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HIPAA medical billing, HIPAA medical billing and coding, healthcare services, healthcare system, outsource HIPAA medical compliance, Protected Health Information, PHI, billing companies, Medical Billing and Coding Companies, HIPAA violation, HIPAA compliance, HIPAA rules and regulations, HIPAA compliant medical billing, medical billing services, medical billing companies

HIPAA Medical Billing Is More Important Than You Think

If you belong to the healthcare industry in any capacity be it as a physician, nurse, surgeon, pharmacist, or health IT specialist, you would know the importance of privacy protection and confidentiality obligations.

HIPAA medical billing needs no introduction. The practice of HIPAA medical billing and coding has proved only to be fruitful for a progressive healthcare system in the USA.

Therefore, taking casual measures to ensure data protection and using ordinary software to store data is now just not enough.

Private Data is at Risk!

We say that healthcare services have progressed and we have gone automated, but so have data hackers.

Medical Billing and Coding Companies need to upgrade their systems and take standardized measures.

Lots of sensitive data is transferred from physicians to insurance companies to patients.

As billing companies are directly responsible for data handling, they are held accountable for any mishap.

Why HIPAA Compliance Is Important?

Because the expense for data breaches go far beyond fines and penalties.

No matter what the reason may be for healthcare organizations to outsource HIPAA medical compliance. We should keep in mind the following perspectives.

HIPAA Medical Billing Is Compulsory for Healthcare Organizations

According to the HIPAA Omnibus Final Rule, medical billing companies would be penalized for risking Protected Health Information (PHI). Any violations will not be entertained at any cost, and the company responsible for even minor negligence will have to bear heavy fines. Of course, it would also dent a company’s reputation leading to low revenue.

Data Security Threat Has Not Remained To Just Data Manipulation/Stealing

Not long ago, accidental exposure of sensitive data was considered a HIPAA violation. It means a situation in which you have to bear the financial loss.

However, the modern definition states that even unauthorized access to data is a threat to HIPAA compliance.

The following factors build the base for the damage of HIPAA violation.

  • The scope and type of healthcare data compromised
  • Characteristics of the party or person that accessed the data or violated the HIPAA rules
  • The measures, taken to avoid vulnerable areas to protect PHI

A medical billing company can only be successful by following the HIPAA rules and regulations. The best approach is to include clauses in the BAA – Business Associate Agreement.

Moreover, the Office of Civil Rights (OCR) also allows a bit of relaxation in HIPAA regulations to promote the trend of HIPAA compliance.

Things to Remember

To safeguard the interests of HIPAA compliant medical billing, it is important to not over-commit responsibilities to clients. The things, which, medical billing services are unable to commit can be strictly stated to the physicians.

Here’s a List of Things Medical Billing Should Perform

  • Perform thorough risk assessment
  • Design and implement a full-proof security plan
  • Secure Privacy policy
  • Dedicate trained resources for operations

The accuracy of billing procedure is the second priority; the first remains the infrastructure that supports the cause of HIPAA compliance. Thus, meeting security parameters and confidentiality clause is the only way forward for medical billing companies.

MIPS Qualified Registry, Qualified Clinical Data Registry, MIPS, QPP, QCDRs, CMS, MIPS 2019 reporting process, MIPS submission methods

MIPS Qualified Registry VS Qualified Clinical Data Registry

There are not many agencies in the US healthcare system that earns the status of MIPS qualified registry. Each of the seven MIPS submission methods has its own advantages, and eligible clinicians can choose to submit data via anyone.

However, healthcare organizations or physicians often confuse MIPS qualified registry and Qualified Clinical Data Registry (QCDR). Particularly, physicians who don’t have much knowledge about the MIPS 2019 reporting process and mechanism, find it difficult to decide the submission strategy.

P3Care being the MIPS qualified registry for three years now has the expertise and knowledge to know how things work with different submissions methods.

Here’s a quick overview of the two most confusing terms in the MIPS QPP.

A MIPS registry reports clinical data on behalf of eligible clinicians or healthcare organizations.

While QCDR is a CMS-approved entity that collects clinical data for CMS on physicians’ behalf. This entity is generally not managed by an individual. It also differs from the former submission method, as it is not restricted to certain measures for data submission.

The qualified clinical data registry is also allowed to host non-MIPS measures, which are approved by CMS.

The categories for QCDR reporting measures are as follows:

  • National Quality Forum (NQF) endorsed measures
  • Current 2019 MIPS measures
  • Measures in regional quality collaborations
  • Other measures approved by CMS
  • Measures used by boards or specialty societies
  • Clinician and group consumer assessment of healthcare providers and systems (CAHPS), measures reported by CAHPS certified vendor
  • National specialty societies administer or endorse registries/ QCDRs

Reporting Mechanisms

Depending upon the reporting type and category, physicians can submit data via any mechanism.

Either as a group, individual, or virtual group, there are four performance categories to report on, Quality, Improvement Activities (IA), Promoting Interoperability (PI), and Cost.

