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.

Uninsured population rate percentage vs. Physician’s density ration in Texas, Mississippi & Oklahoma

Physicians work scope is expected to change with millions of Americans to gain health insurance through the Affordable Care Act in 2014. On the upside Physicians especially primary-care provider will experience higher demand transforming to higher reimbursements and job security. However, on the  other hand other healthcare reform initiatives would require better quality patient care at subsidized costs and hence the pressure of catering to a larger number of patients along with quality and cost targets will build up for physicians.

Physicians in certain locations are likely to face a tougher time compared to others, most probable providers in states currently facing physician shortages, will face the biggest challenge fitting in new patients into their busy schedules. Moreover states currently possessing the highest number of uninsured individuals will experience the highest increase of new patients.

According to 2011 Reports including rankings of states based on physician density and the 2011 insured population data:

Four states with the worst density/uninsured combination are:

State	Uninsured population rate %	Least physician-dense
Texas	27.2%	One of the least physician – dense State
Mississippi	24.5%	Third least physician-dense State
Oklahoma	22.5%	Second least physician-dense State
Arkansas	21.0%	Seventh least physician-dense State

The physicians in these states are likely to struggle the most in 2014 due to a high influx of patients and shortage of doctors with healthcare reforms demanding quality and cost benefits.

States with the most favorable density /uninsured combination:

State	Uninsured population rate %	Most physician-dense
Massachusetts	5.3 %	One of the most physician-dense State
Maryland	11.4%	Second most physician-dense State
Connecticut	10.3 %	Fourth most physician-dense State
Vermont	9.2 %	Sixth most physician-dense State

Physicians tackling the patient influx:

Even though the Obama administration has relaxed rules limiting the use of nurse practitioners and physician assistants, Physicians need to gear up for the expected patient influx especially in the states facing a physician shortage. Higher reimbursements and incentive may drive physicians to take on more patients; conversely insuring maximum claim generation while trying to maintain quality of care, dealing with new standards like HIPAA 5010, ICD-10, etc and government and private payers could seem as an insurmountable task to most of the Physician practices. However, services of skilled service providers possessing the requisite credentials can be availed by hospitals and medical practitioners.

Medicalbillersandcoders.com experts being constantly updated with the requisites of the industry and healthcare reforms are the right choice for physicians. Our team trained on ARRA 2009, ICD 9, ICD -10, HIPAA 5010 and handling Revenue Management Cycle for various clients, are highly motivated to provide you with the right course of action to take in the current challenging healthcare industry – right from EHR selection, increased data management, increased patient registration right up to denial claims management. 

Maximizing your office’s efficiency and cutting your costs are some of the priorities of medical billing and coding specialists located in Texas, Mississippi, and Oklahoma we also serve across the other 47 states in US.

The Changing Landscape of Healthcare Reimbursement in 2012

“As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.”

While the dawn of a new year brings forth a renewed optimism about offering enhanced quality medical care and accelerated revenue generation, there also seems to be an undercurrent of apprehensions about complying with the ensuing medical reforms that are going to be effective very soon – the Affordable Care Organization Concept, the undecided fate of Sustainable Growth Rate (SGR) fix, the mandatory transition to exhaustive ICD-10 and HIPAA 5010 medical coding and reporting compliance, and the last but not the least,  the revised ABN (Advanced Beneficiary Notice of Non-coverage), Form CMS-R-131.

The imminent weight of these factors is sure going to press all the stakeholders – physicians, medical billing companies, and medical billing software providers – for realigning their resources and competencies to address the change-scenario prompted by these radical reforms.

Foremost, as the CMS (Centre for Medicare Services) has made it obligatory that physicians form suitable cartels among themselves to be eligible for incentives from savings out of Affordable Care Organization concept, a considerable time and resource is going to be spent on arriving at judicious decision on joining the cartel that best suits the concerned practitioners’ business model.

Though, CMS has given an extra leeway of 90 days more for complying with HIPAA 5010, the obligation to report all Medicare related transactions still remains unchanged. As the ICD-10 and HIPAA 5010 are soon going to be effective, physicians will require upgrading their clinical and operational management, and outsourcing those medical billing companies’ services that have a proactive outlook to embrace newer practices through logistically formed alliances with medical billing and EHR software manufacturers.

Although, with the postponement of SGR fix, physicians have been given a breather, yet, they cannot take it for granted as the threat of cumulatively accumulated figure (of about 25%) always looms large. Therefore, while being assured of 2% hike annually, they need to be vigilant about their operational and capital expenditure, and be prepared for any eventuality.

Adding to the imminent list is the use of the revised ABN form (Advanced Beneficiary Notice of Non-coverage), which is going to be mandatory starting January 1, 2012. And failure to upgrade to this revised form of for disclosure beneficiary notice of non-coverage) will eventually invite hurdles while being audited.

As the projection for 2012 forecasts an unprecedented increase in patient population, physicians will have a hard time balancing their time resources between quality medical care and adhering to imposing compliance regimen promulgated by the Federal Healthcare Reforms. Therefore, it becomes crucial that practitioners seek strategic alliance with medical billing advisories that can ease their burden off the compliance regimen, and help elevate their quality of medical service.

Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – whose credentials have, time and again, come to the fore in successfully aiding physicians comply by healthcare regulations – should be your preferential alliance partner for complying by the imminent healthcare reforms. Our close association with Medicare and Medicaid, leading private insurance carriers, Federal Healthcare Agencies, and leading technology providers lends us the requisite edge in addressing and solving physicians’ apprehensions.

