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.

Streamlined Medical Billing and Coding Helps Increase Physicians Revenue

Are denials, ignored or lost claims, inaccurate coding and underpayments making it difficult for you to collect the revenue you have earned? Physicians have a busy schedule and with the doctor patient ratio getting disproportionate across the US, handling the task of medical billing and coding has turned into a daunting task.

• Complexities of coding can take a toll on your revenue
  A huge problem can occur in case of coding errors. If your staffs happen to give the wrong code, claims will either be paid incorrectly to the wrong provider or not paid at all. Coding is getting complex with revisions in CPT and HCPCS Level II code annually and with the growing number of patients, just an in-house medical coding facility won’t make your task easy.
  
  
• Wrong information
  Filing insurance claims is already a daunting task and in case of wrong information not only will the claim will be denied but you might end up losing or ignoring the claims and not procure significant part of your revenue.

Moreover if you delay claim submission or fail to follow up, you can lose revenue. Can you afford to lose payments every time such an issue occurs?

How to make revenue procurement easier?

Accurate medical billing and claim processing is the only key to obtaining and maximizing revenue for your practice. There is no need to end up underpaid or leave your revenue uncollected just because it is a tedious task.

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• Updating documents as per the coding revisions-
  you will have to ensure that your clinical documents are updated according to the coding changes or revisions so that no error occurs. CPT coding guidelines will have to be applied to cut down the risk of denials
  
  
• Resubmissions of denied claims-
  don’t let denied or lost claims leak your revenue. You will have to make sure that claims are resubmitted accurately
  
  
• Follow ups with insurance companies-
  getting payment from insurance companies is a time-consuming process. You will have to keep following up with them regarding the procedure and resubmitting or making changes till the correct details are not provided to them
  
  
• Proper training to the medical billing and coding staff:
  if you want to rely on your in-house billing system, it is necessary to keep your staff trained and updated about the changes in the health care industry on a time to time basis

Is it too much to handle?

If the process to procure your payment is too much to handle while you struggle with lack of time and staff to attend your patients, why not outsource medical billing and coding services?

Medicalbillersandcoder.com has expert billers and coder who will not only improve your revenue collection but simplify each billing process to ensure smooth functioning of your practice. MBC deals with medical claim filing for physicians from more than 50 US states, relieving them from the headache of managing their funds and revenue cycle every month.

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.

It Is Worth Paying for Medical Billing Services Than Be Affected with Suspended Reimbursements

Affordable Care Act, along with a few other pro-beneficiary health care policies, may have helped rationalize cost of health care as well as cost of health care insurance across the broad spectrum – Medicare, Medicaid, and a variety of private insurance plans offered across the U.S. Beneficiaries could even benefit from lesser co-payment obligations and deductibles. However, it may not be said with any certainty that their woes with delay and denial would come to end. If the recent reactions are any indicators, medical practitioners may well see denials and A/R days going up more than they used to be earlier – there have already been instances wherein physicians’ reimbursements have been held up for as long as 60 days and even more. Just, imagine the kind of negative impact it could have had on their clinical and operational efficiency!

With health insurance premiums reaching lowest levels, payors have resorted to various contingency strategies – abandoning their services altogether, restructuring their portfolios, and of course withholding reimbursements till they are pursued aggressively by the medical practitioners concerned. While payors are within their right to safeguard their financial and business interests, medical practitioners could do better with Medical Billing Practices that are better tuned to expedite A/Rs before they become impossible to be follow-up and may even have to be written off as bad debts.

When it is obvious that such A/R delays will become more common in the coming days, medical practitioners would be left with no alternative but to spruce up their A/R management beyond the routine Medical Coding and Billing exercises. As soon as your bills cross the permissible time, your A/R management team should take over the process of finding out the reason for delay, following up with possible remedial measures, and expediting the process of realization. Operating under multi-payer reimbursement environment, you may have entered into contracts with Medicare, Medicaid, and a host of private health insurance agencies. Therefore, you A/R management team need necessarily have to be versatile enough to deal with multiple payors.

