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Tuesday, November 27, 2012

New Healthcare and How It Will Impact Medical Billing

Radiology practices and imaging centers face many threats to their profitability. Radiology billing is becoming even more complex, and reimbursements are steadily decreasing. There are three key challenges you'll need to understand and address for your radiology business to thrive in the coming years.

The future is less.

Bundling of services and codes has already resulted in lower (and in many cases significantly lower) reimbursements for providers. Some revised codes carry lower RVUs, reflecting the belief that those services were previously "misvalued" (overpriced).

The Medicare Payment Advisory Committee (MedPAC) recently recommended measures to further reduce imaging reimbursements, including lowering the threshold for bundling review from 75% to as low as 50%, reducing professional component payments for multiple procedures and studies conducted by the same practitioner during the same session, and discounting payments for providers who both order and read images.

Some "thought leaders" (see the Radiology Business Journal June/July 2011) think that professional component reimbursements are likely to decrease another 30% over the next five years.

Complexity is increasing.

Impending new coding procedures will affect both clinical and business operations. New compliance requirements will further affect radiology billing procedures. And then there's the move toward more electronic data standards and requirements.

With ICD-10, coding isn't simply being refined and updated. New codes will be longer, and there will be a lot more of them. RVUs will be different, too. Since you won't see much matching between ICD-9 and ICD-10, your staff will have to figure out how to accurately "translate" to the new world.

Of course, we can count on the government to keep working to "correct" pricing, uncover new bundling opportunities and eliminate overuse of procedures. You'll also see more emphasis on linking radiology billing and reimbursements with outcomes measurements, expanding on initiatives such as PQRS (was PQRI).

Change is the new normal.

Your in-house costs are going up.

Daily operations costs will keep increasing, and incorporating new radiology billing requirements will add cost pressures to your financial situation.

Coding and billing staff will have to learn an exhaustive new ICD-10 coding system very quickly. Even after the October 2013 change-over deadline, providers will have to continue processing ICD-9 codes for services rendered before the deadline. Since payors will have an extended deadline, you may face additional "dual" processing issues. This will create more work for your staff and possibly unwanted reimbursement consequences, too.

New, more involved ways to link financial data to reimbursement will require more sophisticated technology and better trained staff. Failure to accurately document patient data, including benefits details, could result in increased denials, even fines.

Annual planning and budgeting may be tougher, because the ICD-10 timeframe doesn't announce changes until October, giving you less than three months to prepare for the next fiscal year.

These radiology billing challenges mean even more attention to the ever-changing coding and compliance requirements. And you'll have to manage the business side of your practice or center smartly and efficiently to remain competitive and prosper.

How To Keep Up With So Many Changes in Medical Billing Maximize Your Medisoft! (Unknown and Underused Functions of Medisoft) Is the Job Growth Affected by the Existence of Software That Handles Medical Billing and Coding? General Overview of the Medical Billing and Coding Process

Baby Boomers Take On the Digital World

Seniors hear a lot about "Gaps" these days. There's the Medicare Gap (which often leads to the need for Medicare Supplemental Insurance coverage), the Employment Gap (seniors who want to stay in the workplace are often finding it harder to do so), and there's the Technology Gap, which is basically the belief that Baby Boomers can't keep up with the tech changes embraced by Gen-Xers and Millenials. Well, Baby Boomers are proving that "Gap" to be a bit of a myth.

Baby Boomers and technological innovation go hand-and-hand, and others are finally starting to realize it. In many cases, it's simply a question of numbers. Despite the "employment gap" we just mentioned, large numbers of Baby Boomers are still running major companies all over the world. In that capacity, they're dictating the course that technology takes. Other important numbers involve the all-powerful "$." Baby Boomers are still major consumers, and in some cases they're the ones who can most easily afford the latest tech products flooding the market.

Of course, Boomers are closing the technology gap in purely social ways, as well. Check out Mashable's How Baby Boomers are Embracing Digital Media and you'll see just how quickly Boomers are growing their numbers online:

"Social network use among Internet users 50 years old and older has nearly doubled to 42% over the past year. In fact, in the U.S. alone there are nearly 16 million people 55 and older using Facebook."