For the cost category, you specifically don’t need to submit data, but CMS will use administrative claims data.

Both submission methods, qualified registries for MIPS and QCDRs can report for a total of six measures and all-cause readmission measures for groups of sixteen or more.

Which Method to Choose?

Either whatever method you choose to report, the decision should not be supported by the number of available measures. Instead, it should be well thought of to score high in the final score of MIPS in healthcare.

Think of the following points before finalizing the submission method.

  • If measures are related to your practice
  • The benchmark for available measures for each submission method
  • Performance rate achievable for selected measures
  • If there are bonus points available for the selected measures
  • Information about which measures are topped out

A correct decision can make all the difference. The path to get incentives and bonuses leads to improved revenue cycle management.

Medical practices when improving the quality of healthcare services move towards progression, and MIPS QPP is a way to measure and judge the performance of how far we have come across.

Either you report via a MIPS qualified registry or any other method, the thing is to clear mind, put forward pros and cons, and then strategize to report clinical data to MIPS via the most suitable method.

Medical billing services, Healthcare System, medical billing service providers, Electronic Medical Records, EMRs, medical billing companies

3 Technologies in Favor of Value-Based Healthcare System

Medical billing services and clinicians have joined hands to strive for a progressive healthcare industry altogether.

As the focus on value-based care services has risen, there is no place for hiding for immature and quacks. The research in the healthcare sector is paving undiscovered paths for physicians and medical billing companies, which leads to better patients’ engagement, coordinated care services, and optimized treatment methods.

Some of these technologies are already in the market, and some are going to be available at the end of the year.

  1. Blockchain Technology in Healthcare

This technology serves a modern data collection and transfer system where blocks of data are connected and secured by cryptography. It was devised for digital currency (bitcoin), however, research shows it has a great potential to transfer data across healthcare organizations without any limitation that Electronic Medical Records (EMRs) have.

Its decentralized mechanism is compatible with every system and thus makes access to information easier and reliable than before. According to Forbes, blockchain applications will be showcased for commercial use at the end of this year.

Medical billing services will find this technology useful to minimize errors in data transmission.

  1. Telemedicine

Telemedicine may be a familiar term for many of you. You even might have seen a practical demonstration of this technology anywhere. Whatever the case may be, this technology reduces the gap between remote patients and clinicians via electronic means.  It also affects the way information is submitted to a physician. The optimized and smart interaction surely brings a breakthrough in a regular patient-physician interaction and consequently in medical billing services procedures.

  1. Artificial Intelligence

Since 2018, we have been listening about the implication of artificial intelligence (AI), and indeed, it is the future of every field.  Speaking generally, artificial intelligence will revolutionize the monitoring of human activity. Reaching far-away areas where there are limited or no resources will be possible with artificial intelligence. Who knows AI modernizes diagnostic procedures so much that the need to take out blood and tissue samples vanishes.

Even Forbes says that work productivity in healthcare systems can be increased by 10-15% within the next two to three years with AI.

In general, when we look upon the healthcare technologies, one thing comes forward. They all strive to improve data transmission and patients’ engagement levels. The factors like interoperability and the burden of shifting to a new system are challenging, but in order to get the best healthcare outcomes, physicians and medical billing service providers need to adopt new methods and implement value-based healthcare strategies.

Do you agree or disagree? Give us your view on https://www.linkedin.com/company/p3-healthcare-solutions.

Looking Back At EHR Meaningful Use From A New Perspective

ARRA – The American Reinvestment & Recovery Act was legalized on February 17th, 2009. It aimed to revolutionize many economic and social sectors including healthcare. Health Information Technology for Economic and Clinical Health (HITECH) Act was also one of its considerations. This act was in great support of the meaningful use of the electronic healthcare records (EHRs), an initiative by the Centers for Medicare and Medicaid (CMS) and the Office of National Coordinator for Health IT (ONC).

Its emphasis on the implementation of EHR technology throughout the USA. Moreover, it is also in accordance with the MIPS quality measure Promoting Interoperability (PI) in which physicians use innovative methods to improve the quality of care services. It requires the use of certified EHR technology to provide a secure exchange of healthcare information.

Plays an Important Role in MIPS Data Submission

The meaningful use of EHR technology also helps physicians to efficiently submit MIPS data to CMS. On the other hand, physicians using this technology can also report measures regarding value-based services to the Secretary of Health & Human Services (HHS) and get incentives.

The Need for Meaningful Use (MU) Act

This act is helpful in generating five possible outcomes for the betterment of the healthcare industry.

  • Improvement in public health
  • Improved coordination in healthcare sectors
  • Increased engagement of physicians and patients
  • Protect patient’s private data from unauthorized use
  • Improved services, safety, and efficiency of the healthcare system

What benefits physicians have for meaningfully using EHR technology?