While your A/R Management team is doing what it is entrusted with, coding and billing efforts need to be equally supportive with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards. Although every medical practitioner aspires to be equipped with as comprehensive a medical billing as possible, he may be limited by time and financial factors. Hence, you may be required outsource your entire process of medical billing from patient enrollment, scheduling insurance verification, insurance authorizations, scheduling and re-scheduling, coding, billing and reconciling of accounts, collections, AR collections, to denial management & appeals. One big advantage from outsourcing is that billing companies can be expected to deliver services at a price that is within your budgetary constraints. Moreover, they are invariably versatile enough to deal with complex medical billing issues. 

As you begin to preempt the possibility of undue delay of A/Rs with external billing mediation, Medicalbillersandcoders.com may just be the platform for complete, flexible, affordable, and more importantly tailor-made to the critical situation when your claims are likely to run the risk of being held up far in excess of admissible period of time.  Our credibility is essentially built around chosen billing affiliates (across the 50 states in the U.S.), who are versatile enough to monitor, follow-up, and expedite claim realization when you seem be giving up on your aging or withheld Account Receivables.

Are Orthopedics Justified in Embracing HIPAA Compliant Orthopedic Billing to Boost Their Reimbursement

Reimbursements have generally been tight recently for orthopedics – Medicare cuts, shrinking fee schedules, increased technology intervention in medical billing, and a multi-payer environment that is more vigilant than ever have really made it tough for orthopedics to realize their reimbursements to the maximum. But amidst these monumental challenges, HIPAA compliant clinical and operational management may still offer avenues to keep reimbursements level above average. Thus, orthopedics across the U.S. are beginning to embrace technology-driven HIPAA compliant Orthopedic Billing to offset the impact of a series of restrictive impositions on medical billing.

The significant about HIPAA compliance is that it can not only endorse orthopedics as being responsive to patient privacy and security but also entitle them to incentives for showing up as responsible partners in effective and efficient health care delivery. Moreover, payors perceive HIPAA compliance to be yardstick for measuring orthopedics’ integrity for medical billing. Therefore, HIPAA compliant Orthopedic Medical Billing may just be the factor that can create a sense of trust among your payors. But HIPAA compliance needs to planned and executed in a way that best suits individual practitioners or hospitals; HIPAA compliance cannot be generalized even though you happen to be in the same discipline as orthopedics. The factors that will need to be taken care of while migrating to HIPAA compliant orthopedic medical billing are:

• Ensuring Protected Health Information (PHI) : HIPAA compliance requires you to protect health information, which may include anything that can be used to identify an individual and any information shared with other health care providers or clearinghouses in any media (digital, verbal, recorded voice, faxed, printed, or written).
  
  
• Adhering to Principles of HIPAA : While HIPAA may allow smooth flow of PHI for healthcare operations subject to patient’s consent, it is deemed violation of HIPAA compliance if you disseminate PHI for purposes other than treatment, payment, care quality assessment, competence review training, accreditation, insurance rating, auditing, and legal procedures
  
  
• Following HIPAA Implementation Process : HIPAA implementation need necessarily include both pre-emptive and retroactive controls and have process, technology, and personnel aspects.
  
• Sourcing right Technology for HIPAA Compliance : HIPAA compliance needs to be served with the right technology that can assure physical data center security, network security, and data security
  
  
• Being enabled role based access control (RBAC) : Because health care data under HIPAA compliance may accessed by multiple stakeholders across the clinical delivery system, it is important that data is made available based on Role Based Access Control (RBAC) to control the extent of data that may be shared with each of such stakeholders.

Because of interplay of these multiple factors in HIPAA compliant orthopedic clinical and medical billing operations, providers may have look beyond internal competence and outsource technology enabled HIPAA-compliant clinical and medical billing implementation. Medicalbillersandcoders.com offers to ease complexities during as critical an implementation as HIPAA compliant orthopedic medical billing. Our affiliation with experienced, competent, and credible orthopedic medical billing resources should provide the right choice of expertise to have your medical billing infused with HIPAA compliance standards.

