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.

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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.

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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.

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Protection From Medical Billing Gaps

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

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

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

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

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

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

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

Reasoning with the Physician community: Medical Billing Services

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

Challenges for Medical Billing – ICD-10 Transition 

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

Coders to prepare for the transition need to:

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

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

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

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

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

The Changing Landscape of Healthcare Reimbursement in 2012

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

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

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

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

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

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

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

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

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

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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