MBC Helps Internal Medicine Specialists In Florida Tackle Medicare & Medicaid Fee Parity Initiative Challenges


Medicalbillersandcoders.com’s internal medicine experts have recently witnessed an increasingly high demand for medical billing services in Florida. MBC recognizes that this is partly due to several professional challenges intrinsic to the discipline, and also due to the fact that Florida is amongst the lowest paying states for Medicaid internal medicine specialist rates.

This dismal state of payment owes mainly to the fact (apart from Florida being a low fee center) that the services provided by internal medicine specialists come under Medicaid which involves much lower rates than Medicare. To bring about a balance between Medicare and Medicaid, medical authorities have equaled Medicaid rates with those of Medicare on a pilot basis applicable until December 2014.

But, alas, at a state level, this will significantly alter policies, claims systems, provider databases and data reporting. MBC realizes that these state-level policy and procedure alterations will drill down to change the way internal medicine specialists make claims and track claim-related documents. MBC has been helping many internal medical specialists in Florida to handle challenges arising from this new rate parity.

MBC noticed the following areas will be of prime concern for internal medicine specialists-

  • Only physicians practicing in certain areas of primary care (internal medicine specialists being one of them) qualify for the increased rates from Medicaid. Physicians have to fill out appropriate forms and furnish accurate documentation to establish their credentials with Medicaid authorities to procure the rate hike
     
  • Physicians will have to establish that at least 60% of their Medicaid reimburse claims submitted the previous year to Medicaid were made using primary care codes recognized by Affordable Care Act

The challenges outlined are going to affect internal medicine specialists in all states that are undergoing this fee parity initiative. But MBC understands that the challenges are going to affect the specialist differently depending on size and nature of the practice and consequently has a different approach depending on the practice.

MBC’s role in assisting Internal Medicine physicians in Florida

The challenges outlined above evidence various areas of concern like- right documentation, staff training for appropriate use of codes, tracking codes which have been used previously etc.

As part of the Revenue Cycle Consulting services, MBC performs-

  • Thorough assessment of your operations
  • Improved documentation and accuracy in billing and coding
  • Works out areas of operational lapses and revenue leakages
  • Improves in-house operations by spotting areas of revenue leakage and staff training
  • When required helps replace old software applications with new
  • Helps implement improved RCM and regularly tracks the process

Many internal medicine specialists from small to large sized set- ups, in Florida, have opted for MBC’s services entirely shipping out their billing and coding responsibilities to MBC – so that their staff can continue to focus on medical activities even as they seamlessly realize claims becoming beneficiaries of the rate increase rather than its victims.

MBC has helped internal medicine specialists overcome challenges linked to fee parity initiative-

  • MBC guides those physicians who qualify for the rate hike to understand which areas of their medical services qualify and realize payments by helping submit appropriate medical information to establish their credentials with Medicaid authorities
     
  • Most internal medicine specialists use Medicaid primary codes; but proving a year later that at least 60% of their reimbursements were procured with Medicaid may be a challenge. MBC helps physicians identify proper documentation and furnish appropriate details
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