CMS’s temporary actions announced today to empower local hospitals and healthcare systems to:

Put Patients over Paperwork

CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.

During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation. Hospitals will also have more time to provide patients a copy of their medical records.

CMS is providing temporary relief from many audit and reporting requirements so that providers, healthcare facilities, Medicare Advantage health plans, Medicare Part D prescription drug plans, and states can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19. This is being done by extending reporting deadlines and suspending documentation requests which would take time away from patient care.

Increase Hospital Capacity

CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries, and other essential surgeries.

CMS will now temporarily permit non-hospital buildings and spaces to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff. This will expand the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.

CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment. In addition, CMS will allow hospital emergency departments to test and screen patients for COVID-19 at drive-through and off-campus test sites.

During a public health emergency, Ambulance Transportation services provide patients to a wider range of locations when other transportation is not medically appropriate. These destinations include community mental health centers, federally qualified health centers (FQHCs), physician’s offices, urgent care facilities, ambulatory surgery centers, and any locations furnishing dialysis services when an ESRD facility is not available.

Physician-owned hospitals can temporarily increase the number of licensed beds, operating rooms, and procedure rooms. For example, a physician-owned hospital may temporarily convert observation beds to inpatient beds to accommodate patient surges during a public health emergency.

In addition, hospitals can bill for services provided outside their four walls. Emergency departments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most. New rules ensure that patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force. This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

Promote Telehealth in Medicare

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. During public health emergencies, individuals can use interactive apps with audio and video capabilities to visit with their clinicians for an even broader range of services. Providers also can evaluate beneficiaries who have audio phones only. These temporary changes will ensure that patients have access to physicians and other providers while remaining safely at home.

Providers can bill for telehealth visits at the same rate as in-person visits. Telehealth visits include emergency department visits, initial nursing facility, and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth. New as well as established patients now may stay at home and have a telehealth visit with their provider.

CMS is allowing telehealth to fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice, and home health. CMS is making it clear that clinicians can provide remote patient monitoring services to patients with acute and chronic conditions, and can be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry. In addition, CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.

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Modifiers will clarify extenuating circumstances, which should allow for payment when they otherwise may not. That said, the improper use of modifiers can be the cause of claim denials just as not using a modifier can be. When using modifiers, make sure you clearly understand what the modifier entails.

In this, and the following blogs, we identify 10 of the most commonly misused modifiers to help you become more aware of the issues surrounding them. We’ll help you understand why they are problematic and how you can use them correctly.

Modifier 79

Modifier 79 is defined by CPT as “unrelated procedure or service by the same physician during the postoperative period.” It is used in the strictest sense for care that is entirely unrelated to the prior surgery that created the current global period.

Modifier 79 is an informational modifier. No additional documentation is required to be submitted with the claim. Supporting documentation must be maintained in the patient’s medical record and must substantiate that the surgeries are unrelated. When appending modifier 79, it is important to keep in mind that this modifier re-sets the global period. A new postoperative period begins when the unrelated procedure is billed.

How it’s misused:

In some situations, it’s easy to confuse modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) with modifier 76 (Repeat procedure or service by the same physician or other qualified health care professional), 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period), or 58 (Staged or related procedure or service by the same physician or other qualified healthcare professional during the postoperative period).

The procedure performed is related to the original surgery or staged (anticipated) surgery. Placed on procedure codes with XXX, (Global concept does not apply), in the GLOB (global) field of the MPFSDB (Medicare Physician’s Fee Schedule Database). If related to the original procedure, it is considered part of the global period.

To describe an unrelated surgical procedure performed during the postoperative period of the original procedure by the same physician. When reporting identical procedures that are performed on the same day, by the same physician, but are not the same service on the same anatomical site.

How you should use it: Pick 79 in a situation where the patient has returned for a second procedure during the first procedure’s global, or postoperative period, and the reason for the second service has no relationship to the reason for the first. You would use 76, 78, or 58 when the second procedure is related to the first in some way — 76 when a provider administers a second, identical service after the first service did not significantly improve the patient’s condition, 78 when complications arise from the first procedure, and 58 if the first procedure is a precursor to the second. But more of that in our next post.

