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Make Sure Your EMR Doesn’t Make You Face Medical Billing Malpractice Charges

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EMR-Overbilling

Beware your EMR could land you in a tight spot !

There is a lot of dust raised about EMR’s again. According to recent reports an EMR can lead to inflated costs and fraudulent billing. Allegedly, physicians have added about 11 billion more to their fees, over the last decade alone. The Center for Public Integrity’s “Cracking the code” series, has found that the usage of EMR/EHR’s have resulted in widespread billing malpractices.

More to it than meets the eye…

Healthcare experts argue that this a strong marker of the negative impact, wishy-washy rules can cause. It can not only make physicians vulnerable to fraud and abuse charges, but also be potentially life threatening for patients. Mostashari, the National Coordinator for Health IT rues that “documenting care that didn’t occur, that’s not just fraud, it’s really dangerous medicine.”

It is being argued that the system is flawed. And it is high time the government sat up and took notice before it snowballs into a huge issue and causes irrevocable damage.

Has coding higher become par for the course ?

Upcoding is rampant. And emergency rooms in particular have been pulled up for assigning high level codes, despite the treatment not warranting it. Whistle-blowers  worried physicians and confused patients are making one collective demand. For, strong auditing tools, and transparent uncomplicated regulations.

The new CMS directive !

The centers for Medicare and Medicaid have issued a new directive to restrict billing malpractices. Federal authorities will be keeping a close eye on EMR users to curb this unhealthy trend.

Where the cracks appear…

Physicians are unusually busy people. Most doctors fume that EMR’s have reduced them to efficient machinery. Nobody likes to sit, and copy paste information. Or, working with straight out of a can, point and click templates. Long loading times and a maze of options can drive physicians round the bend. Impatience with the system, more than the willful intent to over-bill  might be the reason behind improper billing.

A quick guide to bill right !

  • Train your billing team to work closely with your EMR/EHR system.
  • Use an accredited medical billing software.
  • Conduct regular in-house financial audits.
  •  Ensure the same information isn’t entered again. Redundant data is the major cause of over-billing.
  • Educate your practice about CMS guidelines and updates.

Has the Doc-Fix formula saved Physicians but put Hospitals in a Quandry?

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Happy New Year !

The year started on a high note for healthcare professionals. The SGR formula that meant 26.5% cuts in reimbursement has been averted. But nobody is popping the champagne just yet. It is a temporary reprieve and only means that physicians can continue seeing Medicare patients, without the fear of working for free. Till the end of this year.

Left to pick up the Tab !

As the healthcare industry, should by this time know, no reform comes without a heavy price to pay! Hospitals have been forced to face the brunt of the “Doc fix solution”. Heavy operational costs and compliance pressures are giving hospitals, sleepless nights. An additional pain of decreased payment is certainly not what they need, at this juncture.

Bedridden Hospitals…

Many feel that the recently released deal to avoid the fiscal cliff is only going to help in pushing pressing problems, down the stream. The 10 million dollars reduced Medicare payment to hospitals, coupled with the ACO cuts, can lead to bedridden hospitals.

Both Peter and Paul are unimpressed !

The latest move by the government has come in for scathing criticism.

With Chif Kahn the president of the Federation of American Hospitals, to famously quoting that it was like “robbing Peter to pay the fiscal cliff of Paul”.

Though physicians are happy about escaping from the deathly blow of almost 30% cuts in reimbursement. The growing need and frustrating lack of a permanent, workable solution has left neither physicians nor hospitals particularly thrilled with the new arrangement.

Can hospitals manage to stick their neck above water ?

In the present climate it is important for hospitals to take a stock of the situation and act quickly. Hospitals will have to create an annual budget that excludes unnecessary costs. Utilize every resource available whether it is manpower or healthcare IT, to the maximum.

Operational costs need to be reduced to at-least break even for most hospitals. Outsourcing is an option that can cut back on expenses. It requires smart out of the box thinking. Identifying and eliminating money drainers. And start the year with a new and revamped revenue cycle, lots of positivity and a smart annual budget.

Is Consolidation an Imperfect Solution for Small Practices ?

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Are Small Practices Given A Rough Deal ?

Your friendly neighborhood small practice could soon belong to the hazy past. The growing regulatory and financial pressures on independent practices have made most of them gravitate towards big hospitals. Economic realities and a spate of regulatory thresholds are making small practice owners seek shelter under the relative safety of big practices.

Hurried Goodbyes…

Almost every recent stat released recently, Point to just one thing, The demise of small practices.

According to a study by Accenture only 36% of physicians will have a practice ownership stake in 2013. 87% of participants complained that sky-high operational costs were the major reason for most of them to bid goodbye, to, The independent model of working.

Acquisition of small practices is growing at an alarming rate. But will this be the remedy for struggling physicians?

