Medical Billing Blog

MBR Take-Aways

1. There are five different coverage options, all with a different cost structure.
2. All plans will include a basic list of benefits.
3. The Affordable Care Act does not require coverage for dental, vision, disability, life and critical illness to be listed on the exchange. 

MBR Take-Aways                      

1. The “silver plan” will cost an average of $328 a month for individuals across the US
2. Prices were lower in states with more competition among insurers and higher in states with fewer players
3. The Obama administration is counting on signing up 7 million Americans in the first full year of reform

On Tuesday, the Obama Administration released the first detailed look at premiums to be charged to consumers for health insurance bought on the new insurance markets mandated by the 2010 Patient Protection and Affordable Care Act. Information released on Tuesday is based on approved insurance plans in the 36 states where the federal government will operate the insurance exchange.

You worked hard to get through med school and specialty training, and you like to think it’s all paying off in increased earnings because of your credentials.  You’re genuinely concerned for your patients, and take pride in providing the best cardiovascular care available.  You can’t imagine why anyone would opt to receive the same services from another provider who doesn’t have the same c.v, especially when patients don’t set payer rates, so why would you think you should settle for anything less out of your billing service?  

On Jan. 25, 2013, the Department of Health and Human Services (HHS) published the “Omnibus Rule,” which is a final set of regulations that enforces various provisions of Health Information Technology for Economic and Clinical Health (HITECH) Act which in turn is designed to enhance the Health Insurance Portability and Accountability Act (HIPAA).  In general, the new rules expand the obligations of physicians and other health care providers to protect patients’ protected health information (PHI), extend these obligations to who has access to PHI, and increase the penalties for violations.
There are basic areas providers will need to comply with:

The healthcare industry is changing rapidly and providers are facing many new challenges, with ICD-10, meaningful use, and fee schedule reductions being only a few. If you feel like there are just too many cats in the herd, there is one area where you can take control of the situation, and that is by re-evaluating the effectiveness and adaptability of your billing function.  Whether you have an in-house billing staff, or an outsourced revenue cycle management team, it’s crucial to make an accurate assessment of the processes associated with your billing function to ensure that you are not part of the majority of practices expected to face serious cash flow problems when ICD-10 goes into effect next October. 

When the transition to ICD-10 officially begins on October 1, 2014, those in the US healthcare industry will be in a position to benefit greatly from lessons learned by our neighbors inCanada, who also recently made the transition between 2001 and 2004.  Canadians already experienced similar transition situations to what the United States will be facing according to Cindy Grant, Certified Healthcare Information Manager (CHIM) and ICD-10 practice lead at TELUS Health Solutions in Toronto,Ontario; and Kerry Johnson, MAEd, CHIM, senior lecturer and HIM instructional coordinator at the University of Ontario, Institute of Technology in Oshawa,Ontario.  Coders in Canada struggled most with anatomy and physiology, not the coding logic itself.  "It wasn't so much the coding system and how the codes work," says Johnson.  "We found them struggling with anatomy and physiology and understanding what exactly the intervention was, including determining the root operation."

A recent survey conducted by the Workgroup for Electronic Data Interchange (WEDI) regarding the preparations for transitioning to ICD-10 being conducted by healthcare providers shows that nearly half of the survey group either have not started preparing for ICD-10 or do not know when they expect to start their testing. 

The new PCI codes introduced into the CPT Code Set in 2013 may seem confusing, but it’s worth wading through the information available, since their use can more than make up for revenue lost to fee schedule cuts and previously non-reimbursable procedures and decision making.  In fact, creation of these new PCI codes represents a positive response to requests from providers for revision of the codes to allow payment for actual services performed.

Managing a successful medical practice involves more than just practicing medicine.  You must also view it as a successful business, and put into place sound business practices, as well.  Many providers are seeing their revenues decline as payers are reducing fee schedules, so it’s more important than ever to collect every dollar that you’re entitled to, and to manage how you budget that revenue to keep your practice running in the black. 

The HITECH Act (Health Information Technology for Economic and Clinical Health) was passed in February 2009 as part of the American Recovery and Reinvestment Act, it expanded the obligations of covered entities and business associates to protect the confidentiality and security of Protected Health Information (PHI).  Passage of the HITECH Act was timely because its main purpose was to address voids inherent in HIPAA due to the development of new technologies that did not exist at the time HIPAA was originally implemented.