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Four US Healthcare Market Issues for 2014

healthcare medical billing coding trends

Outlining key healthcare issues for 2014

From HER fraud to unveiling of, from dynamics of new payment models to ICD-10 progression, it seems an eventful 2014 waits us as far as healthcare is concerned. Here are four issues to watch in the coming year.

1. EHR Fraud

I couldn’t believe when I read that “Electronic Health Records may be doing greats for patient care, but they have also made it easier to commit fraud, according to the findings of a new report from the Office of Inspector General (OIG).” The report is available here.

Yes!! That’s how US healthcare industry going through the rough patches currently. On $250 billion fraud in Healthcare, almost $75 Billion contributes to EHR Fraud. OIG is encountering to major issues in EHR fraud regarding copy and paste

  • Healthcare Provider Copies the information from one patient account and paste to multiple patient records.
  • It fails to update the patient data.
  • It fails to review the documentation of patient treatment.
  • False or irrelevant documentation for higher level of service.

But what’s more alarming to add-on to this issue is, only 3 out of 18 Medicare contractors used EHR audit log data as part of their review process. According to AHIMA report in September, 78 to 90% of physicians, use copy and paste function in EHR. Besides, 20 to 78 % of physician notes are copied text.

2. Insurance Exchanges

Despite the appalling start of, thousands of civilians chose new insurance plans, receiving one of the key aspects of the Affordable Care Act under way. Now the entire US economy is waiting to see, whether the exchanges will work, said Tom Carden, a senior managing director at New Jersey-based Martin Healthcare Advisors.

The Healthcare industry will be observing for responses to demands such as:


  • What are the real numbers in terms of people buying insurance?
  • What will it really mean in terms of economics?
  • Will it be more expensive/less expensive, more complicated/less complicated?


“It will all boil down to supply and demand. If there is more competition prices could fall. If there is less competition, prices could rise,” Carden said. “2014 will be a very pivotal year for the future of healthcare.” More on 4 healthcare hot topics in 2014.

3. New Payment Models

Anticipate seeing continuous progress in reimbursement models, including accountable care, bundled payments and shared savings, wrote Catherine Sreckovick, Navigant Healthcare Managing Director, in a blog for Navigant’s website.

4. ICD 10

Despite of implementation deadline of OCT 1st 2014 for ICD 10, the healthcare industry is not on track to meet the ICD 10 compliance. As a matter of fact, healthcare providers had fallen even further behind with timeline indicators than they did back in February, according to new report findings. But it’s not just providers. Vendors also have a long way to go. In a recent survey conducted by leading EDI work force, more than 80% of providers will fail to complete their business changes in 2014 due to ICD 10. Read more: Outlook Grim for Docs’ ICD-10 Readiness.

Some of the other facts that survey reveals,

  1. Some 50% of healthcare providers have completed their ICD-10 impact assessments.
  2. About 50% of providers expect to begin external testing in the first half of 2014; only one-tenth expected to start in 2013.
  3. The top three barriers to providers’ ICD-10 delays were cited to be: staffing, competing priorities and vendor readiness.
  4. Vendors indicated their top three barriers were: customer readiness, competing priorities and other regulatory mandates.

It would be interesting to see these strategies and their timelines, whether the healthcare industry going to foresee a further delay to avoid the disruption.

Further reading

ICD-10 Delay Impacts All Sectors of Healthcare – AHIMA Journal

Priority List for ICD-10 Readiness

An Overview on Affordable Care Act (Obamacare)

With Affordable Care Act 95% of Americans will be insured.

With Affordable Care Act, 95% of Americans will be insured.

Off late, I have been hearing the name of US president with his care and suddenly triggered me this Joke

“Anybody try to sign up for the Obamacare? It’s impossible, and everybody’s furious. The Republicans are upset about Obamacare because something they tried to stop now won’t get started.” –David Letterman (Source)

First of all, we need to understand something to critic it. The fact that remains unchanged from 2008 President Elections is that Affordable Care is a new healthcare reform in US, which increases the quality, availability and affordability of private and public health insurance to 44 million uninsured civilians. In civilian terms, it’s “Medicare for All” (proposed by Clinton Administration).

Key elements includes in Affordable Care Act (ACA)

  • Measures to Eliminate Pre-Existing Condition
  • Expand Medicaid to 15.9 Million civilians below 138% of poverty level.
  • State specific health insurance market places (Exchanges)
  • Low to middle income Americans can shop for free or low cost health insurance
  • Forbids insurance companies from plummeting civilian coverage, if they get sick or make an honest mistake on your application.
  • Let’s young adults stay on their parent’s plans until 26.

