CMS Explores Consolidated Payment System

Over the last several years, CMS has worked with the Medicare Payment Advisory Committee to streamline payments for a number of patient services and procedures. Each group has proposed changes to Medicare billing that, if adopted, could streamline and reduce annual healthcare spending for the program.

The current payment system allows for differing payments for the same service depending on where and by whom it was performed. Hospital outpatient departments, for example, receive a higher payment than a physician’s office for the same procedure. However, differentials are also present when measuring payments received by the same physician for the same procedure based on how it was coded.

Several elements contribute to the billing differences that CMS and MedPAC hope to eliminate, including packaged versus separate payments; where providers choose to perform services (and patients choose to receive them); and different methods of weighing payments between different facilities.

Proposed changes include updates to this year’s physician fee schedule and limiting billing to either physician rates or hospital rates. The larger question this creates, however, is which system is the best to determine payment rates at all

A site-neutral payment program is slowly developing: beginning in 2016, long-term care hospital pay rates will shift to align with existing inpatient PPS rates. In the meantime, both CMS and MedPAC continue to identify inconsistencies in payments and potential solutions for them.

In the last 15 years, PRN Funding has provided comprehensive alternative funding solutions for healthcare companies. To learn more about the benefits of healthcare factoring and medical receivables factoring, contact PRN Funding today.

Obamacare Greatly Boosting Areas of Healthcare Staffing

Obamacare has been receiving plenty of criticism due to accusations that the health care law will hurt employees by eliminating positions or reducing hours to part-time. While the actual effects are still relatively unknown, staffing recruiters and HR professionals are confident that Obamacare will help drive job growth in certain areas.

Since PRN Funding works with numerous healthcare staffing companies, let’s take a look at the positions that are prepping for fast growth in the healthcare realm.

1. Nurse practitioners and physician assistants
Due to an increased demand for routine checkups and preventative medicine, physician services are set to increase at least 2 to 3 percent by next year. Nurse practitioners and physician assistants can perform similar services for the fraction of the cost of a doctor. Not to mention, general physicians are still in short supply and take much longer to enter the workforce. The Bureau of Labor Statistics (BLS) predicts the demand for PA’s will swell by 30 percent and staffing for registered nurses will increase 26 percent by 2020.

2. Medical billing coders
Healthcare IT staffing will be huge. Combine the requirements for healthcare facilities to transition to electronic health records and comply with a new medical coding system (ICD-10) with millions of newly insured patients and you have a recipe for lots of jobs to fill.

The International Classification of Diseases (ICD-10) will include a staggering 69,000 diagnostic codes and physicians will be required to submit claims with the new codes starting Oct. 1, 2014 if they want to get paid. Lots of healthcare IT staffing will be necessary to build these codes into the electronic health records software. According to Staffing Industry Analysts, medical coding is one of the hottest jobs right now.

3. Occupational therapists
Occupational therapists make appropriate modifications to the homes and workplaces of the disabled to accommodate their mobility needs. Since Obamacare prohibits insurance companies from denying coverage, more disabled people will be able to take advantage of health insurance coverage. The BLS forecasts a 43 percent spike in occupational therapy employment by 2020.

4. Wellness and fitness coaching
The need for health education specialists is expected to rise by 37 percent in 2020, according to the BLS. Many employers will want to encourage healthy lifestyles, so the demand for workplace wellness programs will skyrocket.

Aside from healthcare staffing, Obamacare is also expected to help spur career growth for payroll service providers, computer programmers, lawyers, insurance consultants, customer service reps and human resources professionals.

Medical Transcriptionists Face Dictation Challenges

For years, physicians have been dictating their patient reports while medical transcriptionists have been trying to figure out what they’re saying. A recent article in For the Record discusses how technology such as electronic health records (EHRs) and speech recognition are turning these transcription challenges into serious downstream problems and what can be done to fix it.

Various habits and practices cause poor dictation, and even articulate dictators can sometimes fall victim to one or more of them. The propensity to multitask also can undermine the quality of the dictation. Physicians may eat or yawn while talking. They may be trying to speak on a speakerphone while driving in the car with the windows down. Oftentimes, dictation is done with others in the room so the medical transcriptionist must decipher one voice among four others in the background.

Unfortunately, the more physicians in a health system, the broader the range of poor dictation excuses. Melissa Campion, RHIA, CHDA, CHPS, CMT, an eHIM senior systems analyst for transcription at a big integrated health system in Melbourne, Florida, says that foreign accents, which many would assume to be an issue for transcriptionists, aren’t always a challenge. “The accents are actually easier to deal with because most of the doctors with a heavy accent are aware of it and try harder to make it clear,” Campion says, adding that her team has more difficult with dictation from physicians from the Deep South who may be oblivious of how their accents come through in the reports.