Example1:

Dr. Jones performs cataract surgery on Mrs. Smith’s right eye on September 2, 2017, and billed 66982-RT. Dr. Jones then performed cataract surgery on Mrs. Smith’s left eye on October 2, 2017. Since the second cataract surgery was performed within the 90 days post-operative period of the first surgery, Dr. Jones would report 66982-79LT. The use of modifier 79 on the second surgical procedure would be appropriate because the surgery is unrelated because it was performed on a different eye.

Example 2:

A 19-year-old man falls and breaks the shaft of his tibia. The orthopedist performs an open reduction of the fracture. Two weeks later, the patient trips while going down the stairs with his new cast and breaks his ulna. He returns to the same orthopedist, who performs another open reduction on the new fracture during the global period of the previous procedure.

Since the procedures are completely unrelated, you should report 27758 (Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclage) for the tibia fracture repair. Then, report 25545 (Open treatment of ulnar shaft fracture, includes internal fixation when performed) for the ulna fracture repair with modifier 79 appended to show that the tibia and ulna repair were unrelated surgeries and that the ulna treatment occurred within the 90-day global period for the tibia repair.

FAQs:

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According to the 2016 CMS data, National healthcare expenditures rose 5.3 percent in 2014 to $3 trillion, accounting for 17.5 percent of gross domestic product. Also mentioned is the fact through a study from Avalere Health that hospital ownership of physician practices moved up to 86 percent between 2012 and 2015.

However, the long years of experience in marketing have made me take a step back to assess the changes affecting healthcare since the introduction of ICD-10 and the Affordable Care Act (ACA) or known as Obamacare. In a short span of time healthcare providers have been impacted both positively and negatively – revenues have either gone up or gone down drastically depending on how prepared one was to deal with the changes introduced.

Technology has also affected both positively and adversely- both in terms of infrastructure and the need to adopt and adapt new software platforms, and the social media platforms, reaching out to patients that healthcare practitioners had never done before.

From a marketer’s perspective business is as usual across industries given the up and down of markets. But when it comes to healthcare there our marketing perspective has to change when viewing the solo practitioner and the big giants of healthcare. Be they a small-time physician or a medical specialist in the field, the need to maintaining one’s reputation among their colleagues be it their competitor is always the most prominent and consistent.

Hence when trying to asses if only the big giants will survive the changes that have impacted the healthcare industry, we need to tread rather delicately- as we need to take into account not just a business that is there for profit, but it also takes into account a patient’s well-being that most healthcare practitioners have at heart!

So when we look at the big giants of healthcare who survive because they run their healthcare business based on lines of profits, looking at solo practices that have survived or adapted to changes as best as they can is pure because of the spirit and passion and dedication towards their patient’s well being.

This is not to say that those who practice in the bigger hospitals are not caring towards their patients, but the way they are run and what is demanded from them, so as to meet targets, etc. can take its toll on the way they interact with their patients.

Added to this, is that small practices are often intimidated by the rules and regulations that govern them right from the way they practice to what they practice and even to marketing their own services as the marketing and advertising guidelines are imposed on them by their state licensing boards.

They thus lose out on the benefits that positive marketing can bring rich rewards as it does for the big giants in healthcare. This makes it even more difficult for marketing healthcare executives to go out in the field and help them strategize ways in which they can further their practice be it for profit or even the well-being of their patients.

A change in public and private actions is causing a stir, creating more administrative burdens that cause small practices to shut down. I have witnessed many of the private practices during my marketing tenure with them get acquired by the larger hospitals and private centers.

Managing set levels of transparency required by insurers and government with respect to cost and quality through government-enforced laws are seemingly difficult for solo practices, as they lack the infrastructure required to maintain these levels. Most times, such situations lead to hospitals and big physician groups buying small practices to retain their position.

Independent physicians do seem to have a difficult time balancing between offering value-based care while also focusing on the financial part. The enormous amount of paperwork to integrate patient details is only an addition to the present situation woes.

Of course, EHR contribution has been massive, and there is a sincere hope that the EHR companies continue enhancing their systems to complement the present healthcare requirements. A shift in the insurance will see more patients being burdened under giant medical costs and this will, in turn, cost small practices, since patients may not have the money to pay off the balance.

