What Happens to Health Reforms under Donald Trump’s Presidency?


You may like it or not, but Donald Trump has become the 45th President of the United States after a heated election battle with Democrat Hilary Clinton. With promises of ‘Make America Great Again’, the Trump administration is all set to overhaul the healthcare scenario in the country and usher in new policy changes that may have a drastic impact on policy holders as well as healthcare providers.

Donald Trump has crusaded to revoke and replace the Affordable Care Act, also called Obamacare, once he gets into office. Now that he’s won the Presidency with a lion’s share, the accomplishment won’t end up being too simple.

Will there be a new act in place of the Affordable Care Act?

While it’s essentially given that the Affordable Care Act won’t survive under the Trump administration and Republican Congress in its present frame, there are ramifications of reversing a law that has come in such a large number of courses into our insurance framework. The government has never scrapped a major benefit program after its successful implementation.

If your head is turning a because of the legislative issues and dialect that is being tossed around, here’s an introduction on what we think about the president-elect’s arrangements so far and what they may mean for the ACA market places, doctors, Outpatient facilities, and of course the medical billing and coding perquisites.

If the Congress and the Trump’s White House administrators withdraw the ACA, how soon would my market place health plan go away? 

 It’s difficult to know, yet there is little intimation. Early this year, when officials sent Obama an ACA-repel charge, which they knew he wouldn’t sign, they incorporated into the enactment a two-year time span before the market place and other law cease.

At this moment, the fourth year’s open enrollment for market place health plans is underway. The arrangements that buyers can purchase until Jan. 31 have vowed to participate through 2017. More than eight in ten ACA clients get government sponsorship’s to pay for their premiums, and it is improbable that those will leave when Trump takes office. As indicated by the Health and Human Services Department, a little more than 1 million individuals picked ACA plans during the initial 12 days in the month of November, around 50,000 more than the same period a year ago. That puts enrollment generally poised to coordinate the 1.6 million who joined during the initial three weeks of the last enlistment time. HHS authorities said that sign-ups expanded amid the three days after the election.

 What were President elect Donald Trump’s promises during the campaign trail?

As a Presidential candidate, Trump released a plan, “Healthcare Reforms to Make America Great Again,” which required a full nullification of Obama’s signature domestic accomplishment at the very beginning of the new organization. He later said he would call Congress special session to annul the law. Since he has been chosen president, Trump’s course of events is still unclear. A large portion of what he needs to do requires an act of Congress.

 This will certainly have an impact to the current healthcare plans bought by people, but it will most appropriately hamper the proceedings of the doctor’s office. Many are still unsure about the reimbursement arrangement under the new healthcare arrangements, and are also looking at outsourced medical and billing agencies to help them out, if any policy changes are made in the future.

 What has Donald Trump said on the subject since getting elected? 

In his campaign trail Trump has openly said that he may amend the ACA as opposed to revoking and replacing it. However, his perspectives on substance of the law didn’t change. As he’d said amid his campaign, he specified keeping the arrangement that denies insurers to reject coverage to individuals with previous therapeutic issues. He likewise said he’d like to continue, letting the millennial a chance to remain on their parent’s insurance program, until they are 26 — a thought that has been a part of House Republicans’ healthcare plans.

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5 Services Offered by Your Medical Billing Company to Improve Your Practice

Services Offered by MedicalBillersandcoders.com

Whether to outsource your medical billing or to do it in-house is a difficult decision many practitioners face. However, it should be as easy as performing your own surgery. Medical billing requires a high set of skills, and in the recent years we have seen a steep increase in the complexity.

Due to the high deductible plans, patients are facing bigger and bigger medical billing, but may lack the means when the bill comes due. This indicates to the medical practitioners that improving your medical billing should be your top priority for 2017. For so many reasons, outsourcing your medical billing and coding has become a necessity. Profit margins are shrinking with reduced carrier allowances.

Once you realize that your medical billing is taking a hit, you cannot afford to lose more revenue due to the changing ICD-10 norms and larger co-pays. This is true for small practices with limited budget. An end-to-end medical billing company can handle practices revenue and claims efficiently with all the insurance carriers. Let’s cover the 5 most important things offered by a medical company to help improve your revenue.

Dedicated and highly experience staff

The team at your medical billing company has only one objective; to increase the profitability of your practice. They post and review all the claims to ensure that all the payments are done correctly and avoid incorrect adjustments. They can even be integrated with your office staff to meet certain goals. The dedicated team not only helps you save time, but also ensure you give enough time to your patients which actually are your practices real need.

