Value of Outsourcing Family Practice Billing Amidst Changes to Medicare Rates

Medicare rates are expected to dip by 25 – 30% in the months to come. Casual healthcare observers may think family practices will be affected only financially by this. But the fact is Family Practices are contending (or will) with a series of impacts caused by changes in Medicare rates-

  • Decrease in Medicare rates will be accompanied by increase in Medicaid rates to bring the two on the same rate platform
  • The period will also mark a shift from pay-per-performance model to value-based payment model
  • Additionally, bundled payments will introduce new coding and billing changes

These will change the details related to billing and coding as well as trigger procedural changes. And unless handled deftly, they will cause, low reimbursements, reimbursement denials, underscoring, etc., affecting the inflow of revenues. To ensure an uninterrupted cycle of revenues, family practices have to realize their payments from insurance authorities with greater regularity than today.

Moreover, these issues may be of concern to family practices-

  • Widening gap in the family physician and patient ratio leaving family physicians with more patients per physician but less fee and lesser time for administrative activities
  • Ever-increasing complexities in billing and coding – A broader fact that contributes to it is that family practices deal with a very wide range of age group (children through adults to the elderly) and medical issues, and on a specific note, migration from ICD 9 to ICD 10 codes, testing and implementation of EMR and EHR, etc.
  • Accurate billing and coding – Although efforts are afoot to equate Medicaid service reimbursements rates with those of Medicare by 2014, successful reimbursement will remain subject to accurate submission of claims and that will become increasingly complex in days to come

MBC’s flexible billing and coding service modules can help you overcome these challenges. MBC’s Revenue Management Consulting services can help you by identifying gaps in your processes and address them by providing advice in replacing, if needed, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training helping your in-house staff to be familiar with complexities of EMR, EHR and ICD 10. MBC will help you be organized from a documentation point of view and impeccable in your billing and coding.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several small to medium size family practices, in various states of the US, with its Outsourcing Billing and Coding services. MBC handles a range of activities involved in billing and coding – starting from preparation of claims through submission to post-submission follow-ups – leaving the family practice to solely concentrate on family care.

MBC’s services help you avoid modifier omission, lack or inadequacy of supporting documentation, underscoring and claim submission.

You can also pick and choose such parts of our services as meet your specific billing and coding needs, like only claim submission or post-submission follow-up etc.

Many family practices have been joining ACOs to thwart the effects of payment cuts and handle changes brought by reforms more effectively, and MBC has been helping many such family practitioners by providing them with counseling on how to join ACOs and CHCs and helping them to meet the needs of being part of an ACO or a CHC.

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