Thus, regardless of the changes in policies, small practices would sustain in rural areas, as also in big cities, but they would need a considerable amount of change in their current way of practicing. So along with these changes, our marketing strategies have also had to change over leaps and bounds. The role of not just being an informer but also now guiding healthcare practices in what is best suited to what they can and cannot implement.

Helping them strategize their decision-making based on the external and internal factors at play- make the role of the healthcare Marketing executive not an easy task especially when dealing with small practices trying to survive among the giants.

Thankfully, our task has been made easier as CMS has agreed to assist solo practices to adapt to MACRA and offer all the help required to them so that they are able to keep up with alterations that happen from time to time.

However, in the long run, what is best for the patient would need to be also surveyed. Convincing small practices that they do play a prominent role in the healthcare industry like helping reduce the overall medical costs on the federal services – is an uphill task given the small revenues with which they work with and also amidst the fast-growing specialty services that have been encouraged to grow either within or outside the giants of healthcare organizations.

So only time will tell if profits win or passion and the spirit of patient well being will either help make or break the small solo healthcare practices!

The post Will only the big giants of healthcare survive? appeared first on Medical Billing and RCM Blogs.

The year 2015 saw several healthcare reforms bring changes into the way healthcare is practiced in America, the main goal being to provide healthcare for all and also improve on the delivery of healthcare. With the number of footfalls coming into healthcare provider organizations and the insurance sector too gearing up to deal with the numbers, healthcare reforms in all aspects will be seeing major changes. So let’s see what we can expect for 2016

1. Increase in Digitization:

Going digital – documentation of patient’s records, employing the ICD-10 coding systems, changes in fee based system, insurance payments etc.  now need to be digital and online. Appointments, accessibility to patient records, physicians and organizations are now reaching out to patients via social media, new software to deal with the new coding systems and the rules and regulations.

This has all built up an energized and significant digital health.  This year major changes in the way healthcare providers interact and work with patients and vendors will soon see a major change and use of the digital system which will lead to improving the Revenue Cycle Management.

2. Alternative Payment Models:

The year 2016 will witness the gradual emergence of shift from fee-for-service payment models to value-based care, given the unprecedentedly large aging population. Hospitals and healthcare providers will work towards providing effective models to deliver effective and efficient clinical care.

This has already led to several complementary service payment models that physicians have begun to practice like the boutique service payments. This shift will also lead to a point of care testing and an increase in usage of medical devices and their innovations which will give a thrust to the Accountable Care Organizations.

With Medicare getting stricter, penalties for Meaningful Use, Value Based Modifier, E-Prescribing, the impending MIPS program, and new revenue opportunities for CMS Chronic Care Management and Advance Care Planning and other Medicare programs, the commercial payers are becoming more aggressive with alternative payment models.

3. Employers & Employees healthcare plans:

Although both employers and employees foresee a slight increase especially in terms of raised plan deductibles and coinsurance requirements, yet they feel that these may still be lower than that that was predicted for 2015.

Moreover, the Affordable Care Act has a provision effective in 2018, which will impose a 40 percent federal excise tax on the portions of group plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. This itself will help keep costs under control.

4. Shift from Providers to Consumers:

2016 will see the shift from what healthcare providers want, to what consumers want. Consumers will now play a more active role in plan selection and healthcare decision making.

This shift is already visible in the number of social media platforms providing healthcare information to the consumers, the way insurance companies have started wooing employees rather than employers, and ways in which higher deductible plans consumers can be prevented from not availing treatment on time. Healthcare will soon akin to an online shopping like experience.

5. Shift from Individual to Community:

This year will see a tiny discernible shift from concern towards individual well-being within the hospital walls to a more encompassing community wise response, more so after the Ebola outbreak and the terrorist attacks in Paris and California.

Minimizing mortality and morbidity, and delivering better healthcare  as part of the Obamacare Act, or known as the Affordable Care Act, tied up with the new payment models, emphasis will now be on the community led events rather than just handling hospital like cases.

