Challenges Push Family Practitioners to Partner with Billing Specialists to Improve Revenue

Despite the delay in implementation of 26.5 percent cut in Medicare family practitioners payment, AAFP continues to call on Congress for a repeal of the sustainable growth rate (SGR) formula. This is understandable because the deferment means a temporal relief for family practitioners and if SGR is around, given that it assesses growth solely from a financial standpoint, payment cuts introduced without taking medical and human factors into account will continue to recur.

Though, this cut which is framing the political discourse around primary healthcare in the US is a recent phenomenon (the cut was scheduled for implementation on 1st January, 2013), if we go about a year back and take the case of Dr. Hammond, we will see financial problems have been ailing family physicians for some time now.

Dr. Hammond is an independent family physician with a clinic in Denver who ramped up his in-house IT operations and staff to make his practice and services more holistic, such that with his increased staff strength and upgraded IT his practice is able to cover the entire need of a modern-day healthcare operations starting from keeping in touch with patients to track their health and progress to maintaining electronic data. It’s the most ideal practice to have, isn’t it?

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Though, Dr. Hammond and many family practitioners across the US have upgraded their family physician practices to meet the modern needs of healthcare (like outreach and coordination), the fact remains that these enhancements are not reimbursed under traditional insurance contracts making profitability difficult. This together with new payment reforms which encourage healthcare providers to come together is making independent family practitioners a dying breed in the US. Whether this is good or bad for US healthcare is debatable, but a close look at Dr. Hammond’s operations would reveal that it includes lot of things that are not part of core physician practice (like IT data maintenance) and could be kept out to keep the operations thin, nimble and cost-effective.

And as family practitioners wake up to the prospect of frequent cuts in Medicare family physician payments, there problems seem to be getting enough and counting. However, to upgrade their operations, thwart the effects of Medicare cuts and also to gear up for the innovative payment model, many family practices have been joining Accountable Care Organizations (ACOs) or setting them up.

But transitioning to ACOs from their traditional mode of practice may not be easy as it involves negotiating pay schedules, negotiating payer contracts etc. Also, it requires monitoring and analyzing information, like eligibility for Medicare, medical outcomes, Medicaid and private insurance, and clinical compliance and reimbursement requirements to name a few. Family practitioners in addition to the Medicare cut challenges will have to ensure ICD-10, HIPAA 5010 compliant billing and coding along with EHR and PQRS.

Medicalbillerandcoders.com, the largest consortium of billers and coders across US, has also been helping various healthcare providers with billing and coding services for over a decade now. MBC’s Revenue Management Consulting services can help family practitioners by assessing their in-house revenue management cycle and ensure sound coordination between various components of healthcare, facilitating smooth flow of medical data for ACO operations and otherwise.

We also identify gaps in your process blocking areas of revenue leakage and identifying areas of staff training.  Additionally, we can help train your staff to  replace applications where required and handle new billing and coding challenges like EHR, PQRS, and ICD-10, and HIPAA 5010 compliance so that they can make error-free insurance claims.

Overcoming Cardiology Billing Concerns in 2013 with Complete Revenue Cycle Management

As a specialized healthcare field, Cardiology has cherished generous government support for testing services and unhindered reimbursements. However, with new developments in Patient Protection and Affordable Care Act (PPACA) and lower reimbursements given recent healthcare reforms, Cardiology billing is expected to face some serious issues in 2013. In addition, ICD -10 and HIPAA regulations are bound to complicate the financial scenario for Cardiologists. Some of the major concerns in Cardiology Billing are expected to be –

• New Regulations & healthcare reforms – PPACA, ACA, HIPAA and ICD – 10 are some of the most popular regulations and reforms that have shaken the healthcare industry. Cardiologists are facing disconcerting billing issues, patient data documentation issues and coverage related dilemmas

• Reduced Reimbursements – Due to ever-increasing complexity of claim procedures for insurance providers and reduction in reimbursements from Medicare and Medicaid by up-to 25%, financial performance of every Cardiology Practice is bound to take a hit

• Consolidation and ACA – With increasing consolidation of large hospitals and independent practitioners, surgeons and physicians are losing their autonomy. Many organizations and practices are participating in Accountable Care projects to reduce costs but are in turn exposing themselves to heightened risks as well

• Increased no. of patients – With 30 million more patients expected to be covered by the end of the year 2013 as per new government healthcare reforms, burden on care providers is expected to increase multifold

• Stress on Quality of care – Increasing shift towards quality of care is adding to the service expectations from Cardiologists. Coverage is denied and audit issues arise in case of re-admittance of patients that had cardiac procedures administered on them within a 30 day time period