However, poor dictation isn’t really about accents, background noise, or speech patterns. Manager of transcription services at Lancaster General Health in Pennsylvania Kathy Lengel says communicating correct and complete data in an effective manner also can notably influence the quality and timeliness of the final report. “Poor dictators are very inconsistent in the format they use,” she states. “They don’t provide good patient information, and some of our poor dictators enter no patient demographic information. They jump all over the place. They have no rhyme or reason to how they’re dictating.”

The safety and quality of patient care are the main concerns when dictation challenges arise as they affect the timeliness and accuracy of the report. Treatment decisions are based on information in a patient’s chart so accuracy is of utmost importance as incorrect dosages could be disastrous or fatal. Many organizations refuse to fill something in if they aren’t 100 percent sure. The uncertainty impacts turnaround time and often requires reports being sent to the hospital to be manually fixed.

Being a good dictator takes several qualities, including being cognizant of the fact that someone on the other end has to be able to make sense of what you’re saying.

Medical transcription service organizations (MTSOs) may want to contemplate including contract language that tackles dictation problems. Medical transcriptionists are paid on a production basis, so having to struggle with poor dictation hampers their income potential. MTSOs may want to consider charging more if physicians are poor dictators and unwilling to improve the quality of communication.

Prepare for Affordable Care Act: Tips for Employers

With the Affordable Care Act (ACA) set to go into effect in January 2014, many employers supporting group health care plans are rushing to get ready for the impending changes. Here are some tips on how to prepare for the upcoming implementation of the ACA:

1. Figure out how the ACA will affect your business. According to Forbes, when the ACA is ratified, it will oblige businesses with over 50 full time workers to offer affordable healthcare to them. The ACA is demanding employer coverage just for those who work over 30 hours per week for a period of a month. Corporations who wish to avoid providing this medical insurance for their workers and who are on the verge of having 50 employees may then look to temps and staffing agencies in order to evade being forced to obey the law or create more part-time jobs as another way to shirk the ACA’s policies. Companies doing this will undermine the legislation and its intentions of increasing coverage to more American employees.

2. Choose whether to “pay” or “play” and make decisions about your insurance. To “pay” is to pay employer-shared-responsibility penalties of around $2,000 per employee per year. To “play” is to offer employer-sponsored coverage to fulltime employees.

3. Think about adding wellness program incentives. According to a recent survey by the Midwest Business Group on Health, more than 80% of the country’s biggest employers are looking to implement a penalty and reward system to encourage their workers to get healthy.

4. Organize and give out obligatory employee communications like a summary of benefits and coverage, plan descriptions, etc.

5. Amend your Health Insurance Portability and Accountability Act privacy and security rules and processes before the Sept. 23, 2013, deadline for acquiescence with final regulations.

6. Pay the first comparative effectiveness research fees by July 31, 2013, and plan for future reinsurance charges.

Some Call for Medical Billing Act

Medical billing is a complex process, and like anything that involves money and credit it is sometimes controversial. While no one likes getting a medical bill, but sometimes it is even worse than that and customers are left with ruined credit over procedures and charges they don’t even remember incurring. Credit advocate Call 12 for Action is currently investigating medical billing issues, and are pursuing legislation that would treat medical billing the same as credit card billing. Credit card billing has the The Fair Credit and Billing Act, a strong consumer protection law that gives customers rights when disputing bills.

A big problem with current medical billing is that unpaid bills are sometimes reported to credit agencies before they have a chance to be paid or while being processed by insurance. Therefore, a current bill that Call 12 for Action is backing is the Debt Responsibility Act, introduced by Senator Jeff Merkley, D-Ore, which would prohibit credit-reporting agencies from using paid or settled debts to determine credit ratings.

A reformed billing process might cause cash flow issues for medical providers, and that’s where factoring comes in. Medical factors solve cash flow issues for facilities that need it, and if the bill passes then medical providers might just need it.

For the full article, see Credit Advocates Calls for Medical-Billing Act

Medical Billing and Coding Industry Predicted to Boom by 2020

While some industries are stagnant or losing steam in the slowly rebuilding economy, one industry is predicted to grow faster than any other- medical billing and health information.

The Bureau of Labor Statistics projects that job growth in that sector will increase faster than any other occupation at 21 percent by 2020. Salaries for these positions are also expected to increase by over 20 percent over the next five years to match as well; all in all, great prospects for a growing field.