Keeping data secured

The medical billing company is committed to keeping your patient health information (PHI) secure from thefts and frauds. This indeed will be a big “NO” if your billing company does not consider this as a high priority or cannot ensure high level of security.

Not only this, even if your company is promising to keep you PHI secured, you have the every right to know how they are doing it. Talking to your billing company about how they are storing your system password, the details of the processes etc. will help you properly understand the level of security they offer.

Business intelligence to identify areas of improvement

Having an immediate access to the data you require helps to make better decision and delivers control over your financial and clinical data. Accurate data mining is one of the best ways for medical billing agencies to improve their level of service and collection. With these innovations in medical billing, it’s become easier to generate unique reports which assist in decision making and implementation.

Constantly improve services and technology

The billing company will always keep you informed about new services and codes your practice can use. If it does not have an experienced billing staff to help physicians to improve its documentation process, it is recommended that you consider evaluating other options.  Choosing your medical billing company should involve thorough research based on your specific needs and requirements. The above criteria are just a few things you should consider while choosing your billing company.

Deliver detailed and useful reports

Measuring and analyzing your monthly performance report is crucial for the success of your practice. The reports tell you which areas are doing well and which areas needs improvement, either on your end or by your billing service team.  By reviewing your past performance data and patterns, you can set realistic expectations and goals for the future.

If your billing company isn’t providing with monthly reports and analysis, you should better search for a new company who allows you to run and access your own reports whenever you want. This way you can ensure the data is accurate and calculate metrics against your benchmarks.

Now these are just a few good reasons why it is best to outsource your medical billing to a specialist team. If you chose to go this way, make sure you carve out more time, not just to follow up on outstanding claims, but to stay up to date on carrier rules and regulations.

Posted in Accounts Receivables, Claims Denials, ICD-10, ICD-10 Coding, ICD-10 Testing, Medical Billing, Medical Billing & Coding jobs, Medical Coding, Medicare Medicaid, Revenue Cycle Management (RCM) | Tagged , | Leave a comment

10 Signs You Should Invest in Managing Your Accounts Receivables

In the spirit of thanksgiving, we wanted to share some of the most surprising facts about the state of accounts receivable management. Prepare yourself for some truly frightening facts that may make you think twice about your current accounts receivable management. Read on….

account receivables, medical billers and coders

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Guidelines for Reviewing your Billing Manager’s Performance


Conducting performance analysis has been an age old practice by many businesses worldwide. However, we come across many such physicians, solo and group practices, who do not feel the need to have any assessment and review done for their billing or accounts managers job. This can give rise to many of the following problems that are experienced:

  1. A billing manager does not have his/her clear statement of criteria for performance. In such situations, the billing manager puts forth his criteria that seem good enough to the entire billing team. The problem is, there may be some area that needs the physicians attention, which is many a times being neglected. This results in lack of oversight regarding billing and collection activities- which is the main lifeline of the practice.
  2. Secondly, a physician does not have any clear idea of the manager’s job. For instance, we have seen physicians who reviewed their EHR without any consent and involvement of the billing manager. The possible integration of the EHR systems into the A/R system coveys a high priority in the investigation. Hence the billing manager should be a part of the study even if he’s not heading it.
  3. Many a times, the physician’s attitude is, as long as the practice is performing well, the billing manager is assumed to be functioning properly. But when this is not a case, it is likely that the physician will put blame on the billing manager. In group practices, it is seen that different medical physicians have different interpretations regarding the manager’s performance.

The first important step

Are all of the billing guidelines relevant to your billing manager’s position? Both practice physician as well as the billing manager should spend time reviewing the guidelines.  For instance, in many smaller practices the billing manager does an annual budget. Again, some smaller-practice managers are very much intricate in negotiating with managed care plans. And in a few practices, a part-time bookkeeper or even a practice owner’s spouse, have the accounts payable work being done. Therefore the guidelines should be modified, as seen fit for your practice.

Advantage for Billing Managers

Billing managers will find this type of evaluation very useful for their work. First, they can get a better picture of goals related to each of the many tasks in the manager’s job. Second, these guidelines can be used for self-evaluation. Third, they can feel comfortable that their physician bosses will use the same criteria in evaluating the manager’s performance.

Physicians Involvement

Practitioners and hospitals should closely review and learn the guidelines. Then, in concurrence with the billing manager, they should modify any of the required guidelines for their practice. Once that agreement has been negotiated, it would probably be feasible to consider an initial evaluation in three to four months. Subsequently it could be done annually.

