How are Physicians Expected to Bill Post Implementation?

Even though ICD 9 and ICD 10 are very similar in many ways including the guidelines, rules and conventions used which consequently brings out similarity in the organization codes as well; ICD 10 is a product of many improvements done in ICD 9 coding.

In spite of the overwhelming improvements, the transition from ICD 9 to ICD 10 has been a huge challenge for the physicians, medical billers and health care workers to catch up with the advancements. Also the staggering number of new codes has made the learning process a tad complex along with complicating the coding process, making the claims susceptible to errors and vulnerable to denials. This is further exacerbated by difficult denial management.

According to the new proposed rules from Department of Health and Human Services, health care professionals would be required to bill their services using ICD 10, with effect from October 1, 2014. This date has already marked the one year extension to the previous date of October 1, 2013. Along with the introduction on 5010 new electronic codes, the physicians are also expected to meet a few other health and quality information technology initiatives like adopting electronic health records and participating in physician quality reporting system.

With the number of codes skyrocketing from 17,000 to around 140,000, healthcare providers along with their medical billers and coders need to pull up their socks in order to avoid having any problem with insurance reimbursements and denials. According to the official website of CMS, compliance date for implementation of ICD 10 is October 1, 2014 with no grace period or further delay expected, however they have not yet mentioned grace period for billing under ICD-9 without penalty post October 2014.

Nonetheless the transition period would pertain roughly for two years during which the coders would have to work simultaneously with both, ICD 9 and ICD 10. At the same time, the billers would be required to train with new set of procedures and policies, in absence of which the employer might result in lowered productivity in the future. The billers also need to learn about the policies introduced for payment reimbursements along with the new ANSCI reposting methods and electronic formatting procedures.

Medical Billers and Coders with ICD 10 implementation will additionally need to possess a more detailed knowledge of the anatomy, physiology and medical terminology and also work in close association with the doctors and educate them about the proper coding methods.

Also as mentioned earlier with no further delay expected, medical practitioners need to catch up with the new reforms; to avoid as much as possible any chance of decreased cash flow. With a possibility of increasing call volume for denials and rejected claims along with increased billing audits, it is advised that physicians take the next step towards ICD 10 transition soon.

MedicalBillersandCoders.com serving healthcare for more than a decade now have already initiated a unique ICD 10 training program which helps coders and billers get updated with the latest ICD 10 developments and reforms. Our billers and coders are already preparing for this transition as our training program endeavours to positively help you, as a medical coder and biller to remain at your competent best when the times change from ICD 9 to ICD 10.

HIPAA 5010 enforcement delayed to ensure doctors & entities complete transition

Enforcement of HIPAA 5010 transactions on March 15, 2012, was delayed for the second time for another 3 months by the government, with the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) pushing the date further to June 30, 2012, in order to not compromise physician cash flow. Physicians have previously communicated to AMA significant cash flow problems they encountered associated with the transition to HIPAA Version 5010. Essentially the rule called for compliance by January 1, 2012, however earlier on November 17, 2011 OESS announced its first enforcement delay of three months, referring to the move as “enforcement discretion”.

OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format

Commercial plans are reporting similar numbers

State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

How are States retaining physicians in times of shortage?

Physician shortages is a growing concern and is pushing various states to keep doctors trained in medical schools and residency programs from crossing state lines to practice medicine. According to new statistics from the Assn. of American Medical Colleges- nationwide, there were 258.7 active physicians per 100,000 people and in individual states, ratios range from a high of 415.5 physicians per 100,000 people in Massachusetts to a low of 176.4 per 100,000 in Mississippi.

