A rising concern for most patients is the out-of-pocket expenses incurred. The ebbing insurance premium has undoubtedly brought health insurance within the reach of most consumers. There are employer plans to ease the medical bills and government plans such as Medicare, Medicaid and Obamacare are playing a pivotal role in alleviating health costs. And yet, the rate of growth continues to be dismal. The $2.9 trillion healthcare industry that makes up for virtually 17.4 percent of the economy owes this slump to hefty deductibles and co-payments.

A PwC study suggests that:

• The number of hospital admissions has fallen considerably since 2003 and people are avoiding hospital stays.
• Ambulatory care units and clinic visits seem like the more viable options and there is a greater reliance on generic drugs.

Costs in Healthcare and Revenue Cycle

Obamacare has been a huge help in bringing about a slowdown in healthcare costs though the fate of health insurance largely hinges on premium costs and deductibles. In such a challenging scenario, it’s important that you have proper software systems in place. The revenue cycle begins the very minute a patient walks into your clinic and it is important that you adhere to the protocol to maintain it.

Without the right processes and procedures, your revenue cycle is at risk. Revenue loss may happen due to various reasons like a painfully slow collection process, wrong documentation, or inexcusable billing errors.

Health Insurance Sign-ups

The 2016 open-enrollment period prompted 12.7 million consumers to sign up for health insurance. As opposed to the 2015 record of 8.84 million Americans signing up for a health plan or renewing their earlier plan in the 37 HealthCare.gov states, the number has risen to 9.63 million in 38 states. Going by the recent numbers, it’s safe to conclude that enrollments have witnessed a precipitous rise in 2016 as compared to the previous year.

As pointed out earlier, out-of-pocket costs are posing a greater challenge. That’s exactly the reason why healthcare organizations are reconsidering their prices to entice cost-conscious consumers. This could be a huge step in boosting the revenue cycle in the wake of high-deductible health plans. Also, master price lists are being tweaked to facilitate better negotiations with insurers.

Denial Management

Yet another important factor that can have a huge impact on the revenue cycle is denial management. The right denial management programs can also help reduce AR (Accounts Receivable) considerably. The AR milieu in recent times is dominated by issues pertaining to denials. Having a good denial management program in place can help overturn a denial way earlier.

 The right denial management programs help organizations complete claim denials in the shortest time. Understanding why a patient’s claim was denied is critical in maximizing collections revenue and preventing future claims from happening. Not all patients understand the way insurance denials work. Hospitals therefore are employing advanced tools and technologies to help patients and also keep tabs on denials.

The key is to work around the three main areas namely; prevention, review, and trend tracking. While prevention strategies focus mainly on the prevention of the very occurrence of denials, review ensures that a proper analysis is done to set up a follow-up process. Tracking trends is crucial for the long-term efficiency of any denial management program since it monitors the payment patterns and notifies if there is even a slight deviation from the normal trend.

Small changes can go a long way in maximizing the healthcare revenue cycle efficiency. As such, the inherent purpose of every denial management program should be to track an error before it travels through the revenue cycle.

The post Keeping Pace With The Changing Landscape Of Health Insurance appeared first on Medical Billing and RCM Blogs.

You Don’t Know the Future – Not Even the Present

No matter how we praise technology and science along with its noticeable improvements, you should always keep in mind that no technology or applied science can predict the future or the present of your life. Now, I am writing this post, sitting before my PC screen, but we do not know what is going to happen in the next second. Since the lack of the awareness about the future is applicable to you too, you cannot estimate your life either. Therefore, it is a good move to keep your life secure, at least for the future. You simply know that sudden deaths are much usual in our life.

Nevertheless, you should not force your loved ones to spend thousand dollars by begging in front of others. Instead, you can purchase a good life insurance like the UK’s aviva, which can even pay the death duties and other expenses of your loved ones whenever they are required. Despite the fact that nothing can replace ‘you’, this small amount of premiums can help your loved ones a lot. Hence, it is a good way to show your never-ending love to your children or spouse as well. As you know, most insurance firms can give them a decent amount for leaving their life. This means that your loved-ones can manage their living costs as well as get financial support in necessary situations, if you have purchased one life insurance policy from a reputed firm.

