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The Role of Medical Billing Companies amidst Healthcare Reforms

March 19, 2012

Medical billing is one of the most important factors in a physician’s practice and can be the reason for the financial affluence of the practice. Medical billing services are not just limited to billing and submission of claims for payment to insurance companies and government payers. Such services usually entail numerous other responsibilities such as interaction with payers, resubmission of claims that are wrongfully denied, finding errors in denied claims for resubmission and compliance with HIPAA guidelines. Medical billing and coding is one of the most complex and important functions as far as the financial aspect of a practice is concerned. Medical billing companies deal in accounts receivables and revenue cycle management to optimize the process of receiving payment and to increase reimbursements.

Healthcare reforms have affected the medical billing industry and numerous changes have been brought about in the way in which this departmental process is carried out. The adoption of ICD-10 codes and the 5010 platform that is required for the adoption of such codes is a huge challenge to medical billing. ICD-10 codes are not only extensive compared to ICD-9 but are also more specific in nature and thus improve the quality of reporting. This approach towards medical billing and coding will positively affect those physicians’ finances who are successfully adopting EHRs along with the services of medial billers and coders who are armed with newer codes and processes.

Although the many departmental processes along with medical billing are changing rapidly, physicians’ income has not been affected as positively as it ought to have. The reason for such financial stagnation can be due to poor EHR adoption rates and/or due to weak departmental processes; especially medical billing. However, those who have adopted fully functional EHR systems along with medical billing services that take a modern scientific approach towards revenue cycle management and accounts receivables have experienced increased revenues within a reasonable period of time. Compliance not only means increased revenues but also imply the strong possibility of qualifying for the incentives provided for ‘Meaningful Use’ (MU).

Medical billing services provided by the in-house staff already handling various administrative functions of the clinic, may at times not be as well organized as those provided by professional medical billers and coders who are specialized in this field. Moreover, the new requirements and complexities due to health reforms have made the process of medical billing even more specialized in nature requiring a unique skill set that would usually be lacking in an in-house staff. However, there are numerous types of medical billing and coding companies, who either charge a flat fee for their services, while some charge a percent of the revenue claimed, and some use a combination of both these pricing models. Billing services that charge a percentage of the claimed amount are usually a good choice since they get paid when the provider does and this offers a motivation for such companies to get paid for as many claims as possible.

There are numerous other factors that are required for successfully operating a medical billing company such as HIPAA compliance, error tracking and control, and reporting and analysis of the financial processes involved in the practice. Familiarity with Health IT is also one of the requirements for providing optimized revenue cycle management and in claims submission processes. Medical billing companies that are successful and apply all possible ways and means of optimizing revenues can bring about positive financial changes for practices since even a small percentage increase in revenues can add up to a big amount.

Medicalbillersandcoders.com which is the largest consortium of medical billers and coders in the United States, provide revenue cycle management and accounts receivables services through scientific approaches towards these processes. The A/R is handled using a systematic bucket approach that helps in receipt of monies within a reasonable period of time. Revenue cycle management is a process that involves processes such as charge entry, payment posting, denial management and appeals, and physician credentialing. The combination of the successful implementation of all these processes can definitely bring about a positive change in the revenues of physicians within a reasonable period of time.

We are constantly upgrading themselves with the requisites of the industry and healthcare reforms are the right choice for hospitals and practices as they try to streamline their medical billing processes. Medicalbillersandcoders.com experts trained on ARRA 2009, ICD 9, ICD -10, HIPAA 5010 and practicing 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 collection, increased patient registration right up to denial claims management.


Category : ACA / HIPAA / Reforms