Protection From Medical Billing Gaps

The disappearance of a landmark law in Florida has a lot of doctors and others who speak fairly to limits in network costs in a variety of healthcare settings, and how to provide patients with transparency with respect to their eventual costs of medical treatment. The Florida Senate has refused to pass a bill called SPB 7186, two issues addressed by this bill, a version that was passed in the House of Florida, is the best quality out of network charges and what is called "balance", where expenditure is not collected by an insurance company are inserted into patients. There is also a part of the bill that requires a clearer explanation of the costs of the procedure and treatment to patients.

It seems that this type of legislation should be very popular because it offers some consumer protections that many patient advocates have been demanding, but some Florida physicians and other critics are firmly against the bill, and glad to see defeated him. Some claim that the bill actually destroy existing PPO health insurance plans by altering the agreement on non-network charges that are part of the complex insurance contract between doctors, insurance companies and other parties. It was suggested that the needs of accounting for the costs of health care could end up being too complicated for many health care providers to handle.

Although local doctors can be considered saved from the burden of compliance of such law, many consumers feel pressure from high medical expenses, due in part to balance the revenue-related situations and where an insurance company does not accept Certain value of services rendered. Too often such gaps billing amounts responsibility for patients referred to the stratosphere, and harassed patients either refuse to pay, or end up struggling with complex debt negotiations in a fog of bureaucracy and communications of others . For many consumer advocates, the conclusion is that something like this bill is finally necessary to better protect Americans from medical bankruptcy.

Unfortunately, with all faults and complexities of the industry complicated current medical billing, which is often up to patients to take a stand and protect their own rights and their own finances. One way in which patients may require more transparency and fairness in medical billing is to sign the petition for a "Bill of Rights Patient's financial statements." The website billadvocates.com maintains this resource for U.S. consumers as a way to push for more of what patients today need from their suppliers, insurers and other interested parties seeking, as government programs. Help advocate for the many Americans who are threatened by high medical debt today.

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Billers and Coders to gear up for 1CD- 10 –despite physician community pushing the deadline

ICD-10’s implementation on October 1, 2013, according to AAPC – will alter everything from the way health care providers document services to the way codes are selected, reported, and reimbursed, however it will be coders who will play a vital role to achieving success in ICD-10 implementation.

AAPC’s vice president of ICD-10 education stated that with the expected advantages of electronic health records (EHRs) aside, all eyes will turn to coders to make sense of ICD-10-CM and ICD-10-PCS, he further cautioned even the best coders in the industry need to increase their understanding of anatomy and pathophysiology (A&P). Further elaborating that specificity of ICD-10 codes is based on a precise identification of body sites and function; hence increasing coders’ knowledge of A&P would be necessary.

Reasoning with the Physician community: Medical Billing Services

With the pressure elevating in the physician community the American Medical Association (AMA) adopted a policy of resisting the implementation of the ICD-10 during its semi-annual policy making session. Implementation of ICD-10 would increase physician burden immensely as practitioners are already clambering to implement electronic heath records, facing high reimbursement cuts while trying their best not to lose focus on their patients. In this scenario it is imperative for physicians to acquire services of proficient billers and coders for revenue maximization.

Challenges for Medical Billing – ICD-10 Transition 

Adoption of ICD-10 will lead to expansion in the number of codes available for both describing diagnoses and procedures from the currently used ICD-9 codes.

Coders to prepare for the transition need to:

• Learn the new coding system, which includes roughly 55,000 unfamiliar codes
• Learn the new code books and styles, which are receiving complete overhauls
• Use both ICD-10 and ICD-9 simultaneously for a period of roughly two years
• Work with your office’s physician to go over the new documentation requirements
• Thorough understanding of medical terminology and human anatomy, due to the increased specificity of ICD-10.

According to Director of coding and classification for the American Hospital Association failure to successfully implement ICD-10 could: Create coding and billing backlogs, cause cash flow delays, increase claims rejections/denials, bring about unintended shifts in payment and place payer contracts and/or market share arrangements at risk because of poor quality rating or high costs.

Gearing up for the change: turning point for Biller and Coders

Hence the importance of the right Billers and Coders in ICD-10 transition couldn’t be more elaborated, and whether or not physicians are able to at this point prepare for ICD-10, Billers and Coders need to gear up and start preparing for the change. Moreover as other healthcare reforms along with ICD-10 necessitates physicians need to prepare themselves to remain afloat, and with various physicians willing to invest into their practices – could be a turning point for Billers and Coders to expand their scope of work and opportunity.

Various physicians are already seeking services of medical billers who are proactive and prepared with material-requisites for ICD-10. Medicialbillersandcoders.com is a viable option for physicians in smooth transition to ICD-10; moreover MBC is equipped with experienced Billers and Coders well-versed with HIPAA, ICD-10 and other compliances, and training themselves constantly as per the industry requirements, along with a long-standing reputation of being the largest consortium of medical billers in the U.S.

The Changing Landscape of Healthcare Reimbursement in 2012

“As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.”

While the dawn of a new year brings forth a renewed optimism about offering enhanced quality medical care and accelerated revenue generation, there also seems to be an undercurrent of apprehensions about complying with the ensuing medical reforms that are going to be effective very soon – the Affordable Care Organization Concept, the undecided fate of Sustainable Growth Rate (SGR) fix, the mandatory transition to exhaustive ICD-10 and HIPAA 5010 medical coding and reporting compliance, and the last but not the least,  the revised ABN (Advanced Beneficiary Notice of Non-coverage), Form CMS-R-131.

The imminent weight of these factors is sure going to press all the stakeholders – physicians, medical billing companies, and medical billing software providers – for realigning their resources and competencies to address the change-scenario prompted by these radical reforms.

Foremost, as the CMS (Centre for Medicare Services) has made it obligatory that physicians form suitable cartels among themselves to be eligible for incentives from savings out of Affordable Care Organization concept, a considerable time and resource is going to be spent on arriving at judicious decision on joining the cartel that best suits the concerned practitioners’ business model.

Though, CMS has given an extra leeway of 90 days more for complying with HIPAA 5010, the obligation to report all Medicare related transactions still remains unchanged. As the ICD-10 and HIPAA 5010 are soon going to be effective, physicians will require upgrading their clinical and operational management, and outsourcing those medical billing companies’ services that have a proactive outlook to embrace newer practices through logistically formed alliances with medical billing and EHR software manufacturers.

Although, with the postponement of SGR fix, physicians have been given a breather, yet, they cannot take it for granted as the threat of cumulatively accumulated figure (of about 25%) always looms large. Therefore, while being assured of 2% hike annually, they need to be vigilant about their operational and capital expenditure, and be prepared for any eventuality.

Adding to the imminent list is the use of the revised ABN form (Advanced Beneficiary Notice of Non-coverage), which is going to be mandatory starting January 1, 2012. And failure to upgrade to this revised form of for disclosure beneficiary notice of non-coverage) will eventually invite hurdles while being audited.

As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – whose credentials have, time and again, come to the fore in successfully aiding physicians comply by healthcare regulations – should be your preferential alliance partner for complying by the imminent healthcare reforms. Our close association with Medicare and Medicaid, leading private insurance carriers, Federal Healthcare Agencies, and leading technology providers lends us the requisite edge in addressing and solving physicians’ apprehensions.