Thus, changes encompassing both healthcare providers as well as community at large, leading to the goals of the ACA, will see better streamlining of Revenue Cycle Management processes, better diagnosis and documentation as demanded by the ICD-10 coding systems now in place.

This will eventually lead to better revenues for healthcare providers and initiation of improved healthcare reforms for the community of Americans at large.

The post Predicted Healthcare Reforms in 2016 appeared first on Medical Billing and RCM Blogs.

As we move to a close of 2015, the healthcare Industry has seen a lot of ups and down, and changes that although seemed to threaten disruption, but have created just minor ripples. Here is a fleeting glance at the industry.

CMS & Reporting Requirements

In January 2015, Medicare announced that it would ramp up its timeline for the Transition of fee-for-service (FFS) payments to value-based reimbursement. Necessary, but caused heartburn for many physicians through the year.

Physicians had to integrate quality reporting and enable Meaningful initiatives into their Value based purchasing program by the CMS. Physicians who were not meaningful users of certified EHR technology saw a one percent cut in their Medicare Fee Schedule. Further, eligible professionals also saw a reduction in reimbursements for noncompliance with Medicare’s Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS).

As part of Medicare’s efforts to improve healthcare, physicians were also required to comply with CMS’s new Value-Based Payment Modifier program, or face penalties. The Value-Based Modifier program calculated Medicare’s payments to physicians in group practices based on annual cost and quality measures.

Billing Requirements

With the October 01 deadline that loomed and the number of codes that needed to be introduced, given its complexity, some good news for physicians who were feeling the heat financially, CMS allowed for a new procedural terminology (CPT) code, 99490, which enabled then to bill CMS $41.92 per month for providing remote chronic care management to qualifying patients.

Further, more states under Medicaid and commercial payers added telemedicine to their reimbursement fee schedule, which allowed physicians to bill for these services too, thus helping their medical billing revenue cycles.

Technology requirements

Integrating updated technology into their workflow has hit the physicians the most. Many payers have insisted on Electronic Health Records, the shift from paperless to digitizing, has costed many a disruption to physicians. But given the changing in coding and payment models, this shift was essential and beneficial to both providers as well as the healthcare industry in the long run.

However, Interoperability of EHRs will soon become essential and need to be addressed by physicians who attempt to successfully participate in the advanced stages of meaningful use.

Patient Care & Payment models

Patient care, due to Obamacare reforms took precedence. The use and deployment of social media by many hospitals, and physicians saw more usage of different social media platforms for keeping the footfalls and focus on patient the underlying theme. Increase in the prevalence of ACOs also evidenced a shift to patient care alongside the shift with payment models

Switch from ICD-09 to ICD-10

This switch took centre stage prior to October 01, 2015. However, the heat that was generated before that was tremendous. But, when the switchover happened, the ripple was hardly felt and it was a seamless process, hardly a whimper.

The preparations across websites for small clinics, physicians, hospitals, etc. was probably one of the factors that made the switch seamless, besides the earlier delay probably helped physicians prepare, knowing that no further delays would be entertained.

Open Enrollment Period (OEP)

The Open Enrollment period for Obamacare health insurance in 2016 was November 1, 2015 to January 31, 2016 where citizens could enrol for 2016 coverage and a chance to change their health plans. And if you don’t enroll in Obamacare in 2016, you’ll be fined 2.5% of your income or $695 per adult, whichever is higher. When compared to 2015 when total enrollments were down 13 percent, the present saw 1.65 million enrollments during the initials months itself.

Thus, both hospitals as well as physicians have had to make tremendous changes in their workflows, right from upgradation of systems to training their staff and themselves. As they say change is inevitable, but necessary for healthcare to bring forth change in its overall system and stop wastage of expenses given the high healthcare expenses, nearly 21 percent of the GDP.

The post Health Care Industry Highlights-2015 appeared first on Medical Billing and RCM Blogs.

But given the number of footfalls, with the Affordable Care Act (ACA), which has made it mandatory that every American needs to have insurance to avail of healthcare, medical practitioners are seeing the number of patients to be dealt with increase. With administrative tasks that leave physicians with very little time to interact with patients, how can patient satisfaction become their focus?