Despite prospects of difficult times ahead, Cardiology Billing concerns can be effectively addressed with efficient Revenue Cycle Management (RCM). RCM is gaining popularity with healthcare service providers due to the unparalleled time and freedom it offers practitioners to focus on patients. Judiciously aligned RCM can enhance productivity of billing process and reduce financial concerns dramatically-

• Accurate RCM reduces the claim denial rate by arranging pre-authorizations and checking patient coverage with insurer at the time of registration itself
• RCM monitors claim filing and coding process for immaculate documentation and patient record maintenance, that supports efficient billing
• Effective RCM improves revenue capturing and collection of outstanding bills by applying effective denial management, capturing proper documents, handling claim entry and secondary billing
• RCM also analyzes and realigns the payer mix, ensuring improved payouts per revenue cycle by cutting down the risk of practice

Expecting a Cardiologist to handle all this while delivering quality care service is like hoping for a daily miracle. Medicalbillersandcoders.com is therefore nothing short of a miracle partner that can solve all your Cardiology Billing concerns. We improve access management, handle regular claim denials with impeccable turn-around time and expedite cash collections. With a team of experts dedicated to handle all aspects of Revenue Cycle Management, medicalbillersandcoders.com transforms your Cardiology Billing concerns into guaranteed financial success.

How will the Affordable Care Act Impact Cardiology Practitioners and Their RCM?

Healthcare industry has been undergoing steady reforms over the past couple of years and the changes are expected to continue. The objective of this ongoing transformation is to achieve improved healthcare services with increased focus on quality care. In such a scenario, Affordable Care Act is being viewed as a promising way of improving healthcare and strengthening financial conditions of the industry. However in addition to expansion of coverage, increased accountability of insurance companies, lowering of healthcare costs and enhancement of quality care for Medicare patients; ACA is expected to increase revenue risk for physicians as well. As a shift from fee-for-service to revenue and cost sharing model of ACOs (Accountable Care Organizations), Cardiology practitioners will face a lot of challenges in realigning their revenue cycles.

Some of the major RCM parameters that ACA will affect practitioners are –

• Due to bundling efforts, cardiovascular coding will undergo additional changes
• Medicare fee schedules will change for physicians in addition to the continued threat of reimbursement cuts by 30% due to SGR
• Penalties for non participation in federal incentive programs like EHR, quality reporting system and e-prescribing
• Government and commercial insurers will pay for value based services (pay for performance reimbursement model) instead of continuing with the volume based or fee for service model
• Increased number of Medicare patients to be covered by Cardiology practitioner participating in ACO project, meaning more financial risk and heightened burden on RCM

With rising focus on quality care and expected collaboration between hospitals and independent medical practitioners under ACA, to cut down costs and enhance care coverage, Cardiologists will have to adapt their practices and RCM as per the imminent changes.

RCM or Revenue Cycle Management is the strength of any medical practice aiming to stay financially viable. RCM cannot afford to stagnate in its processes as the healthcare environment is changing on a continual basis. With industry changes, RCM of a Cardiology Practice must transform to better suit the needs of the practice. Given a high likelihood of ACO participation by most Cardiology Practices, some well planned changes in RCM can prepare a practice to absorb heightened risk and derive better revenue from ACO –

• Compliance to changing regulations and participation in federal programs designed to incentivize practice performance can save your practice a lot of future costs and penalties. Thus RCM of your Cardiology practice must comply with new regulations and keep your practice up to date
• Change in fee schedules and expected reduced reimbursements by Medicare would mean diminished revenues. Thus focus of your RCM must be to diversify the payers mix to absorb this inevitable decline in revenue
• Coding and billing changes due to bundling must be tracked and updated in your system to avoid any claim denial or audit complications
• RCM must strive to adopt value based reimbursement model for your practice and gradually shift away from fee for service payment model

As RCM and billing experts, delivering optimum medical billing and coding services across all 50 US States, medicalbillersandcoders.com can help add value to your revenue model and save you tremendous costs and expenses. Your Cardiology Practice can benefit from our billing and coding experts help and our accurate revenue cycle management can transform a high risk ACO project into a high return venture for you.

