single payer system vermont

Vermont: State with Single payer system

“Single-payer health system” which was passed in May 2011 by the Vermont governor, expects to accumulate savings of 24.3% of total health expenditure between 2015 and 2024, according to Harvard economist William Hsiao. Vermont is to be the first state in USA to implement this system, which will move many state residents into a publicly financed insurance program.

Single-payer system: is a healthcare financing system, run by the state, providing universal coverage to all the residents, where both the collection of funds; and the reimbursement are the responsibility of the government. Funds are collected mainly in the form of taxes by the government, and the government reimburses healthcare providers- doctors, hospitals, etc.

Outlook:

On the upside, in a single payer system consumers have various benefits over private insurers like:

• Nonprofit compared to private insurers where overpaid management is mainly interested in making profits
• Doctors and hospitals need to interact with only one payment entity
• The funding is obtained through taxes in a fair manner
• Costs are controlled as the level of health spending is determined through a public process.
• Consumers can have a free choice of doctor or hospital
• Savings are used by people for other needs and patients need not worry about healthcare cost
• Relief of the health care burden on businesses will help stimulate the economy and improve the global competitiveness of U.S. businesses. Lower healthcare costs will help reduce the prices of products, and US companies will be able to compete easily with foreign companies

According to a Commonwealth Fund report, single payer would create about 3,800 new jobs and increase the state’s total economic output by more than $100 million in 2015 and can save Vermont households and employers nearly $200 million in the first year alone.

However, critics fear that moving to a single-payer system in Vermont would create huge budget deficits, while some business owners are concerned about legal and fiscal challenges. Health care advocates feel the law should be clearer about not having copayments and deductibles. Rutland City Treasury is of the view that the administration is over-estimating the cost savings a single-payer system will deliver and the state is likely to run budget deficits of 300-million dollars a year.

Implementation of this herculean task will finally depend on groundwork, overcoming certain legal challenges, challenges from self-insured employers, etc. A report depicts consumer concerns about details regarding medical and pharmaceutical benefits covered under the system, cost covered by patients, etc. There will be winners and losers once this system is implemented and solutions will have to be provided. Physicians will have only one entity to bill: the government, but they will need to be updated with all the necessary legal data, medical benefits, deductibles, well informed about self-insured employers, etc. to guarantee accuracy in medical billing and coding.

Single payer or Multi- payer systems, physicians do end up spending a lot of their time supervising Medical Billing functions in order to keep their practices profitable. Moreover the pressures of evaluating the extent of change in single payer exchange and interaction can drive a practice to way more administrative jobs than anticipated.

Physicians can benefit vastly by hiring or outsourcing to experienced medical billers and coders, who can provide the services and in-depth research required while transitioning to another payer system. Medicalbillersandcoders.com, the largest consortium of Medical Billers and Coders, has a vast talent pool of billers and coders who can help in understanding how these changes will affect medical practices and will prepare Vermont Healthcare Providers for a smoother transition to the single payer system.

Top 4 Challenges in Healthcare Information Exchange (HIE)

Healthcare Information Exchange is the end goal of the recent health reforms in the United States and aims to provide better patient care on a continual basis by multiple organizations. The implementation of HIE not only helps in providing quality care to patients but also assists in reducing costs and errors that arise due to duplicate tests, cost of paperwork, and other manual efforts such as scanning of documents, printing, and traditional procedures that consume time and money. Since HIE is still in its implementation stage, many health care providers, hospitals and the government are facing numerous challenges in this area.

Meaningful Use

The biggest hurdle that the government and physicians are facing is the Meaningful Use of EMR. Physicians, clinics, and hospitals have to demonstrate that they have been using the IT reforms in a meaningful manner and this entails numerous requirements to be met. These can range from recording the smoking status of patients above the age of 13 years to providing e-prescriptions. Many physicians are finding it hard to implement the technology and successfully demonstrate meaningful use due to many reasons. Some of these include resistance to new technology by the staff or physicians, older physicians who are set to retire in a few years and are reluctant to adopt such technology, and the possible adverse legal implications of successfully implementing EMR and EHRs.

