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.

Unbalanced equilibrium: US States facing shortage of Medical Coders in spite of high supply

As if hospital shortages of nurses and pharmacists were not enough, the shortage of medical coders has risen to high levels in some areas in the US and physicians need to act fast least they lose millions of dollars in unbilled charges. American Health Information Management Association (AHIMA) has reported a nationwide shortage of certified medical coders in hospitals, physician practices, and other healthcare facilities, with the most critical shortage in the northeastern and western parts of the country.

President of Provider HealthNet Services Health Information Management Inc. estimates a nationwide shortage of almost 30%. According to The Bureau of Labor Statistics, U.S. hospitals will need a large number of new medical record and medical health technicians to replace those who are leaving the field now.

Imbalanced scales 

On the upside with the increasing demand for coders, their role in health management is expanding, however there is a nationwide shortage of credentialed coding professionals, Coders already present in the profession are facing a difficult time keeping up with the various changes demanded by the industry. There are a multitude of circumstances contributing to this shortage-most graduates are unaware about medical record coding professions, while ongoing changes in the coding profession make it difficult for even skilled coders to keep up. A recent American Hospital Association survey showed that about 18% of billing and coding positions remain unfilled due to a lack of qualified candidates.

Many hospitals are also beginning to implement internal measures to ease the shortage: upgraded pay scales; sign-on bonuses; flex-time and overtime opportunities; scholarship programs for coding education; online training programs; in-house training for internal employees; and increased use of freelance coders.

Increased demand for coders

Coding is highly critical to a physicians practice as any discrepancy in this area can result in high penalties. The scope of health information management (HIM) has grown significantly over the past five years. The health care system has employed a number of techniques to combat the shortage, including contract services. According to the U.S. Bureau of Labor Statistics, medical billing and coding demand is projected to increase by nearly 20% by 2018.

Coders are an integral part of a health care system playing a key role in reimbursement and processing claims. Medicialbillersandcoders.com is the largest consortium of medical billers and coders in the US providing updated knowledge, placement opportunities and analyzing current salary trends.

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

Strategic Realignment to Affordable Care Organization Model – providers perspective

“While physicians embark on such transformational healthcare model, their quantum of Medicare reimbursement, and its amicable distribution among themselves is sure going to be complex issue. Given such complex calculation on Medicare reimbursements and qualifying incentives, an external medical billing services that is best acquainted with Medicare environment becomes more pronounced.”

As time closes in on the Accountable Care Organization model of healthcare under Medicare, physicians across the US are busy realigning their practice models and alliances in congruence with the mandate of Section 3022 of the Patient Protection and Affordable Care Act (ACA). Commencing with January 2012, physician networks intending to participate in the program will be required to enter into an agreement with the Secretary to participate in the program for not less than a 3-year period, and be accountable for quality healthcare to at least 5,000 Medicare beneficiaries.

Coupled with the mandatory agreement with the Program Secretary, physicians also have an ominous task of setting up of mutually complimentary alliances among themselves that can efficiently enable division of diagnosis, treatment, and supervision of their target group of patients. Yet, incentives for keeping Medicare expenditure as minimum as possible will not be guaranteed until and unless the participation physicians:

• Become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.

• Adhere to the formal legal structure that would allow the organization to receive and distribute payments for shared savings to participating providers of services and suppliers.

• Abide by the ACO’s policy of including primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO under subsection.

• Agree to be supervised by a leadership and management structure that includes clinical and administrative systems

• Work in sync with processes that  promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies

• Demonstrate to the Secretary that it meets patient-centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans

• Do not cross over to other Medicare shared savings programs

Commit themselves for evaluation vis-à-vis their ACO’s patients’ health needs
Therefore, amidst such governing principles, the intending physicians need to realign their practices in a way that best meets the Accountable Care concept. While physicians embark on such transformational healthcare model, their quantum of Medicare reimbursement, and its amicable distribution among themselves is sure going to be complex issue. Given such complex calculation on Medicare reimbursements and qualifying incentives, an external medical billing services that is best acquainted with Medicare environment becomes more pronounced.

About Medicalbillersandcoders.com

Medicalbillersandcoders.com – known for a healthy rapport with Medicare for more than a decade, and self-sufficient in the requisite qualification and competence, such as certification from  American Association of Professional Coders (AAPC); expertise in advanced technology interface for medical billing and coding;  proficiency in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting – should be a preferential recourse to physicians on the verge of forming Accountable Care Organization model.

Outsourced Medical Billing – the prescription for new practices’ impressive ROI

Given the rapidly expanding patient base, and an insatiable demand for quality medical care, it is not surprising that each passing-by moment is witness to the birth of a new practice. Despite being driven by a larger healthcare vision, new practices – operating in a market-driven environment – are inevitably forced to lend equal significance to Rate of Return on Investment (ROI), which is the operational yard-stick for sustenance and growth in a highly competitive medical service market.

If pooling in the requisite resources to launch your medical services is one huge task, operating it on profitable basis is altogether a different proposition. Having ventured into a socially-responsible service, most of your time and resources will be expended on employing the best of physicians, diagnostic and curative measures, support and administrative staff, and facilities – all of which have direct impact on quality medical care, patient satisfaction, patient retention, and credibility that would further expand your patient referrals.

Assuming that you go on, and eventually achieve the objective you set out for – medical service credibility – would there be any guarantee that you would have achieved an equally credible and sustainable Rate of Return on Investment (ROI)? Medical bill realization, which is a matter of insurance coverage, would weigh heavily on venture practices, who are generally novice to stringent billing regimen governed by CMS. Further, a full-fledged in-house medical billing team may not be advisable as it, being slow to yield results, is equally capital-intensive requiring heavy investment on: Installation of Billing and Coding Platforms, and Training the staff on best practices in medical billing.

Amidst the prevalence of such uncertainty on in-house medical billing results, it is prudent to source your medical billing needs from a competent outside agency;

• Application of Advanced Technology Interface comprising use of latest medical billing softwares such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc.,
• Use of latest coding softwares such as EncoderPro, FLashcode and CodeLink
• Application of standard CPT, HCPCS procedure and supply codes, and ICD-9-CM diagnosis coding as per CMS guidelines and HIPAA compliant medical reporting
• Successful track-record of processing medical bills with the leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and Medicaid as well

Beyond the above requirements, the Medical Billing agency must also provide comprehensive medical billing complete with:

• Patient Enrollment
• Insurance Enrollment
• Scheduling
• Insurance Verification
• Insurance Authorizations
• Charge Entry
• Coding
• Billing and Reconciling Of Accounts
• Denial Management & Appeals, and
• Physician Credentialing

Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical billers in U.S. for over a decade, and whose medical billing service – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, account receivables, and compliance standards – can be an ideal solution for new practices that require phased implementation of medical billing process before considering in-house medical billing themselves.

Going by the recent statistics – 30 to 40% reduction in medical billing costs – our comprehensive billing solution is the prescription for new practices that seek an impressive ROI through simplification of revenue cycle, appreciable increase in collection rates, more patient inflow and referrals, and increased avenue for medical research and development.

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