So, let them keep throwing out the latest "Gap" and telling the world where Boomers are lagging behind this time. You know the truth. It's a digital world, and we're not going to just sit on the sidelines and let it pass us by.

About Medigap Supplement Insurance

Medicare Supplemental Insurance, or Medigap Insurance Plans, are not an alternative to traditional Medicare like Medicare Advantage Plans, but instead work with traditional Medicare. Also, Medigap Insurance Plans differ from Medicare Advantage Plans as they have no deductibles, no co-pays and no network restrictions as to where you can receive medical treatment.

Most Medicare Insurance recipients could save money by switching to the same plan with another company. However, most people covered by Medicare Insurance pay more than they should for their Medicare Supplemental Insurance Plan. The reason is that they simply don't shop around. By shopping multiple companies many could get the exact same coverage at a lower rate.

If you choose the right Medicare Supplement Plan (like Medicare Supplement Plan F) you will never have to pay a single dollar when you receive treatment in a physician's office, hospital or specialty treatment center that accepts Medicare.

Medigap Insurance Costs differ between Medicare Supplement Insurance Companies for the same coverage. This is why it is important to work with a Medicare Supplement Broker who will help you find the best Medigap rates and plans.

How Much Money Can I Make As A Medical Insurance Biller And Coder?

How much money you can make as a Medical Insurance Biller and Coder is one of the first questions people ask who are interested in taking medical billing training. I've included coding here since some many schools combine billing and coding courses and programs now and there are good reasons to be familiar with how to do both.

You may not need to do actual coding if you are a biller but you will need to understand codes. Likewise you may not need to know how to do billing if you're a coder. This is all going to be dependent on the company that hires you and there are hundreds of variations related to a job as a medical insurance biller or medical coder.

The amount of money you'll make or your wages and salary as a Medical Insurance Biller and Coder will depend on how much education you've had and what kind of medical billing training and how much experience you've had. You may make more money in a billing service that focuses on medical billing than you would if you worked in billing in a doctor's office or even a large medical office.

The salary range can vary a great deal from $25,000 on up. If you start your own medical billing service you'll make more money perhaps once you have the clients but you'll also have more expenses and overhead to contend with. And getting those first clients will not be easy.

You can work part-time and full-time in billing claims services. Many opt to work part-time to get their foot in the door and gain some experience then approach large companies and offer their resume, experience and services.

What your salary or wages will be shouldn't be the only criteria for working in medical billing and coding. You want to make sure you'll like the work and would be happy. Also you want to get your training in the minimum amount needed and without paying a lot of money outlay before you know that you'll like the work and be happy go to work every day.

You can call your local billing services and ask for the Human Resources Department and ask what the pay averages for a Medical Insurance Biller and/or Medical Coder. Some areas of the country pay more money than others and you'll get a good idea if this field is the best fit for you in terms of salary.

What Medical Billing Job Ads For Specialists And Medical Billers You Should Look For

If you've spent any time looking for a medical billing job you know that there are a wide variety of jobs that could fit the bill. Oftentimes it's not clear in the title of the ad what they're looking for. But after looking at ads for many months I've found there are a few important things to look for.

The most important thing I think is once you've found the medical billing ad or billing specialty ad, whether it's on Craigslist on in your local newspaper, is to read the ad all the way through. They're looking for the best person they can get with the experience they want. They will start out asking for certification or an associate degree or related education but if you read the entire advertisement all the way through they often say they'll exchange experience instead.

I recently read one ad that strongly asked for medical being certification or an associate degree but farther on down the ad clearly said they would exchange that for experience. Many people by that time may have tossed the ad aside or closed the window on Craigslist.

Employers are really trying to find someone capable of doing the job and are less interested in the medical billing certification or degree. Experience is what they need and they don't care how you got it. Often someone with experience will outdo someone with the degree in that field who has little medical billing job or career experience.