Relevance of Outsourced Medical Billing as Hospitals’ Rely More on Technology to Elevate Patient Satisfaction

Patient satisfaction has always been the yardstick for operational success, and hospitals have tried out novel ways to keep patient experience enriched. While physicians’ skills have primarily been pivotal, technology too has helped considerably. And, technology has begun to be so significant that hospitals seem to have accepted them to indispensable in enhancing overall patient satisfaction, comply with evolving industry regulations, and being competitively ahead. As growing number of hospitals across the U.S. are beginning to embrace technology to elevate patient satisfaction, they are realizing the need to integrate clinical activities with medical billing activities to arrive at mutually beneficial equation – patient satisfaction that promotes practice revenues. Therefore, they may have to leverage with outsourced hospital medical billing that are integrated with clinical and operational features.

When confronted with the question of finding technology that is clinically and operationally dependable, integrated Electronic Health Record (EHR) systems come to be recognized as the most reliable technology platforms. EHR systems integrated with Practice Management Systems (PMS), Clinical Decision Support Systems, and Patient Communication Network Systems can create both clinical and practice efficiencies, and promote opportunities for enhanced patient access to data and patient engagement. The combined impact of these features may significantly improve patient satisfaction as:

• Patients perceive them to be part of improved care system: Experience has shown that patients value doctors who are progressively tech-savvy. It is interesting to note that around 75 percent of U.S. population associate technology-inclusion with better care.
  
• It would enable convenient access to scheduling and communication through patient portals; patients would appreciate the ease and convenience of online tools that allow them to schedule appointments, request for appointments, ask questions, and more.
  
• There would be swift prescriptions with eRx; patients will benefit from the efficiencies created by e-prescribing capabilities within the EHR. With e-prescribing, a prescription is sent to the pharmacy as soon as the provider prescribes it, which means patients can avail their medications faster. E-prescribing also eliminates the need for patients carry and present paper prescription.
  
• EHR solutions offer the capability to automate email appointment reminders, which will help patients remember their appointments and show up on time.
  
  There would be enhanced clinical efficiency; clinical decision support tools and clinical protocol compliance tracking tools within EHR systems can help providers enhance the care they deliver to patients.
  
• Last, but most significant, robust EHR system can make medical billing and coding accurate and compliant with coding and billing conventions, thereby enabling hospitals show up as Meaningful Compliant with HIPAA practices and maximize reimbursements from Medicare, Medicaid, and commercial health insurance payors.

For a considerable segment of hospitals that are yet to migrate to full-pledged technology-defined clinical care delivery, it might seem a daunting task. Thus, they may have been drive to outsource medical billing services integrated with EHR platforms. Medicalbillersandcoders.com offers them the right window for sourcing resources (medical billers and coders) that are skillful, tech-savvy, and versatile enough to balance hospitals’ primary concern of patient satisfaction and operational success.

Improved and Advanced Billing Processes Help in Increasing Physicians’ Revenue

Medical practices and hospitals are required to deal with the challenging task of getting their due payments. The rules and procedures governing the payments have become increasingly complex and confusing, resulting in greater denials, lost claims or underpayments. Manual processes human errors and claims submission can be time consuming and slow down the claim process. Sophisticated electronic Medical Billing and Coding processes and advanced practice management software solutions can help improve the billing process and contribute towards increased physician revenue.

How do advanced billing processes help in improving revenue?

• Accuracy: Research conducted in Medicare as well as Medicaid centers suggests that hospitals routinely experience revenue leakage due to lost or denied claims. Of the 30 percent lost or denied claims, approximately 60 percent are never resubmitted. Practices and hospitals also fail to collect approximately 18 percent of the claims. It is therefore extremely critical for hospitals to ensure accurate submission of claims in the first instance. Sophisticated billing processes and technological tools can help in identifying inherent reasons for denials. Specialized software can identify claims that may be denied and robust procedural rules can ensure scrubbing of the claims.
  
  
• Faster collections and greater control: Sophisticated billing software is constantly updated and can also track denial trends to identify issues and improve the collection rates. Patient billing and Revenue Cycle Management Software can also easily manage complex payer contracts so as to ensure accurate collections. The different software tools can also help in tracking of patient co pays as well as deductibles.
  
  
• Improved collection with specific focus on accounts receivable management: The streamlined processes and advanced technological tools can ensure that practices achieve accuracy in billing and coding along with improved first time resolution rate. With faster and improved collections practices can concentrate on improving cash flow through aggressive follow-up on accounts receivables.

