coding construed as fraud by Medicare or over coding a code under surveillance without documents and details to support it.

Guarding your practice...

You can guard yourself against eventualities stemming from this by tightening up your revenue management system so that there is adequate coordination between various processes ensuring a seamless flow of information and then conducting periodic internal audits by certified coders who will randomly pull up billing and coding documentation of recent patients to check their accuracy.

A clean in-house process or billing and coding handled by experienced billers and coders is the best way to avoid fraudulence and wrong data leading to financial penalties and resulting and attendant consequences.

MBC has helped several big and small care providers to spruce up their revenue management system through its Revenue Management Consulting services. We perform a thorough analysis of your revenue management cycle and lubricate various points of interaction it has with other areas of operation ensuring smooth flow of data. This involves identifying gaps in your process and addressing them by replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.  

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, who are experienced, certified and updated regularly, has helped medical practices improve their finances due to accurate electronic billing, intricate procedure coding, electronic filing of claims and a multi-layered application process - collectively resulting in reduced claim denials and enhanced core-business focus.

Protect Your Medical Practice in Uncertain Times with a Medical Billing Specialist

The healthcare reforms brought by the Obama administration have in many ways been an industry-churning affair. They have changed the number of patients the healthcare centers receive today, affected the administrative activities that revolve around a typical treatment episode, shifted the professional location of several medical practitioners (independent physicians aligning with hospitals) etc.

These changes have caused severe hurt to small healthcare centers and left the big ones financially ruffled, leaving organizations ill-equipped to meet their future goals leaving them far behind organizational aspirations.  

If we look at the changes triggered by reforms as separate facts without any connecting link between them, the situation will look irretrievable. But if we look a little closer to find out that link which unites them, what will spring to our attention is the fact that all of them have a revenue impact on a healthcare organization.

For example, a healthcare organization receiving more patients stems from the fact that the reforms have widened the healthcare security net to include more people than before. It is commendable but more patients may lead to more rejection of reimbursement claims if their insurance eligibility and extent of insurance coverage are not properly checked and proper codes not assigned while preparing their claims, not to mention the fact that more volume causes oversight of minor details.

The second example pertains to administrative responsibilities. While administrative responsibilities were always part of a treatment episode, they have become a concern today as the new changes brought by reforms need a greater collaboration among medical and nonmedical (billing and coding) sections of a healthcare organization to ensure a steady flow of medical information between them based on which decisions will be made. A point in case is the Medicare frauds coming to light in case of E&M coding where the choice of appropriate codes is done by the coder based on medical inputs he/she receives. 

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There is also a need to understand the medical information (about procedures and diagnoses) passed on to billers and coders accurately so that proper coding choices can be made preventing making under-claims and over-claims, especially the latter as it can lead to security by Medicare authorities, now overly sensitized by rising insurance frauds. Similarly, there are other operational challenges brought in by reforms.

Independent physicians aligning with hospital is not a very old phenomenon and one that had been sparked by healthcare reforms – because, to transfer cost benefit to the patient, reimbursement requires services to be bundled up, which has forced hospitals to align with independent physicians to offer varied medical services under one roof, begetting a new set of problems for in-house billing and coding and administrative teams to contend with.

And the impacts of these challenges accumulated over a period of time starts showing on the financial performance of a healthcare organization leading to a situation where yearly financial targets missed by small margins each year adds up to form a big lag after the lapse of a passage of time, sapping vigor and life out of the organization. 

Medicalbillersandcoders.com the largest billing and coding consortium in the US has helped both small and big healthcare centers to avoid this scenario by offering billing and coding service modules that are flexible and can be adjusted to fit the billing and coding needs of any healthcare organization regardless of size.

If you are a large medical outfit with an in-house team of billers and coders to handle claims, as part of our Revenue Management Consulting services, we can prune up your revenue management system by advising you about software applications suiting your purpose and environment, sprucing up your lengthy processes or replacing them with new ones if required and training people in new billing and coding techniques and methodologies.

However, if you neither have an in-house team of billers and coders nor any reason to have one, you can outsource your entire billing and coding process to us and nullify your claim rejection rates and boost your revenues.

The Significance of HIPAA Compliant Medical Billing Services for Gastroenterologists

Gastroenterologists trade patient-centric information for a variety of purposes, and Medical Billing is one of them. While physicians clinical notes on gastroenterology procedures are made use of by coding and billing staff, there may be possibility, intentionally or accidentally, that vital patient-centric information being exposed to security and privacy breach in the form of theft or hacking.  As we know that any compromise with patients’ data security and privacy could lead to monetary as well criminal penalties. Therefore, with gastroenterologists’ practice credibility and reimbursements at stake, it is inevitable that Gastroenterology Billing partners or service providers become HIPAA compliant.

