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.

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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

Job Opportunities: A New Positive Outlook for New Physicians amidst healthcare reforms

The shortage of physicians, the health reforms, the skyrocketing costs of health care , the Medicare cuts worry and the influx of health IT into the health industry has created a bit worrying albeit a dynamic environment. Although there are critics who oppose the health reforms and suggest other methods, there are optimistic physicians as well as patients when it comes to improving healthcare even in this environment of hullaballoo that threatens to change the drudgery of the maintenance of the health care industry in the United States. According to the Bureau of Labor Statistics, a physician’s profession is much coveted and in demand and has immense growth prospects in the future which can be a good omen for the future of health care delivery in the country. A recent survey from physician search firm Merritt Hawkins revealed that more than 75% of physicians in their final year of training received at least 50 job solicitations, and 50% got 100 or more.

The reform has forced many solo and small group practices to pack up their practices and opt for employment at hospitals and along with bigger group of physicians since these have started to hire physicians. Hospitals are also hiring physicians since the number of insured in the country is soon going to rise by about 31 million and physicians in hospitals would be desperately needed to treat the patients who would inundate hospitals after the reforms take hold. Many physicians are retiring and almost one third of physicians in the country are set to retire in next few years which create opportunities for new young physicians and providers to take their place. Moreover, physicians are relieved of the non-clinical obligations while working in hospitals such as billing, extensive interaction with payers, and other administrative tasks.

Although solo practices and small group practices are slowly declining, it does not necessarily imply that new jobs for physicians are not being created. According to the Bureau of Labor Statistics, the employment of physicians and surgeons is set to increase by 22% between 2008 and 2018 and the reasons cited by the bureau are numerous. Physicians’ job outlook looks positive because of an expanding health industry, the increase in demand for the services of physicians, increased level of enrollment in medical schools and the policies implemented by the United States government to encourage the growth of this profession qualitatively as well as quantitatively.

The biggest challenge faced by new physicians is related not just to professional core issues but also to financial issues. There are numerous financial challenges and problems in the form of paying off the debt, implementing ‘Meaningful Use’, striving for the incentives provided by the government and avoiding financial penalties for non-compliance of health reform policies. Even with so many challenges and problems faced by new physicians who have just started practicing can successfully kick start their work in financially and professionally fruitful manner. However, support is available for physicians who are just stepping into this dynamic yet progressive health care industry in the form of processes that aim to maximize physician revenues and ease the problems faced by them in many departmental processes involved in running a practice or even when joining a hospital.

Whether as a physician, you work in a hospital or starting a solo practice, medical billers and coders at www.medicalbillersandcoders.com can offer you a wide range of services that will not only assist you in medical billing and coding but also facilitate services such as revenue cycle management, denial management, interaction with payers, research, consultancy, streamlining various processes for EMR or EHR implementation, and assistance in health IT implementation in this dynamic health industry. This will help you in avoiding the pitfalls faced by new physicians in the country and also assist in increasing your revenue in a lesser amount of time.

For more information visit: medical billing

Hospitalists as Primary Care Providers

In all the states of the US, healthcare is becoming an integrated affair with hospitals combining traditional healthcare services like surgical treatments with primary health care activities responsible for elementary requirements of a treatment cycle from blood tests to coordination of various activities within a treatment episode to ensure availability of all components of healthcare services under one roof, when seen in the larger context, and advantages like proper coordination between various components/phases of a care cycle and day-to-day patient care within the scope of a treatment episode.

Primary healthcare providers integrating with hospitals are, in a loose sense, family physicians, traditionally located outside the big organized healthcare space, relocating themselves to the sphere of hospital-provided healthcare system where they are called hospitalists. Albeit, the difference is hospitalists have to be more acquainted with sophisticated healthcare procedures to function in the environment of a big healthcare operator.

This practice of hospitals providing physician services (or integrating with hospitalists) is over a decade old in US healthcare which owes its survival to the fact that these services (or hospitalists) bring into conventional hospital treatment a combination of old-world healthcare values like individualized attention to patients and patient safety and new-age methods like proper coordination, documentation, etc., which have collectively been found to lead to improvement in quality of treatment and reduced costs.