In this scenario medical school, hospitals, medical societies and state legislatures are increasingly taking a practical approach to retain the physicians and doctors-in-training in their state. According to a report by AAMC Center for Workforce Studies on average:

39% of U.S. physicians practice	State where they went to medical school
48% of U.S. physicians practice	State where they completed graduate medical education

Methods adopted by states to retain physicians

AAMC projections depict that physician shortages nationwide are projected to reach 62,900 doctors by 2015 and 91,500 by 2020 and several states to retain physicians have:

• Opened new medical schools or expanded existing ones
• Are offering incentives such as bonuses, scholarships or loan repayment programs to physicians
• Communities are developing new residency programs with the aim that physicians will develop long-term professional and personal relationships during GME training and keep them from moving out
• Certain schools’ mission is to train physicians from their states to practice in their states. However states need enough GME training positions else this efforts are wasted as then physicians will shift to another state

Iowa is below national average retaining 22% of its medical school graduates and 37% of physicians who complete GME training in the state and several efforts in Iowa have been designed to attract physicians to stay in the state. Several other states including Kansas, Mississippi and Alabama offer loan repayment programs for doctors to practice locally.

In Oklahoma, the state offers scholarships and loans to medical students and residents who agree to practice in rural Oklahoma for a set amount of time. Hence Oklahoma is above national averages, retaining 48% of its medical school graduates and 52% of physicians who complete residency training.

Physician adapting to this shortage

Higher revenues and incentives would attract more physicians to the profession and also keep doctors from moving out from states. Healthcare reforms are striving to improve quality of care and physician incentives, to entice more doctors to stay in the profession; but this leaves doctors with little time to balance both patient care and Revenue Cycle Management. As physicians move towards a value based system of healthcare delivery, they would be well-off by partnering with experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization.

Medicalbillersandcoders.com experienced in offering cost-optimizing and revenue-maximizing Medical Billing Revenue Cycle Management in tandem with their goal to assist healthcare should be able to play an essential role in making physicians’ transition towards a value based model easier and profitable, hence also helping towards eliminating physician shortage in the long term.

How medical billing consultants are crucial to Credentialing with Medicare & Medicaid?

Over the years, Credentialing has become an indispensable thing to medical practitioners’ sustenance and growth; so much so that it is impossible to think of undertaking medical practicing without a valid credentialing from the authorized health agencies. Today, credentialing, as much as a mandatory requirement for commencing and running clinical operations, is also physicians’ passport to attract and retain patients. Moreover, unlike during the pay-for-service era, the job of Credentialing does not stop just with attracting and retaining but far beyond that.  Today, physicians have to contend with Credentialing of a different type – Credentialed with healthcare insurance providers.

Sometime ago, when medical practices had only to deal with either the Federal Government sponsored Medicare or state-wise Medicaid schemes, the process of getting Credentialed was seemingly manageable by physicians themselves. But, as the healthcare industry opened up to private insurance carriers, the task got a bit heavier as they had to deal with multiple insurance carriers along with Medicare and Medicaid. As physicians were treated to a multiple portfolio of reimbursement sources, they started to feel a decline in their ability to bargain positively with these multiple sources. Consequently, this started to reflect negatively on their revenue generation. Eventually, they had no recourse but to opt for specialized Credentialing services from medical billing companies.

While outsourced Credentialing has been able to nullify the adverse effects on medical reimbursements, its significance may once again be re-emphasized as Medicare and Medicaid reimbursement environment is going to be even more stringent post Federal Government’s decision to bring in quantitative and qualitative reforms to Medicare and Medicaid. Given the likely scenario,  physicians will have to seek  outsourced Credentialing  that  can effectively and efficiently steer them through laborious Medicare & Medicaid Credentialing process comprising:

• Setting up of all Medicare and Medicaid applications
• Proofing of submitted Medicare and Medicaid errors and omissions
• Submission of the Medicare and Medicaid application
• Setting up and submission of all provider assignment forms and documents
• Following up with Medicare to insure the completion of all required processes
• Following up with Medicaid / designated agent to insure the completion of all required processes
• Archiving of all filed documents for future reference

Medicalbillersandcoders.com (www.medicalbillersandcoders.com)  – by virtue of credible source for Credentialing with Medicare, Medicaid, and prominent private insurance providers – should be physicians’ preferential choice for outsourced Credentialing services. Our process follows tried and tested path: clients set up their account with our firm by utilizing our secure online form. Once the form is submitted, we will obtain the credentialing documentation from the Insurance providers (Medicare, Medicaid, and private insurance carriers) or directly from the Physicians. Medicalbillersandcoders.com will then set up all complicated, and laborious process till physician offices are credentialed amicably.