Meaningful use of EHR

The incentive payment ranges from $44,000 for 5 years to $63,750 for 6 years (Starting from 2011).   Eligible physicians (EPs) and eligible hospitals (EHs) demonstrating adaptation and efficient use of EHR, get valuable rewards. To encourage physicians to go for EHR meaningful use and reduce the burden for healthcare providers, it is classified into three stages.

Stage 1 of Meaningful Use

The requirements of this stage are divided into the 15 core set and 10 menu set objectives. There is an option of choosing 5 out of 10 menu set objectives with the compulsion of at least one population/public health measure.

Stage 2 of Meaningful Use

CMS and ONC have also set standards for the second stage of meaningful use (MU). It released the final rule for incentive programs of Medicare, Medicaid and EHR technology in August 2012.

For this stage, eligible physicians are required to meet for the exclusion to 17 core objectives and 3 out of 6 menu set objectives.

Whereas, it was a must for eligible hospitals and Critical Access Hospitals (CAHs) to qualify for an exclusion to 16 core objectives and 3 out of 6 menu objectives.

Stage 3 of Meaningful Use

In the modified version of stage 2 meaningful use for 2015-2017, clinicians attest to any combination of 2 measures out of 3, while EHs and CAHs attest for any combination of 3 measures out of 4. For stage 3, submitting data for meaningful use was obligatory in 2018.

ONC along with HHS (Department of Human Health & Services) released a final rule in the context of meaningful use and gave certification to the 2015 edition of electronic healthcare records (EHRs). This initiative allowed diverse types of healthcare organizations to get access to healthcare IT.

Thus, medical practices that adopted EHR technology in previous years are now in benefit and can target more incentives, as they have completely understood this method. To get incentives and adopt healthcare IT, physicians should invest their efforts in this system respectively.

HITECH provides high opportunities for healthcare providers to improve their medical practice. The phased approach of three stages allows room for improvement in the public health sector. Moreover, it sets the base of the healthcare system with fewer discrepancies and controls chronic diseases.

For more information, visit, https://www.linkedin.com/company/p3-healthcare-solutions

How To Avert Medical Billing Claim Denials?

Medical billing denial is the rejection of a claim by an insurance company made by an individual or by the provider, to pay for the rendered health care services. If you are a financial administrator in a hospital or any other healthcare facility, you would have an idea about the complications involved in medical billing claims. The denial of claims proves to be a continuous headache as it affects the credibility, cash flow, and the overall efficiency of a healthcare provider.

Studies suggest that the annual claim denials for hospitals stand at 2 percent, whereas, for medical practices, the percentage increases up to 10 percent. It makes medical practices less profitable by comparison.

Some of the healthcare organizations even undergo denial rates of 15 to 20 percent, which is considered extremely high. It means that providers facing this kind of denial rate have one out of five medical billing claims denied.

In addition, the providers have to spend a net amount of $25 for every denied medical billing claim.

However, you can avoid most of your medical billing denials by taking simple precautionary measures. They might not vanish completely, but the steps below assist in minimizing them. The underlying fact is that reducing them even by 1% has a massive impact on lowering provider’s accounts receivable.

Let’s go through the measures we need to take to reduce medical billing claim denials.

  1. Categorizing and Quantifying Medical Billing Denials

Providers can reduce receivable claims by properly analyzing, calculating and reporting patterns of different healthcare providers, departments and payers. These analytical measures are essential to run an efficient medical billing management system.

  1. Create a Professional Taskforce

Put together a task force to analyze and rectify medical billing trends. It is also important to find out which trends are worth looking into and which are not. Well educated and trained team of professionals can quickly streamline the medical billing process for the provider.

  1. Organized Data Portals

Organized patient data portals handle information in a more structured manner. Make sure to design a smooth registration process. Otherwise, it may lead to errors resulting in medical billing denials.

  1. Find Out Reasons behind Denials

You need to find the root cause of denial. For this purpose, you have to go beyond any coding clarifications and design different analytical techniques.

  1. Use Updated Claim Management Software

It is important to ensure that all the edits made are functional, recent and contribute to a continuous improvement cycle. This improves the overall claim recovery rate. Pick up a vendor that can provide you with better claim recovery rates.

  1. Automated Predictive Analytics

It is crucial to flag potential medical billing denials and rectifies any errors before claiming the medical bill. The automated predictive analytics help quickly identifies incomplete medical billing claims.

  1. Work Alongside Payers

Providers need to work with payers to eliminate the specific contract requirement which may lead to medical billing denial. Data analytics can help determine the trouble spots and falsely navigated support systems.

The best way to reduce your accounts receivable is to identify the reasons leading to medical billing claim denials. Medical billing and coding play a vital role in the acceptance or rejection of claims. Staying alert and always on the lookout for billing mistakes, removing them, and taking measures so that they don’t happen in the future increases a provider’s credibility.

P3 comes up with medical billing services for clinicians across various specialties. It is not always the technical skills that matter but the will to complete a certain task. We have the passion to deliver results on behalf of doctors when it comes to billing or the Quality Payment Program.