However, primary care mostly deals with elderly patients suffering from ailments that require not a touch-and-go treatment but protracted care either through extended stays in hospitals or through recurrent readmissions. Because of their age bracket and the nature of their ailments mostly related to heart brain, lung, lever, etc., these patients account for majority of medical expenses billable to Medicare. 

This being the nature of aliments primary healthcare mostly deals with, its involvement is not restricted to any one part of treatment but is spread like a grid across the treatment cycle, forming its basics starting from, if viewed from a financial viewpoint, registration to reimbursement.  And this leaves healthcare providers to handle financial administration activities that warrant a strong Revenue Cycle Management system, a process that covers the entire range of financial needs/activities resulting from initiation to termination of a treatment episode.

Browse All: Hospitalists medical billing

Medical Billers and Coders, through its RCM consulting services, scrutinizes the areas of deficiencies in your Revenue Cycle Management, like outdated processes, software inadequacies, under-optimized   workforce, unidentified training needs, and helps detect the sources of revenue leakage and plugs them by streamlining your processes. As a result, a coherent RCM process helps healthcare organizations to prevent registration errors, lack of pre-verification of insurance coverage and facilitates an effective collection policy for insurance deductibles and co-pays, and an in-depth analysis of Account Receivables reports on a payer- patient-service basis. Additionally, it also prevents audits by detecting overpayment by Medicare and helping return it on time.

Medicalbillersandcoders.com brings these RCM benefits to its clients through a team of specialists with expertise and experience of dealing with healthcare providers for years combined with sound knowledge of changing trends and regulations operating in the US healthcare industry, resulting in saved cost and time for healthcare operators.

Medical Billing | Medical Billing Services | Medical Billing Companies

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.

Browse All: Florida Medical Billing

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.

Physician Credentialing: Worth Getting Right to Get Paid

As physicians, despite your reputation for benchmarked medical services, you could be losing out when it comes to realizing medical bills reimbursed fully from respective health insurance carriers. And when you start to analyze that elusive reason responsible for hampering your reimbursements, you would invariably end up discovering ‘Credentialing’ as the chief culprit. Quite contrast to the earlier scenario, wherein your credential as a qualified and competent practitioner could alone determine your practice’s sustenance and growth, the present day scenario, characterized by innumerous practitioners and heterogeneous mix of insurance carriers, requires your practices to bear the stamp of ‘Credentialing’ to stay well clear of audit, delay or denial exposures.

Although, physician practices require to be credentialed from Federal Health Agencies (for being compliant with requisite health care standards) as well as Medicare and Medicaid, and respective private insurance carriers (for being compliant with medical billing standards), it is the latter that assumes greater significance as it has direct impact on operational optimization and revenue maximization. Credentialing in the medical billing context means that your medical practices are compliant with the benchmarked clinical and operational practices as deemed suitable by the prevailing health insurance convention. And as we stand at an important juncture when health insurance sector is realigning its revenue structure post the Federal Government’s radical healthcare reforms, there is a growing emphasis being laid on Credentialing, first by the Centre for Medical Services, and then by private insurance carriers – making it mandatory for physicians to have their practices duly Credentialed.

But, owing to its exhaustive process, Credentialing itself could be one of your major pre-occupation, relegating the all important medical practice to the second! Here are the series of process that would invariably have to clear for being eligible to Credentialing:

•  Preparation of paper CMS 855 & other Managed Care applications for all payers
•  Preparation and submission of online applications to federal and non-government carriers
•  New provider affiliations and Group Contracts
•  Maintaining and updating specific Provider information directly with carriers at frequent intervals or when requested
•  Resolving enrollment issues and tracking Managed Care contracts
•  Validating information provided by payers
•  Handling Provider letter of interest & enrollment transactions
•  Setting of Provider information in the Practice System
•  Obtaining Contracted Fee Schedules and negotiating changes
•  Preparation of contracting documents for scanning and long-term storage electronically
•  Preparing, maintaining and monitoring Managed Care Summaries that Provides Effective dates, Fee Schedule details and Group affiliation.
•  Monitoring Expiry dates for NYS-Registrations, DEAs, and CLIA registrations and also handling re-applications for the same.
•   Handling Re-Credentialing whenever required
• But, because of its inevitability and the incidental benefits that come with a well-documented Credentialing, it is prudent that you outsource from competent and proven medical billing companies that can offer quality services at a more economical cost than it would cost if it done internally. The following overriding advantages should amply justify the efficacy of going for outsourced Credentialing:
•  Insurance carriers pay better to the physicians who are in par with the insurance
•  Credentialed physicians are considered as reliable providers and are listed in the ‘preferred physicians group’ from which patients usually select their physicians in order to get maximum benefits and avoid ‘out of the pocket expenses’.
•  Since physician credentialing involves complete background check on providers’ educational qualifications, professional licenses, experience, fellowship programs, and residence, it helps in controlling the healthcare fraud-related crimes and ensures that only qualified physicians deliver services to patients and thereby improving the quality of healthcare in US
•  Credentialing offers comprehensive access to the fee schedule, which aids in knowing in advance the exact quantum of medical billing for diverse medical practices rendered.
•  Credentialing is also an accelerator of strategic clinical networks and market expansion as your practices begin to command unprecedented goodwill in the medical fraternity.