Any explosion in growth is necessarily followed by expansion. Expansion in staff or facilities requires cash on hand, which can be a problem for outsourced medical coding and billing services waiting weeks for payment from clients. Invoice factoring is one financing option that affords this industry flexibility, and the ability to pay obligations in a timely manner. As the industry grows exponentially, so will the cash needs of medical billing and coding businesses- and that is where factoring can help.

For the full article, see A Whopping 21% Increase in Medical Billing and Coding Jobs Salary

Hospitals for Profit or for Help?

Did anyone see the article A Giant Hospital Chain is Blazing a Profit Trail in the NYTimes earlier this week?

The article talks about HCA’s revamped billing procedures and revised patient screenings that have led them to be extremely profitable health care industry giant during a time when so many of America’s hospitals have been struggling to stay out of the red.

According to the article, “Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the costs of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.”

What are your thoughts on this article?

Swipe Fees Threaten Merchant-Customer Relationships Nationwide

Did any of the small business owners who regularly read The Factoring Blog see the article in The Wall Street Journal today, entitled: The Swipe Fee Conundrum?

We thought our small business factoring readers and Americans everywhere should be concerned about a recent court settlement against major credit card companies that may open “the way for millions of businesses to add checkout fees when customers pay with plastic.”

This surcharge comes as the result of 1-3% charges burdened on businesses by credit card companies. This fee may be passed on to customers, who may remain entirely unaware that they are being charged extra for credit card companies’ profit.

Of course, though most business owners would rather be transparent in dealing with swipe fees, “many don’t want to run the risk of alienating credit-card users” by exposing swipe fees to the public.

The fees, which have been deemed by merchants and customers alike as “petty” is undermining the relationships that business owners have with their clientele, as well as the hard-won credibility that make those relationships work.

According to this article in The Wall Street Journal, “The proposed settlement sets aside $6.05 billion,” and “the biggest portion of the money will likely go to large retailers.”

Small business owners may be fortunate to even receive several hundred dollars from the settlement, making this lawsuit a purely corporate affair.

Supreme Court Stuns Nation with Obamacare Decision

The outcome appeared uncertain, but in a 5-4 decision, the Supreme Court ruled the Patient Protection and Affordable Care Act to be constitutional in accordance with U.S. tax laws.

Chief Justice John Roberts opined that the individual mandate, the clause compelling all Americans to own some sort of health insurance, was unconstitutional if the penalty took the form of a fine. Instead, if

Americans decided not to follow the individual mandate, they would be taxed in accordance with the burden that any potential uninsured illnesses might pose to taxpayers.

Though, prior to signing the bill into law in March 2010, the president had vehemently denied the bill to be a tax, his wording was corrected by the court on Thursday June 28, 2012.

Beyond compelling Americans to purchase policies from healthcare insurance companies, the bill also limits insurance companies’ rights to severability. The PPACA holds that no insurance company can terminate coverage because of a person’s pre-existing condition.

Limitations upon the rights of private sector insurance firms are subsequently countered by the bill’s expansion of Medicaid. The federal government has offered to fund the expansion in every state, to the tune of 100% of the cost.

The act, pejoratively known as Obamacare, has a host of pros and cons that will be sure to affect the well-being of each and every American. It is unforeseeable how our small business, healthcare factoring clientele will be affected, but we will keep you posted as new information becomes available.

Invoice Factoring Case Study: Outsourced Medical Billing Company

The outsourced medical billing factoring specialists at PRN Funding wanted to share one of our more recent invoice funding case studies with the medical billing company owners that read The Factoring Blog:

David had aspirations of entrepreneurship ever since he graduated college. Due to the ever-increasing demand for health care, he spotted an opportunity to start his own medical billing company. As word quickly spread about the company’s unparalleled customer service, David’s start-up medical billing company began getting more calls and business soared. As a result, David needed to hire more medical billing specialists to handle the new demand. Because his customers took about 45 days to pay him for his medical billing services, David realized that he would not have enough readily available cash on hand to pay his employees on time. As a result, David began researching financing options. Unfortunately, because David’s company was relatively new, the bank he initially approached turned him down.

Medical Billing Factoring

David didn’t know what to do. He called his friend Steve, who is a broker for alternative financing companies. Steve informed David about accounts receivable factoring, which would help him stabilize his cash flow through the company’s growth period. Steve referred David to PRN Funding, LLC, who has a dedicated medical billing factoring program.