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5 Reasons Why You Will Love To Partner With MDSPROUT?

Handling multiple patients at once can bring a lot of paperwork to your table. As a healthcare provider,

you may have no time to rearrange vast data of rendered services with suitable codes in your practice.

On one hand, hiring staff for the job proves a costly affair but your compliance gaps are left

unaddressed. On the other hand, patient visits to your office are on the rise and so is the volume of their

medical records. Over a period, you realise the amount of revenue you lost on countless arrears which

seriously affects your workflow. This eventually limits your practice management and could prove

insufficient to payer requirements causing inevitable payment delays and even unwanted claim


In all this, there is a wiser option – to outsource your medical billing to companies that can best

customize their solutions to your billing woes. Lower cost factor is unequivocally the prime motivation

behind opting for outsourcing. Usually, companies charge only a certain percent of the collections you

actually make, which could save your practice up to tens of thousands of dollars each year. But here are

5 quality reasons why providers must hire a medical billing company besides the advantage of

phenomenally low costs.

1. Tech-Savvy team of medical billing experts

Medical billing companies are a treasure-trove of well-trained coders and certified billing professionals

who are employed specifically to cater to their clients with an incredibly high turn-around time. With

their assistance, the scope of billing errors for any practice could stand at an all-time low, which means

drastically lower resubmission costs of insurance claims. Billers are also proficient with legal, medical

and insurance terminologies and healthcare plans, which means they are aware of payer requirements

and billing priorities that lead to more accurate claim submissions and little or no denials.

2. Timely reimbursements and higher cash flow

Medical billers are very good at step-by-step management of work where no arrear is overlooked. They

create and translate superbills to claims most systematically, making sure that charge capture is on

target. All this in just few days from the date of service. Claims are then immediately posted to payers

through most efficient third-party web platforms that ensure timely reimbursements of your rightful

earnings. Such revenue cycle management model brings higher payment velocity earlier than the

average rate and net collections higher than the previous average amount. In fact, the undivided

attention you get from medical billing companies helps you gain upto 200,000 dollars annually in net

collections on average, that would have otherwise been lost in with poorer charge capture and

observation anomalies the in-house scenario.

3. Lower administrative and infrastructure costs

If the practice is fairly new and is looking out to save administrative costs, then outsourcing medical

billing can help save up to 55% of its annual average income that would otherwise have been spent on

staff salary and other human resource-related benefits. Infrastructure costs of setting up an office

space, equipment and maintenance of the same on a daily basis could incur you a sizeable fraction of

your expenditure which you can completely avoid by partnering with a medical billing company.

4. Longer interaction with your patients

Two parameters that have the capacity to single-handedly determine the success of your practice are

greater patient satisfaction and therefore, greater patient inflow. Both are significantly enhanced if

practices opt to outsource their medical billing. It specifically benefits small groups of practices that do

not have the bandwidth to handle the financial side of the practice simultaneously with interacting and

being courteous with patients. Medical billing companies will help save time, increase productivity and

encourage the existent providers and other medical staff to concentrate on their respective specialties

and practices. The uninterrupted nature of professional assistance by doctors and support staff is what

makes a lasting impression on patients and auditors alike. Hence healthcare providers must devote their

time to patient care and core activities by letting medical billing companies responsibly takeover your


5. Total compliance, hence better ratings

Medical billing companies take care of your credentialing and compliance requirements as under the

Health Insurance Portability and Accountability Act, 1996, as well as various healthcare plans that have

constantly changing regulations. Monitoring the gaps, eliminating them and achieving successful billing

cycles is a full time job that medical billing companies will be dedicated towards till the very end. This

automatically leaves a good impression on audit reports, brings in higher profits and efficiency and

enhances the overall image of the practice within the medical community. Even CMS takes note of the

multi-dimensional progress and feature the practice as one of the best medical spaces that patients can

opt for.

ICD-10 has arrived. Are you there yet?

ICD-10, or the 10th edition of the International Statistical Classification of Diseases and Related Health Problems, is a high-in-detail, more advanced and optimally flexible set of medical terminologies classified by the World Health Organization (WHO).  Post October 1, 2015, the ICD-10 version serves as the current coding norm for all medical services rendered in all identified levels of diagnosis and hospital procedures.

While most information and training modules about ICD-10 are available online, practices need to be more proactive in mastering it at the earliest. MDSprout thought it fit to write about why it is so important, what is the current medical scenario and what you must make sure immediately, so you could better position yourself to kick start the journey:

Why should you switch to ICD-10 as soon as possible?