Fundamentally, HIPAA compliant Gastroenterology Billing services are required to be  integrated with various advanced systems to protect all health information that can identify a patient including name, dates, zip code, e-mail ID, telephone or fax numbers, medical record information, health plan and social security information, license numbers, and photographs. Gastroenterologists who happen to source HIPAA compliant medical billing services would invariably be assured of:

• Requirement-specific application of medical billing software
  
  
• Web based medical billing software with EMR solutions
  
  
• High security measures
  
  
• VPN system
  
  
• Frequent reports
  
  
• Insurance authorization
  
  
• AR follow-up
  
  
• Higher confidentiality
  
  
• Anti-virus and firewall software on each computer
  
  
• 24/7 response management

While gastroenterologists’ medical billing staff may have been using HIPAA 4010 platform until now, they certainly need to migrate to HIPPA 5010 in view of ICD-10 coding replacing the erstwhile ICD-9 system. ICD-10 being more specific and alphanumeric, HIPAA 4010 software platforms would certainly not support ICD-10 compliant gastroenterology coding and billing. Therefore, HIPAA 5010 version would invariably have to be introduced, and aligned with advanced billing software such as Lytec, Medic, Misys, Medisoft, Inception, IDX, and NextGen. Such monumental system-change can only be achieved with highly efficient workforce that is conversant with electronic medical records (EMR) and electronic practice management (EPM) systems – believed to be crucial in providing a complete and quality medical billing service as per the requirements of gastroenterology clinics, hospitals, and practitioners.

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Even as gastroenterologists try to bring about these HIPAA compliant gastroenterology billing changes, the extent of system upgrading and staff orientation may be too much to take in. As a result, they would have to depend on outsourced HIPAA compliant gastroenterology billing services that:

• Ensure periodic backup of data and critical facilities accessibility
  
  
• Are fortified with secure workstations, storage facility and authorized access
  
  
• See Firewalls and antivirus software on all systems are updated frequently
  
  
• Ensure technical evaluations are performed on a routine basis
  
  
• Come with affordable pricing: with 30 to 40% cost savings
  
  
• Provide free billing analysis
  
  
• Employ password protected lockers

Medicalbillersandcoders.com – by virtue of having nation-wide affiliation with a chosen pool of gastroenterology billing professionals attuned to HIPAA compliant Gastroenterology medical billing practices – can help gastroenterologists reap the benefits of HIPAA compliant  medical coding, medical insurance collection, medical paper and insurance electronic billing, charge entry, cash posting and reconciliation, management of old accounts receivable collections, and insurance verification and authorization.

Demand for Gastroenterology Services to Impact Medical Billing in Clinics and Hospitals?

The consistent rise in demand for Gastroenterology services has really been a boon for clinics and hospitals. But the growth has been so overwhelming that it started affecting their reimbursements in a big way. While practitioners have generally been preoccupied with clinical duties, their medical billing staff have found the voluminous growth simply hard to cope with. As a result, there may been considerable delay in processing claims, leaving physicians’ bills to pile up as ‘account receivables’. The situation is likely to be even more demanding as a large percentage of population is going to be brought under Medicare and other insurance schemes. As per the reliable industry sources, Gastroenterology specialty alone will see 20 to 25 percent growth over the next five years or so.

Fortunately, Gastroenterology practices can replace or ease medical billing woes with outsourced Gastroenterology medical billing solutions. The quality of services offered is generally good across the US, but it is still advisable to gauge your prospective service providers’ credentials before taking them onboard. Amongst many parameters against which you may judge your prospective Gastroenterology Billing partners’ competence, following assume more significance than the rest:

History of your prospective Gastroenterology billing partners: It is always safe and prudent to engage with billing partners with considerable and demonstrated ability to handle medical claims with Medicare, Medicaid and commercial carriers.

Staff’s experience and credentials: It is the billing professionals’ experience and credentials that translate into tangible benefits for you. Thus, it is important to verify your prospective billing company’s staff’s experience and credentials such as being certified billers and coders from authorized institutes.

Timeliness and accuracy of service: Notwithstanding your Gastroenterology billing company’s credentials, it all the more important that they deliver on-time and accurate billing services.

Being compliant with Federal as well as state-specific Gastroenterology regulatory compliance: Outsourced billing service providers are bound by the regulatory compliance standards, either Federal or state-specific. As outsourced service providers, it is imperative that your prospective Gastroenterology billing partners comply with either of the two

Competitive cost: With other things being equal, you should insist on those partners whose prices are relatively less.

Inclusiveness of services: While you may be availing Gastroenterology billing solutions, yet your billing partners should be judged for their ability to offer inclusive set of services, such as the entire process of Gastroenterology Revenue Cycle Management (RCM).

The advantage of this fact-checking is that it you can be sure of the following benefits from your billing partners:

Timely Processing and Submission of Claims: Once you have chosen Gastroenterology billing company against the parameters listed above, it is more or less guaranteed that your claims will be processed and submitted in time either through paper or electronically. The timeliness and accuracy of submission will go a long way in fast realization of your Gastroenterology claims with Medicare or commercial carriers.

Follow up with payors: Follow up, being an integral component of your billing providers’ services, will help isolate partially paid or unpaid claims and entitle you to the amount due to you.

Report Generation: The utility of having an inclusive Gastroenterology billing service partner is that you can expect to be fed with reports that can be used to bring about clinical and operational improvement.

As you begin your search for inclusive Gastroenterology Billing service providers, you may find the selection a bit tricky. That is precisely why we, at Medicalbillersandcoders.com, are committed to mediate the deployment of Gastroenterology billing resources chosen from a talent-pool of Gastroenterology billers across the 50 states in the U.S.