How Streamlined Medical Billing Protocols Can Help Fight Challenges for Hospitals in 2014?

Not just small practices but hospitals in the US are also facing the pressure caused by healthcare reforms. Many hospitals are closing down, merging with bigger hospitals or experiencing major financial problems. It is being expected that 2014 will also bring various challenges for hospitals in the US for which, they will have to be prepared.

Challenges to be faced by hospitals in 2014:

• Strong preparation will be required by hospitals for ICD-10 that will come into effect this year. As per a study, various hospitals are moderately to very confident of meeting the deadline; however, some hospitals noted risks to successful implementation of the new coding system like, issues related to working with technology vendors and payers and successful adoption of EHRs

• Hospitals might face challenges under health insurance exchanges such as, low reimbursement under the exchanges, signing patients up for exchanges and dealing with effects of high-deductible plans. A huge collection burden might be placed on hospitals, forcing the management to upgrade collection capabilities. However, if they are well prepared, they will be able to reduce bad debt if high-cost patients will be gaining coverage under the exchanges

• Hospitals will have to revive their strategic plans and decide on how many projects they will be able to complete with their current resources

• Hospitals will have to train physicians, maintain quality clinical care because the small supply of primary care physicians will not be enough to fulfil high demands for specialists

• In 2014, non-profit hospitals will have to take care of charity care, especially with newly insured patients

• Community hospitals will have to decide if clinical affiliations should be formed or if specialized services should be left to advanced providers

How can hospitals handle these challenges?

With so many challenges, hospitals are finding it difficult to balance between hospital billing, coding, physician training, EHR implementation, HIPAA and so on. These challenges are especially daunting for small rural hospitals that face lack of staff and money.

A large number of hospitals are outsourcing billing and coding tasks in order to ensure efficiency in revenue cycle management. By streamlining, they are not only strengthening cash flow of their hospital but also improving the level of patient satisfaction.

By hiring a billing partner, hospitals are eliminating the headache of balancing patient care and billing amidst lack of skilled staff. Since a medical billing company will make use of latest technology to handle billing tasks, hospitals won’t have to invest in health IT.

Medicalbillersandcoders.com has been offering medical billing services to various hospitals across the US. We have the largest consortium of billers and coders who are experts at handling RCM, denial management, consultancy for large as well as small hospitals. Our well-trained team can handle all your hospitalist medical billing requirements. At MBC, we strive to streamline billing tasks to ensure improved cash flow and enhanced patient satisfaction for hospitals. While our team handles the challenges, your hospital can concentrate on provision of quality patient care.

Overcoming Recent Billing Challenges with Efficient Medical Billing Services

Overhaul of codes, forms, rates and standards: the current year is going to be very eventful for care providers from a medical billing and coding standpoint. But whether you will emerge through these challenges 11 months later with your revenues stronger or weaker - depends on how well you can prepare your practice to meet the challenges.

If you closely look at the four challenges cited at the beginning, you will understand the wide-ranging impact they will have on cross-sections of your practice. This article will closely look at the specific issues, but it will first explore Healthcare exchanges (HIXs).

HIXs are meant to implement the principle of Affordable Care Act (ACA) which seeks to expand the base of insured Americans by making insurance policies cost effective. In practice, HIXs will allow a large number of insurers to sell policies at affordable rates to American citizens increasing the number of insured Americans to 40 millions.

This is highly commendable, but how HIXs will set the lower rates of insurance policies to facilitate this huge leap in number of insured Americans is not known; but that this will lead to plummeting reimbursement rates for physicians is easy to foresee. And this follows a two percent slash in Medicare rates, affected in April 2013.

But the good side of this rate decrease is that it’s going to a huge base of Americans (about 35 to 40 millions) to the current patient increasing the number of patients per care provider substantially.

Additionally, transition to ICD 10 from the ICD 9 platform has kept care providers concerned, especially with the effective date of 1st Oct. 2014 nearing. The wide-spread concern is justified for various reasons. ICD has 13000 diagnostic codes while ICD 10 includes 70000, which leaps to 155000 if you include the procedural codes. Not only that. Medicare & Medicaid Services introduced a new form which practices have to use to submit their claims.

Moreover, ICD 10 will also require practices to move to a new HIPPA platform, which means additional operational adaption and cost for them. No wonder ICD 10 is being seen as the biggest ICD code overhaul in years.

MBC has been helping many care providers, both in small and big cities of the US, to overcome their billing and coding challenges. We have guided many practices in setting up EHR so that they can handle larger number of patients and leverage the current HIX-caused patient influx. We have also helped practices with ICD 10 transition.

Our Revenue Management Consulting services can help you to fix and optimize your revenue management cycle. To help you do this, we assess it and identify it through training, installation of proper software applications etc.

Medicalbillersandcoders.com the largest consortium of billers and coders in the US, has also been helping many practices to overcome challenges of slashed rates and ICD 10 with its outsourcing medical billing services handling the entire range of activities involved in billing and coding, starting from preparation of claims through submission to post-submission follow-ups. Our service modules are flexible and you can pick and choose only those pieces of our services that meet your coding needs so that you can avoid paying additional cost.

Hire a Medical Billing service to Streamline Patient Flow

Efficient patient flow is extremely important if medical practices want to achieve timely patient care and high levels of patient satisfaction. Long waiting time is the biggest complain patients have and if this problem is not solved; your practice might start losing revenue due to poor productivity, lost referrals, lost patients and employee turnover that is caused due to dissatisfaction at the workplace.

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If your practice is experiencing the following issues, you need to work hard to improve patient flow. Efforts will have to be made to enhance staff scheduling and appointment scheduling as these two issues cause long wait times.

• High appointment cancellation rate
• No-shows
• Frustrated patients
• Rise in employee turnover
• High rate of patient record transfers
• Decline in referrals
• Less rooms to accommodate rise in number of patients 1
• Unsatisfactory reviews about your practice on the Internet

How can you solve these issues?

You will have to identify the problem areas and decide if patient flow is poor due to lack of skilled staff, bad patient scheduling system or something else. In case there is lack of staff, hire a skilled front desk person who will ensure that all the patient appointments are scheduled in the right manner.

Your billing department should also be prepared to step in if your front desk employee needs extra help in maintaining patient flow. Length of time to return patient phone calls will have to be improved along with development of standardized order sheets for common procedures or conditions. Through this, clinicians will be able to communicate orders easily and quickly, saving time to concentrate on patient care.

Tasks being handled previously by specialists should be transferred to other professionals like nurse practitioners or physician assistants. This intervention will enable physicians to spend more time on patients.

In conjunction with standardized order sheets, patient information and instruction sheets will also have to be developed which will help in the streamlining process of patient education.

Do you have the required time to enhance patient flow?

Rise in work pressure, compliance and billing requirements leave providers with less or no time to focus on improving patient flow. To ensure that no revenue is lost because of this, many practices are outsourcing patient scheduling tasks to an external company.

Patient scheduling solutions provided by a billing partner offer various advantages to a medical practice such as, enabling doctors or staff to access patient schedules from anywhere and anytime, getting informed about upcoming appointments, reduction in no-shows and missed appointments, ease in identification of vacant time slots and so on.

Medicalbillersandcoders.com has been offering effective solutions to streamline patient flow to practices across the US. We have the largest consortium of billers and coders who make use of the latest technology to ensure that you focus on provision of quality patient care rather than worrying about heavy patient influx. MBC also handles tasks like timely claim submission, HIPAA compliance, error-free coding and so on.

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.