Driving patient engagement through healthcare-based social media

Posted on May 19, 2012 by admin

From seemingly innocuous platforms for personal interaction amongst registered community members, social media (comprising Face Book, Twitter, and other interactive sites) has emerged as a powerful channel for marketing. In fact, its business-utility has grown to so much that it has evolved to be a parallel channel to the traditional mode of advertising of products and services. And, with healthcare being no exception, has slowly but surely embracing it in what has come to be recognized as “healthcare-based social media”.

As healthcare-base social media has the potential not only to drive stakeholders’ (providers, payers, and pharmaceutical companies) offers to the target population (patient community), but also encourage patient engagement through interactive communication, there is a growing realization that social media needs to implemented in such that best serves both business as well as welfare of the patient community at large. While stakeholders devise unique social media strategies for attracting substantial healthcare market for their products and service offers, the response from the patient community seems to be quite encouraging. According to a recent study from PwC’s Health Research Institute, 40 percent of the sample population has been found to be using social media to find health-related consumer reviews. Twenty-five percent have been found to use social media for “posting” about their health experience; and 20 percent have joined a health forum or community. Forty-one percent of the respondents have confessed that social media would affect their choice of a specific doctor, hospital or medical facility, while forty-five percent of them have even said it would affect their decision to get a second opinion.

The survey results are sure indicator of growing interest from patients in using social media platforms, such as Face book, Twitter or a patient-based community site like Patients Like Me, to share and engage in their experiences. Now the only it is imperative that providers, payers, and even pharmaceutical companies put themselves in position where they can listen to the conversation that is happening in social media, decipher patients’ expectations, and engage them with amicable solutions. The initiative of some organizations in devising unique social media initiatives should instill others to follow. These leaders have developed both internal and external media platforms – the internal system allows for knowledge sharing, innovation, and communication across their wide spectrum, while the external platform allows for patients to create communities and find legitimate medical information.

Therefore, there is really shift from using social media as a mere marketing tool to being a patient-engagement tool. The fact that the PwC survey found 80% of the 124 members (comprising providers, payers, and pharmaceutical organizations) is itself is an endorsement of this shift towards engagement model of service through social media platforms.

While there can be no denying as to social media’s potential to impact patient engagement and involvement, connectivity between individuals, and flow of information across the macro healthcare continuum, there is always an undercurrent of it being susceptible to privacy concerns. As more physicians and healthcare organizations move to social media, its misuse will increase the exposure of Protected Healthcare Information (PHI).  Consequently, they may have to face the wrath of the governing body, such as HIPAA, which restricts and prohibits the circulation of clinical information that infringes patients’ privacy norms. Therefore, providers, payers, and pharmaceutical companies need to get their social media platforms customized and run in congruence with HIPAA mandate to avoid being dragged into any legal issue.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long standing reputation for credible and comprehensive solutions comprising the entire gamut of clinical and operational management – is poised to play a catalyst-role for those embracing social media as a channel for offering their healthcare products and services.

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Averting common operational & legal pitfalls at your medical practice

Posted on May 18, 2012 by admin

Medical practice and legal issues have long been inseparable. History is full of examples wherein practices have run into legal hassles, and eventually been penalized with criminal as well civil charges. Barring some strange cases that have been intentional, physicians have had to pay for what is known as negligence or reluctance to avail medico-legal services. While legal issues surrounding negligent medical services may have severe repercussion on the mere existence of one’s medical practice, issues surrounding medical fees and other operational things may well impede one’s Revenue Cycle Management and the prime source of income besides inviting penalties from the governing authorities. And, it is the latter that we are going emphasize since practices are likely to be more vulnerable to revenue crunch emanating from negligent handling of some of the operational things.

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.

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The growing shift from private practice to hospital employment

Posted on May 17, 2012 by admin

There seems to be something really interesting as far as the shift from private practice to hospital based employment recently:

  • A consistent 2% annual decline in private practicing by physicians, which is expected to be at 5% annually by 2013
  • An upsurge in hospital employment accounting for nearly 51% of the physicians employed last year, which is up from 14% percent eight years ago

Judging by the current trend, the U.S. will have only one-third of the total physicians left in the private or solo-practices.

The radical shift has not come about naturally. The proposed cuts to the Medicare physician fee schedule conversion factor, the additional bundling of specialty procedure codes, the challenges associated with EHR implementation, and the monumental shift to ICD-10 have all been instrumental in forcing physicians to hospitals, which are deemed to be safe haven for off-loading administrative challenges. Moreover, hospitals themselves are also eager to acquire physician practices in an effort to provide integrated “one-stop service” for patients, reduce market competition, firm up referral sources, and benefit from the higher revenues garnered by many specialties, such as gastroenterology, neurosurgery, and cardiology, among others.