For more information visit: medical billing

Flexible work hours, employment options and career growth for Medical Billers and Coders

Various options in Medical billing and coding jobs provide ideal opportunities to billers and coders to choose from an array of different types of work environments giving them several opportunities along with flexibility in the rapidly growing health care field. According to a study by the American Association of Professional Coders (AAPC) to determine the types of environments in which medical billers and coders worked, stated most medical billers and coders work in:

Physicians’ offices	49.2%
Billing companies	11.8%
Outpatient hospitals	9.8%

Medical Billing and Coding Work Environment & Employment Situations

The report depicted that – 68% of medical billers and coders were paid by the hour, while 32% were on salary. Moreover 84.6% worked full-time, while 11.9% of medical billers and coders work flex-time and 3.5% work part-time.

• 7194 from 7898 (91%) respondents agreed accuracy determined the value of a medical biller and coder to their manager, while the remaining 9% disagreed
• 6476 from 7898 (82%) respondents agreed their managers would determine their value based on productivity, while the remaining 18% disagreed

Giving an insight that on average, accuracy is slightly more valuable than productivity to an employer and overall depicting medical billers and coders are expected to efficiently produce accurate work.

Growth & Profitability in varied environments

Careers in Medical Billing and Coding is highly promising providing flexibility, growth and profitability in varied work environments – from home, a medical billing company or working from home in medical billing jobs with larger health care firms that make and track medical billing work assignments electronically. One of the reasons for the growth in varied environments is the wide availability of online training in medical billing and medical billing software.

Health care and in turn medical billing and coding has grown with the scope of health information management over the past five years and besides being restricted to only the doctor’s office the scope of medical billing has now grown to hospitals, pharmacies, nursing homes, mental healthcare facilities, rehabilitation centers, insurance companies, health maintenance organizations (HMOs), consulting firms, the government and health data organizations.

Moreover to combat the increasing shortage of medical billers and coders across US states one of the new techniques evolved include contract services. Contract coding companies have emerged as a trend and have become nearly a $5 billion dollar business and are now helping many hospitals in US states to increase their revenue by almost 50%. Due to outsourcing hospitals and physician revenues are rising and in turn coders salaries too are increasing as they can earn 20 to 25% more than what is offered at most hospitals. Medicialbillersandcoders.com experts fulfill this need as key players in the healthcare workplace to deliver quality healthcare by capturing accurate and timely medical data. Our Coding professionals possess a thorough understanding of the health record’s content we have thousands of medical billers and our certified medical coders are trained to understand the procedures to be coded.

Flexible work hours, employment options and career growth for Medical Billers and Coders

Various options in Medical billing and coding jobs provide ideal opportunities to billers and coders to choose from an array of different types of work environments giving them several opportunities along with flexibility in the rapidly growing health care field. According to a study by the American Association of Professional Coders (AAPC) to determine the types of environments in which medical billers and coders worked, stated most medical billers and coders work in:

Physicians’ offices	49.2%
Billing companies	11.8%
Outpatient hospitals	9.8%

Medical Billing and Coding Work Environment & Employment Situations

The report depicted that – 68% of medical billers and coders were paid by the hour, while 32% were on salary. Moreover 84.6% worked full-time, while 11.9% of medical billers and coders work flex-time and 3.5% work part-time.

• 7194 from 7898 (91%) respondents agreed accuracy determined the value of a medical biller and coder to their manager, while the remaining 9% disagreed
• 6476 from 7898 (82%) respondents agreed their managers would determine their value based on productivity, while the remaining 18% disagreed

Giving an insight that on average, accuracy is slightly more valuable than productivity to an employer and overall depicting medical billers and coders are expected to efficiently produce accurate work.