• Improved practice management: Advanced software solutions also allow practices and hospitals to take benefit of customized reporting feature. This can allow practices and hospitals to get reports of specific data, carefully track payments and increase overall efficiency within the organization. Practices can also forecast the future collections and analyze existing and future practice performance. Advanced data mining and reporting features can support critical decision making and help the management in exercising greater control over the practice or hospital performance.
  
  
• Improved patient satisfaction: Advanced billing processes ensure that all critical information is accurately handled and complete clarity is maintained regarding the billing practices of the hospital. In such a scenario the practices and hospitals can concentrate on providing the best possible medical care to the patients and patients are guaranteed of transparency and clarity.

Medicalbillersandcoders.com (MBC) is a recognized organization with a network of highly experienced coders and billers that have consistently exceeded industry benchmarks with their sophisticated solutions. Through a unique combination of highly trained professionals, systematized processes as well as proven software solutions, MBC helps physicians, practices and hospitals to improve their revenue and enjoy enhanced cash flows.

The Prominence of Health Records in Clinical and Medical Billing Efficiency

Health practitioners often find themselves dealing with a variety of records – from records pertaining to practice license and credentialing documents to financial and compliance records. But none of them are as significant as ‘health care records’ (often known as ‘patient records’) simply because of its clinical and Medical Billing value. While health care records may have practical applications in clinical management, research, and Federal health care policies, its holds special prominence in medical billing. Thus, the quality of health care records invariably decides the level or quantum of reimbursements for physicians.

Over the years, much like the continual advancements in clinical research and health care delivery system, documenting, storing, and sharing health care records too has undergone considerable change from paper-based to computer-aided, web-based, and networked mode.  While the improvement may have helped streamline medical billing, it has also made health records vulnerable to risks of being hacked or leaked to unscrupulous intentions. Coupled with these inherent risks, there is also the feeling that health care organizations have not been keen on investing in resources to protect patient data – the percent of healthcare organizations still to explore data-security options is still as high as 40%. This tendency may be limiting their Medical Bill Reimbursements apart from exposing them penalties for breach of patient privacy, which 94 percent of physicians have had to pay for breaching the privacy and security norm at least once in the last two years.

 

When health records are detected to have compromised with patients’ secrecy and privacy, it could start impacting negatively on their credibility as well as their good medical billing terms with payors. Therefore, it is important that physicians have a policy to:

• Streamline documenting, storing, and sharing healthcare data
• Save it from being exposed to malicious and criminal intentions
• Protect from being targeted by criminal social engineers
• Allocate enough resources, IT, expertise to data security

Fortunately, you have Electronic Health Record (EHR) systems that seem to have panacea for all medical records-related ills, and contribute to enhanced medical bill reimbursements. The right EHR solutions can create both clinical and practice efficiencies, and can make health care records private and safe to be accessed and shared for multiple purposes that are potentially laden with benefits such as:

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Quick access to patient records from inpatient and remote locations for more coordinated, efficient care

Enhanced decision support, clinical alerts, reminders, and medical information

Performance-improving tools, real-time quality reporting

Legible, complete documentation that facilitates accurate coding and billing

Interfaces with labs, registries, other EHRs and HIEs

Safer, more reliable prescribing

Reduced need to fill out the same forms at each office visit

Reliable point-of-care information and reminders notifying providers of important health interventions

Convenience of e-prescriptions electronically sent to the pharmacy

Patient portals for online interaction with providers

Electronic referrals allow for easier access to follow-up care with specialists

Increased accuracy in coding

Improved care delivery from clinical decision support capabilities

Increased patient flow, staff productivity and increased revenue

Irrespective of where you stand in terms of having your health records streamlined to the requisite level, it always advisable to have your EHR systems reviewed and upgraded to serve patient privacy, security, and medical billing purposes. Medicalbillersandcoders.com offers the right platform for sourcing and engaging resources (medical billers and coders) that are versatile enough to advise, implement, and monitor health records in the way that best supports your patients’ privacy, security, and medical billing efficiency.

What Prompts Providers to Hire Specialists in Transition to ICD-10?

