Coping with Diverse Medical Billing Challenges in different States


Like in any service sector, medical practitioners’ sustenance and growth has always hinged on their ability to adapt and reinvent themselves to the evolving market scenario.  While they have been quite enterprising enough to demonstrate the requisite character, the magnitude of healthcare reforms unleashed by the Federal Government, and its possible impact on their revenue generation has compelled them to add a new dimension to the usual scheme of adapting and reinventing.  And, majority of physician practices are beginning to realize that new dimension in business expansion – strategically expanding facilities to the areas that offer clinical and operational advantages.  While U.S. is abound with endless opportunities – the imminent expansion of Medicare population and an ever-growing demand for medical services in remote and sub-urban regions being the main source of opportunities, the physicians will have to contend with some unusual operational barriers. And, these operational barriers stem out of the diverse rules prevailing across the 50 states.

Amongst such heterogeneous rules, the regional modification of Medicare happens to be a significant one. Despite Federal Government’s universal Medicare scheme, states are privileged to modify Medicare and Medicaid rules pertaining to coverage, pre-existing condition, and fee-schedule as per their socio-economic conditions. In view of this scope for regional interpretation of Medicare and Medicaid rules, physicians are advised to be knowledgeable of them before they undertake expansion to multiple states or regions with heterogeneous interpretation of Medicare scheme.

Complying with state-specific practice registration is another equally important issue when you contemplate on expanding your practice.  Although you carry a valid Federal license to practice medicine, yet you may still need to be registered separately in each of the Federal states you intend to practice. Otherwise, apart from facing legal hassles, you may not be eligible to any of the reimbursement schemes.

Adapting to regional billing demands is another challenge. Certain states have their own Medicare-specific rules, and they employ varying degree of audit intensity. Moreover, in every state the rules are different regarding fee-splitting, corporate practice of medicine, and scope of practice. As these things would have a direct bearing on the revenue, practices should be mindful of them before embarking on expansion.

The important issue that hospitals of group practices will have to contend with is the restriction on certain combinatorial practices in some of the states. Therefore, you may have to restructure your physician composition prior to expanding your hospital or group facilities to the regions with such imposition on certain combinatorial practices.

While you seek to avert and adapt to these operational issues through timely intervention of healthcare legal advisors and medical billing consultants, finding those that can effectively and efficiently match up to the region-specific challenges can be a daunting one. Therefore, it boils down to carefully choosing the one with diverse capabilities. – being a credible source for medical billing management and allied solutions across the 50 states in the U.S – stands up to be reckoned as the leading consortium for such interventional advice. Its diverse pool of competent medical billing professionals is strategically spread across all the clinical destinations so that you can have instant access to their expertise.

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