Coping with financial challenges in US healthcare


A Brief Anatomy of Financial Challenges Faced by Physicians

The US healthcare system is facing major reforms in the next two years and this not only includes adoption of new healthcare IT reforms such as EHR (Electronic Health Records) and EMR (Electronic Medical Records) but also changes in the way physicians are reimbursed. The most crucial aspect of health care in the United States is cuts in Medicare which would leave doctors with reduced revenue resulting in dropping of Medicare patients by physicians. This 21% cut in the reimbursement for Medicare is scheduled to take effect on January 1, 2012 and would have negative financial repercussions for physicians, clinics, hospitals as well as patients. However, President Obama mentioned in a Whitehouse weekly address that such cuts would be unfair for health providers and the senior citizens of the country adding that this problem can be counteracted by reducing abuse and fraud in the health care industry.

The Overheads
One of the major problems that physicians and health providers face is the overheads that amount to more than 40% of the revenue that is earned. In an era where baby boomers are at their highest, it does not make sense to drop Medicare patients when the cuts take place (if they, in fact, do take place, which is unlikely). Instead reining in the overheads can work wonders if the cutbacks happen. Getting partial or even full-time support for billing and coding requirements as well as other revenue cycle management areas from expert professionals can help healthcare providers in cutting costs to some extent. It also frees up the staff to focus on voluminous core areas such as patient care and research etc. Apart from that, getting experienced and expert support for medical billing and coding and denial management can reduce avoidable errors and improve revenue as well as save time and efforts.

Revenue Cycle Management
Revenue cycle management is an integral part of a financially successful physicians practice and optimization of the same can lead to prevention of losses due to an inefficient or ineffective revenue cycle management. The process of revenue cycle management is a job that requires meticulousness and understanding the technology that boosts the outcome of such management. Using the latest technology can not only increase the revenue by saving time but also through the incentives provided by the government for using such technology. However, successful revenue cycle management also entails shorter turnaround time for reimbursement and efficient and productive interaction with payers which can be done much more effectively by a dedicated and professional team of medical billers and coders rather than a physician’s assistant.

Codes and Ethics
The transformation from ICD-9 codes to ICD-10 codes is going to impact the finances and the cash flow of hospitals, clinics, and physicians because of the complexity and increased volume of codes. The number of codes are going to increase more than six times and handling and navigating through this maze of medical codes would increase the chances of errors. To solve this problem, it is imperative that physicians and healthcare providers hire dedicated medical billers and coders who are experienced and trained in utilizing ICD-10 codes. Moreover, HIPAA guidelines also require that patient privacy be given paramount importance since information would be transmitted to various entities using the internet. To establish patient data privacy, the healthcare providers need to ensure that the third party vendors who support their administrative, technical and revenue cycle management are fully conversant with HIPAA privacy laws, as also their staff has stringent training in HIPAA compliances as they are the first ones to handle PHI data. This would ensure that HIPAA guidelines are not compromised even by mistake and they do not have to bear the financial brunt of breaking such regulations.

Facing financial challenges in the current scenario is not likely to be easy but for long term gains and standardization it makes good sense to initiate meaningful changes and actions now. And doing this with an expert’s support will only establish those changes more efficiently and effectively in the physicians’ practice. For more information on how to bring about desirable changes to enhance your practice and revenue management and move ahead in these challenging times, please visit Medicalbillersandcoders.com – the largest consortium of healthcare professionals dealing with Financial Challenges in the industry.

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