When The Department of Health and Human Services' drew out a time table for ICD-10 transition, all the stakeholders including the providers felt the time-frame was sufficient to migrate comprehensively to ICD-10 compliant clinical and operational practices. But that has not been the case – in view of woefully slow pace of transition across the health care, The Department of Health and Human Services' has acceded to the demand for extending original deadline from Oct. 1, 2013 to Oct. 1, 2014. And, with no possibility of further extension, majority of providers are not risking going all by themselves. Instead, they are seeking out specialists for the purpose – nearly two-thirds (65 percent) of them are understood to have employed third-party specialist to look after the entire process of transition to new coding system.

The providers’ decision may have been prompted by inherent challenges in transforming to as gigantic and as complex a transition as ICD-10.  The ICD-10 code structure is distinctly unique and more elaborative than its predecessor, ICD-9. Because the previous coding system was inadequate to cover the evolving diagnosis and disease management procedures, ICD-10 was conceived with as many as 69,000 diagnosis codes and 72,000 procedural codes. While such extensive coding may eventually eradicate ambiguity, the accuracy of coding demands proficiency in anatomy, pathophysiology, Medical Terminology, and ICD-10 coding conventions. Because of such complex, time consuming, and costly upgrading, providers may not ventured on their own. Amongst many crucial areas where ICD-10 specialists may be required to intervene are:

Cross over ICD-10 compliant IT platforms, which requires choosing and engaging IT vendors that are credible and competent in implementing customized IT architecture.

Anticipate and prepare providers for possible productivity loss when crossing over form ICD-9 to ICD-10. As the entire health information management/coding, case management, claims processing and follow-up, research, and decision support gets revamped, there may be likelihood of increased number of claims denials.

Chalk out a detailed training program for staff the concerned with clinical documentation and coding, which would comprise anatomy and physiology courses, detailed clinical documentation requirements, practice coding experience with real-time feedback, and general awareness sessions for staff currently using ICD-9 data.

Address the possible escalation of A/R days and respond to RAC audits for any errors in coding Medicare/Medicaid bills (classified as fraud and abuse)

Restricting access to sensitive data during multiple unit and integration testing cycles when Protected Health Information (PHI) may be most vulnerable to security and privacy risks.

Despite ICD-10 transition being complex, time consuming, and costly, it could eventually result in:  

Improved reimbursement as specificity in the ICD 10 codes can equate to more accurate claims, more efficiency in the billing and reimbursement process, and the ability to differentiate reimbursement based on patient acuity, complexity and outcomes. Reimbursement for new procedures may come from improved claims adjudication between provider and health plans.

Superior collaborative clinical management as appropriate application of ICD 10 codes can lead to increased efficiency in the exchange of patient profile information, treatments across the care process, and hospital resource management.

Enhanced Patient Safety as efficient use of all the data generated by the ICD 10 process can improve patient care and safety by observing usage trends and analyzing outcomes.

Better compliance with quality yardsticks as improved clinical documentation and coding accuracy will enhance the assessment and monitoring of patient quality indicators, as well as compliance with third-party payer coding and billing rules and regulations.

While fully endorsing providers’ decision to seek third-party specialists’ intervention in ICD-10 transition, Medicalbillersandcoders.com is confident and competent of engaging providers with specialists that are resourceful enough to plan, test, and implement ICD-10 compliant clinical documentation, coding and billing practices. Our affiliation with ICD-10 specialists across the 50 states in the U.S. makes us the leading source of ICD-10 change-agents for medical practices of diverse sizes and disciplines.

Streamlining your thoracic and cardiovascular surgery medical billing practices with integrated PMS

Practice in Thoracic and cardiovascular surgery means expensive facilities that often need to be upgraded to clinical innovations. Despite such expensive cost outlays, continued shortage of physicians may still have allowed them to see more patients, thereby garnering revenues well over capital expenditure. But, severity of health care reforms and Medical Billing challenges has not allowed physicians in thoracic and cardiovascular practice to realize their dues fully. While Medicare, Medicaid, and private insurance fee schedules have greatly been reduced these days, accountability in terms of coding compliance, meaningful use of information technology, and reporting under accountable care organization model (ACO) has increased beyond the control of traditional practice management. As a result health care practitioners, particularly thoracic and cardiovascular surgery practitioners may need to streamline their medical billing in order to remain financially healthy.

