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Billers & Coders in demand to help decipher altering Medicare & Medicaid reimbursements

In the healthcare industry, every participant is affected by the Medicare and Medicaid programs in some way. The healthcare providers face complex system of rules and regulations regulating Medicare and Medicaid coverage and reimbursement for services. With the constantly evolving rules and regulations, it has become difficult for the healthcare provider to manage reimbursements in their faculty. In such cases, medical billers and coders provide valuable services in deciphering the constantly changing Medicare and Medicaid coverage and reimbursement.

Industry facts state

More than 50% physicians accepted that they can no longer afford to accept new Medicaid patients because of declining pay
Many practices in various states have stopped accepting Medicare patients because of its dynamic nature of reimbursement

How does altering Medicare and Medicaid reimbursement affects your revenue?

The complex, constantly changing rules and regulations governing Medicare and Medicaid coverage and reimbursement for services pose significant challenges to providers' ability to continue profitable operating margins. This increasing level of regulatory scrutiny makes it difficult for the healthcare providers to understand the market dynamics. In such cases, a cost-benefit analysis of these public insurance programs can help physicians determine whether participating in these programs will pay dividends.

Billers and coders analyze the cost-benefit structure to assess profitability

Choosing to opt for Medicare or Medicaid is a complex decision and it requires thorough analysis of cost and benefit. It is important to consider the fact that there will be many new Medicare and Medicaid beneficiaries in future. Thus, it presents a range of quantitative and emotional factors affecting the decision. Before making such a crucial decision, medical billers and coders need to make a thorough analysis of the following factors:

Balance sheet analysis: Understanding your balance sheet with respect to pay rate mix, other sources of your revenue, etc. helps in understanding your patient panel and segment by payer
Market analysis: One of the main factors in this area is to understand the market where your facility is located. If your facility is located in an area where Medicare is high, it would be unwise to refuse such patients. Another factor is to consider whether your decision to opt for or deny public insurance will affect the way you run the business. In case your facility is placed in a rural area where you are the primary healthcare provider, it is crucial to determine whether your decision will leave a hole in your business
Analysis of business opportunity: Understanding your business dynamics is another factor in assessing profitability. Business expansion in other areas, possibility of self-pay, and getting more commercial insurers should not be overlooked
Examining the hassle factor: It is important to determine how you are affected by the new requirements and red tape and the current Medicare reject rate before making the decision. Looking at your claims payments is one way billers and coders determine the hassles involved. It is also crucial to consider the influx of Medicaid starting in January 2014 and its effect on the growing market before making the final decision. It is important to determine how you are affected by the new requirements and red tape and the current Medicare reject rate before making the decision. Looking at your claims payments is one way billers and coders determine the hassles involved. It is also crucial to consider the influx of Medicaid starting in January 2014 and its effect on the growing market before making the final decision

Choosing to opt for Medicare or Medicaid presents a wide range of quantitative and emotional factors affecting the decision. Thus, many providers now seek for medical billers and coders who can identify the challenges faced by hospitals and health systems, and work closely with them to develop and implement strategies that increase their ability to achieve compliance with Medicare and Medicaid and boost the revenue.

Medicalbillersandcoders.com is catering to the healthcare industry for over a decade now, across all 50 states and 42 specialties. MBC’s wide network across all the states and the MBC job board strives to provide all medical billers and coders with a platform to acquire jobs in various healthcare organizations. MBC also monitors federal regulations and CMS clarification’s to analyze areas of reimbursement risk and emerging issues that may impact the clients

Our job portal, industry updates and newsletters provide a vast pool of opportunities and knowledge to our coders; along with constant updates about industry changes like the ICD-10 transition updates through our ICD-10 training guide. Our consultants are dedicated to keeping ahead of the curve by working with clients to identify issues, analyze proposed rules or modifications and propose meaningful solutions.

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