You might be having some debts during your lifetime, for which your professional earnings cannot compensate. However, it is not a good option to pass all your debts and burdens to your successors or loved ones, followed by your sudden or usual death. Most insurance firms also give the ability to fix their debts and burdens, which in turn provides a good financial environment for your loved ones or partners. Hence, you should purchase a life insurance, if you do not want to pass your debts or burdens to your children, spouse or partners.

Secure your Retired Life

It is not at all sure that you will get your earnings seamlessly once you have retired from your long or short profession. Unless you are a government servant, you cannot avail the benefits of pension either. However, you can purchase one life insurance service that provides pension after your retirement and hence power your after-retired life. Hence, life insurance can improve your before-death life as well.

We hope that the reasons, mentioned above, are enough for forcing any family-lover to purchase one good life insurance service. By the way, have you purchased life insurance and secured your life? Do let us know via your valuable comments. We are eagerly waiting for your esteemed replies.

The post Why you should have Life Insurance? Some Strong Reasons appeared first on Medical Billing and RCM Blogs.

However, the American Association of Medical Colleges (AAMC) has released a report which states that physician shortage will quadruple after the full implementation of health reforms in the year 2015.

The reimbursement cuts in Medicare are another factor that is impacting delivery of healthcare, physician revenues, and the shortage of providers in the country.

Moreover along with the expected attrition in the healthcare industry due to the reforms, almost one third of physicians are set to retire in the next decade. The number of new physicians is not going to be enough unless the Congress ensures a 15 percent increase in residency training slots in the country.

The outlook for physicians remains bittersweet. On the bleaker side of things are the Medicare cuts, the new extensive guidelines to be followed under the health reforms, with scare time resources.

However physicians who successfully demonstrate Meaningful Use and follow such other guidelines and who choose to work in Health Professional Shortage Areas are set to gain financially from health reforms.

The importance of revenue cycle management, payer interaction, and similar revenue-related functions becomes accentuated in light of the changes taking place in the health care system.

The need for better interaction with payers, improved medical billing and coding, and revenue cycle management is being felt because of the increased volume of patients and the lesser time available for treating each patient. Errors in medical billing and coding and mistakes in related “back office” functions can negatively affect the revenue of providers, as providers face these challenges:

• With the increased number of patients due to universal insurance coverage, the number of denials by insurance companies would also increase necessitating constant interaction with insurance companies and payers
• Another unique challenge faced by providers is the increasing population of baby boomers in the country. High numbers of elderly patients would mean more physicians –patient encounters and lesser time to provide quality care

One of the better ways of managing such high volume of patients is to optimize revenue through various processes including efficient medical billing and coding process, so that there are no losses due to avoidable errors and to ensure that lesser amount of time is spent on managing denied claims.

Professionals at medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States, not only provide effective medical billing and coding services but can also offer optimized revenue cycle management processes, better payer interaction, assistance in Meaningful Use implementation, and consultancy services for effectively dealing with challenges in the near future.

The post Physicians Shortage – Is There a Perfect Storm Brewing in the Healthcare Industry? appeared first on Medical Billing and RCM Blogs.

The medical billing and coding cycle requires thorough knowledge and deft handling of the entire process and related procedures including familiarity with electronic platforms and the ability to handle sensitive medical data.

The above scenario, if broken in terms of skills doctors expect their billers and coders to have, will demarcate the following areas:

• Knowledge of billing life cycle
• Theoretical and working knowledge of data collection, data entry, paper claims, creating and editing reports, patient demographic forms, etc
• Usage and understanding of codes
• Knowledge of electronic platforms in use

This makes medical billing and coding among the most knowledge-driven and challenging disciplines which needs keeping up with the changing trends of the industry to effectively handle billing and coding responsibilities for care providers, so that they can concentrate on quality of care even as they enjoy a steady flow of revenue.

