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.

Physicians tackle HIPAA requirements and increased scrutiny by Government

The health reforms have not only affected the way in which healthcare is delivered but also the way in which information is shared among various professionals and entities in the health industry. Health Insurance Portability and Accountability Act (HIPAA) regulations have become more stringent for physicians, and patient privacy is one of the issues that are emphasized in the health reforms. Physicians are tackling this increased scrutiny by the government by adapting various methods in the various core and departmental processes involved in the delivery of healthcare.

The HIPAA and the HITECH Act have brought about new changes to the way physicians’ roles are scrutinized in the country. The privacy guidelines in the HIPAA Act are exhaustive and physicians need to be aware of these in order to avoid penalties in the form of cuts or worse. Moreover, these guidelines regarding patient privacy are not only applicable to physicians who follow proper EMR or EHR implementations and the reform guidelines but also to those who choose not to implement such requirements. Physicians need to disclose only the “minimum necessary” information needed for the particular purpose to certain entities. Even oral communication about patient information can be considered breach of privacy under HIPAA.

HIPAA compliance is not just necessary for physicians but is also applicable to their staff, on-site or otherwise. Physician assistants and professionals in other departmental processes also need to comply with HIPAA guidelines and prevent the breach of patient privacy by securely utilizing protected health information (PHI). With physicians using various methods to access and modify data on EHRs, the HIPAA privacy rules take on a new meaning. Those on the other end of the tech spectrum who still use paper based records cannot possibly implement such safeguards for privacy. Therefore adoption of EMR and EHR systems that are HIPAA compliant along with recruitment of compliant professionals in various departmental processes has become crucial to the well-being of a practice.

Providers are required to give notice of privacy practices to patients explaining how the health information of the patient is disclosed and used. Providers cannot reveal PHI to the patient’s employer unless there is a written permission from the patient for doing so. Healthcare providers are not allowed to reveal PHI to family members without receiving permission from the patient. In addition to these safeguards, there are other types of safeguards to be implemented such as physical safeguards of workstations and software used in accessing or modifying PHI. The onus of the protection of information lies with the physicians or practices and their staff and with the increasing volume of the information, it becomes necessary for physicians to hire professionals who are HIPAA compliant.

The departmental processes involved in the health care delivery system such as medical billing and coding, transcription, denial management, and revenue cycle management also need to be HIPAA compliant. Medical billing and coding services at medicalbillersandcoders.com, which is the largest consortium of medical billers and coders in the United States, are not only HIPAA compliant but also offer numerous other value added services such as consultancy, research and improved denial management.

Hospitals expand to attract well-insured patients despite pressures of healthcare reforms

Several hospitals are looking for well-insured patients beyond traditional market boundaries, both in prosperous suburbs and in nearby areas with growing, well-insured populations. According to a study by the Center for Studying Health System Change (HSC) hospitals seeking a competitive edge in the marketplace are targeting geographic expansion into new markets which are well-insured.

The study based on HSC’s visits to 12 nationally representative metropolitan communities, depicted that hospitals are expanding despite the pressures of the healthcare reform. Hospital strategies mainly include – building full-service hospitals, establishing freestanding emergency departments and other outpatient services, acquiring physician practices, and operating medical transport systems with several hospitals building near major highways to be accessible.

Hospitals expansions survey findings

• In all 12 markets surveyed results depicted that hospitals are looking for full-service hospitals or freestanding emergency departments, buying or establishing physician practices and developing a regional presence through emergency medical transport systems
• Recession rather than diminishing has heightened the drive among hospitals to pursue well-insured patients beyond traditional hospital market boundaries
• Expansion appears more frequent where large hospital systems were pursuing significant employment of physicians and where service-line strategies, such as cardiac or cancer care, were well entrenched

Impact on Hospitals & Independent physicians

The overall impact of hospitals’ geographic expansions is still to be observed, there are conflicting views within the industry regarding these new hospital competitive strategies, if they will increase costs, improve care or both. Hospitals are of the view that the expansions will increase efficiency, increase access and improve the quality of patient care, while payers and competitors argue such strategies will lead to elevated costs.

Also Independent Physicians in most markets due to health reforms who are faced with financial pressures along with difficulty in hiring younger physicians, who often prefer employment in larger organizations, are actively seeking the stability and security of employment in larger physician-owned or hospital-owned groups. According to the HSC study in fast growing and well insured Greer, SC, there are no more independent primary-care practices left.

