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.

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”.

Contrary to single-location practices that were the norms during olden days, the recent trend has been the exploring of practice opportunities in multiple locations. It is not strange for a medical practice/clinic/hospital to expand its operations beyond the original location once it has built up a considerable reputation. Moreover, multiple-location operation has its own advantages: economies of large-scale operations, regional advantages, off-setting adverse practice results in some dormant locations against the profitable locations, and above all nurturing the vision of nation-wide presence.

Medicaid not only plays a significant role in helping disabled and indigent people in the country but also provides important financial support for long term care patients. However, Medicaid also has a pivotal role to play in crowding-out private players in the insurance industry. Medicaid is essentially for poor people or indigent individuals and families and those with disabilities or people living with HIV/AIDS and since it is publicly funded, the reimbursement is on the lower side compared to other private health insurance payers.

The extent and scope of ICD-10’s clinical and operational impact is such that it is going to influence how functional departments coordinate and operate internally among themselves as well as with external entities such as payers and regulatory bodies. Therefore, it is imperative that providers migrate to clinical and operational practices that best endorse ICD-10 requirement. Hence practices are increasingly realizing the need to spruce up and better integrate the three important components: people, technology, and processes. While they may have the will and financial might to pay for elevating these three factors, they may still lack the requisite foresight and planning, which are the pre-requisites to a successful ICD-10 implementation. This is where, the external consultants – with a track record of delivering HIPAA 5010 and ICD-10 assessments, ICD-10 impact analysis, and ICD-10 implementation plans on time and on budget with excellent results – assume significance.

MBC has recently launched a job board to lessen the complexity of bringing physicians and coders together, eventually working as an easy-to-use interface between them through the facility on job listing. According to the US Bureau of Labor Statistics (BLS), Medical billers and coders are considered to be in high demand among the allied health occupations, with demand for healthcare professionals expected to increase by 18% considering the increased shift from paper to data storage and increased shortage of qualified professionals with specialized skill-sets. 

The number of days a physician’s takes to collect their receivables is a good indicator of how well the physician’s clinic is collecting its accounts receivables.

Medicare, which continues to remain as the nation’s largest public health insurance scheme covering nearly half the United States’ population in its health insurance ambit, has gone through considerable reforms over the years. In fact, the evolution of Medicare can be defined as:

The procedure of appealing an insurance claim is intricate, although it can be successful if completed properly because there are many grounds for claims to be denied by an insurance company or a payer. The payer collects a lot of claims on a daily basis and the claim can be easily denied if there has been a mistake in analysis or Medical Billing and coding errors including many others. Furthermore, there is also a requirement to understand if the claim is of importance because a claim of a very small amount need not be appealed and can be written off but one which is worth a considerable sum needs to be scrutinized. However the physician’s office in this case may need to apply various measures considered the following challenges.

Accounts receivables (A/R) management is a vital element of revenues for physicians and forms a crucial part of a physician’s revenue because of the role of insurance companies and other similar entities in the whole revenue cycle process. There are several methods of managing accounts receivables and there are no common techniques of evaluating this aspect of a business.

There has been a definite improvement in the United States in the adoption of Electronic Medical Records (EMR) and its implementation in the last decade (2001-2011). A report by Centers for Disease Control and Prevention (CDC) states that 57 percent of office-based physicians in the country have adopted EMRs. However, 34 percent of physicians only have a basic system, which means that only 22 percent of physicians have a fully functional EMR system. Therefore, only 22 percent of physicians are qualified for the incentives and are demonstrating “Meaningful Use” (MU). The reasons for the poor adoption rate of fully functional EMR systems lie in the numerous functional hurdles faced by providers in successfully implementing a fully functional system.

The intense competition in the healthcare industry is triggering unprecedented benefits to the patient fraternity. While the quality of medical care has improved by leaps and bounds, patients now, have choices and alternatives just in case they feel deterioration in the perceived level of medical care. This sudden shift in favor of patients means physicians will now have to devise ways in not just attracting patients but also retaining.

As the insurance reimbursement environment becomes increasingly stringent, the incidence of denials, delays, underpayments, and lost or ignored claims seems to be on the rise. Consider this interesting statistics compiled by the Centers for Medicare and Medicaid Services (CMS: 70% of claims are paid the first time they are submitted; 30% of claims are either denied (20%) or lost or ignored (10%); 60% of denied, lost or ignored claims will never be resubmitted; 18% of claims will never be collected. Therefore, it is obvious that physicians are losing a substantial portion of their reimbursements unable to keep pace with medical billing challenges. But it is not a thing that can be neglected as medical reimbursements happens to be the life-line of medical practices.

Small and Medium size Clinics: Great Expectations 

Optimizing Fee Schedules for Physicians: An Overview 

That means nearly half of your total patient population comprises of Medicare beneficiaries.  And, you could have remained indifferent as long as Medicare’s reimbursements continued to be as normal as private health insurance reimbursements.

• The New Mexico state government has introduced an incentive program where healthcare providers will be rewarded for moving their data operations to an electronic platform to be HIPPA complaint
• Chronic diseases and conditions prevalent in New Mexico have led to an increase in consumption of healthcare services like laboratory studies, radiologic imaging, oncology treatment and other specialties

These two seemingly disconnected developments, one relating to insurance compliance and another core care, have collectively made New Mexico a state highly in demand by medical billing and coding professional to be in for job and career opportunities.

A significant challenge that care providers face in the US today is unrealized account receivables stemming from rejected insurance claims by Medicaid and Medicare officials. Physicians often find this challenge daunting because it requires them to handle what they are not meant to: administrative responsibilities 

Numerous Small and solo practices have been impacted in a positive manner by the implementation of Health IT (HIT) and this trend is not just limited to Electronic Medical Records (EMRs). Physicians are utilizing smartphones and tablets for accessing and using EMRs. Moreover, the incentives paid by the Federal Government have added to the actual revenue of many physicians across the nation. Implementation and use of HIT has proven to be beneficial for patients and for physicians since it reduces errors, saves paperwork, provides quick and instant access to information, and saves time and effort in delivering quality healthcare services. Small practices have been paid a major chunk of the incentives in August 2011 whereas hospitals have only received a tiny portion.