Bigger Not Always Better !

Mergers and consolidations are hoped to bring about positive change. The much needed respite for small practices battling a lopsided battle. But they aren’t a foolproof solution. A recent controversy surrounding a major healthcare provider, has posed a question that nobody has an answer for. What is the future of small practices ?

A, Whole Lot Of Dust Raised…

If somebody told that the calm metropolis of Boise, would stage a fierce medical battle, It might have sounded like a joke a few years ago.

Cut to 2012 St Lukes health system, found itself in the midst of controversy.

Independent doctors complained that referrals were dropping steadily and of almost complete domination by the health system.

An Echo Of A Hundred Other Voices !

Repeatedly, large scale health systems have been in the news for dominating and pressurizing small practices to attain difficult financial goals. Everybody is blaming everybody else and very few physicians are happy with the whole set-up.

Opening New Avenues !

Experts argue that it is too early in the day to give ‘consolidations and acquisitions’ the thumbs down. The trend is still young and can lead to better care and lower costs in the long run. It can also put an end to fragmented patient care and documentation.

For Those Who Want To Remain Independent…

What about the doctor who doesn’t want to wait for a pay check every month? There is got to be a way! This is most definitely a challenging time for small practices. But with every challenge comes an opportunity to turn things around !

Operating in less populated, remote, areas that cannot accommodate huge organizations, can provide steady income and clientele. Independent practices can also Outsource Billing to contain costs. In the end what matters most is that small practices must focus on offering a distinct, tangible value for its patients.

2013 Ahead ! Will your Practice fly across the Fiscal Cliff or fall into an Abyss?-Infographic

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Beware Medical Practices 2013 Ahead !

And we are not exaggerating. The whole nation is gone into a huddle, discussing about the eminent Fiscal Cliff. Medical practices, small independent practices in particular, are going to be the worst hit. Across the board sequestration cuts and a 2% reduction in Medicare reimbursement, have left physicians fuming.

716 Billion Payment cut over the Next Ten Years…

The patient protection and affordable care act are aimed at improving the quality of patient care and reduce duplication. But, at what, cost ? From 2013 to 2022 it is going to be one rollercoaster ride for medical practitioners. Hospitals are increasingly merging and affiliating to handle the reimbursement cuts.

Declining reimbursement means, acquiring and consolidating independent practices seems to be the most viable and sustainable model. Doctors, who want to continue to be independent, are facing the possibility of becoming endangered species.

Small Practices Shutting their Doors…

A recently published whitepaper by the Physicians Foundation and Merritt Hawkins suggest that small practices will be uniformly replaced in the coming years. It is a known fact that physicians are under-compensated.

Small and medium practice owners should focus completely on maintaining RUV production at a sustainable level to tackle operational costs.

A Few Ways to Survive the Tough Years Ahead !

  • Review and rework on existing physician compensation formulas.
  • Renegotiate contracts with payers.
  • Develop a strategic plan. Every staff member should remove themselves from the everyday workday, to reflect, and devise strategies to stay profitable.
  • Concentrate on meeting Meaningful Use standards to receive MU incentives while they are still around.
  • Consider outsourcing certain aspects of the Medical Billing Workflow such as  to cut back on costs.
  • As reimbursement models place a greater share of financial risk on physicians, it is important that they focus more on their Revenue Management Cycle.
  • Conduct internal analysis and identify throughput issues.

Bracing for Change !

Change is the only constant. This is the time for medical practices to scale up and meet the financial pressures placed on them. And wait for the regulatory changes to see how they play out !

In-fact, the Fiscal Cliff can even prove to be a good thing. According to a poll conducted by TCB around 51.7 % respondents felt that going over the cliff, could prove to be a good thing after all !

It could induce people to look beyond the tried and tested, and focus on coming up with novel solutions. The reimbursement and tax cuts can help a staggering economy get back on its feet. And, like they say when you hit the bottom the only is up ! As with every New Year, this is the time for reflection, resolutions, and most importantly, hope.

Compliance Thresholds and Reimbursement cuts. How can Radiologists Survive 2013 ?

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Can Radiologists cope with the changes Ahead ?

It is a particularly challenging time to be a radiologist. In fact a majority of radiologists would rather forgo financial incentives instead of participating in meaningful use programs. We all know that MU 1 left a lot to be desired. There were rumbles and murmurs about imaging being sidelined.

The stage 2 meaningful use guidelines is believed to be more achievable and radiology specific. But are radiologists ready to embrace the changes ahead ?

“I have no idea”

Most radiology practices especially solo physician practices have no idea about MU guidelines. A survey conducted by RSNA and KLAS sheds more light into this subject. It is reported that about 40% of radiologists complained about lack of clarity. Or, a steep decrease in efficiency after adopting MU guidelines, were the major reasons why they were reluctant to join the MU bandwagon.