Physician Involvement in the Manager’s Review

In any group practice, every physician should be provided an evaluation form to review. In group practices, one physician should be the adviser of these evaluations. The purpose of the review is not to provide a progress card. Rather it is, first, to understand those tasks that are “meeting goals” and “better than goals.” These merits are acknowledged and commended to the manager. Lastly, notable attention should be addressed to any tasks not meeting the goals. These things need a very close study. The physician should aim for answers to help solve the low-performance tasks.

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Why We Love Medical Coder (And You Should, Too!)

With the increasing number of healthcare service providers all over the world, the demand for medical coding professionals is also increasing. Recent news also mentioned that this profession will be in great demand within the next 5 years. But, due to the recent transition to the new ICD-10 classifications, there’s a shortage of medical coders.

Coding is an important aspect as it can directly, or indirectly, affects the reimbursement of a medical practice. Coding is also important for demographic assessment, treatment outcomes and other reimbursement systems. To make your practice more profitable, one can also outsource their medical coding services.

A medical coder is an integral part of any medical practice for efficient working of the healthcare industry. Some coders work at the physician’s office, some at the hospitals, and some even work remotely. If medical coders can handle the coding, the physician can focus on their core tasks of treating and communicating with their patients, keeping the AR and revenue cycle in place. These reasons offer advantages like:

  • Enhanced revenues and profits
  • More focus on patient care and less administrative work.
  • Keeping confident patient records
  • Transparency in revenue cycle management.
  • Visible reduction in AR days
  • Denial Management and analysis

The primary responsibility of a medical biller is to see that the services that are provided to the patient by the medical practices are properly billed. Codes have to be properly assigned for the services and procedures that were provided. Seeking the help and support of a medical coder ensures that your medical billing is done correctly to ensure faster reimbursement.

Benefits of having a medical coder for your practice

A medical coder knows the value of time and is trained in that manner to process the claims. Therefore, whether it’s a single coder or a team of coders, they will passionately work for you. Reputed billing companies have a good record of billing practices and let you have maximum reimbursement. They provide services relating to charge posting, charge entries, patient inquiry and billing process, submission of Insurance bills and claims, follow up if any rejections, and finally the payments are made on time.

The medical coding specialist integrates medical reports, outlines information in the documentation process, assigns them appropriate codes, and develops claims to be processed. Accuracy in coding is crucial. It makes the difference in the claim reimbursement process.

Here are other reasons why a medical coder is so important:

  • Enables assigning of charges to resources that have been utilized in patient care.
  • Establishes Medical Indispensability of Treatment
  • Creates supportive coding documentation to apprehend why particular charges were submitted.
  • Provides Precise Reimbursement
  • Assists with Appeal Denials

A professional medical coder has advanced knowledge of coding. He provides the required information to the billing staff, as and when required. At the end of every month, they provide you with the managerial and financial reports by keeping a transparency within the system.  The medical coders provide a competitive edge to you practice and their services come at a decent price. You can expect maximum reimbursements and this also results in less or no denials. And with this, medical coding specialists have become the front line in healthcare data analytics.

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Wound Care Reimbursement guidelines that are worth following

In today’s scenario most of the patients expect clinicians to go by evidence-based medicine for wound closure and for preventing relapse for a persistent wound that refuses to heal. Wound care billing guidelines indicate that physicians need to provide services that are not only effective but billable at the same time. Or else, it is going to be rather difficult to sustain in the business of wound care. Hence, it is important that a multidisciplinary team comprising physical and occupational therapists (PTs & OTs) is used as they have the requisite theoretical and practical methodologies that hasten wound healing.

Ideally, a therapist (PT & OT) would first examine the skin integrity and carry out an assessment of skin afflictions, including subcutaneous changes like pressure and other areas like vascular, neuropathic (diabetic, for instance) burns, ulcers and other traumas. With mobility being the ultimate goal of therapeutic care and subsequent wound healing, therapists know that they have to get a better understanding of how to utilize various therapeutic interventions like ultrasound and electrical stimulation.  Wound care billing companies as well as the therapists are aware that wound care service is part of the therapy plan which will be reimbursed as per the Medicare Physician Fee Schedule irrespective of whether the therapist is working in a hospital based outpatient department or private practice or at any other nursing facility.

Wound care billing & coding service providers and the therapists also know that the Current Procedural Terminology (CPT) come under the 97000 series, however, the therapist is at liberty to report any CPT code (97597 – Selective debridement, first 20 sq cm, 97598 – Selective debridement for each additional 20 sq cm) provided the healthcare provider is qualified to offer the service relating to the specific code.