Primary prerequisite to streamline thoracic and cardiovascular surgery medical billing is to have competent and experienced billers and coders who are adept at applying correct ICD-CM, CPT, HCPCS Level II and modifier coding assignments to thoracic and cardiovascular surgical procedures; evaluation and management of documentation guidelines; Medicare billing rules and regulations on coding of surgical procedures performed by thoracic and cardiovascular surgeons; familiarity with medical terminology associated with Thoracic and Cardiovascular specialty; and proficiency in Thoracic & Cardiovascular anatomy and physiology.

Equally important is to have such billing staff oriented to electronic practice management systems that have effectively replaced paper and manual process of billing, coding, and submission of claims. The unique value proposition of an integrated practice management system is that allows physicians to streamline their medical billing and other administrative tasks without requiring the time and expenses of setting up their own IT architectures. Therefore, it is crucial that Thoracic & Cardiovascular Surgical practices chose practice management systems that are integrated with seamlessly integrated with electronic health records and medical billing software in order to streamline medical billing and other administrative functions. Further, it is imperative that such systems conform to Federal security requirements and HIPPA regulations.

Here is a list of capabilities that you seek while selecting an integrated practice management system for your Thoracic & Cardiovascular Surgical practice:

Can it process third-party payer claims with reduced occurrence of errors and realize claims within permissible time limit?

Whether it can accomplish insurance verification and authorizations?

Does it facilitate monitoring, and following up on denied claims and collections under account receivable status?

Is it capable of producing reports for audits and reporting requirement?

Is it flexible enough to adjust to operational requirements?

Is it scalable to suit your evolving operational size and volumes?

The significance of verifying your prospective practice management systems against the checklist stated above is that it saves you from making inadvertent decision. Thoracic & Cardiovascular surgical practices on the verge of streamlining their medical billing practices may even have to rely on external sources while migrating to integrated practice management systems. Medicalbillersandcoders.com – with resource capability and strategic partnership with credible practice management systems manufacturers and vendors – might just be the platform to engage with right choices for streamlining your Thoracic & Cardiovascular surgery medical billing, and expect:

To get your patient information transferred over secure software platforms, thereby conforming to HIPAA rules and regulations for patient health information and data transfer.

To have your bills accurately coded, billed, and processed electronically in time to be submitted to insurance carriers.

Expedite the process of claim realization, resubmission, follow-up and conversion of account receivables.

To be assisted with quality medical billing reports comprising of patient demographics, referrals, coding, insurance verifications, account receivables and collection.

And more importantly, show up as conforming to Meaningful Use of EHR, which not only saves you from being penalized but also help qualify for monetary incentives.

How Rising Usage of Thoracic Ultra-Sonography Would Prompt Physicians to Opt for External Medical Billing

How Rising Usage of Thoracic Ultra-Sonography Would Prompt Physicians to Opt for External Medical Billing The safety and precision factors associated with Thoracic ultrasonography have made it a more indispensable and preferred imaging modality to the traditional radiology imaging procedures that often have been criticized for compromising with patient safety and accuracy of diagnosis.

Thoracic ultrasonography, as a noninvasive imaging modality, has significant applications in pulmonary medicine, allowing the physician to diagnose a variety of thoracic disorders at the point of care. It has been found to be extremely useful in imaging of the chest wall, pleural space, diaphragms, and the lungs; lung consolidation, pleural-based masses and effusions, pneumothorax, and diaphragmatic dysfunction can now be accurately diagnosed and assessed.  Observation, palpation, percussion, and auscultation are key elements in the evaluation of any patient, and physicians seem to be better managing these disease processes with Thoracic ultrasonography. With so many noticeable advantages, it may not be surprising to see patients and physicians alike opting for Thoracic ultrasonography.

Just when physicians feel that they have found a way to appreciate their practice volumes with Thoracic ultrasonography, there is a parallel realization that charging, coding and claim realization may not be all that easy. They may come across a variety of billing and coding issues such as global fee, technical fee, and professional fee. And these fees may have to be billed in combination or isolation depending upon how and where utlrasnography services are offered –  if thoracic ultrasonography is performed in the hospital setting, all of the technical costs are absorbed by the institution, as the hospital owns the machine and provides the supplies required for scanning. The clinician receives payment only for the professional component of the procedure. In contrast, office-based thoracic ultrasonography allows reimbursement for both the technical and professional component, provided the pulmonary practice owns the ultrasound machine.