We, www.medicalbillersandcoders.com – known for offering imperial Credentialing, both as an individual component as well as an integral part of our comprehensive suite for Medical Billing Revenue Cycle Management – should be your preferential choice for “Outsourced Credentialing”.

Paid-sick-days concept as a preventive option for Federal healthcare expenditure

“Coming at a time when Federal Government itself is promulgating radical healthcare reforms to tackle growing medical expenditure on public healthcare, and promote efficient and quality medical care to its ever growing insured population, this paid-sick-days concept promises to complement the macro healthcare reforms formulated by the Federal Health Department.”

 

Strange it might seem, yet there seems to be substance in the thinking that offering employees with paid-sick-days option will eventually bring down Federal healthcare spending on emergency medical services. The logic sources its root to a forthcoming report by the Institute for Women’s Policy Research (IWPR), which estimates that giving employees access to paid sick days would reduce visits to hospital emergency departments (ED) and save $1 billion in medical costs annually; currently public insurance programs support approximately half this bill.

Although the projected saving is roughly around 2% of the total spend of approximately $47 billion annually on emergency department services, there is growing consensus among the policy makers the paid-sick-days option would encourage a proactive and preventive healthcare conscience amongst the employees and their dependents, who otherwise would procrastinate medical visits for seemingly trivial cases that potentially would be more serious. Thus, by encouraging a proactive and preventive healthcare conscience, Federal Healthcare Body can look forward to ensuring a healthy population as well as substantial cumulative savings on public insurance programs such as Medicare, Medicaid, Medicare, Medicaid, SCHIP, and Veteran Affairs Services.

Coming at a time when Federal Government itself is promulgating radical healthcare reforms to tackle growing medical expenditure on public healthcare, and promote efficient and quality medical care to its ever growing insured population, this paid-sick-days concept promises to complement the macro healthcare reforms formulated by the Federal Health Department.

Quite presumably, there would be an additional burden on physicians committed to serve Medicare, Medicaid, SCHIP, and Veteran Affairs Services beneficiaries, who would show propensity to regular medical visits, encouraged by the paid-sick-days concept. Although physicians can count on pay-for-service fees, the potential growing volume would surely put their practices under tight schedule that would render them vulnerable to operational and administrative in-efficiencies. As their practices’ fortunes hinges solely hinges on efficient clinical management and operational management practices, a dedicated clinical management and operational management service becomes crucial. With in-house services failing to match up to the requisite bench-mark, outsourcing seems to be a viable option.

And, when you contemplate on hiring such competent outsourced services, Medicalbillersandbillers.com name should invariably crop up owing to its credible history in being an able ally to a diverse composition of clients comprising Cardiology, Dermatology, ENT, Endocrinology, Family Med, Gastroenterology, Internal Medicine Sub-Specialty, Internal Med,

Long-Term Care, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Orthopedics, Physiotherapy, Pediatrics, Podiatry, Psychiatry, Pulmonology, Rheumatology, Sleep Med, Surgery, Urgent Care, Urology, and the rest.

Therefore, if you are looking at cost-effective yet efficient medical billing and practice management services, Medicalbillersandcoders.com ingenious and comprehensive Revenue Cycle Management – comprising Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing – should be an ideal choice.

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Radiology: Finding New Meaning in “Meaningful Use”

Radiologists in the United States are currently facing a dilemma as far as “meaningful use” (MU) of Electronic Health Records (EHRs) is concerned. The American College of Radiology (ACR) IT and Informatics Committee leaders and staff have met the National Coordinator for HIT (ONC) as well as Center for Medicare and Medicaid Services (CMS) staff to discuss the HR incentive program from the point of view of radiologists, on October 13, 2011.