This is where healthcare analytics can help understand how an organization is performing, in what way are the clinic results helping achieve their goals, and how patient satisfaction can be the vital factor towards a better healthcare situation. Moreover, the ACA now provides more Americans access to affordable, quality health insurance, and was introduced with the aim to reduce the growth in health care spending in the U.S. which in 2013 spent $ 3trillion, nearly 15 percent of the GDP solely on healthcare.

The ACA wants to focus more on wellness and disease prevention, and this is where healthcare analytics can help understand the healthcare scenario and plug the gaps for more efficient and cost-effective treatments

Analytics is useful in predicting the trend followed in the patients historical data and can help in enhancing business performance. How to improve quality of care and simultaneously optimize on operational efficiency are the basic questions that trouble the healthcare reform practitioners.

Moreover, if better connections can be drawn between diagnosis, drug discovery, healthcare providers, patients, payers, and communities, a comprehensive and smart healthcare system can be initiated. For this kind of system to be introduced, integration and aggregation of health data for analysis, querying and reporting of the results within changing demographics and prevalence of chronic diseases, is very essential to provide for patient satisfaction.

So what are the ways in which healthcare analytics ensure patient satisfaction?

• Empower patients to make better healthcare decisions and about lifestyle changes based on the data gathered and analyzed – factor in how heart strokes can be prevented across all ages
• Pharmaceutical companies can help provide better drugs to combat chronic diseases and epidemics thus preventing epidemic outbreaks in time
• Medical device manufacturers can use the analytical information to provide improved devices like hearing aids, pacemakers, etc in keeping with advancement in technology and also better access for disability patients
• Analytics can help in planning for predictable/seasonal changes in disease numbers, reduce medical errors, standardize clinical care, reduce repetition of medical tests which benefit patients and communities in the long run
• It helps in better disease management and thus target prevention rather than expensive treatments in the long run
• Analysis of historical data can help in better patient management by customizing interventions to patients, ensuring high risks patient are sent to the proper care unit and monitor patients who could be at the risk of decompensation
• Analytics can also improve the bottom line for providers by ensuring better revenue cycle management, enabling effective cost control measures and improving vendor analysis. All this collectively works towards the discovery of new revenue opportunities, supply cost optimization and more efficient fraud identification

The post Ways in which Healthcare Analytics are Ensuring Better Patient Satisfaction appeared first on Medical Billing and RCM Blogs.

The administrative costs in US healthcare sector consumed approximately $156 billion in 2007. This spending is projected to reach $315 billion by 2018. Recently, a study published in Health Affairs compared hospital administrative costs of eight nations. According to the study, the US hospital administrative costs were the highest, consuming 25.3% of hospital budgets in 2011.

Canada and Scotland had the lowest expenses amounting to just 12%, whereas German and French hospital expenses were 20% higher than Scotland in UK and Canada. But it is still 40% lesser than US. According to the industry experts, if the per capita spending for hospital administration was reduced, the US healthcare industry would have saved more than $150 billion in 2011.

Reason behind High Administrative Costs in the US

Hospital administrative cost accounts for approximately 25% of the total US hospital spending. The healthcare system in the US is different from other countries. How the hospitals get funding affects the administrative costs. For instance, in Canada and Scotland, hospitals are funded through a single-payer-system whereas the United States are funded through a multi-payer system that adds to the administrative time.

Hospitals in Canada and Scotland receive funding from direct government grants and global operating budgets, whereas in the US, surpluses from day-to-day operations account for most of the hospital capital funding.

US hospitals also have a large number of administration personnel compared to other nations. Countries where hospital administrators have few responsibilities aside from management and co-ordination, administration alone takes up approximately 12% of total hospital spending.

How Can US Hospitals Bring Down their Spending?

• Hospital administrative spending totalled $158 per capita in Canada, $164 in Scotland and $667 in the US.
• According to David Himmelstein, Lecturer at Harvard Medical School and Professor at CUNY / Hunter College School of Public Health, around $300 billion and more is wasted every year in the US on overhead of insurance companies and the paperwork these companies inflict on doctors. He also said that US is consuming approximately $150 billion every year on hospital bureaucracy.

