The Growing Emphasis on Medicare-Specific Medical Billing Services

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:

  1. Phase-I when it actually used to reimburse physicians the actual cost of medical services
  2. Phase- II when it introduced Fee Schedule formula to marginally discount the reimbursements
  3. Now when it is linking reimbursements to the level of Physician Quality Reporting System (PQRS) adopted by physicians

While the Federal Government believes that Physician Quality Reporting System (PQRS) will complement its endeavor to curb the sky-rocketing Medicare expenditure, which has already overshot the Sustainable Growth Rate (SGR) by nearly 25%, the response from the physician community has been a mixed one.

  • A recent report by the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures
  • More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria
  • More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum

Judging by these statistics, PQRS is still a long way from witnessing cent percent voluntary participation from the physicians across the nation.

Inevitably, the CMS (Center for Medicare Services), which happens to be the governing body in the US, has made it clear that it will introduce penalties (along with the current system of incentivizing physicians meeting and surpassing the PQRS) beginning with 2013.  Consequently, physician community – which looked encouraged by Federal Government’s recent announcement of extending Medicare to every citizen – will have to contend with mandatory PQRS compliance to avoid getting penalized.

One of the first steps to comply by PQRS mandate is the implementation of an effective and efficient EHR implementation for clinical and operational excellence. Furthermore, such EHR implementation should be customized in a way that responds to Medicare’s PQRS requirement. Physicians, who are already faced with the monumental task of transiting to ICD-10 and HIPAA 5010 clinical and operational functioning, will surely be overwhelmed by the PQRS burden.

Therefore, in view of these inherent demands, physicians would do well to collaborate with service providers who not only specialize PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. Such collaboration with credible service providers would necessarily yield multiple results:

  • Frees physicians from the burden of attending to non-core activities
  • Qualifies their practices for incentives and bonuses along with maximizing their Medicare revenue generation
  • Above all improves their goodwill, which might pave way for further expansion of medical services across multiple locations

As physicians seek to collaborate with external service providers for PQRS-specific EHR implementation, and ICD-10 & HIPAA 5010 compliant clinical documentation needs, – with the requisite technical competence and professional excellence – should not only be able to ensure PQRS-specific EHR implementation, but also make it responsive ICD-10 and HIPAA 5010 compliant clinical documentation needs. The combination of strategic partnership with leading EHR vendors, a dedicated a team of Medicare billing & coding professionals, and a rapport with Medicare makes it the most sought-after Medicare billing service provider in the U.S.

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