The Fact is Affordable Care reform is only stepping stone for the future. Some of the facts that has really amazed me are

  • The Health Care System in US is projected to cost citizens 2.8 trillion dollars in 2013 and would grow every year and it is being projected that Americans will spend 4.5 trillion dollars on health care in 2019.
  • According to a report by Health Care for America Now, America’s five biggest for-profit health insurance companies ended 2009 with a combined profit of $12.2 billion.
  • The top executives at the five largest for-profit health insurance companies in the United States combined to bring in nearly $200 million in total compensation for 2009. (Source)

Bottom line remains unchanged that ACA aids to restructure the healthcare system by giving more Americans access to Excellence, reasonable health insurance and helps to restraint the progress of healthcare spending in the U.S.

ACA states the following areas in detail. Each topic is a title, which contains segments of necessities that reform health care system.

  • Title I Quality, affordable health care for all Americans
  • Title II The role of public programs
  • Title III Improving the quality and efficiency of health care
  • Title IV Preventing chronic disease and improving public health
  • Title V Health care workforce
  • Title VI Transparency and program integrity
  • Title VII Improving access to innovative medical therapies
  • Title VIII Community living assistance services and supports
  • Title IX Revenue provisions
  • Title X Reauthorization of the Indian Health Care Improvement Act

Do we really need this care? 

YES! This Act would help 32 million civilians to afford healthcare, who could not get it before. 95% of Americans will be insured. Though the high-earners might get some new taxes especially on the employer mandate and individual mandate but the flip side, over half of the uninsured civilians can get free or low cost health insurance using their State’s Health Insurance Marketplace. Remember, the individual mandate says that you have to gain health coverage by Jan 2014 but if you are not, then pay a fee or get an indemnity, if you can afford it.

With Maine to become the first state in the country to offer residents access to their personal health records via health information exchange, ACA already creating waves across the nation. As on Jan 24, according to Obama administration, more than three million people have signed up for private health insurance on the federal and state health insurance exchanges. I am sure these numbers would increase in 2014, which would eventually fulfill the objective of this ACT.

Analytics To Play a Crucial Role in The Evolving Healthcare Market

Looking deeper into healthcare processes by extracting insights from big data and merging statistical data mining

Looking deeper into healthcare processes by extracting insights from big data and merging statistical data mining

For everybody in the healthcare community from the providers, hospitals, health systems, exchanges, payers and technology experts the need of the hour is analytics. Data is generated in numerous steps and processes in the revenue cycle arena, from the time the patient visits the facility to the time the reimbursements are made.

Healthcare analytics is needed for everybody to provide value to their business unit, to their customers, at the same time reduce their operating costs without impacting the level of services that they are offering.

Data coming from thousands of data points unless analyzed and its intelligence used will be of no use, healthcare analytics is the answer if the industry which has to focus on the actual care, reduce costs and at the same time comply with the industry standards.

It is not an option for any entity involved in healthcare, particularly the payer. The payer might want to focus on avoiding ‘over payments’ as the current scenario does not help in that perspective thereby increasing costs per member.

While the industry gurus are focusing on improving the actual care from the patient stand point. With the data coming from different sources, in different formats, the regulations such as Affordable Care Act, the patient protection act and so on makes it mandatory for people to go electronic, thereby implementing EHR becomes mandatory because of which the analytics can be created.

With the current limitations in analytics the ever growing costs are due to readmissions, repeat visits to healthcare providers. Healthcare community across the world is getting better at focusing on value instead of sheer volume, to do that analytics is definitely the answer.

Billing Outsourcing Services: Changing Face of Medical Billing & Coding Outsourcing

Billing & Coding Outsourcing Services from India

Solve medical billing & healthcare revenue cycle management issues through strategic outsourcing

Every year, a colossal $350 million is spent to submit and process claims in the healthcare industry, stated a Dell report. No wonder, the number is only going to up and further up in the future. Equally disheartening to see how hospitals and healthcare centers are finding it difficult to liquidate various streams of revenue. Reimbursements are down from both government and commercial payors. Issues like juggling several major initiatives at one go because the gigantic ICD-10 storm is about to hit the shore, lack of experienced talents in high priority areas, narrowing margins are  complicating things even more.