More to it than meets the Eye !

Complicated guidelines that are difficult to report against, no penalties at least for the time being are just the apparent reasons. The pressures and financial stress associated with running a radiology practice are the stuff nightmares are made of.

Medicare Physician Fee Schedule; Can have a Chilling effect…

The reimbursements cuts for the year 2013 will lead to a drop of almost 19% in the collections of radiology practices. A 25% cut for interpretation of images has led to voices of dissent and ruffled feathers. Against this backdrop it is only natural that radiologists are not up to speed with the proposed guidelines.

A lot to cope with !

Compliance and quality thresholds, lowered payments and radiology billing issues ensure that the physicians cup of woes brims over ! There are always a million things to do. And that could well be the reason why adopting the latest guidelines, has found its way to the bottom of the priority list.

Take the First step now !

It is likely that radiologists are going to avoid MU as far as possible. But with challenges come opportunities. Though the pains faced by radiologists are not new, the pressing need to address them is increasing by the day. It is important that radiologists step back and take stock of the situation.

Innovative Solutions ?

Healthcare providers have heard this term all too often. But the remedy that radiologists need is certainly nothing unique or path breaking. It is a fact that good old outsourcing can save radiology practices from sinking into an abyss. Letting third party associates to handle billing and clinical documentation needs can reduce costs.

It can also give radiology practitioners the much needed space to concentrate and adapt to changing guidelines. And with financial incentives being available only till 2016 it is time for physicians to take a call, fast.

Is your Practice Safe Against Fraud and Abuse Penalties?

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You hear it everyday, practices being penalized, physicians being brought to book. But like cancer it is something that happens to somebody else, unless it hits you out of the blue.

Every physician strives to work in an ethical, profitable and secure practice. With Medicare coming down heavily on physicians with improper records, it is high time physicians took a closer look at what they’re billing for.

If it is not in your Records, it never Happened !

And that is why errorless medical documentation is absolutely necessary. The AMA and other regulatory bodies stress on the importance of having clear documentation for every claim submitted. More often than not physicians’ frantically search and put together documents to substantiate their claims, after a rejection slip from the insurer. It is good practice to have the necessary documents supporting your claim prior to filing it.

Small Errors can lead to Big Repercussions.

It is disheartening that most medical practitioners, who are penalized for fraud and abuse, are victims of minor errors. The most common mistake is upcoding. Not knowing how to assign E/M codes for subsequent visits or misuse of modifier – 25 are what most practices are guilty of.

Report Over-Payments inside of 2 months…

Just spotted a billing error? Report it and return the overpaid amount to Medicare and Medicaid funds. Practices who fail to return overpayments within sixty days will be penalized under the false claims act. Regular audits and close introspection of billing reports can help practices to notice and return overpayments, before it’s too late.

The Ball is in the Doctor’s Court !

Though being responsible for so many aspects of a medical practice can be burdensome it is also highly rewarding. Physicians need to juggle a lot many tasks. But the fact that the ball is always in the physicians court, and there is a chance to correct flaws is reason enough to smile.

Physicians need to be more proactive and involved in their billing cycle and the latest guidelines, are a remainder to stay in the loop !

Medicare Fraud one of the Biggest Exposes in Recent times

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The Biggest Expose in Recent times !

The healthcare industry is in the news once again. But this time, forentirely the wrong reasons. Medicare fraud has always been discussed about in hushed whispers. The lack of concrete evidence and mutual finger pointing ensured that allegations and counter allegations, soon faded into oblivion.

A 430 Million Dollar Scam.

We repeatedly hear of doctors being brought to book for billing errors. But more often than not it turns out to be miscommunication between the patient and doctor or not following revised guidelines. The recent expose that indicts over 90 physicians for submitting fraudulent bills and cheating medicare of four hundred and thirty dollars reveals a much darker story.

Higher Healthcare Costs… 

It is coordinated frauds like this that hike up the average patient’s bill, medico-legal experts allege. But the biggest fallout of this scam could be that physicians who make genuine mistakes with their bill could face more stringent action. Not to speak of the loss of faith and belief, of the public.

Steering Clear of the Muck.

Physicians will have to ensure that every claim sent out is thoroughly scrubbed and “clean”. A scam of this magnitude is certainly going to put everybody else in the scanner. And as skeletons keep tumbling out of the closet, the dust is not going to settle down anytime soon. Medical practices will have to be fully aware of, and pay close attention to the billing process.

The Man in the Mirror…

Like the cult song, nothing much is going to change if the man in the mirror refuses to change. No healthcare reform, billing audit or screaming headline is going to bring about a better and safer healthcare environment, unless physicians take it upon themselves to ensure their medical practice bills the right way ! Or call up their physician billing company to ensure that they’re following all billing regulations.