Healthcare Systems Adopt Trend of Outsourcing in the New Era of Value-Based Care

In the time when both, federal and provincial healthcare quality initiatives have come up with healthcare reforms, thus making EHR mandatory in order to avail the incentives under ARRA, the compliance with Medicare Medical Billing norms, demand of documentation under Medicare’s Accountable Care Organisation (ACO) model and the transition of both ICD 10 and HIPAA 5010, health care documenting in healthcare would probably never be the same. Though these reforms have been introduced with the sole aim of increasing the clinical and operational efficiency in healthcare organizations, the physicians have a lot to cope up with and this can hinder them from focusing in their function of providing medical services.

In the era of value based care, physicians find it tough and time consuming to balance administrative along with their prime function of patient care on their own. Outsourcing the administrative processes which needs expertise and resources is significantly more appropriate approach when these aren’t available in house. Health care organizations and physicians are increasingly seeking contractors for services like billing, coding, medical staffing and information technology services in order to bridge the gap. The companies providing these services have no doubt proved to be beneficial for the growth of its clients. Moreover, it has been found that the growth in outsourcing between the 2010 and 2011 was reported to be around 13.1% with 20 outsourcing firms which served 16,463 clients.

Benefit of Outsourcing

Partnering with an outsourcing firm has brought more technology and expertise in the industry, thus expanding the job options in the field, along with helping physicians extract most of the money for the services they deliver.  Contrary to the popular belief that the small healthcare firms do not need outsourcing, truth is small facilities too are finding it beneficial to outsource as they adopt electronic billing and EMR implementation along other reforms in the new era of value-based care.

Outsourcing the task of medical billing relieves the medical professional from various administrative tasks. The health care organization can be saved from a few issues which are unavoidable like:

• Staff retention: with the outsourcing process, healthcare organization need not worry about recruiting, managing & retaining billing staff and training new billing staff  when old staff retires or moves on, hence helping in smooth functioning of the billing process
• Billing possible on all days: with in-house billing there is complete dependency on fixed staff members and in case of absence of any of the staff members or any holiday, the billing process is kept on hold, but with outsourcing this headache is eliminated ensuring on-going billing process throughout the year

Outsourcing can make your office run more efficiently and systematically with small investments which although go unnoticed, but are considerable in total like postage charges and telephone bills also reduce. Added costs for labour, office system and other operational expenses are also reduced considerably. Furthermore a better turnaround time with better revenue cycle is guaranteed along with improved collection rate on an average of nearly 20%.

MedicalBillersandCoders.com the biggest consortium of billing and coding experts, has been assisting medical practitioners and health care workers for over a decade now towards betterment of revenue cycle and management of administrative tasks. Our billing and coding experts are also constantly trained and updated with the latest reforms, thus rendering the clients stress free and relaxed as far as revenue is concerned.

Physicians tackle HIPAA requirements and increased scrutiny by Government

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

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

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

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

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

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

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

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

Hospitals expansions survey findings

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

Impact on Hospitals & Independent physicians

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

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

Revenue cycle management amidst hospital expansion and reforms

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

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

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Challenge of EMR deployment for Small Pediatric Practices

The use of Electronic Medical Records (EMRs) or Electronic Health Records (EHRs) in pediatric practices presents numerous challenges due to the dynamic nature of this particular specially. The reasons for these challenges are myriad and range from the changing nature of the body of children and also the medical care that is provided during childhood. This care can include immunizations, growth tracking, and other critical aspects such as obesity. Another advantage of EHRs is that children over 13 have to record their smoking status which may lead to positive health outcomes. The burden of all this EMR testing and implementation lies with the physicians and their assistance but this is usually possible in bigger settings such as hospitals and small practices have traditionally suffered due to lack of proper EMR facilities. Moreover, taking responsibility of such amount of work in pediatrics is costly as well as time consuming for novices in the field.

It cannot be denied that there are numerous advantages of EHR implementation in pediatrics and the general medical history of the child can be continuously recorded. However, there are numerous challenges as well and these can range from financial to functional. Physicians are finding it hard to dedicate time updating their EHRs which in turn has dropped the productivity. Another factor is that since pediatric patients have a constantly changing BMI (Body Mass Index) and features, recording this also consume resources in the form of time and money. Hospitals are finding it easier compared to small practices to implement EHRs since they have the groundwork in the form of infrastructure to implements such EHR systems.

The challenges faced by pediatrics in implementation of EHRs are similar to those faced by other specialties and these may include lack of adequate funding, lack of training, resistance to change and lack of resources. However, the biggest advantage is that there are numerous types of EMRs available in the market and many of these support pediatric services; but, the adoption of such EHRs/EMRs is not enough. The ‘Meaningful Use’ criterion needs to be met in order to qualify for the incentives offered by the government.