Wound care services providers should also realize that therapists linked to any hospital based outpatient department have to use the relevant revenue code (either PT = 042X or OT=043X) For the benefit of wound care coding companies, the Center for Medicare and Medicaid Services (CMS) has classified several CPT codes coming under the 97000 series as “sometimes therapy”, the services for which need not necessarily be provided by a therapist. In case a therapist is performing any service coming under any of these codes he or she has to use the appropriate modifier (GP= physical therapy, OP occupational therapy). Any therapist who wishes to be part of a multidisciplinary team has to be familiar with unique payment rules along with the routine rules.

While nurses have direct-supervision requirements through CMS or any other payer, PTs and OTs do not have any such requirements. Nurses need to work under the direct supervision of a physician while performing clinical services as defined by CMS as “immediately available to furnish assistance during the performance of procedures”. Whereas PTs and OTs need to just ensure that the physician has approved the established therapy plan. Therapists and wound care billing companies need to realize that it is important that therapists get the National Provider Identification (NPI) number which needs to be used on all the reimbursement claim forms they submit, however this is not required if the therapist is part of a large hospital.

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Lessons to learn about medical billing from 2016 to improve on in 2017

To err is human; but in the healthcare industry, it can cost a patient all his savings, or can drastically reduce the revenues of a physician. Hence, in all possibilities, the medical billing and coding team must avoid slip-ups or inaccuracies in billing claims that cause denials or rejections. Lessons learnt from 2016 must be improved upon so as to not be repeated in 2017.

In the medical practice, ‘insurance verification’ is the topmost concern of providers of medical services. Lately, Americans have been paying higher premiums along with fewer choices for their healthcare coverage, mainly due to insurance payers backing out of several states. Practices too face a brunt as they need to be aware of which and how much of their services is paid due to decreased incentives, taut payments, reimbursements based on metrics and bundled payments. Hence, it becomes all the more liable on the medical billing professionals to verify insurance coverage of the patient and ensuring that it is active along with a check on procedures/services covered/not covered by insurance providers; an communicate wisely with the patient to make them aware of billing procedures and payments.

The medical billing professionals must not leave any missing information while filing a claim. Very often, the social security number is missing which triggers 61% of initial medical denials. Again, the claimant must be aware of the correct address, contact numbers, name and DoB for precision in billing. Up to 32% of denials occur due to duplicates (billed twice for the same service, beneficiary, provider, encounter, date etc.). It is advisable to not carry this factor in 2017. Delays also occur due to laxity in filing claims after the submission dates allowed by insurance payers. It is advisable to hold financial meetings to regularly review your collections and make a note of the processes that are working and those which aren’t.

For efficiency and effectiveness, it is required that technology is used. As Medicaid and Medicare rules tend to change often, the software’s are updated automatically leaving lesser chances for errors. Usage of business intelligence will be an added advantage in the coming year. Due to data mining and improved medical billing software, specific reports can be generated giving the information required for decision making and improvising, also increasing productivity, and identifying and eliminating payment inaccuracies. It is vital to invest in one.

If your staff has not been trained well in 2016, it is about time to realize that their skills must be upgraded at regular intervals to create awareness of the latest changes in medical insurance policies, appeals and claims processes. Offer incentives to your staff to keep them motivated.

If you haven’t added the USPS service in 2016, its time to add it now. For a small fee, add the ‘address service requested’ while posting physical bills to obtain the new address of the patient from the post office.

Around 20% of a physician’s earning is through patient co-pays. The hospital staff must clearly explain the payment options available to the patient (payment plan, payments on portal through credit/debit cards, deferral, interest only payments etc.) along with being courteous at all times. Also, collecting at the time of service/creating POS collections can increase timely and accurate payments. ‘Patient statements,’ if clearly mention the provider details, services performed, charges, payer adjustments etc. can effectively initiate a response from the patient for apt payments.

Incorrect coding and insufficient documentation leads to errors in medical billing. It is essential that E/M claims are accurate; documents include physician authentication, and the right place of service. Awareness and implementation of specificity in CPT codes, modifiers, and ICD-10 coding can increase revenues to a great extent. Also, CMS has released the ICD-10-CM updates for FY 2017. These are to be used for patient encounters beginning Oct. 2, 2016 to Sep. 30, 2017.

A medical biller must work towards requirements of claims and their follow-up, reduce the number of days for payments, and receive appropriate payments for services provided by the healthcare practitioner, along with understanding insurance rules and regulations. However, outsourcing remains to be viewed as one of the best options for minimizing errors and ensuring accurate and timely claim submission and revenue collections. Medical billing companies efficiently and proactively submit clean claims, streamline processes and reduce denials. Their team is aware of the latest ICD-10 changes, the revised ABN, the HIPAA 5010 medical coding and reporting compliance etc. thereby providing a competitive edge in your medical RCM services.

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