The American College of Radiology committee reiterated its previous requests for certain criteria regarding meaningful use such as – the sharing or accessing imaging data as part of Meaningful Use, robust radiology order entry requirements for referring physicians with appropriate clinical decision support, and addressing Meaningful Use challenges within the radiology community and other specialties.

The American College of Radiology Meaningful Use Report

A report released by the ACR regarding Meaningful Use for radiologists specifies the steps taken by the CMS regarding some of the “Core” and “Menu” objectives and their relevance to radiology. The reports summary states that according to the Continuing Extension Act, outpatient hospital settings (POS Code22) are not considered hospitals in the EHR incentive program. A vast majority of radiologists will be eligible for the Medicare version of the EHR incentive program.

Defining Hospital-based Physicians

The report by ACR also states who would be considered as hospital-based by the CMS and would be ineligible for the incentive program. The CMS defines hospital-based physicians as those providing 90 percent or more of their covered professional services in inpatient (POS Code 21) and emergency room (POS Code 23) settings. Therefore hospital-based radiologists who do not meet the above mentioned criteria are eligible for the Medicare incentive program. However, Medicaid eligibility has stricter rules that require the EP’s 30 percent volume must be attributable to Medicaid which is a tall order for any radiologist if not impossible.

Who is Qualified?

The Medicare version of the incentive program only applies to physicians and radiologic technologists, medical physicists, or other technical staff is not eligible. However, the Medicaid version of the incentive program is limited to physicians, Certified Nurse Midwives, Nurse Practitioners, and Physician Assistants who furnish services in a Federally Qualified Health Center or Rural Health Clinic that is led by a Physician Assistant.

Radiologists vs. Primary Care

The meaningful use objectives appear to be focused on primary care and present some confusion as to how radiologists would comply with such objectives. However, CMS provides exclusions to many meaningful use measures as well as “menu set” measures to counteract this problem to adjust specialties such as radiology.

RIS and PACS

According to the report by ACR many HIT products that are not considered traditional, complete EHR/EMR could still achieve certification via the EHR module pathway. However, these modules need to be tested and certified before they are considered certified EHR technology. Moreover, there are advanced RIS solutions that have already received complete EHR certification or are in the process of receiving it. This implies that RIS/ PACS can be adopted so as to be certified EHR technology in the near future.

The Exclusions for Radiology in Core and Menu Objectives

Out of the 15 core objectives there are nine that are not excluded and are – Drug-Drug and Drug-Allergy interaction checks, update problem list, medication list, medication allergy list, record demographics, report clinical quality measures to CMS, implement CDS rule, HIE test, and security risk analysis. For all other core objectives, exclusion is available for radiologists. As far as the “menu” objectives or discretionary objectives are concerned, only two out of the ten objectives are given exclusion for radiologists. These two menu objectives exclusions are – generate list of patients by specific conditions and patient-specific education resources. All the other eight objectives are not excluded for radiologists.

The anxieties over radiologists’ eligibility for the incentive program are now slowly being dissolved due to the correction and amendments made by ONC. The vast majority of radiologists are eligible for incentives; even those that are hospital based, if they meet certain criteria laid out by the ONC.

For more information about “meaningful use”, EHR certification and implementation, PMS implementation, consultancy, and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

Tackling the Demands Of Gastroenterology Medical Billing in Illinois

Like most of the states in the US, Illinois too boasts of quality medical services. Lying in the Midwest region, Illinois population, being the largest in the region at 12,830,632 as per 2010 census, offers endless opportunities for diverse medical practitioners. Coupled with the demands of the ever-increasing population, Illinois’ robust economy, estimated to be US$652 billion, and per capita income at US$41,411, has greatly been influential in encouraging medical infrastructure for diverse medical disciplines. Whereas Illinois commands as great goodwill as the rest of states in attracting practitioners and patients alike, it has its edge in being a major destination for Gastroenterology Medical Services that merits a special mention: “of the 44 U.S. News Best Hospitals in the Chicago, Illinois metropolitan area, 19 are nationally ranked or high-performing in Gastroenterology, the care of digestive-tract disorders” – as per the survey conducted by a medical agency.