Meaningful Use’ Compliant EHR Technology Implementation – specialists’ perspective

“While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners.”

There has hardly been anything that has got as much an attention as the CMS’ Meaningful Use criterion for medical practitioners – a program for eligible practitioners to be able to qualify for Medicare incentives upon meeting a certain set of core objectives set out in the Meaningful Use Clause under the ARRA. Although CMS has laid down guidelines for general practitioners, who serve the bulk of Medicare beneficiaries, yet their specialist colleagues – such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. – are not out of the CMS’ Meaningful Use ambit; after all they too are indispensable to CMS’ initiative towards an efficient healthcare environment. But, because their service-composition and documenting varies from general practitioners, specialists’ requisite compliance with core objectives set out in the Meaningful Use Clause under the ARRA gets a little different.

Recognizing the diverse nature of specialists, CMS has allowed for certain exceptions and exemptions from complying with certain objectives that does not owe allegiance to these specialist practices. Therefore, of the 20 mandatory objectives to be met out a possible list of 25, specialist practitioners can still seek exemptions on the ground of being unique fields of medicine. Consequently, their mandatory objective-list ultimately becomes less than 20; while CPOE, eRx, Vital Signs, Smoking Status, Electronic Copy of Health Information, and Clinical Summaries are usually allowed exemptions from Meaningful Use objectives, the following exclusions may still be claimed under substantiated evidence: Drug Formulary Checks, Clinical Lab Test Results, Patients Reminders, Patient Electronic Access, Medication Reconciliation, Summary Care Record, Immunization Registries Data Submission, and Syndromic Surveillance Data Submission.

While specialist practitioners, such as Radiologists, Psychiatrists, Chiropractors, Urologists, etc. can claim exemptions and exclusion of certain objectives set out in the Meaningful Use Clause by CMS, they are not treated preferentially as far as documenting clinical processes using approved and compliant EHR software is concerned:  their responsibility for reporting clinical data using Certified EHR Technology and EHR modules remains as mandatory as for general practitioners. Thus, everything points towards sourcing and implementing EHR software’s that best serve unique needs of diverse practices while also being compliant with the CMS mandate on Certified EHR Technology for achieving Meaningful Use criterion bench-mark.

Despite the market being replete with numerous EHR software – a prior advisory on judicious selection is always advisable as any hasty selection can have multiple repercussions: adverse impact on clinical documenting, practice management, and revenue generation. Given the prevailing scenario, Medicalbillersandcoders.com proven credentials in advising and implementing certified EHR software platforms –  Medisoft , Misys Tiger, Eclinicalworks, Advanced MD, Office Ally, Sage Medical Manager, GE centricity, Lytec, Altapoint, Dentrix being some its leading names in an exhaustive portfolio innovative and futuristic models – for diverse clients comprising Allergy, Anesthesiology, Cardiology, Dermatology, ENT, Endocrinology, Family Med, GI, Geriatrics, Internal Medicine, Long-Term Care, Multi-Specialty, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Ophthalmology, Optometry, Orthopedics, Pediatrics, Plastic Surgery, Podiatry, Psychiatry, Psychology, Pulmonology, Rheumatology, Surgery, SurgicalCenter, Urgent Care, Urology, and the rest.

About Medicalbillersandcoders.com (www.medicalbillersandcoders.com)

Medicalbillersandcoders.com has been a leading source for comprehensive medical billing revenue cycle management. A talent-pool of qualified and competent medical billing professionals with diverse skills specific to unique needs of multiple medical disciplines has been instrumental in our being a leading consortium for medical billing management.

CMS encouraging physicians for health care reform innovation: grants offered

At last someone is looking to cut healthcare cost innovatively- The Health Care Innovation Challenge program, announced on 14^th November, last year is the most recent federal effort by the Center for Medicare and Medicaid Innovation (CMMI) to support health care innovations. The program is aimed at awarding grants to physicians and other health professionals, payers, local governments, to improve care and reduce costs for patients with public coverage.

The center will provide grants of $1 million to $30 million, which is to come from the $10 billion the center is receiving from the health system reform law. With applications for the innovation challenge grants due on 27^th January, 2012, the innovation center expects to notify awardees by 30^th March, 2012. Additionally CMMI – part of the Centers for Medicare & Medicaid Services (CMS), is managing several similar programs designed to improve health care by providers.

Priority Areas for Proposals for the Health Care Innovation Challenge program include:

• Workforce Development and Deployment of health care workers in new, innovative ways
• All proposed models must be operational or capable of rapid expansion within six months
• All proposals are expected to define a clear pathway to sustainability

The Health Care Innovation Center recognizes that new types of infrastructure activity are critical for implementation of the recent program like: data intermediaries for quality reporting and information sharing; transparency initiatives; preventive care models; medication reconciliation systems, etc. Physicians to cater to the likely increase in administrative burdens can utilize professional healthcare services.

Medicalbillerandcoders.com has been advocating the use of new workflows and innovative ideas of practice management to cut healthcare costs since a decade now. MBC has been offering innovative but ethical means like work-specialization, training and implementing simple technology to reduce tedious administrative jobs. MBC is a well-entrenched association of highly experienced medical billers and coders who can provide services to ensure a healthy revenue returns for healthcare providers, and assist them in solely looking at improving healthcare for the aging US population.

For more information visit: Medical Billing Services