While the trend is likely to continue, there is also a growing apprehension that such rampant realignment would pave way for:

  • Eventually rise in medical cost owing to induced monopoly
  • Extinct of solo-practices, which still are indispensable in remote areas devoid of access to hospital care
  • Restrict physicians’ entrepreneurial capabilities
  • Piling up medical billing and coding task
  • Excessive financial burden initially for hospital management

In the wake of these perceived apprehensions and the failure of physician employment initiatives in the 1990s, industry experts are uncertain the future of this current trend which is still evolving around by changes in reimbursement and regulatory reform. While physicians are justified in their decision to be on a wiser side, they need not lose heart in private or solo-practices, which have withstood many such challenges in the past. Moreover, private or practice offer physicians many benefits, such as:

  • Incentive to learn HR, marketing, finance, IT, contract negotiation, revenue cycle management & facility management
  • Being in control of oneself
  • Being in control of decision-making that can lend their practices brand mileage in the competitive market.

Drawn between these extremes, one feels that there should be a balanced growth that can positively contribute to the nation’s macro healthcare strategy: optimizing healthcare delivery through controlled medical expenditure. And, when it comes to playing a catalyst role in this regard, none is better equipped than medical billers and coders, who have always been the pillars of strength for physicians. While hospitals, by virtue of their financial strength, can easily opt for outsourcing the whole of their medical billing practices from credible sources, private or solo practices need not lose heart as they can still survive the test through economy services in EMR/EHR implementation, professional Revenue Cycle Management, better denial management, and error-free medical billing and coding. Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S. – is capable of addressing the duality of the situation through professional competence in clinical and operational management practices.

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The Impact of Hospital Billing Processes on Patients’ Longer-Term Satisfaction

Posted on May 15, 2012 by admin

The sway that business offices can have on reference patterns amongst consumers is a tactical opportunity as the insurance market moves to high deductible plans and hospitals take in new physicians into their business. According to a survey conducted by Connance in 2011 Americans who received hospital services in the past 2 years, merely 21% of patients engaged with the business office after discharge are completely contented with hospital billing, and those less happy are less liable to recommend the hospital to their friends and acquaintances.

Moreover the survey also suggests that among the insured respondents, 31% had high deductible plans. Overall contentment with the hospital billing procedures is low with just twenty one percent awarding billing processes a score “5” (on a 1 to 5 scale) and sixty five percent giving a “3” or less. Customers with balances due of fewer than $100 are likely to be less unhappy, with thirty six percent giving business office procedures a top score of “5” and forty six percent a “3” or less. Among those with balances over $100, just fifteen percent scored the business office process a “5″ whereas seventy two percent rated it a “3″ or less.

General contentment at discharge is high compared to satisfaction in later months. When asked to rate their satisfactions with the general hospital experience at the time of discharge, 32% are completely contented. When requested to rate their general approval with the hospital experience post-discharge and subsequent to business office processes, as mentioned earlier merely 21% percent are completely contented. The billing process has a definite impact on patient satisfaction and optimizing the process would not only increase the satisfaction of consumers but also positively affect the revenue.

A simple way of maintaining the quality of the billing process without high costs is outsourcing the process to professionals who have experience in this area. This would ensure that wastage due to a high insurance denial rate does not happen and hospitals and clinics are paid the right amount at the right time. Medical billers and coders at medicalbillersandcoders.com play a crucial role in optimizing the revenue cycle management of hospitals and providers and thus contribute to a better patient experience and satisfaction.

For More Information Regarding hospital medical billing Or Even hospital billing procedures, Please visit: Medical Billing Companies

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Exodus to hospital-based employment and its effect on healthcare industry

Posted on May 14, 2012 by admin

While the recent healthcare reforms ushered in by the Federal Government promises to elevate clinical and operational efficiency across the nation’s healthcare continuum, it is also going to induce physicians into a more accountable and responsible quality clinical regime. The imminent Accountable Care Organization Model, Medicare cuts, the fear of Sustainable Growth Rate (SGR) backlash, the compulsory implementation of EHR, coupled with the monumental shift to ICD-10 and HIPAA 5010 compliant medical billing and coding have begun to take heavy toll of lone-standing clinical practices. The effective influence of these factors is showing up in an unprecedented exodus to hospital-based employment by both new entrants as well as those that have been practicing for a considerable period of time.