While the survey findings speaks highly of Illinois’ progress to being a front-runner in Gastroenterology, strangely there has been  a shortage of gastroenterologists in the wake of disproportionate population growth, and alarming rise in digestive-tract disorders warranted by life-style changes. Path breaking advances in diagnostic and treatment procedures have been catalyst to rapid expansion of scope of Gastroenterology. The scenario has prompted an unprecedented increase in workload for the existing Gastroenterologist, who, considering the critically sensitive nature of their practice, have rarely been able to take their eyes off their core concern of quality medical care to their patient fraternity; leave alone time and resources for medical billing management.

Having to take on mounting loads of practice, Gastroenterologist have been losing on efficient management of medical billing management, which is the fulcrum on which their sustenance and growth hinges on. But, inevitably, before it becomes detrimental to their very existence as Gastroenterologists, they need to seek out ways to balance their progressive medical care with efficient medical billing management. With in-house gastroenterology medical billing being largely unsuccessful both cost and result-wise, an outsourced gastroenterology medical billing solution has seen a better results.

Yet, physicians/hospitals need to be weary of unscrupulous service vendors so as to avoid repenting on wrongful choice of outsourced gastroenterology medical billing solution. A thorough examination for the prospective vendor’s self-sufficiency in the requisite qualification and competence – certification from  American Association of Professional Coders (AAPC); expertise in advanced technology interface for medical billing and coding;  proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting – should be the yard-stick to judge its credentials as a medical billing solution provider.

About Medicalbillersandcoders.com

Medicalbillersandcoders.com – known for their credible medical billing to diverse disciplines in gastroenterology through accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – have been able to turnaround many a gastroenterology practices with simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and Increased avenue for medical research and development.

Effective patient care versus revenue cycle management: physicians perform a balancing act

Physicians in the U.S., despite ranking high for their medical competence, have never been able to fully realize and optimize their medical bill reimbursements owing to an increasingly complex health insurance system that has been constantly evolving, and characterized by:

• HIPAA Compliant Medical Reporting
• Stringent Billing and Coding Regimen
• Technological Interface for Electronic Billing and Coding
• Multiple-payer Health Care System, both Private Insurance Plans, and Federal Health Plans such as Medicare and Medicaid.
  • Patient Enrollment
  • Scheduling
  • Insurance Verification
  • Insurance Authorizations
  • Scheduling and Re-scheduling
  • Coding
  • Billing and Reconciling of Accounts
  • Collections
  • AR Collections
  • Denial Management & Appeals
Physicians, whose core concern being the elevation of medical care in congruence with the ever evolving global competitive benchmark, have reported medical billing managementto be an undesirable diversion that can negatively impact their medical efficiency. Experimentation with in-house medical billing practice has not been encouraging either – with in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system-implementation. Consequently, physicians – with no avail but to practice medical billing somehow – have inevitably been driven to seek professional help in medical billing from medical billing specialists.
Experience has shown that successful medical billing has followed the dictum of perpetual reinvention in tune with stringent compliant standard (coding compliance), privacy compliance regimen (as per HIPAA), and ever advancing technological platforms for billing management cycle – all of which have contributed to an imposing environment that demands a highly qualified, experienced and dynamic team of medical billers, who along with a comprehensive knowledge of billing, are adept at conducting medical billing management in a sequential manner:
Consequently, physicians’ search for comprehensive medical billing service has led them to leading medical billing specialists, such as Medicalbillersandcoders.com – the largest consortium of medical billing professionals, who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards.
Carrying impeccable qualifications – certified by the American Association of Professional Coders (AAPC); proficient in using advanced medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc., and latest coding softwares such as EncoderPro, FLashcode and CodeLink, these medical billing specialist help physicians to streamline their current operations.
Expert at applying standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis; HIPAA compliant medical reporting; and an impressive track-record of maximizing reimbursement of medical bills with the leading private insurance carriers such as United health , Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well – our medical billing experts ensure simplification of your revenue cycle, appreciable increase in collection rates and operational margins, more patient inflow and referrals, and Increased avenue for medical research and development.