The financial aspect of successful implementation of EHRs is not limited to the incentives provided by the government but is also in the form of increased revenue due to efficient departmental processes. The financial success of the practice depends on a holistic approach by not just implementation of EHRs or EMRs but also through outsourcing such essential departmental processes such as medical billing and coding, interaction with payers, and denial management in addition to other value added services such as pediatric EHRs and research and consultancy that are provided by www.medicalbillersandcoders.com the largest consortium of medical billers and coders in the country.

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Challenges Faced by Diabetic Specialists in EHR Implementation

Electronic Health Records (EHRs) and Electronic Medical Records (EMRs) have started to affect almost all the specialties and diabetes care is no exception. A study by The New England Journal of Medicine finds that EHRs can have a positive impact on the quality of the care that is provided to diabetes patients. The report titled Electronic Health Records and Quality of Diabetes Care clarifies that sites with EHRs have better quality of care compared to those with paper based records. Another survey by the U.S National Library of Medicine, National Institute of Health also presents the advantages of using EHRs for caring for diabetes patients in another case study.

There are approximately 24 million diabetes patients in the country and as the population ages, this number will grow. Moreover, since diabetes is a chronic condition that has no final cure, caring becomes a continuous process with numerous hurdles. These hurdles can be overcome by using EMRS and EHRs which are especially designed in order to periodically monitor the condition of the patient and provide better care due to this approach. The biggest challenge in diabetes is the monitoring and control of blood sugar on a daily basis which can be exhaustive for the patient to check and keep a detailed record of. This is where EMRs and EHRs can be of immense help. EHRs and EMRs can help in keeping a detailed record of blood sugar levels along with other factors such as Body Mass Index and numerous other features. Such reports can be sent to patients in the form of lab reports and assessed by the patient regularly to maintain better health.

Even though EMRs and EHRs help in assisting physicians in taking better care of diabetic patients, EMR and EHR adoption rates in the country are not very encouraging. A yearly survey by the Centers for Disease Control and Prevention (CDC) has released a report containing the EMR adoption rates in late last year (2011). The report finds that only 10.1% of physicians in the country had a fully functional EMR system.  The successful implementation of EMR/EHR system seems to be the biggest challenge in health reforms and also in aspects related to diabetes care. There are numerous reasons that have been presented for this lag in the implementation of EMR/EHR systems. Factors such as the anxiety regarding the financial viability of such systems, a steep learning curve for providers, and the complexity in maintaining such systems are the most common reasons for the reluctance to fully implement systems that demonstrate ‘Meaningful Use’ (MU).

The financial advantages of implementation of EMRs and EHRs are apparent in light of the incentives provided by the government for MU. The advantages for patients are projected and expected to be excellent with the use of EMRs/EHRs; however, the study of the impact of EMRs on chronic conditions is limited yet positive. The ideal solution for proper implementation of EHR systems is to outsource the billing and coding process to professionals who possess experience in assisting in providing solutions for streamlining various processes related to EMRs.

Choosing the right EMR vendor is just the beginning because the maintenance of such EMR systems is more difficult compared to just implementation. Vendors should be able to provide basic education about the system and also support the practice in various ways for a period of time after implementation. Medical billers at medicalbillersandcoders.com will not only provide solutions to your billing problems as a provider but also offer other value added services such as assist in implementation of EMR systems after a thorough study of your practice, revenue cycle management, denial management and consultancy services.

The primary care physician shortage in California

State of California is facing an increased shortage of primary care physicians especially – with a rise in the number of elderly population in the State leading to increase in health coverage under Federal Health care reforms. Additionally 30% of primary care physicians in the state are nearing retirement being above 60 or older- the highest percentage in any state.

However compared to the shortage, the State has not significantly increased the number of primary care physicians trained. HHS’s Council on Graduate Medical Education recommends 60 to 80 primary care physicians per 100,000 people to adequately serve a population. Statistics show in fast-growing regions of California such as the Inland Empire there are only 40, whereas in low-income rural communities where care for 25% patients is paid by Med-Cal, there are only 45 primary care physicians.

Even though medical school applications have been high in California, with a high proportion of U.S. medical school graduates filling all of the 2011 family medicine slots, state and federal policy decisions too need to be on the same lines. However the State of California is trying to reduce physician fees by 10% in the Medicaid Program, putting physician payment at risk. According to the California Academy of Family Physicians (CAFP) a comprehensive state and nationwide effort would be able to effectively solve this shortage.

Tackling the shortage issue

Increase the number of medical school – The State and federal policies need to encourage funding for higher education and primary care residency programs. Absence of this funding may lead to students pushed to choose non-primary care specialties or to train in medical schools and residency programs in other states. To provide for increasing needs high quality primary care residency programs are the need of the hour to fill vacancies left by retiring physicians.