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Further, they should necessarily have to be conversant some of the crucial and high-yielding codes, such as: 

Code-76604 when real time image with documentation is generated for chest (including mediastinum)

Code-76942 when ultrasonography used to guide needle insertion with image documentation.

Code-75989 for guidance of drainage devices (chest tubes, tunneled catheters) that will stay in the patient for some period of time

76604-26 codes that allow professional component only

76942-26 codes that allow professional and 76942 that allows coding global component

The payout on these codes or reimbursement rates vary according to geographic area and insurer, thus the physicians need to be mindful of these geographic-specific and insurer-specific variations. With possible increase in ultrasonography cases, physicians may entirely find themselves occupied with clinical quality, with little time to manage complexities of charging, billing and reimbursement. Therefore, it might warrant the intervention of experts in ultrasonography medical billing and coding. Medicalbillersandcoders.com serves as an ideal platform for physicians seeking ultrasonography billing experts. We have ready access to a chosen pool of ultrasonography billing experts who can be entrusted with managing intricacies associated with ultrasonography medical fee charging, billing and reimbursement processes.

How Vital Is an Effective and Efficient Medical Billing and Coding in Preserving Thoracic Surgery Practice Profitability?

Thoracic surgical specialty is one of those priority specialties that have always been in high demand across the 50 states in the U.S., and the forecast is for an increased incidence of thoracic surgical cases. While practitioners in thoracic surgical specialty may continue to be optimistic about their future practice, constant clinical innovations and complexity of the procedures would still have to be taken care of.  Thoracic surgery often involves preoperative, operative, and surgical critical care of patients with problems within the chest. The magnitude of focus leaves physicians confined to clinical care alone, leaving them largely ignorant of finer aspects of Thoracic medical billing & coding, and reimbursement management.

A specialty as complex and critical as Thoracic surgery requires physicians to be conversant with the entire process of Thoracic medical billing, beginning with:

Ability to read and abstract physician office notes and operative notes to apply correct ICD-CM, CPT, HCPCS Level II and modifier coding assignments

Evaluation and management (both the 1995 and 1997 Documentation Guidelines)

Rules and regulations of Medicare billing including (but not limited to) incident to, eaching situations, shared visits, consultations and global surgery

Coding of surgical procedures performed

Knowledge of Medical terminology associated with Thoracic specialty

Complete proficiency in Thoracic Anatomy and physiology

They may further be required to:

Customize and generate HIPAA compliant claim codes as per situational needs that vary depending upon on patients’ health insurance coverage under Medicare, Medicaid, or private health insurance policies.

Create separate reports for diagnosis, treatment, and procedures.

Function in collaboration with major healthcare Insurances such as Medicare, Medicaid, and a host of private insurers such as Oxford, United, Aetna, Hip, No Fault, Medicaid, Humana, etc.

To be certified by certified by the AAPC (American Association of Professional Coders) and conform to coding norms as defined by AMA and CMS.

To be comfortable with generating medical codes on both paper and electronic formats. In addition, they should also be trained on medical billing and coding software to generate instant medical billing reports.

Have a thorough A/R management in place to monitor, track, and expedite the claims within the permissible time limit

Take up delayed or rejected claims with appropriate arbitrary agencies for possible remediation.

Thoracic surgery physicians, who happen to be more concerned about clinical quality, may not be too interested in doing medical billing, follow up, A/R and denial management by themselves. Thus, experts in Thoracic billing and coding may have a crucial role to play in ensuring unhindered practice revenues from reimbursements. Medicalbillersandcoders.com has a credible history in deploying medical billing resources for a variety of priority specialties across the 5O states in U.S. As Thoracic Surgical specialty is expected to be inundated with unprecedented patient influx, physicians may look forward to leverage their Thoracic medical billing with cost-efficient, technology-driven, and revenue-maximizing Thoracic medical billing practices from our chosen pool of Thoracic billing experts, accessible at all major clinical destinations in the U.S.

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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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.