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The Top 5 States for Physicians to Practice Medicine

The best states in the US for practicing medicine can be determined by taking a holistic view of the state of health care in that particular area and comparing it with other places. Some states are surprisingly physician friendly while some may not be very suitable for physicians in certain specialties. The ranking can be based on factors such as the availability of physicians, disciplinary actions against physicians, the premiums paid for medical liability coverage, cost of living index and state income taxes among many other factors linked to the cost of administration.

Texas

Texas is one of the better states for general surgeons and internal medicine because of the low liability insurance premiums for these specialties. A low cost of living index and low state income tax rates make it one of the top states for physicians to practice medicine. The high percentage of uninsured in this largest state would create a need for health care providers in the future which could be much larger compared to any other state in the country. Moreover, there is no shortage of medical billers and coders in Texas and this makes administrative processes frugal and efficient at the same time.

California

California is the best state as far as physicians’ salary is concerned and is also favorable in terms of Geographic Practice Cost Indices or GPCI. Another feature that is in favor of physicians in this golden state is the comparative lack of competition in the state in many areas coupled with low medical liability premiums.

Alabama

Alabama is one the states where competition is thin for physicians and almost 20% of the people in the age group 19-64 are without health insurance. In face of health reforms, these would be entitled to insurance and the number of patient-doctor encounters would also increase. The cost of living index is lower in Alabama compared to many other states in the US. Furthermore, less number of disciplinary actions by the medical board in Alabama in comparison to other states makes it a place which is lucrative and suitable for physicians.

South Dakota

South Dakota is also one of the states which are ideal for physicians and health care providers due to zero state income taxes and zero liability insurance premiums. Moreover, South Dakota also has a low cost of living index and a comparative scarcity of physicians, making it financially beneficial to provide health care services here. South Dakota is one of the states with very high density of medical billers and coders making it apt for physicians and health care providers from the point of view of administrative and medical billing and coding support.

Tennessee

Tennessee is one the states that is physician friendly mostly because of zero state income taxes, higher pay scale compared to numerous other states, low number of disciplinary actions, and a low cost of living index.  Moreover the easy availability of medical billers and coders in Tennessee makes it ideal for cutting costs as far as the administrative processes related to practicing medicine are concerned.

Although many other states also have positives for physicians but these five states are among the best because all or most of the factors such as cost of living, remuneration, liability insurance premiums, number of disciplinary actions against physicians, state income taxes, GPCI, and number of health providers in the state are in favor of health care providers.

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About Medicalbillersandcoders.com
Medicalbillersandcoders.com is the largest ‘Consortium of Medical Billers and Coders,’ across the US. The portal brings together hundreds of billers, with experience in different specialties, on the same platform to service physicians in their local areas. This network of coders and billers is growing rapidly and is currently servicing over 50 specialty physicians, across the US (Iowa Medical Billing, New York Medical Billing, Ohio Medical Billing, Texas Medical Billing), with the most prominent being Cardiology Medical Billing, Mental Health Medical Billing, Dental Billing, Oncology Medical Billing, and General Practice.

Upgrading to HIPAA Version 5010

Adhering to the HIPAA 4010 compliance has been a long-standing ordeal for medical billing and coding professionals and now, on January 1, 2012, the electronic healthcare transactions standards change from version 4010/4010A to version 5010 will definitely need a closer look at the compliance guidelines. The healthcare industry and professionals need to thoroughly acquaint themselves with the upgraded HIPAA version in terms of its impact and implementation process to provide hassle free medical care.


What is HIPAA Version-5010?


Version 5010 is the latest revised set of HIPAA transaction standards which will be adopted to replace the current version 4010/4010A standards from January 1, 2012. The 4010-compliant “electronic transactions” will not be accepted after this date as being non-compliant with the latest regulation. The electronic health care transactions include functions such as claims submission and status, eligibility inquiries, remittance advices, and referral authorization among others. Unlike the current version 4010/4010A1, version 5010 accommodates the ICD-10 codes, and the application of HIPAA 5010 must be in place first before the changeover to ICD-10.


Impact of Version-5010


It is inevitable that Version 5010 change will have an enterprise-wide effect on physician practices and hospital operations. From front end to back end, the level of impact on a physician’s practice is directly related to how well each practice is prepared to send and receive the 5010 transactions. Physicians practice will have to rely on medical billers and coders who are updated and well trained with the requirements of version 5010.