Revenue cycle management amidst hospital expansion and reforms

Hospitals backing expansions as necessary countering that even though there are costs increases, their efforts provide increased high-quality care; will need to cater to higher patient influx and increased medical billing. Hence in this scenario along with the growing pressure of health care reforms, services of skilled service providers possessing the requisite credentials can be availed by hospitals and practitioners to maintain favorable revenue cycles management.

Medicalbillersandcoders.com the largest ‘Consortium of Medical Billers and Coders, servicing over 50 specialty US physicians, are constantly updated with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices. Medicalbillersandcoders.com has in-depth knowledge and expertise in the delivering the best quality services to hospitalists. Hospital employment will affect patients, hospitals and doctors – as healthcare will require greater coordination, greater use of clinical data and collaborative provider teams — which MBC is best positioned to deliver.

For more information visit: hospitalist billing

Gauging your Medical Billing Company on ICD-10 compliant resource-capability

“As much as the intrinsic competencies of your medical billing companies, their ability to advise on EHR/EMR implementation for efficient clinical and operational management  should equally hold prominence. As HIPAA 5010 compliant EHR/EMR is the prerequisite to medical billing under ICD-10 system, your practices needs to be equipped with EHR/EMR that meets HIPPA 5010 standards both as a compliant measure as well as qualifying measure for incentives under Meaningful Use Criterion.”

Physician practices, clinics, and hospitals, who hitherto have been safely entrusting all their billing operations to their respective outsource providers, will soon have to run a reality check of the level of preparedness that their medical billing service providers possess or likely to possess in congruence with the ensuing ICD-10 – going to be operational from October 1, 2013. Although most of the medical billing companies are mindful of the efficacy to be resourceful with ICD-10 medical billing management requisites – as they themselves will not be able to operate with ICD-9 compliant practices, which are soon going to be obsolete – yet it is a kind of reassuring exercise that your medical billing reimbursements are channelized through incredible and safe hands.

Now, having been convinced of the efficacy of running a reality check of either your current or prospective medical billing companies, it is quite natural to be inquisitive of the nature and extent of such reality check. Primarily you need satisfy yourself whether the service provider is self-sufficient in resources – both human as well as technological – that render medical billing management possible in the ICD-10 compliant environment. Notwithstanding other things like credibility in the industry, composition of clients, and experience as a medical billing company, it is this resource capability for ICD-10 compliant medical billing that holds the key to your delay-free and denial-free medical reimbursements of your medical claims for clinical services rendered to the Medicare or private insurance beneficiaries. And, when you consider how vigilant and stringent health insurance carriers are becoming, your medical billing service providers’ ICD-10 compliant competencies assume ever more significance.

When it comes to gauging your medical biller’s human competencies, it is necessary that professionals are trained in ICD-10-CM Implementation Training, ICD-10-CM Anatomy and Pathophysiology, ICD-10-CM Code Set, and ICD-10-CM Specialty Code Set. Further, along with a knowledge background, they need necessarily hold qualifying certificates from authorizing agencies that confer professional certification in ICD-10 compliant billing and coding –  AAPC (American Association for Professional Coders) and American Health Information Management Association (AHIMA) happen to be the competent agencies in the U.S.

Orienting your support staff to the integrated EHR eco-system

“Before expecting your support staff or divisional departments to contribute qualitatively into the integrated EHR system, care must be taken to identify and train them for orienting them to the mechanism of the EHR”

By now medical practices must have realized that EHR is not just about technology but beyond that. As EHR becomes mandatory in clinical and operational management, practices’ responsibility to comply by EHR mandate would also double up: while they have to ensure EHR compliance for avoiding penalization for being below the EHR benchmark, they should also strive to be eligible for incentives under the ‘Meaningful Use’  criterion as determined by the HITECH Act. Therefore, the whole task of living up to the requisite level of compliance would surely demand not just physicians’ knowledge of EHR, but the integrated effort of functional divisions of medical practices/hospitals.

Before expecting your support staff or divisional departments to contribute qualitatively into the integrated EHR system, care must be taken to identify and train them for orienting them to the mechanism of the EHR.