So, how healthcare as an industry is poised for the changes, challenges and subsequent growth? What undercurrents are influencing the sector now? What problems hospitals are struggling with? Take a look at the trends that healthcare professionals must know to stay relevant in the game. Click to know more about how Medical Billing & Coding Outsourcing is evolving in the changing Revenue Cycle Management milieu. Image courtesy: ddpavumba/ 

Outsourcing Data Entry Services: Advantages of Insurance Claims & Medical Billing Data Entry Services


Outsource insurance claims data entry services

Universally, correct data or collections of information are single version of the much desired truth. By gaining accurate  information, clients achieve extraordinary outcomes from outsourced data entry services. A smarter decision can take off based on correct information capture and customized solutions. In this extremely competitive business world, highly accurate and most up to date data are imperatives organizations can’t live without. What they want is glitch free data, error free transformation and spotless merges during integration of multiple data sources. Nothing can destroy the goodwill and potential adoption of an information faster than wrong, vulnerable or low quality data. No wonder, achieving the highest degree of data accuracy is now absolutely indispensable in modern marketplace. And, it’s the speed of production, faster turnaround time and 99% accuracy that produce greater business value.

Businesses look at online data entry services providers as entities that can ensure high quality data driven solution which is accurate, consistent, reliable and secure. It ultimately enables better business management and organizational performance. Whether the company is giant or small-medium in size, the more they extract information from the market, customer, trend or competitor, better they can track result and measure efficiency. And sooner they have vital information in their reservoir, faster and improved becomes its impact on bottom-line. This holds good for insurance payors, third party administrators, medical billing companies and hospitals/clinics.

Insurance Data Entry Service

Insurance claim data entry is a process where the policy holder files a claim and gets benefits in times of destruction of valuables. Insurance company evaluates the authenticity of the claim. Outsourcing data entry work to an ISO standard, premier offshore data entry company can benefit a client who wishes to lighten its data entry work load. Broadly, an ISO certified company can offer insurance claims data entry services for

  • HCFA (Health Care Financing Administration)/ CMS 1500 claim forms
  • Life insurance claim form
  • UB (Uniform Billing) health insurance claim forms
  • CMS (Centres for Medicare & Medicaid Services) forms
  • ADA claims forms
  • Dental insurance claim form
  • Homeowners Insurance Claim data entry
  • Medical insurance claim form
  • Insurance Claim Adjuster data entry
  • Specific Excess Reinsurance
  • Accident Insurance Claim data entry
  • Auto insurance claim form
  • Disability insurance claim form
  • Insurance Claim Settlement data entry
  • VIP pet insurance claim form
  • Long-Term Care Insurance Claim data entry
  • Record Changes- Name, Beneficiary, Address
  • Medicare health insurance claim form
  • USPS insurance claim form
  • Validate Reserves
  • Health insurance claim form PDF
  • Collateral verification
  • Aetna insurance claim forms
  • Blue Cross insurance claim form
  • Veterinary pet insurance claim form
  • ADA insurance claim form
  • Accident insurance claim form

Medical Billing Data Entry

Outsourced Data Entry Services for Medical Billing are required to track operating expenditure and medical reimbursement. A HIPAA certified, premier medical billing data entry company will not only possess medical coding data entry expertise, thanks to the medical billing experts, but also offer cost effective, value driven services 24X7X365. Broadly, an electronic medical billing services company offers following medical billing services:

  • Medical billing and coding
  • Medical claim processing
  • Pre-certification & insurance verification
  • Medical data entry
  • Complete backup, recovery and archival processes
  • Medical billing data entry
  • Accounts Receivable (AR) analysis and management
  • Revenue cycle management (RCM) and collection management
  • Patient demographic analysis
  • Denial, claim/tracking management
  • Electronic and paper claim submission
  • Persistent follow-up on all claims
  • Creation and mailing of patient statements
  • Payment posting and reconciliation

Benefits of outsourcing data entry of insurance claims and medical billing

  • Improves customer and intermediary service levels
  • Saves time and cost
  • Reduces capital investment
  • Improves levels of accuracy
  • HIPAA, ISO certified partner
  • Streamlines business operations
  • Improves document access between multiple users and locations
  • Faster billing cycles
  • Maximizes process efficiency and economies of scale
  • Reduces billing errors
  • Enhances cash flow
  • Ensures billing compliance