A recent study by the Medical Group Management Association (MGMA) quite endorses this shift to hospital-based employment: 65% of physicians that changed jobs recently have all moved into a hospital employment model. What is more interesting is that the propensity to this model is more common amongst new entrants – almost half of new fellows across all specialties are in favor of hospital-based employment. The shift has really assumed a gigantic proportion. And, when we begin to trace the reasons behind this radical shift, we are invariably led to the following interesting factors:

  • The new entrants may not be in a position to match up to the administrative challenges associated with running a medical practice; whereas seasoned practitioners seem to have had enough of their share of administrative challenges
  • Many associate hospital employment with a source of secure salary, which might take years in private practice. Therefore, most of the entrants view hospital employment as a safer bet
  • Hospitals provide resources such as advanced technology and electronic medical records that small practices might find financially taxing to acquire
  • The imminent cuts to Medicare and Medicaid reimbursement rates also happen to be a major discouragement to own private practices as majority of U.S. population is supported by either Medicare or Medicaid
  • The monumental shift to ICD-10 and HIPAA 5010 compliant coding, which requires considerable resource allocation on training and system implementation

While physicians are justified in their decision to safeguard their professional interest, this trend of increasing hospital employment may well jeopardize the remote clinical access to millions of people residing in the remote areas where private practices have been the only source of medical care. Moreover, there is a growing apprehension of this exodus making way for monopoly in clinical care. Either way, there needs to be some kind of balance between hospital-based employment and private practices in the nation’s macro healthcare well-being. Yet again, medical billing and coding specialists, who hold the crucial to this restoring this balance through off-loading the administration task off physicians, come to the fore.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – with a long-standing reputation of being the credible source for medical billing management comprising streamlined medical billing practices, such as 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, A/R management, and financial management reporting – is poised to play an important role in this direction.

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The Changing Face of Primary Care: An Overview

Posted on May 12, 2012 by admin

The shortage of primary care physicians (PCPs) in the United States has been a well publicized and well documented issue. However, the solutions to the various issues faced by primary care in the country have been obscure even after the implementation of the Affordable Care Act. The complications in finding the solutions to the challenges faced by primary care stem from factors ranging from policy reform to changing demographics. According to a New England Health Institute report, primary care in the country is facing a crisis due to the shortage of PCPs and the increase in demand for such physicians.

Factors Complicating PCP Tasks

According to a report by the American Medical Association one of the biggest challenges faced by primary care physicians are the increasing number of visits by elderly patients. The report clarifies that the average visit duration has increased due to the fact that an increasing chunk of the total visits by adults to PCPs are elderly patients. The report also specifies numerous factors that complicate the tasks faced by PCPs in the country, such as the need for PCPs to balance acute care and preventive care, the increasing diversity of the population and, the recent changes and expanding choices in drug therapy.

The Impact of Reforms

The Patient Protection and Affordable Care Act has numerous provisions that are applicable to primary care and some of the crucial ones are providing pay-for-performance models, expanding access to primary care services, and models that transition primary care practices away from fee-for-service based reimbursement and toward comprehensive payment or salary-based payment. The Act also lays out financial policies that promote systematic coordination of care by primary care physicians across the full spectrum of specialties and sites of care, such as medical homes, pay-for- performance programs and capitation arrangements. Section 5405 clarifies the Primary Care Extension Program under the Act and provides support and assistance to primary care providers, in order to enable providers to integrate such matters into their practice and to improve community health by working with community-based health connectors.

The Impact of Health IT

The Agency for Healthcare Research and Quality (AHRQ) has released a report which concludes that implementation of health IT measures in relation to primary care work flows have resulted in gains in productivity and patient volumes, and decreases in various practice expenses. Other conclusions include a need for emphasis on relationships with software vendors, and a need for financial alignment between those stakeholders paying for EHRs and those receiving potential benefits.

In light of the many challenges faced by PCPs and the need for integration of this new primary care system, a holistic and professional approach towards the various aspects of primary care is required for avoiding complications stemming from the various challenges discussed above. The integration in the form of better revenue cycle management, improved payer interaction, and optimum utilization of Health IT can only be achieved with the assistance of dedicated professionals who are experienced in these fields. For more information about integration of Health IT services, EMR/EHR implementation, better revenue cycle management, efficient payer interaction and medical billing and coding services, please visit medicalbillersandcoders.com, the largest consortium of medical billers and coders in the United States.