Experts believe that a single-payer model in the US healthcare system will lead to administrative savings. In the US, complexities involved in billing various insurers with different payment rates, documentation requirements and rules have led to the rise in administrative costs.

There is a strong need to implement effective cost-cutting measures that will help bring down the expenditures without affecting quality of patient care.

Till bureaucracy doesn’t come up with the required changes in US healthcare system, many hospitals are outsourcing their billing requirements to companies like Medical Billers and Coders (MBC). Billing companies like MBC have a team of certified and experienced coders and billers who are well-trained in handling different insurance company requirements.

Since their team is constantly updated with any changes introduced by the insurance companies, hospitals or private practices don’t have to worry about denied claims or underpayments. Outsourcing to companies like MBC has helped many hospitals and private practices maximize revenue and streamline revenue cycle.

The post Why are US Hospital Costs Higher than those in Canada and Scotland? appeared first on Medical Billing and RCM Blogs.

• It is being predicted that partnership and collaboration among healthcare organizations will increase in order to survive the transition to value-based healthcare. These new partnerships will also include companies outside of healthcare. For instance, Anthem Blue Cross Blue Shield of Wisconsin recently collaborated with Aurora Health Care and the Aurora Accountable Care Network for a shared-risk program to support value-based payment models.
• Meaningful Use stage 2 will create trouble for eligible professionals in 2015 as they will have to face a 1% decrease in Medicare reimbursement for not meeting the MU requirements. Penalty will increase by 1% every year and might go up to a maximum of 5%. Under Meaningful Use stage 2, providers have been given time until the end of February 2015 to ensure attestation.
• Second phase of HIPAA audits started in October 2014 and will continue until June 2015. Providers will need to be prepared in case their practice gets audited for violating HIPAA requirements this year. 350 healthcare organizations will be asked for submitting information on patient health data security out of which around 150 will be audited. Fines for violation will start at $100 and might go as high as $50,000. Reputation of the practice will also get damaged in the market.
• ICD-10 will be the biggest challenge faced by providers in 2015. With just eight months remaining for the compliance deadline, practices will have to prepare for potential revenue disruptions post implementation. According to a survey by the Medical Group Management Association in February 2014, 79% medical practices had not yet started preparing or were only somewhat ready. Transition to ICD-10 will prove expensive for many practices. They will have to keep some extra cash in hand to sail through revenue disruptions caused due to denials from miscoding.
• Medical practices will feel the impact of the Affordable Care Act (ACA) on their reimbursement. ACA challenges will increase for providers working with Medicare patients. Failure to participate in the Physician Quality Reporting System (PQRS) will lead to penalties for physicians under ACA. They will face 1.5% penalty in Medicare payments in 2015 and this will increase to 2% thereafter.

In order to sail through healthcare challenges, many providers are opting to outsource their RCM to a third party. By choosing a reputed billing company such as Medical Billers and Coders (MBC), providers have been able to improve cash flow and streamline their business functions.

MBC has an expert team of certified coders and billers who are well-trained in ensuring timely payments. They not only comply with reforms and use latest technology to handle RCM tasks but also help practices identify and solve problem areas in their revenue cycle.

The post Top 5 Healthcare Changes in 2015 appeared first on Medical Billing and RCM Blogs.

However, the new fee schedule is not just about reimbursement reductions and payment cuts, but stresses on other aspects of healthcare as well. Major changes in the 2014 physician fee schedule are as follows –

PQRS and e-Prescribing standards is one of the main changes that will affect medical practices under the fee schedule. The ACC has been offering medical practitioners an opportunity to participate in PQRS or Phyisician Quality Reporting System over the years to encourage a more comprehensive quality based and pay-for-performance healthcare service platform.

Medical practitioners that have managed to adopt PQRS system of reporting nine measures under three different domains covering efficiency and patient safety will be eligible for 0.5% bonus in reimbursement in the year 2014.

However, physicians and medical practices that have failed to show compliance to PQRS and e-prescribing standards will be facing reimbursement reduction to the extent of 1.5%. Next year this reduction will further be increased to 2% and after 2016, if practices are still not compliant with PQRS system of reporting then this reimbursement penalty can be increased even beyond 2%.