Growth & Profitability in varied environments

Careers in Medical Billing and Coding is highly promising providing flexibility, growth and profitability in varied work environments – from home, a medical billing company or working from home in medical billing jobs with larger health care firms that make and track medical billing work assignments electronically. One of the reasons for the growth in varied environments is the wide availability of online training in medical billing and medical billing software.

Health care and in turn medical billing and coding has grown with the scope of health information management over the past five years and besides being restricted to only the doctor’s office the scope of medical billing has now grown to hospitals, pharmacies, nursing homes, mental healthcare facilities, rehabilitation centers, insurance companies, health maintenance organizations (HMOs), consulting firms, the government and health data organizations.

Moreover to combat the increasing shortage of medical billers and coders across US states one of the new techniques evolved include contract services. Contract coding companies have emerged as a trend and have become nearly a $5 billion dollar business and are now helping many hospitals in US states to increase their revenue by almost 50%. Due to outsourcing hospitals and physician revenues are rising and in turn coders salaries too are increasing as they can earn 20 to 25% more than what is offered at most hospitals. Medicialbillersandcoders.com experts fulfill this need as key players in the healthcare workplace to deliver quality healthcare by capturing accurate and timely medical data. Our Coding professionals possess a thorough understanding of the health record’s content we have thousands of medical billers and our certified medical coders are trained to understand the procedures to be coded.

Medical billing to assist Primary Care Physicians in streamlining their practice

The lack of primary care providers in the country is a topic which has been hotly debated among many circles and written about vehemently. Not many medical students are ready to enter primary care due to lack of great financial prospects in the future. This is resulting in even more shortage of physicians and problems when it comes to the reputation of this line of medicine. The remuneration problems along with other difficulties faced by Primary Care Providers (PCPs) is affecting the revenue of PCPs and bringing a disparity between other physicians who practice other specialties of medicine. Here are numerous reasons for the reimbursement disparities for PCPs and some possible solutions for countering this problem.

One of the reasons for the lesser amount of remuneration for PCPs is that specialists who perform routine procedures such as some specific types of surgeries take lesser amount of time to complete their task compared to a PCP whose case can be of any nature. Another explanation for the comparatively lesser amount of pay of PCPs are that the majority of these are either solo practitioners or work in a small group whereas specialists like surgeons and cardiologists have a chance to work in a big hospital  with even bigger pecuniary benefits.

Browse All: medical Billing

There are many problems that are synonymous with the problems of PCPs and of those faced by solo practices. The burden of supervising all the functions of a small practice along with carrying out the core aspects of medicine is also a hurdle that hampers efficient time and financial management. Moreover, the Medicare rates given to PCPs are causing resentment among PCPs where a group of people have a filed a suit against Medicare regarding their low reimbursement rates to PCPs. Medicare cuts are another problem faced by especially PCPs since they are responsible for treating a large number of elderly patients and act as an entry point for specialties if any particular problem is diagnosed, which is usually a possibility in elderly patients.

The health reforms have provided a glimmer of hope for PCPs due to many policies that have been implemented. However, compliance of these policies is also a challenge that is faced by physicians and providers along with PCPs. The incentives provided by the government for the implementation of EMR and EHR systems can be a definite financial advantage, especially for PCPs. However streamlining all the departmental process to implement this cutting edge technology is perhaps the most important prerequisite for qualifying for the incentives through ‘Meaningful Use’.

PCPs can take advantage of companies that provide assistance in the latest departmental processes required for maximizing the revenue and improving the quality of care. Medicalbillersandcoders.com is one such company that streamlines all your processes such as revenue cycle management, denial management and, of course, also performs medical billing and coding. We also provide other value added services such as consultancy and research.

For more information visit: medical billing services, medical billing companies