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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.

Dont let 55,000 more Codes Faze you !

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Is 10.1.2014 a Date set in Stone ?

Much to the consternation of physicians, according to the department of health and human services, it most certainly is. After frequent postponements, much hullabaloo and divided opinions, a date has been finally announced to make the transition.

Though the granularity in codes can lead to more clarity and a more structured coding system, most codes physicians fume, are never going to be used.

An Expensive Change !

Change comes with its own baggage. Now healthcare providers will have to make major changes to the infrastructure and workflow of their practice, to accommodate the revised coding system. One of the biggest roadblocks is to train staff and set up a testing schedule, amidst busy workdays. The slew of recent changes in healthcare informatics and billing regulations is going to leave physicians with little time to catch their breath.

What Defines ICD 10 ready ?

This is a question that stares at the face of every healthcare provider today. Most find working with codes that are not going to be of any purpose or use till 2014 a drain of time and human resources. But, the time to start gearing up for the change is, now !

Small Steps can make Huge Strides.

Small steps can shorten the path to adapting to an entirely new coding system. One easy way for medical practices, to stay ahead of the curve is to have a database of ICD10 codes that they’re most likely to use. This will get the “55,000 more codes” scare out of the way.

Assess the Impact of ICD 10 .

Performing a realistic and comprehensive assessment of the impact that ICD10 is going to have on your practice is essential. Draw a bucket-list of the aspects of your workflow that are going to undergo major change during the transition, and start a testing plan on them. Educate staff members or if you work with a vendor request for a detailed plan of action to deal with the onslaught of codes.

Being quick and informed can beat those deadline blues, and make your practice truly ICD-10  ready ! Whether you are planning on creating a training program for your team or ask your ICD-10 medical coding services company to set up an implementation plan, do it today !

Important Decision Making Factors to choose a Medical Billing Company

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Tick all your Boxes before Making that Call !

To trust someone with your medical practice’s future is not an easy choice. But a choice that medical practitioners and practice managers are forced to make. Due to evolving guidelines and the need to be on top of them, physicians all across the country pin their hopes on medical billing companies Not spending enough time on checking the facts can dash hopes and lead to bitter arguments.

A quick checklist of what you need to keep in mind before making that call.

Know what your Bill is !

You don’t want to receive a fat bill whether you get paid or not. Option for a billing company that charges a percentage of your collections. Ensure that the percentage is fixed. This will drive your biller to collect more and also save you from spending dollars when you aren’t earning any.

Truth is in the Details…

A lot many physicians just ask for the names of a few clients and projects, the firm’s handled before, and leave it at that. It is always advisable to shoot a mail or make a call to existing clients to cross verify facts. Like they say, the proof is in the pudding.

24×7 is not Enough !

A 24×7 firm that never sleeps looks good on paper. But the focus should be on what difference that can make to your practice? Whether it will help in quickening your workflow or not ? Ask for a detailed, blow by blow account, of their work process.

Be in the know…

It helps to always be at the driver’s seat. Somebody else to work on your claims and make that long calls to insurers is wonderful. But that doesn’t mean you loosen your tie and take the backseat. It is the physician who is held responsible for billing errors. Ask for regular work reports and fix up the cracks instead of falling through them.

Scout for Someone who understands your EMR !

Most healthcare providers use an eclinicalworks emr billing services or ehr system and have gone the electronic way. Whether you use an emr or planning to make the transition, ensure that your biller understands the workings of it. This will help in cutting down mundane tasks such as pasting records.

Go beyond what the brochures claim, and invest a little time on choosing a concern that is the best suited to your needs.

Do EHR’s really help Physicians take the Back-Seat ?

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An Electronic Health Record (EHR) is quite arguably the single most expensive investment a physician is ever going to make. An increasing number of medical practices are taking the electronic route. Implementing an EHR is just one small step towards a more streamlined medical practice. It is not a magic vehicle that can help you reach your goals faster. But focus and constant effort can help you reach there.

Geared up for Change  !

An EHR can revolutionize your workflow. It leads to greater operational efficiency and helps different departments, specialists and healthcare facilities to access and share data effortlessly. But the huge change that it can bring to your practice may not always be for the better. The shift can unsettle your existing revenue management system.

It is imperative for physicians to upgrade their revenue cycle and better optimize its functions to support the new entrant into the office. The most critical components of the revenue management system such as claims submissions, insurance verification and front-end processes need to be reworked to work in a new environment.

Are all your Claims Clean ?

Yes, an EHR greatly automates your workflow process and helps in maintaining accurate medical information. But quite disturbingly there have been several hospitals that have been warned for misusing an ehr to create falsely inflated claims. The lack of clarity in CMS guidelines is cited as one reason for physicians to make billing errors.

But the major reason could be that physicians are still learning the ropes of working with a new system.

Better Patient Communication and Care…

This is a debate that has been raging in Linkedin, Facebook and near the water cooler for the past few months. Can an EMR or EHR system truly help the doctor to spend more time with patients? It does help save on time and effort but whether an ehr can help in better communication, is still being debated about.

EHR’s certainly a Quantum Leap into a Better Future !

EHR’s are a huge, collective step forward for the healthcare industry. It is certainly going to light the way ahead and be a catalyst of change. But EHR’s cannot in themselves create a more profitable or efficient medical practice. The other important parts of the puzzle such as revenue cycle management services , patient communication and everything in-between needs to be fitted together to create a pretty picture !

 

How can Multispecialty Hospitals Tackle the Challenges Ahead?

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A busy multispecialty hospital resembles a war-zone. The audit issues, billing hassles and operational pitfalls faced by multispecialty hospital are more difficult to manage than the challenges thrown at single specialty hospitals. Office managers of multispecialty hospitals feel that they’ve bitten off more than they can chew. Keeping in line with almost unfair demands and regulations can be a nightmare.

 

Frequent Audits give Sleepless Nights  !

Facing billing audits can scare the daylights out of physicians. CMS has placed the onus on healthcare providers to create and maintain evidence based precise billing information. In a large scale set up the costs and infrastructure needed to maintain accurate medical documentation belongs to the realm of wistful dreams.

The billing regulations for each specialty, varies and a little slip-up can lead to the hospital being booked for fraud and abuse. But this not the only roadblock multispecialty hospitals face.

 Zeroing in on a Compensation Formula that works for Everyone…

Well, coming up with a compensation formula that makes everyone happy can be an uphill climb. Multispecialty hospitals have on board, specialists from different medical specialties, surgeons and imaging technicians. To come up with a compensation formula that is fair and in compliance with all regulatory controls, in today’s tough healthcare climate is almost next to impossible. It requires enormous amount of time and understanding to whip up a solution that makes everybody smile.

Is it the Best time to become a part of Multispecialty Groups ?

Surprisingly yes! According to the Great American Physician Survey an increasing number of physicians prefer employment than to start a practice of their own. This attitude shift is attributed to the responsibilities a medical practice owner is likely to face.

Working with Off Shore Firms…

Outsourcing medical billing needs is one way of ensuring profits and operational ease in a multispecialty set up. Hiring, training and monitoring large team of billing and coding professionals can only add up to expenses. To scale down on the efforts and money spent on the everyday workflow of a hospital, outsourcing is the preferred choice.

It will give doctors more time on their hands to fix a workable compensation formula, keep regular tabs on their workflow and keep abreast with changing guidelines and reforms. As most medical billing companies work round the clock the response time for additional documentation requests is swifter and being swift is best way to handle the challenges ahead for multispecialty hospitals.