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Is Medicare and Medicaid Reimbursements fairer than Private Insurers: a Brief Comparison

Posted on May 11, 2012 by admin

Various providers despite being paid lesser by government than by commercial insurers believe that Medicare and Medicaid reimburse more fairly than commercial payers. Findings from a recent survey depicted that 93% of respondents feel that Medicare is fair always or frequently while 62% felt the same about Medicaid, whereas 62% were of the view that commercial plans are not fair in all or most cases; and 49% said commercials are fair sometimes. One of the factors in assessing fairness can be speed –approximately two-thirds of respondents said Medicare pays the fastest, 26% said Medicaid and only 9% opted for commercial payers.

The differences between Medicare, Medicaid and private insurers is not limited to the reimbursements but are also observed in various other fiscal features such as the overheads where private insurance companies have more overheads in the form of administrative costs, overhead for Medicare – approximately 2-3% whereas for private payers – 12%. This comparison sheds some light on the way government and private payers operate as far as their fiscal policies are concerned. However the looming Medicare cuts though postponed by the Congress time and again will affect physician perspective towards government payers.

The Committee on Ways and Means (US Congress) in its latest efforts in the health reforms regarding payments from private payers and its implementation in Medicare has started to explore how private payers are rewarding physicians who provide high quality and efficient care. The report released by the cites the Sustainable Growth Rate (SGR) formula in Medicare Fee-for-service (FFS) as lacking in recognizing the quality of care that is offered by the provider. A report by the U.S National Institute of Health clarifies that in 2004 31% of all outpatient physician income was derived from government sources and this number is set to rise as the reforms ensure health insurance for the remaining 32 million uninsured in the country. This essentially implies that even if Medicare and Medicaid pay a less amount per claim compared to private insurers, more than one-third of physician income is set to come from such government sources.

The inherent advantage that government payers seem to possess is the trust that the government enjoys from the public as well as from beneficiaries such as physicians. Private players bear more risks in terms of bankruptcy and losses compared to government payers. Moreover, Medicare historically accounts for more than 50% of total public spending by the government for US healthcare; this implies that the option of dropping Medicare patients due to any reason does not seem practical financial prudence. Another advantage of Medicare for physicians is that it pays providers roughly the same amount throughout the country regardless of the consumer’s socioeconomic status. Therefore, even though Medicare and Medicaid are faltering, they are still viewed as trustworthy services.

On the other hand Private payers have traditionally created numerous problems for physicians and patients in the form of errors in claim processing, delays in payment, incorrect payments and excessive denial of claims. Private payers at times deliberately commit errors in claims and such errors amount to almost 19% of the claims that are denied for no reason after submission. These claims need to be filed again which takes considerable departmental work and invariably increases costs and delays reimbursements. To deal with both upcoming healthcare reforms affecting government payers and policies of private payers, physicians require assistance of professional departmental processes. Medial billers and coders at medicalbillersandcoders.com not only offer such professional services in the form of denial management and revenue cycle management but also offer traditional medical billing and coding services for better returns.

For More Information Regarding medical billing Or Even Medical Billing Services, Please visit: Medical Billing Companies

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The Financial Importance of Timely Medical Claim Submission

Posted on May 10, 2012 by admin

The importance of timely claims submission is not lost on physicians or their staff and is an integral part of the revenue cycle management (RCM). The dynamic nature of the health industry and the reforms has further exacerbated the already volatile situation when it comes to claim submission, denials, and re-submissions. There are numerous factors that affect the efficiency of the claim submission process and these may range from type-o errors to other issues regarding medical billing and coding or policy matters. Moreover, the tendency to deny or reject claims based on simple errors seems to be the unwritten principle of most of the insurance companies in the market which further hampers the whole RCM process, thus affecting physician revenue and patient satisfaction.

The most important aspect in RCM is the timely filing of claims that has an undeniable impact on how much and when the providers get paid. There are, however, numerous hurdles in timely filing of claims that can be encountered in a clinic and by their staff or even medical billers and coders:

  • One of the most common hurdles in timely filing of claims is the fact that simple errors can and do occur while submission and this rate is even higher for an in-house staff that juggles with numerous issues and interacts with numerous payers
  • The biggest hurdle in timely filing is resubmission which is when the claim is denied and filed again due to some error or incompetence on the part of insurance companies
  • However, there are other more practical hurdles such as unavailability of time, work pressure on staff, increased demand, and other pecuniary factors that influence the timely filing of the claim

The most important factor that affects the timely filing or submission of claim is whether the in-house staff is handling claim submission or interaction with payers or if the complete RCM process has been outsourced to a professional billing company that not only has competency and professionalism but is also professional and scientific in its approach. The dynamic insurance market also plays a role in the timely submission of medical claims and the rules and regulations governing various providers are also responsible for influencing the way in which claims are filed. Usually claims should be filed within 30 days of the day when the service(s) was provided; however, this may differ according to the provider policies and government guidelines.