Legal Implications

The utilization of HIE can have legal implications for small providers of EHR systems but larger government sponsored providers face lesser risks in the form of legal actions. Moreover, physicians and hospitals may face legal penalties if the system is not used in an appropriate manner which can lead to reduced quality of patient care. The legislation regarding HIE and EMRs or EHR is still being developed and this uncertainty and lack of proper regulations in the initial stages of the HIE implementation is creating anxiety among health care providers.

Costs

Health Information Exchange is a complicated and sensitive issue where there is very little scope for errors and so the costs for implementation and utilization over longer periods of time are another problem physicians and the government is facing. The major issue as far as costs are concerned is the downtime costs which would be borne by physicians. If the HIE or EMR systems are down even for a short period of time, it can cost the physicians a lot of money and result in a drop in their revenue. As many physicians and hospitals scramble to implement Electronic Health Records to assist in the HIE process, this aspect of system downtime is sometimes ignored by system providers and health care providers as well.

Privacy

The biggest concern that physicians and patients have is the privacy of their records since there are many professionals who would have access to their health information. Since the information shared by them can be misused by many agencies such as competing insurance companies, training physicians, pharmaceutical companies and unauthorized research agencies, there certainly is a growing concern over the security of such sensitive data.

Solutions

There are many opinions, debates and solutions which are being proposed to meet these Healthcare IT sector reform challenges. However, some of the most simple and cost effective measures are physician education about HIE, legal reforms related to HIE, ensuring technical efficiency, and better administrative processes including efficient medical billing and coding, medical transcription, lesser turnaround time and efficient interaction with payers. In fact, to focus on optimizing your processes in keeping with the HIE injunctions you could hire the support of excellent consultants. These HIE specialists have the capability of directing your precious time and effort towards implementation of technology and processes rather than creating trouble.

Although there are various challenges faced by HIE in the United States, it is possible to successfully implement it with the help of experienced HIE and revenue cycle consultants. For more information regarding healthcare IT reforms and end to end revenue cycle consultancy you can visit medicalbillersandcoders.com – the largest consortium of medical billing professionals across all states, handling all specialties.

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Professional Revenue Cycle Management Consultancy Services by Medicalbillersandcoders.com

MBC offers expert consultancy services to healthcare providers across the US for strategic, operational, and revenue cycle management, no matter the size of their organization. Viewing the dynamic changes sweeping through the healthcare industry, we have perceived an urgent requirement of professional support and assistance to healthcare providers to adapt to the latest regulations and flux in the healthcare industry.

2012 is the year when health reform actually hits home and the healthcare providers need to put their practices in order, in terms of regulation compliances such as HIPAA 5010, ICD10, PQRI (Physician Quality Reporting Initiative), CPOE (Computerized Physician Order Entry), HIE (Health Information Exchange) along with the latest EHR updates.

The MBC consultancy professionals can effortlessly implement and integrate these compliances into physician’ system. This can save the physicians immense administrative complications and inconvenience during the transition process as also after the regulation deadline.

We believe that the regulation related changes are not complex per se; the challenge lies in actively motivating the physicians’ teams to adopt these compliances by underlining their relevance and scope in effective patient healthcare and improved revenue cycle management.

The niche of Medicalbillersandcoders.com remains revenue cycle management and solutions to problems around optimized revenue cycles. MBC as a market force believes that it is best equipped to handle physician difficulties given its hundreds of billers and coders who cater to all specialties and face operational difficulties everyday.

MBC offers comprehensive consultancy services to optimize the revenue generation of healthcare providers by a thorough analysis of their revenue cycle management. Our experts minutely scrutinize the various stages of revenue cycle management to identify the root causes of revenue leakages and inefficiencies in order to provide pro-active solutions for healthy revenue generation.

MBC aims to provide value-added consultancy across the spectrum of healthcare services throughout the US.

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Primary care Physicians to be the most affected by the proposed 30% CMS Cuts on Medicare payment for 2012

The physicians’ proposed fee schedule issued by the Centers for Medicare & Medicaid Services (CMS) for 2012 includes approximately 30% payment reduction in Medicare payments. If the proposed Medicare cuts become a reality, it may result in the primary care physicians, both government employed as well as private physicians, withdrawing from Medicare, as it is bound to turn the odds against them in terms of financial feasibility.