Let's say you've found an ad for a medical biller or related job. Perhaps you have some office experience and it's in the insurance or health fields. You may have worked with billing somewhat so it's certainly worth pursuing. I would submit a job application and detailed resume focusing on your experience that is related for that job. They may not be able to find someone with the medical billing certification or college degree they're looking for.

It can be discouraging sometimes when looking for a job or maybe you're just scouting out what type of ads are out there for billing specialists or medical billers or assistants. But if you're serious about looking for a medical billing job I would apply to any that sounds within reason. Others may be too discouraged or don't think they have enough experience to even apply. It's always worth a try. As they say - nothing ventured nothing gained. You have nothing to lose and will gain more experience in the job application process.

International Traveling and Your Health

This is the time of year when many people travel, some internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

- You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have US based medical coverage.

- Medicare does not provide coverage for hospital or medical costs incurred abroad.

- Senior organizations can assist with obtaining foreign medical coverage for Medicare supplement plans.

- US consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.

- You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, any medical bill and claim resolution which may be needed to decipher charges may be difficult to do while abroad.

Other Considerations

If you are older or have a disability and will be traveling out of the US, there are other things to consider:

- The conditions of the local area. For example, is there any local topography (like high altitude) or climate conditions (hot and sticky) that may have an effect on you?

- Your own preparations. Avoid a lot of physical activity when you are getting ready for your trip. Realize that sudden changes in diet, climate and physical activity can have serious health consequences for an unseasoned traveler.

- Find out what you can about the standards of accessibility for travelers with disabilities in the country where you are going. Also, the Department of Transportation has published two informative pamphlets: New Horizons for the Air Traveler with a Disability and Plane Talk: Facts for Passengers with Disabilities, that will help you.

For any situation, speak with your physician about your general physical condition and the activities you are planning to do while on your trip. This discussion should include decisions on any medications you are taking and immunizations that may be required.

In addition, if you have medical expense coverage and you are travelling out of the US, contact your insurance plan representative to see if you are covered. If not, decide whether you need to purchase a travel insurance and/or a medical evaluation policy.

There is more information available on this topic at the US Department of State site: http://www.travel.state.gov.

Effective Marketing for Your Medical Billing Service

Marketing is the hardest part of medical billing for most owners of medical billing services. Billing, entering charges and payments, submitting the claims, following up on denied or unpaid claims, that's the easy part. Getting the clients is usually what holds most people back. Dan Kennedy (a very successful marketing consultant) says that "marketing is not something you learn, it's something you do". He's absolutely right.

We all know ways to market. Some are easier than others, some cost more, some require us to get out of our comfort zone. It's not that we don't know marketing techniques. In most cases it's that we really don't like to market. Nobody likes rejection. I don't think anybody gets up in the morning and says "Yes! I should get about 20 'no's' today!" So we avoid it. But it is a very necessary part of a successful billing service.

Avoiding marketing only hurts ourselves. It doesn't hurt the providers we aren't marketing to. Unless you truly believe that you are the only billing service out there that can provide the service to get them reimbursed all that they are entitled to. Avoiding marketing prevents you from growing, and taking your business where you want it to go.

OK, so we've established that marketing is a necessity to grow your business. So what can one do to make marketing less painful? Well one strategy is efficiency. If you develop your marketing to target providers that will most likely be interested in using your service you will reduce the number of 'no's' you will get. For example, if you specialize in a certain field then you would want to target your efforts in that field since you can use your expertise in that field as leverage.

Another way to make your marketing efforts more efficient is to do some research about the providers you are going to market to. If you have some clients, you can ask them if they have any colleagues that they feel may benefit from your services. Doctors talk to each other. They know who is having issues in their offices. If you are doing a good job for your doctor, they should be willing to refer you to others. Make sure you ask if you can use their name. It always helps to say "Dr. Soandso suggested that I contact you."

The best way to make marketing less painful is to do it smart and make your marketing efforts more effective.