Another crucial change discussed in the physician fee schedule would be reduction in payment for technical components of low cost services. In an average day, if a medical practice is performing multiple procedures or services, then the payment for low cost services will be reduced by 20 -25%.

In addition, therapeutic and diagnostic services will also be suffering from payment cuts by 20-25%. This would cause billers and coders to separate diagnostic services from episodic procedures in order to realize maximum reimbursements.

The RVU categories of work, practice expense and liability insurance have also undergone an approximate reduction of 4% in pay-out. Resultantly, services with higher practice expense will suffer reductions in reimbursement. While services with technical component will suffer some reductions under this guideline, primarily professional services will experience increase in reimbursement by 3% under this regulation.

The Affordable Care Act that mandates Medicare payment adjustments based on physician’s quality and resource usage is also another imminent change which will start getting manifested with this year’s fee schedule. Physicians are expected to collaborate and adopt a value based care system which would bring down the healthcare cost and get reimbursed based on the value delivered.

In times where healthcare reforms and Medicare modalities can affect your short term and long term financial feasibility, it is better to opt for professional medical billing services providers.

Medical Billers and Coders (MBC) with its team of professional billing experts and experience medical service providers can offer you complete as well as customized billing solutions for your medical practice, helping you to avoid medical audits and reimbursement cuts.

The post What are the Changes in “2014 Physician fee Schedule”, Medicare and its Modalities? appeared first on Medical Billing and RCM Blogs.

Given that, ensuring continual claim settlement and reduced claim rejection requires a dental medical practitioner to focus on final details of dental billing. Whether your dental medical billing is in-house or outsourced, there are certain steps that you can take to ensure an improved medical insurance reimbursement ratio –

• Billing for specific modalities are more frequent than others and therefore coding changes in them are most crucial for oncology medical billing. These modalities include EBRT or External Beam Radio Therapy (EBRT), IMRT and non-IMRT, SBRT or Stereotactic Body Radio, Therapy BT or Brachy-therapy and PT or Proton therapy.

• There has been a consistent rise in billing of IMRT and other radiation therapies since the introduction of their separate codes in early 2000s. Despite being expensive, these are preferred procedures and Medicare, Medicaid or other private insurance carriers process the claims for radiation therapy at a fast rate.

• Payer restrictions on oncology drugs are increasing due to abuse related audits and many oncologists are facing high rate of payer denials for medical billing services of oncology drugs. Medical insurance carriers are growing increasingly cautious about reimbursing oncology drugs claims and therefore the denial ratio is mounting.

• Oncology practitioners are outsourcing chemotherapy coding and billing. Chemotherapy and non-chemotherapy infusion, in addition to radiotherapy is coded with great care and is also the biggest source of revenue for an Oncology practitioner. Therefore, as a rising trend, this coding and billing practice is getting outsourced to capture frequent changes and avoid any discrepancies.

• Ignorance of payers towards technological advancements and changes in oncology treatments makes oncology medical billing an even more difficult task for oncology practitioners and practice managers. This means clarity in claim filing and updating your payer about technological requirements becomes part of your responsibility as a claimant.

• Commonly recognized oncology medical billing errors include misuse of modifiers in service identification and improper documentation related to treatment conducted. These lead to frequent denials and can only be checked by adopting stringent billing practices.

• Pre-authorization requisite for cancer treatments is frequently being mandated by insurance carriers for them to expeditiously complete the claim settlement process. Radiation, oncology drugs and chemo/non-chemo infusions are especially to be pre-authorized by insurers before the oncology practitioners can administer and claim for the same.

Medical Billers and Coders (MBC) is a billing service provider that specializes in oncology billing and chemotherapy or radiotherapy coding. Our team of oncology coders and billers handle multiple chemotherapy administrations, code bundling and therapeutic infusion or injection reporting.

Medical Billers and Coders (MBC) not only offers billing solutions that can enhance your profitability but can also improve your clinical experience and administrative performance. With a billing expert like medicabillersandcoders.com on board, you can focus on the care to be provided instead of administrative and financial aspects of cancer care.

FAQs

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