This will ultimately affect the end users i.e. the patients, particularly the senior citizens as their access to physicians is likely to reduce. A large number of physicians are looking forward to a permanent solution for this problem which can be achieved through the proper implementation of sustainable growth rate (SGR) factor.

With the inevitable incorporation of latest regulation such as EHR, PQRS, and ePrescribing in the healthcare scenario, the role of primary care physicians is set to be even more pertinent and active, putting more burden on them. This might further aggravate the situation envisaged by the proposed 30% Medicare cuts.

The physicians need to gear up to face this challenge of payment cuts by making their system more efficient. They can hire experts to handle their revenue cycle in order to concentrate more on their core competencies like patient care and research. These experts can optimize physicians’ billing and coding process to enhance their reimbursement cycle. This will definitely go a long way for physicians to sustain their business profitably even after the Medicare cuts.

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Latest Coding Resources and Products Available Online, for a Fee

Coding is a very crucial step in a clinic’s revenue cycle process and coders need to keep themselves updated with changing industry regulations and norms to remain competitive. But the question is how? The latest online coding resources offered by the American Medical Association have come as a blessing for the coders by providing electronic access to authoritative coding and compliance resources, as well as updates to the latest coding, billing and compliance changes.

The AMA Coding Online has made available some of its best selling coding products such as CodeManager® in various editions, CPT® Assisstant with latest updates and historical information, RBRVS DataManager as well as many more. These products carry current updates (including quarterly/annual updates) as well as historical changes and are available with clinical examples, illustrations, and description in relevant cases. 

The website is a veritable storehouse of latest coding resources and products for coders who would like quick and pertinent answers to their routine professional queries and stay abreast of the changes and trends; it also provides the physicians with a readymade facilitator to train their staff as well as authenticate coding to external sources.

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ICD-10 Implementation: An update for physicians and coders

The transition to ICD-10 is much more than a mere increase in codes and field sizes. The descriptions of diagnosis codes in ICD-10 may be very different to what coders are used to seeing and using in ICD-9. Therefore, the complexity in transition is significant and shouldn’t be avoided by medical coders.

An easier and successful transition before October 1, 2013 would require a well planned and efficiently managed implementation process. Although the ICD-10-CM/PCS implementation deadline is two years away, good training plans will ensure a smooth transition for physicians, inpatient and outpatient coders.

Impacting Inpatient Coders:

The ICD-10-CM/PCS final rule estimates that inpatient coders will need 50 hours of training. In order to ensure a successful transition, inpatient coders must:

• Possess sufficient foundational knowledge of the biomedical sciences (e.g., anatomy, physiology, patho physiology, pharmacology, and medical terminology)
• Learn how to apply ICD-10-CM/PCS codes correctly on inpatient encounters
• Understand how to apply maps and crosswalks between ICD-9-CM and ICD-10-CM/PCS

Impacting Outpatient coders:

Outpatient coders would require approximately 16 hours of effective training in ICD-10-CM/PCS, presuming that coders already have the necessary knowledge in biomedical sciences. Other requirements are the same as inpatient coders.

Medical coders need to adhere to the stipulated timeline for the various steps of ICD-9 to ICD-10 transition. Though the first phase is already over, the coders can still take assistance from various online resources and webinars conducted by AMA, AAPC, AAHIMA, and many other associations to get the requisite training and prepare for the transition process. Proper training and guidance in using use ICD- 10 will help coders to remain abreast of the changing industry norms and play a vital role in the implementation process for their employers and clients.

Physicians should keep track of the envisaged timeline for implementation of ICD-10 and prepare their clinic for smooth transition through its various phases:

Phase 1: Implementation plan development and impact assessment (first quarter 2009 to second quarter 2011)
Phase 2: Implementation preparation (first quarter 2011 to second quarter 2013)
Phase 3: “Go live” preparation (first quarter 2013 to third quarter 2013)
Phase 4: follow-up post-implementation (fourth quarter 2013 to fourth quarter 2014)

Physicians should also ensure training for in-house coders, or hire coders trained in using ICD-10, as proper coding is required to keep their revenue cycle efficient and optimized. For physician practices or hospitals facing problems in getting their staff upgraded, outsourcing might be a feasible option.