There are many ways of dealing with the issue of untimely claims submission and its inevitable negative repercussions. However, the most important method of ensuring that claims are filed on a timely basis is to analyze the whole process of RCM so that the lacunae and repeated errors can be isolated and corrected. For instance, if a provider is denying more claims or is denying claims even when filed in a timely manner, then such situations need to be analyzed and resolved immediately. This process of finding habitual and regular errors in the process of timely submission can be easily handled by a medical billing specialist in a better manner compared to a novice or an in-house staff member.

The inevitable impact of the health reforms on claim submission and RCM is palpable in the form of adoption of 5010 platforms, Electronic Health Records (EHRs) and numerous other factors and requires specialized training and skill that can only be achieved by dedicated professionals who are capable of submitting claims in a timely manner. Moreover, recent issues such as the rapid changes in legislation, intervention of the Supreme court, legal, financial, and administrative issues surrounding ‘Obamacare’ have made it necessary to have specialized professionals who can keep up with the changes and assist in timely submission of medical claims.

Medical billers and coders at www.medicalbillersandcoders.com are not just HIPAA compliant and legally updated but also perform research and analysis of claims and strive to achieve the maximum efficiency through a scientific approach, be it claims submission or accounts receivables. To find more information and for consultancy as well as other medical billing and coding services.

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Predicting the scope of medical billing consultants after 2014 and beyond

Posted on May 9, 2012 by admin

Although it has been quite a while since the Federal Government announced a series of far-reaching healthcare reforms, we are yet to experience their full impact across the healthcare continuum. And, with the Senate bill deferring a major chunk of the reforms further, it is expected that we may have to wait as late as 2014 to witness their full impact.

Amongst a string of reforms that will take effect from 2014 are the ones emanating from the Patient Protection and Affordable Care Act, which will bring immediate benefits to millions of Americans, including those who currently have coverage. The following benefits will be available in the first year after enactment of the Patient Protection and Affordable Care Act:

  • Access to affordable coverage for the uninsured with pre-existing conditions, which means the act will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions
  • Re-insurance for Retiree Health Benefit Plans, wherein the act will create immediate access to re-insurance for employer health plans providing coverage for early retirees. This re-insurance will help protect coverage while reducing premiums for employers and retirees
  • Closing the Coverage Gap in the Medicare (Part D) Drug Benefit, under which the act will reduce the size of the “donut hole” by raising the ceiling on the initial coverage period by $500. There would also be guarantee of 50 percent price discounts on brand-name drugs and biologics purchased by low and middle-income beneficiaries in the coverage gap
  • Extension of dependent coverage for young adults, wherein act requires insurers to permit children to stay on family policies until age 26

Coupled with this set of reforms, which are believed to improve physicians’ revenues, there are also reforms that are likely to test their ability to practice delay-and-denial-free reimbursement practices:

  • The Accountable Care Organization Model, which requires physicians to realign their practices in congruence with Medicare incentive framework
  • The ghost of Sustainable Growth Rate (SGR) fix, which threatens to substantially erode physicians’ share of Medicare reimbursements
  • Last but not the least, the radical ICD-10 and HIPAA 5010 compliant clinical and coding practices, which, though indispensable to reduce healthcare fraud and abuse, are going to force medical practices into a more stringent reimbursement environment than ever

While the impact of the ensuing healthcare reforms are going to be felt across the whole healthcare continuum, it is the medical billing practices that would be most affected. Therefore, it is going to be crucial that medical billers and coders respond with highest degree of professional dynamism to mitigate the chances of physicians’ medical claims running the risk of denial or delay. When one thinks of the possible areas that medical billers and coders would be addressing post 2014, the following come up to the fore:

  1. Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
  2. Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
  3. Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
  4. Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physicians’ medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
  5. Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
  6. Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s medical billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.

As physicians, in the wake of these sweeping healthcare reforms, look to elevate their billing and coding practices through outsourced medical billing services, Medicalbillersandcoders.com – known for its proven medical billing solutions to a majority of physicians, hospitals, clinics, and multispecialty groups across the whole of U.S – should be a preferential choice for streamlined medical billing practices.

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Physicians tackle HIPAA requirements and increased scrutiny by Government

Posted on May 8, 2012 by admin

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.

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