Accuracy vs. Productivity – Medical Coder

Recently, AAPC conducted a survey to find out from billing and coding professionals which among the two (accuracy and productivity) is preferred over the other by billing and coding managers and the survey revealed a mixed response establishing the supremacy of neither of the two over the other, leading to the conclusion that a billing and coding manager expects his/her team of billers and coders “to efficiently produce accurate work”.

Medical Coding with MBC

Medicalbillerandcoders.com believes, that when it comes to billing and coding, certifications help bridge this gap. Most of MBC’s billers and coders are certified in CPC, CCS which CPAT, all of which require passing a coding certification examination which involves questions to examine the ability of billers and coders to accurately apply CPT and HCPCS procedures and supply ICD-9-CM diagnosis codes. This helps MBC’s coding professionals to refresh and renew their skills and be assured of them.

MBC the largest billing and coding consortium in the US with a countrywide network of highly experienced billers and coders takes particular care of keeping their team updated with the current changes in the industry. With changes taking place in the change-prone areas of medical coding, like – codes, software applications and forms.

For more information visit to : Medical Billing Companies, Medical Billing Services.

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Medicaid is essentially for poor people or indigent individuals and families and those with disabilities or people living with HIV/AIDS and since it is publicly funded, the reimbursement is on the lower side compared to other private health insurance payers.

The fact that private insurance is usually acquired by financially stable families and individuals is a vital point in favor of private insurance companies. However, one of the most palpable benefits of accepting Medicaid patients is the incentive provided by the government for ‘meaningful use’ of EMR/EHR systems which is higher compared to the incentive for accepting Medicare patients.

In relation to Medicaid, the law only covers low-income and indigent families and individuals but does not make it compulsory for providers to accept Medicaid patients. This creates further complications in the form of more and more Medicaid patients for those providers who do accept Medicaid. The distributions of disadvantages for physicians who accept Medicaid are geographic and differ from one state to another.

Many states have not raised the reimbursement rates of providers for more than a decade and this has been a dampener for the expansion plans that were recently undertaken to improve Medicaid. The effect of the reluctance of providers to accept Medicaid patients is not just limited to the revenue of providers but also puts undue pressure on those who accept Medicaid plans by concentrating Medicaid patients to such providers.

Private insurance providers and Medicare are faring much better since Medicare laws do not vary by state and private insurers pay more compared to Medicaid plans. Moreover, many physicians end up accepting Medicare patients since it pays better for the same services rendered in Medicaid.

The irony is not just the fact that many physicians want to accept low-income indigent individuals but are not able to do so due to the lower reimbursement, but also the fact that even though the laws for Medicaid vary by state, the willingness (or reluctance) to accept Medicaid patients has almost remained the same across various states.

The health reforms have improved the outlook for Medicaid and physician revenue due to the incentives provided, but there are numerous challenges for physicians when it comes to managing their revenue in such a dynamic payer environment.

The growing need for better interaction with payers and a scientific and professional approach towards managing the revenue is being felt in contemporary medicine due to the recent reforms and the challenges faced by both publicly funded insurance plans as well as private payers.

For more information about Medicare and Medicaid reimbursement plans, revenue cycle management, EMR/EHR implementation, consultancy, medical billing and coding, and other related services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

The post Medicaid vs. Private Insurance: Providers’ Perspective appeared first on Medical Billing and RCM Blogs.

As we try to ponder over some of the routine operational errors to which medical practices are prone, we invariably come across the following ones:

• Physicians refusing to release medical records on grounds of unrealized fees from patients: While physicians are fully entitled to their fees for medical services, they are not authorized to withhold medical records as long as patients bear the copying or handling charges for medical records. Therefore, it would be legally unwise to withhold patient-pertinent records simply on grounds of non-payment for medical services. Moreover, there are always legal course to redeem your fees from patients in case they are found defaulting.
• Failure to collect co-pays and deductibles from patients insured under unique insurance schemes: Certain patients’ insurance schemes are attached with co-pays and deductible from patients. Therefore, it is prerogative of the physicians to collect these payments directly from patients. Otherwise, insurance payers are not obliged to make good any loss emanating from physicians’ negligence to exercise right on co-pays and deductibles.
• Lack of a written agreement in case of physicians’ soliciting external services on their premises: Although, it is common for physicians to enter into an understanding with an external service provider for clinical investigation services, it is always wise to be bound by a contractual agreement for services involving either receipt or payment of monetary value. Such fore-sight would not only save you from the wrath of governing authorities but also safe-guard your revenue flow.
• Failure to distinguish and credit physicians with certain ancillary or non-ancillary services for federal patients: Often most of the practices make no distinction between certain ancillary and non-ancillary services for which physicians may be credited with. As such injudicious approach may well rob physicians’ off their dues; it could lead to serious repercussion later when found.
• Falling bait to fancy offers from pharmaceutical representatives, durable medical equipment (DME) companies, or physicians to whom your practice refers: As such tendency is deemed serious violation of healthcare norms, practices would do well to promptly refuse such offers in the first place.
• Not having valid endorsement for licensed practitioners from the respective state laws: While your practice can employ certain licensed practitioners as medical service providers, yet it is imperative that you obtain a valid endorsement for having complied with supervision agreement from the authority concerned. Such prior approval would go a long way in mitigating any billing issues later on.

While these are commonly observed operational errors with serious legal implications for physicians, they could also be vulnerable to other factors beyond the list highlighted here. Therefore, physicians would do well to stay clear of such erroneous operational practices, which would adversely impact their RCM and revenue generation from medical bill reimbursements. But, in view of physicians finding it difficult anticipate legal implication emanating from these elusive factors, medical billers and coders – having the first-hand knowledge of medico-legal subject – would invariably be physicians’ best bet for the requisite advice. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – comes across as a preferred name in outsourced clinical and operational solutions for diverse medical practices.

For More Information Regarding medical billing Or Even Medical Billing Services, Please visit: Medicalbillersandcoders.com

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OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

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Although US Healthcare Sector too had to bear the backlash of the global economic upheaval in 2011, the year will be remembered for some bold and progressive healthcare reforms – Accountable Care Organization (ACO) Concept, expansion of Medicare reach, and an honest effort at fixing SGR dilemma being the prominent ones – promulgated by the Federal Government. Radical in nature, the reforms are seen as proactive measures to do away with long-standing issues, and keep all the vested interests happy – patients, physicians, health insurance providers, and the healthcare sector at large.

As the U.S. Department of Health & Human Services (HHS) turns over another year of eventful happenings, there is a feeling of accomplishment and great expectation emanating from the policy decisions made in 2011. As we infer the clues from the recently published annual report, discounting brand name prescriptions for seniors, helping prevent the nearly 2 million heart attacks and strokes every year, and a comprehensive effort to ensure a healthier America at a significantly optimized cost outlay stand out as the major accomplishments in retrospection.

Standing out as the leading healthcare reform, the Affordable Care Act’s reforms are seen as ensuring an affordable yet quality healthcare option for Medicare beneficiaries. Additionally, there has also been cap on the raising insurance premiums collected by the private insurance carriers. While more than 3 million seniors have stood to gain from 50% discount on brand name prescriptions, amounting to a substantial savings of 2 billion dollars for hitherto cash-crunch patients, small businesses could avail 35% tax credit for health insurance premium. Another, notable inclusion to have come out is the extension of parents’ health plan to young adults under the age of 26.

Following closely on the heels of Affordable Care Act’s reformatory changes is Partnership for Patients Concepts, which seeks to seamlessly integrate hospitals, insurance companies and other stakeholders to reduce healthcare-acquired infections and mistakes. Projected to save 60,000 lives over the next three years, the novel concepts envisages decreasing preventable hospital-acquired conditions by 40% in 2013, reducing hospital readmissions to 20%, and saving up to $35 billion across the system, including up to $10 billion in Medicare savings alone.

Last but not the least is the Healthcare Fraud Enforcement, which having already recovered $5.6 billion from fraudulent sources, projects even more stringent actions in the coming years. Specifically targeting Medicare related fraud, the HHS has issued directive to withhold payments on suspicious claims.