Synchronizing ePrescribing, PQRS, and EHR Criteria

There can be many issues with a conventional paper prescription issued by a doctor. To begin with, most chemists find it difficult to understand illegible handwriting on the prescription, leading to disbursement of wrong drugs or dosages. Secondly, patients may need to return to the doctor for changes in the prescription, such as, extending it, or authorizing substitute medication due to non-availability of prescribed drugs. Thirdly, the chemist may not have the medication prescribed and the patient may have to run from chemist to chemist to get the medication and the list goes on.

A lot of prescriptions are misused and dangerous drugs are procured over the counter. One way is for the patient to get the prescription filled and then go to another chemist and fill it again, if the chemist fails to mark the prescription as filled. Thousands of patients die from wrong medication every month and to prevent such deaths, the US Department of Health & Human Services set up the CMS (Centers for Medicaid & Medicare Services) to oversee what is called the Physician Quality Reporting System (PQRS).

In order to effectively solve the above mentioned problem and ensure all physicians and medical professionals adhere to quality practice norms, the CMS set up the PQRS that requires all medical professionals to register by law and offered incentives to medical professionals to sign up for the eRx system to combat the above mentioned problems.

The electronic network of computer systems called ‘eRx,’ or electronic prescription (ePrescription for short) has effectively resolved all the problems faced by doctors, patients and chemists alike. Patients covered by Medicare can benefit from this facility.

Getting Started

It is never too late to get started with the CMS PQRS. First of all, any medical professional wishing to get into the eRx, or ePrescription incentive program needs to check with the list of eligible professionals. These include, but are not restricted to:

1. Doctor of Medicine
2. Doctor of Osteopathy
3. Doctor of Podiatric Medicine
4. Doctor of Optometry
5. Doctor of Oral Surgery
6. Doctor of Dental Medicine
7. Doctor of Chiropractic
8. Physician Assistant
9. Nurse Practitioner
10. Clinical Nurse Specialist
11. Clinical Social Worker

In fact, all professional services covered under the Medicare Physician Fee Schedule (PFS) and physicians charging fee based on the PFS qualify for the PQRS. However, eligible professionals do not have to participate in the PQRS to take part in the eRx or ePrescription incentive program of the Electronic Health Record system.

While there is no sign-up or pre-registration for the eRx incentive program, there are some EHR criteria to be eligible. This includes the professional using any of the qualified eRx systems and reporting to the CMS on his or her adoption of the system. Then the professional must satisfy certain qualifying criteria by using the eRx system for a specified reporting period.

To sum things up:

The incentive is a financial compensation for the medical practitioner that amounts to 2% of a group practice’s total allowed charges for professional services that are covered under the Medicare Part B Physician Fee Schedule, as laid down by the CMS.

Health care providers should ensure that at least 10% of its Medicare Part B charges will be reporting to a particular set of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.

This reporting is required for at least 50% of the Medicare Part B patients that the professional prescribed medication for in the reporting year.

A professional may submit this information one of three ways: to CMS on its Medicare Part B claims, to a qualified registry, or to CMS via a qualified electronic health record (EHR) system.

While the eRx incentive program was started in 2009 and implemented annually by the CMS that updated the Federal Registry regularly, this financial incentive is set to reduce to 1% by 2012 and further to 0.5% in 2013. In addition to this, all eligible healthcare professionals will face penalties in the form of reduced payments if they fail to meet eprescribing criteria. Should they fail to start eprescribing by 2012, their financial incentive will be reduced by 1%. Failing to do so by 2013 and beyond, the penalty will result in a reduction by 2% of the payment they would normally be entitled to.

Undergoing dynamic changes in running a practice, physicians can utilize the support of well trained Medical Billers and Coders and even Practice Management staff. Finding this well trained staff across all 50 states and specialized in all specialties has become much simpler with Medicalbillersandcoders.com

To know more about RCM and Practice Management Consultant visit –www.medicalbillersandcoders.com