Firstly, it is mandatory that all HIPAA-covered entities comply with the new code set with dates of service or date of discharge for inpatients occurring on or after October 1, 2015. In fact, the date of ICD-10 implementation has been pushed back for over 6 years and the Department of Health and Human Services has announced that there could be no more relaxation period. Moreover, CMS had recommended much earlier that medical practices must take several years to prepare for implementation of the new code set.

Secondly, staying in the ICD-9 zone would mean that your cash flows will be negatively affected. This is because all ICD-9 codes used in transactions for services on or after the deadline will be rejected by healthcare insurers as non-compliant.

Thirdly, if you have transitioned into ICD-10 partially, then almost all transactions may face compatibility problems with software and contract provisions at the payer’s end, therefore causing delayed or rejected payments.

How is it going to make my medical practice easier?

Like all mandates, there’s a brighter side to ICD-10 compliance. One of its major benefits is a vastly detailed code list with over 14,000 specific codes, the option of sub-classification and the much-needed space for additional data fields. This may seem longer at first sight but with a closer look, you discover that ICD-10 is systematic, clinically more accurate and comes with simple guiding tools that help you find the right codes instantly, without having to search the entire list. ICD-10 also gives you room for unspecified codes, especially in the case of signs/symptoms and external injuries while most EHRs help you translate ICD-9 codes to ICD-10. What’s more? If you look at the code set by specialty, you discover it’s not so long after-all. There is richer dataset for big data analytics and population health management in the long run.

What are some problems that other practices are reported to be facing in the transition?

Since October 1st, 2015, there have been reports that providers are depending on the flexibility provision of the ICD-10 coding system where they use native coding and other via techniques to convert unsupported medical evidence to specified codes. But this may not prove fruitful since they must inadvertently be familiar with the first three digits of ICD-10 codes correctly in order to avoid an automatic denial for CMS claims.  CMS had also warned against such use well before the implementation deadline.

While initial difficulty with learning and using documentation software has been reported by various practices, the emergency department seems to be facing some hindrance in workflow due to its urgent response requirement. With the end-to-end relationship with payers, a surge in technical problems and query communications have been reported. Additionally, the perception that the new code set is complex to comprehend and memorize has led to slower transition and high denial rates of medical necessity diagnosis

But it is important to note that more clarity is expected only a few months post the deadline. Most organizations around the United States have already submitted their first round of ICD-10 claims. Once they receive Explanation of Benefits on these claims, they will be able to assess the exact reasons for payments or denials and may share the information for better awareness in the medical community.

What are some things you should do right away to get on board?

For uninterrupted cash flow, MDSprout’s experts have put together a comprehensive plan that every practice can adhere to. Here are some tips:

Electronic Health Records are critical to success. Practices must make sure that their EHR is upgraded to the latest version with the ICD-10 coding engine, guiding crosswalk,  all other necessary plug-ins and software updates. It is equally important that vendor software and third-party web platforms stay complaint with the payers’ software so that medical billing is brought in line with in-house documentation.

Once all networking systems are updated for use, practices must run a few mock drills to ascertain if there are more technical glitches to fix before using the process in a real-time scenario.  On the administration front, there would be a need to develop fresh policies, update paperwork and medical forms to keep in line with the online transformation.

The most crucial part arrives. Medical practices must train its physicians, staff members and other administrators through holistic education modules on coding and clinical documentation. Short courses on specialty-wise codes and engaging workshops on medical trends are some ways one can achieve this. In fact, the ICD-10 version itself motivates the physician or provider to note detailed daily progress, capturing the complete clinical picture of the patient, which will comply with ICD-10 oriented clinical documentation, EHR entry and finally, successful claims processing . We recommend that you use native coding and unspecified diagnosis in times of doubt or absence of definitive diagnosis, but not entirely depend on it.

On the financial management front, practices can prioritize funding plans for coder education, clinical documentation improvement and medical billing strategies to leverage as much revenue generation as possible.

Overall, practices must be aware that CMS regularly releases clinical rankings and information related to compliance and high performance. To feature in one of the most note-worthy positions on these lists, practices need to put that extra effort to complete their ICD-10 transformation successfully and in a time-bound manner so it may directly reflect in their workflow, quality of services, financial growth and finally, significant reputation in the medical community.