The updated version of the transactions includes changes in the kind of the data collected as well as the format in which it is reported. For example


1. In the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported.
2. Another example of a difference in the professional claim transaction is the reporting of the billing provider address. In the 5010 version, the address can no longer be a PO Box or lockbox address.
3. The number of diagnoses that may be submitted increases to 12 from the current 4.
4. The new format will also promote assignment of a claim number upon receipt by a payer. By receiving this claim number in your report of accepted claims, you will have the payers I.D. for that claim to use in following up on unpaid or underpaid claims.
5. Manifold expansion in the size of diagnosis code field.
These changes are likely to improve the billing process and, as a consequence, the patient care. Improvements in the 5010 transactions include
• Clearer instructions
• Reduced ambiguity among common data elements used in different transactions
• Elimination of redundant and unnecessary data elements


So, in order to implement version 5010, the health service providers and organizations need to run an internal assessment, go in for software upgrades and train the various departments. Hiring experts to manage and support the billing and coding processes and software upgrades for implementing version 5010 can take away some of the load during the changeover process.


The following flow chart shows a checklist for version 5010 transitions which you can do in the coming six months.





Understanding these changes and how they will affect medical practices will prepare you for a smoother transition to the updated transactions.


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Upgrading to HIPAA Version 5010

Improving Quality And Revenue In Face Of Healthcare Reforms

The recent healthcare reforms proposed by the white house may affect the revenue as well as the quality of the service provided by physicians in the United States. According to a recent survey by Thomson Reuters, almost two-third of doctors in the US fear that health care reforms proposed by Mr. Obama might flood their offices which in turn would mean reduced individual attention to patients. Simply put, doctors would end up working more for lesser remuneration.


The survey also reveals that almost 68% of doctors think that the quality of service would drop because of the reforms. However, repealing the bill would also mean that more than 100 million people under the age of 65 would not be able to get health insurance because of a pre-existing condition. Nevertheless, the repeal of this bill is likely to fail in the senate. This effectively means that doctors would have to find a solution for plugging the gap between demand and supply of health care services.


2,958 doctors were surveyed by Thomson Reuters and physician services company HCPlexus in various states and of different specialties. When asked about how they were going to handle the newly insured, more than half of them said they would have to delegate the work to an assistant or a nurse. Although this may ease the pressure on doctors, it is just a make-shift solution for a change that looms large and can take place in as less as four years.


Electronic medical records might help according to 39% of doctors who were surveyed. Moreover, delegating administrative work can also be a solution. For instance, all billing and coding can be taken care of by highly trained professionals resulting in better time management and increased revenue.


The health care reform may be a radical change but still everyone would not be covered for everything and it would still be a good practice to send electronic files to a clearing house for determining eligibility. This can save time because it would reduce the amount of claims which are denied. Providing the patients with an electronic version of the bill and E-statements instead of mailing a paper bill would further cut costs by as much as 12 to 15%.


Some resident doctors would find themselves busier than before and since Federal law does not place any limit on the working hours of residents, it would be inevitable that they would spend more and more hours treating patients who are newly insured. Although the Accreditation Council for Graduate Medical Education (ACGME) has limited the work hours of residents to 80 hours, many residents work more and report less for fear of losing accreditation. This can be advantageous for doctors who would rely on nurses, residents and assistants to catch-up with the increasing demand for health care services.


There is no quick-fix solution to this since we cannot “import” doctors from other countries and the number of doctors and nurses cannot increase to a level in such a short period of time where they would be able to meet the demands. However, since Medicare is responsible for funding a majority of residency programs, there is a possibility that the recent bottleneck in such funding can be solved in the years to come which would result in recruitment and training of new residents. Moreover, there has been a growth of around 4% in residency slots from 1998-2004 which is the result of funding from a large number of teaching hospitals.


Some branches of medicine such as radiology and internal medicine do not require long working hours and can cope with increased volume of work. However, most of the branches would struggle to cope with the increased work pressure if a pragmatic solution is not developed before the reforms take place.


The biggest advantage a doctor or a health care provider can have are good medical billers and coders who can ensure quality even when meeting deadlines. This will make the process smoother for the physician as well as relieve him or her of work pressure. Now looking for Medical Billing Specialists locally and specialized in your specialty could be more taxing. In these trying times Medical Billers and Coders from every state, city and specialty have come together and are available to physicians at no cost at www.medicalbillersandcoders.com

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