• To begin with you have the Front Desk, which usually attends to Patient Registration and Admission. As EHR marks a deviation from paper filing to electronic registration, the Front Desk needs to be taught of ways to enter in registration and admission processes into an automated and networked EHR module, which enables viewing and interfacing across the all the connective eco-system of hospital management.
• Next, you have support staffs, who take of monitoring and administering physicians’ instructions for clinical management of patients inside the hospitals. But, for the medical support staff that hitherto has been following instructions orally or from notes, the transition to deciphering instructions from  an electronically automated EHR system would somewhat seem alien initially. But with proper orientation, they would not only be able to appreciate the change but also contribute positively towards the integrated EHR eco-system.
• Following the support staff is the clinical and diagnostic department, who play a vital role in screening and detecting the medical condition. With an integrated EHR in place, their task of collaborative sharing the clinical and diagnostic findings would surely get faster and more efficient.
• Then, you have the all important part in the hospital eco-system: the medical billing staff, who are crucial to the revenue generation from factual medical billing preparation, coding, submitting and realizing the medical claims from the Medicare as well as private insurance carriers. With a streamlined EHR that can ensure compliant billing and coding, you can always expect your billing staff to deliver efficiency and contribute to operational efficiency.
• Finally, you have the Executive Board or the Management, whose task of decision-making would surely be devoid of blemishes as they would have ready access to clinical and operational data from the integrated EHR eco-system.

But, when you consider the time and resource required for comprehensive orientation of all your functional entities, you would rather be well-off opting for outsourced services from credible and competent vendor. Medicalbillersandcoders.com – whose competence and credibility in advocating and practicing EHR implementation and training for diverse medical practices is well-known across the U.S – should be an ideal recourse for practitioners seeking to opt for orientating their support staff to the integrated EHR eco-system.

Browse All: Medical Billing Services, Medical Billing Companies

Dispelling hospitals’ reluctance in adopting Alternative Therapy & Medical Billing

“As much as its popularity amongst larger population of patients, Alternative Therapy may well become a viable alternative in ensuring hospitals’ uninterrupted sustenance and growth. And, judging by its popularity, it may well become an integral part of comprehensive medical services offer by majority of hospital”

Many a times, proven medical treatment or intervention may not be able to ensure the requisite relief to patients. Especially, when it comes to clinical management of chronic ailments, proven medical procedures or therapies have been found wanting in as far as providing cure or relieving symptoms associated chronic medical conditions. As medical researchers try to seek answers to these elusive questions, parallel medicine has slowly been evolving as an alternative option – acupuncture, guided imagery, chiropractic, yoga, hypnosis, biofeedback, aromatherapy, relaxation, herbal remedies, massage, and many others forming the composition of Alternative Therapy. More than a curative option in chronic disease management, Alternative Therapy is increasingly being used a proactive method for augmenting mental and physical well-being.

But, despite the enormous opportunities, both practice-wise as well as revenue-wise, medical practitioners and hospitals, in particular, have not been that inclined to adopt alternative therapies as part of their comprehensive healthcare service offer. While there could many reasons for the continued apprehension, the likely increase in workload and billing complexities associated with such appreciation in volume may well have been the prime reasons behind the reluctance. But, as the health radical healthcare reforms – Medicare cuts, Accountable Care Organization (ACO) concept, mandatory EHR compliance, and the ensuing ICD-10 and HIPAA 5010 – begin to impact on hospitals’ revenue generation, they will have to off-set the effect through alternative opportunities, such as Alternative Therapy.

As much as its popularity amongst larger population of patients, Alternative Therapy may well become a viable alternative in ensuring hospitals’ uninterrupted sustenance and growth. And, judging by its popularity, it may well become an integral part of comprehensive medical services offer by majority of hospital. As far as the complexities of voluminous medical billing, coding, claim submission, and realization are concerned, hospital can easily look to avail the services of competent and credible medical billing service providers, who along with the routine billing services, are willing to offer expertise in EHR implementation, denial management, and Revenue Cycle Management. Consequent to such combination of integrated medical billing management, hospitals can easily dispel the apprehensions associated with adopting Alternative Therapy as a viable option along with the regular medical service offers.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – whose long-standing reputation as the largest consortium of medical billers and coders in the U.S. is built on its credibility and competence to offer comprehensive medical billing solutions comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting along with advisory on EHR efficacy and implementation – should instill  the much needed confidence to go in for Alternative Therapy as a viable option along with the regular medical service offers.

For more information visit: medical billing companies

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.