While these comprehensive measures are no doubt indispensable to optimizing healthcare overheads and expenditure, physicians’ task to get their bills reimbursed could get even tougher, thereby making sustenance and growth prospects equally competitive. Although they have had, by and large, a prosperous year revenue-wise, the ensuing financial year evokes an air of apprehension. But, amidst such gathering apprehension, they can still maintain sustainable, growth-oriented and competitive practices through strategic alliances with Medical Billing Companies, who have the credentials to offer turnaround advices for maneuvering through the ensuing spectrum of healthcare reforms.

Medicalbillersandcoders.com, with its long standing reputation of being a premier provider of Medical Billing and Operational Advisories, should be a preferential recourse to a majority of physicians across the U.S.

The post In Retrospection: Revenue Collection Accomplishments in 2011 appeared first on Medical Billing and RCM Blogs.

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.

Medical Billing Companies | Medical Billing Services | Medical Billing Outsourching

FAQs

1. How does offering paid sick days reduce federal healthcare spending?

Paid sick days encourage employees to seek preventive care and address health issues early, reducing emergency department visits. According to the Institute for Women’s Policy Research (IWPR), this could save $1 billion annually in medical costs, with public insurance programs covering about half of these expenses.

2. What are the benefits of paid sick days for public healthcare programs like Medicare and Medicaid?

Paid sick days promote proactive healthcare, preventing minor conditions from escalating into serious issues. This reduces the burden on public healthcare programs, ensuring healthier populations while lowering costs for Medicare, Medicaid, SCHIP, and Veteran Affairs Services.

3. How does the paid sick days concept affect physicians managing public healthcare beneficiaries?

Physicians may face increased patient volumes as more beneficiaries proactively seek medical care. While this ensures better health outcomes, it also necessitates efficient clinical and operational management to handle the growing workload effectively.

4. Why should physicians consider outsourcing medical billing and practice management services?

Outsourcing medical billing and practice management ensures operational efficiency, especially when dealing with higher patient volumes. Expert services like Medicalbillersandcoders.com streamline revenue cycle management, including billing, coding, and denial management, allowing physicians to focus on patient care.

5. What services does Medicalbillersandcoders.com provide to healthcare practices?

Medicalbillersandcoders.com offers comprehensive Revenue Cycle Management services, including:

• Patient and insurance enrollment
• Scheduling and insurance verification
• Charge entry and coding
• Billing and account reconciliation
• Denial management and appeals
• Physician credentialing

These services cater to specialties such as Cardiology, Dermatology, OB/Gynecology, Pediatrics, and more.

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Compared to 156 million physician visits by privately insured patients in second quarter of 2009, there has been a decline to 129 million visits in the second quarter of 2011, a fall of 17%, according to The Kaiser Family Foundation analysis, released on 15^th November, last year.

According to Kaiser Researchers higher deductibles, co-pays and co-insurance increase the cost of care and their impact is magnified during current tough economic times with cost-conscious patients avoiding doctor visits. The Kaiser/HRET Annual Survey of Employer Health Benefits findings reveal the share of workers with a deductible of at least $1,000 grew from 18% in 2008 to 31% last year.

Director of the payer and provider practice at consulting firm McKinsey & Co. stated that only around 25% of the recent decline can be contributed to recession and slow economic growth, while the remaining 75% is due to the similar reasons such as higher costs to patients as cited earlier, hence the declining trend in doctor visits will rebound back gradually but probably not to its original number.

Physicians in the current scenario:

Around 32 million people are expected to be eligible for health insurance coverage in 2014, while patients groups between 55 to 64 years old are seeing an increase in their need for healthcare and are likely to spent more on insurance in the future, moreover the population of those older than 65 is growing. Hence even with an overall per-capita usage fall among people younger than 65, researchers expect physicians to be in demand.

Overall physicians need to take effective measures to educate themselves with all the healthcare benefits and be geared to tackle patients of all age groups beneficially, in this competitive environment and improve their core services of patient care and patient retention. A trend of outsourcing their non core functions like billing and coding and other related services has been steadily picking up.

Under these circumstances physicians choose a billing consortium over billing companies to deal with updates, regulations and technology revolution all together at one go. Medicalbillersandcoders.com is supporting decisions pertaining to all the above with its huge network and expertise of billing and coding.

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