Cardiologists Handle New Regulations and Coding Changes in 2013 with Efficient Medical Billing

Cardiologists are likely to face an entirely new scenario with respect to regulations and coding in the upcoming future. With healthcare industry implementing constant reforms and the government as well as private insurers subscribing to increasingly efficient methods of medical billing and claim filing, cardiologists can’t afford to lag behind. In addition to providing quality care to patients, Cardiologists are expected to follow regulations norms and update their billing practices as per new coding guidelines. 
Some of the imminent changes in 2013, which can affect billing and collections, are –

• New updates in CPS and HCPCS Level II codes, Place-of-service coding errors
• Noncompliance with Assignment rules and Excessive billing of beneficiaries to be penalized
• Inappropriate payments in 2010 by Medicare to be appropriated in 2013
• Questionable billing in electro-diagnostic testing to be introduced
• Part B payments for Glycated Hemoglobin A1C tests to be updated
• Claims processing errors to be corrected with regards to the Medicare payments for Part B claims with G Modifiers
• Use of Modifiers during Global Surgery Period to be evaluated and managed

In addition to these regulatory changes, there will be reduction in reimbursements and payouts to Cardiologists for office testing and medical services. This would mean financial turmoil for many Cardiology practices that are not maintaining efficient billing practices. With reduced government support, Cardiologists will have to manage their revenue cycles more carefully in order to remain financially viable. Thus following billing practices could be adopted by Cardiologists for better productivity and efficiency –

• Updating your billing system with coding changes at a regular interval. CPS and HCPCS coding changes can be readily monitored by keeping in touch with medical publications and coding manuals
• Educating your staff regarding regulatory changes and the expected impact of the same on your billing and collection practices
• Checking with insurance provider for pre-authorization and medical coverage details at the registration stage itself, in order to avoid claim denial later on
• Managing claim filing process and revenue cycle as per the requirements of insurers and reimbursing bodies
• Monitoring outgoing information and incoming requests or notifications from insurers regarding claim settlement, disputes, document requirements and regulatory changes
• Install a denial management system in place to track the reasons and trends in denied claims
• Resubmit corrected claims or file appeal for denied claims with in a turnaround time of 48 hours or less. Ensure review of medical codes, document requirements and grounds of appeal before taking any action
• Streamlining revenue and accounts to absorb the penalties and costs incurred by audit actions
• Adhere to all regulations pertaining to laboratory tests and electro-diagnostic tests. With decreased reimbursements and specific guidelines for conducting tests, even a minute oversight can prove to be expensive for your practice

Medicalbillersandcoders.com has been serving varied specialists including Cardiologists across all 50 US States for over a decade now. Our billing and coding experts can help you in handling new regulations and coding changes by creating an efficient medical billing system for you. We provide meticulous attention to detail and dedicated adherence to regulation and codes for billing practices. Our group of experts handle every detail, allowing you and your cardiology practice to focus on qualitative patient care.

How Can Outsourcing Help Better Position Your Practice for Pay-for-Performance?

Pay-for-performance programs are a great way of rewarding health care providers but do you have the time and resources to make your medical practice eligible for such rewards?
There is no doubt that these programs provide encouragement to doctors and better services to patients but several challenges are also related to pay-for-performance-

• In order to become eligible for these programs, you will be required to reduce variation in your clinical practice
  
• You will have to reduce errors by promoting effective medical safety practice and offering best care to chronically ill patients
  
• As per the present system for Pay-for-performance, factor like reduction in glycohemoglobin for diabetic patients is also a scale on which your performance will be measured
  
• Whether or not your practice will become eligible for P4P also depends on your patient’s hospital stay and emergency room visits. Care co-ordination of patients suffering from chronic diseases between home, hospital and office is also a criteria for rewards
  
• If you happen to use health information technology for improving health of your chronically ill Medicare patient, you will be rewarded under these programs. You will also have to devote enough time and energy to ensure that patients coming at your clinic are well-informed and empowered
  
• In case you don’t participate in P4P programs, you will not only lose patients but also your market share

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How can pay-for-performance benefit you?
If your practice gets to win an incentive award under pay-for-performance program, it will give you an edge over other health care providers. This will result in increased flow of patients at your clinic which will eventually add to your income.

How to make it happen?

At a time when the US healthcare system is facing strain on finance and healthcare delivery due to inflation of medical cost, it has become imperative to offer high quality medical services at an attractive cost. This can happen only when you make your practice eligible for these P4P program by concentrating more on patient care rather than billing and account receivables.

Is AR management and medical billing restricting you?

You may have the capability to offer enhanced medical care to the patients and tackle P4P challenges but tasks like medical billing and account receivable management can eat up all your precious time that can be otherwise devoted in best medical care facilities.

Taking into consideration the complexities of healthcare industry in the US, many physicians are outsourcing these services and buying precious time to prepare their practices for pay-for-performance programs. So, if you also want to improve your services and get the competitive edge, why not make use of increased time and look into patient care?

Medicalbillerandcoder.com has been offering outsourced billing and AR management services to physicians across 50 states in the US. The expert team at MBC also provides consultancy to help doctors enhance their in-house practices and improve health care services to their patients.