Medicaid reimbursements – With Medicaid rates in California being 20% lower than the national Medicaid rate and among the lowest in the U.S, Californians face a severe shortage of physicians willing to cater to them, conversely the California Legislature passed a budget in June reducing Medi-Cal physician payments by 10 %, among other reductions.  This could provide further incentive for students to choose specialties other than primary care. Patient access to care could be hampered as well if practicing physicians opt out of the Medi-Cal program because of the cuts. The state legislature and family physicians needs to work together to remedy reimbursement issues.

California family physicians need a coordinated effort of various entities to remedy this shortage of primary care physicians. In this scenario where primary care physicians need to tackle increased number of patients, cater to shortage issues, physicians may be short of time to give complete justice to their reimbursement strategy and medical billing and coding practices which hampers a steady flow of revenue for smooth running of their practice. Medical billers and coders can not only efficiently interact with insurance providers and increase claims generation but also keep up with health care IT reforms and comply with HIPAA and other guidelines.

Primary care physicians in California need to gear up and face the shortage challenge; moreover they can join a consortium of experts who can provide relevant revenue management services. Medicalbillersandcoders.com  is one of the largest consortiums of Medical Billers and Coders in the United States, our billers and coders in all the major cities of California including Los Angeles, San Diego, San Jose, San Francisco, Fresno can help you settle your requirements through services including- tracking and follow-up on unpaid claims, preparing patient statements and payment posting, customizing billing reports and primary and secondary insurance claims filing.

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Understanding Physician Assistants Reimbursement Environment

“Amidst all these overriding Medicare or health insurance guidelines surrounding the reimbursement for their assistants’ services, physicians would invariably feel exhausted for doubling up as medical billers along with their primary focus of clinical efficiency. Therefore, physicians would be well-off outsourcing medical billing services that are adept at handling their assistants’ reimbursement issue along with their own.”

From what used to be auxiliary to physicians’ main clinical services, services of physician assistants (comprising PAs, NPs, and Clinical Nurse Specialists) have evolved to be substitute to physician services themselves. In fact, in most of the primary care centers and non-surgical clinics, physician assistants’ have become as trustworthy as qualified physicians. Recognizing this phenomenon, majority of the primary care and non-surgical clinics are gradually migrating to an operational model dominated by physician assistants operating under one or two supervising physicians.

Although an alarming shortage of qualified physicians in the face of spiraling patient-population may have been the primary reason behind this changing equation, cost optimization or revenue augmentation (as physician assistants’ services can be bought at a comparatively lesser remuneration than what it can cost for physicians’ services) may also have equally been responsible for the shift towards physician assistants. The clinical or hospital management, on their part, would have happily carried on with this model as long as it seemed feasible but for the nuances of billing for their assistants’ services, which seem as challenging as billing for their own services.

The numerous guidelines that govern reimbursement for physician assistant services have tended to weigh rather heavy on physician practices. Amongst many such guidelines, the following are noteworthy:

• Medicare requires the services provided by physician assistants (PAs) be reimbursed at 85 percent of the physician fee schedule unless specific billing exceptions such as ‘incident to” and “shared visits billing” apply. Further, PAs need to bill Medicare at the full physician rate, and be necessarily carrying a National Provider Identifier (NPI) number to alert the carrier to implement the 15 percent discount.
• NPIs need to be updated with name changes and changes in employer. PAs must enroll with any new employer.
• Services provided by PAs are reimbursable by Medicare when provided in offices or clinics, nursing facilities, hospitals, and ambulatory surgical centers.
• Only services falling under the “Incident to Physician Services” are reimbursable at 100%. Otherwise, Medicare or insurance carriers are obliged to honor only 85% of the bill.
• Medicare maintains a list of approximately 1,900 Current Procedure Terminology (CPT) codes for which a first assistant at surgery will not be reimbursed. For these codes, Medicare determined that a first assistant is not needed and will not pay for the services of any medical professional acting as a first assistant
• Medicare restricts coverage of physicians, PAs, NPs, and Clinical Nurse Specialists for first assisting at surgery only. There are no restrictions for other services PAs provide in teaching hospitals.

Amidst all these overriding Medicare or health insurance guidelines surrounding the reimbursement for their assistants’ services, physicians would invariably feel exhausted for doubling up as medical billers along with their primary focus of clinical efficiency.  Therefore, physicians would be well-off outsourcing medical billing services that are adept at handling their assistants’ reimbursement issue along with their own. Medicalbillersandcoders.com – whose credibility and competence for providing comprehensive medical billing services, comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting ranks amongst the best in the industry – may well be the preferential recourse to physician practices seeking the right answers to billing their assistants’ services.

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