SGR Developments

Federal budget authorities have determined that the amount Congress needs to eliminate for the Medicare sustainable growth rate formula is much lower lower-than-expected due to lowered health care spending.

The reduction in offset figure has led for new calls for permanent Medicare payment reforms..

Secretary Kathleen Sebelius of Health and Human Services said on Feb. 12 that the current administration wants to end the SGR. A 26.5% rate cut was delayed from going into effect, but because it expires in 2014, it does not provide the long term fix that doctors and patients were looking for.

The CBO usually updates lawmakers regarding reforms to Medicare policy and how changes would affect federal spending They have forecasted numbers for keeping Medicare rates for the last 10 years, which was highest in 2011 at twice what it is now.

The CBO projected a $244 billion estimate in November 2012. This was due to slower spending on physician services in the recent years. The SGR works by lowering rates when spending on services exceeds set levels. Medical billing services are reporting lower payment amounts as well.
Because of these improved numbers, the SGR is now planning to increase physician pay instead of the planned decreases over the coming years. If the SGR baseline was recast, it would mean favorable payment updates for physicians.

Medical groups were positive about the lower offset figures. Many are urging lawmakers to take a step toward reforming theMedicare pay system and eliminating the SGR.Slower growth rates in health spending are a key to reforming Medicare’s pay system and continuing the decline is good news in Washington. Reducing future federal budget deficits through savings in entitlement programs is a huge political prize.

The Republican House leadership has proposed repealing the SGR l and to modernize existing pay system without larger deficits. The CBO had earlier estimated the amount of money required to stabilize doctor pay rates, but lawmakers updated the proposal to reflect the latest projections.

The GOP proposal is a multi prong approach to overhauling Medicare. First is to replace the SGR with defined pay rates. Then the fee-for-service system would be changed to reward doctors for better quality care. Lastly, provisions would be put in place to reward physicians who provided care more cost effectively.

The new system would employ medical specialty societies to provide guidelines for quality and clinical improvement activities. Programs would measure patient outcome statistics when comparing doctor’s performance with their peers.

State and Federal Insurance Exchanges

Medcare MSO Presents Managed Solutions
Currently there are twenty three states that have declared they will not be setting up their own health insurance exchange to help people and small businesses find coverage. They want to send the task instead to the federal government and walk away, delegating any responsibility to the federal agencies.

As a medical billing and coding service we are going to see many changes in the way your patients health care covers your services. We offer you a solution for dealing with the confusion that change can bring. Medical practices are challenging enough without having the added frustration of dealing with these issues. Our medical billing software and customer service team is here to take over this responsibility.

The Affordable Care Act allows health insurance to serve as online marketplaces that allow you to choose insurance plans. The government then provides tax-credits to help any premium issues for those with incomes that are just above the Medicaid program levels. These exchanges need to be completed by October 1, so that coverage can begin for people on Jan 1. 2014.

Only 17 states are currently going to set up their own exchanges. Seven want to collaborate with the federal government and another few refuse to take any action at all. The states are moving toward a more harmonious relationship that leave physicians on the other end of the spectrum. What can you expect from these new insurance plans? Rest assured that our staff can help you address this.

The Affordable Care Act gives the department of Health and Human Services the job of determining the health benefits that must be provided on each unique plan. Also, it is held up as the proper way to protect consumers from insurance complications. Some states are willing to go with the flow, while others are unwelcome to the changes. But, the fact remains that there are changes and they need to be understood. This means more training, and more consistent work. Having your team ready with Medicare MSO’s team of experts is the only way to get your medical billing and coding headed in the right direction.

How can we get your monthly revenues moving up?

Helping physicians and their practices get the maximum reimbursement is always a focus at Medcare MSO. However, without efficient systems in place throughout your organization, can you stay ahead of the competition? The regulations and changes at both the commercial and government level have continued to increase. You need the support of a team to stay on top of and navigate complex directives and rules.

Transition to ICD-10: Here it comes

Medcare MSO is Here To Make It Work

Medical Billing is in the foremost phase of transition from ICD-9 to ICD-10. The change will spur the development of the most dynamic, efficient and intelligent software that the medical billing industry has seen.

These changes will not only benefit healthcare payers and providers but increase the effectiveness of office administration.

Identifying need of transition:
The current medical billing ICD-9-CM system lacks the flexibility to organize the codes with an appropriate level of specificity, with each three-digit category only having 10 subcategories.

Technology milestones combined with higher level of specific ICD 10 codes will help to ensure a better analysis on diagnosis, prognosis and treatment outcomes that can improve medical care. It also aids in the collection of statistical analysis for developing better prevention plans by the government.

ICD-10 medical billing and coding is similar yet simpler than ICD-9. Professionals with hands on experience with ICD-9 CM should be able to make the transition to ICD-10 CM. The job of replacing the secondary diagnosis in ICD-9 can now be changed with a single code that reports a disease and its current manifestation. (i.e., type II diabetes with diabetic retinopathy).

CMS has announced that by Oct 1st, 2014; ICD-10 CM will be implemented into X12 version 5010.

At Medcare MSO we make sure that we provide quality medical billing and coding services that are ready for changes being pushed forward through ICD-10 implementation. We work with top PMS vendors that are current with 5010 compliance.

Call us today at 800-640-6409 and schedule a training Webinar with one of our training support specialists and stay up to date with all current updates in ICD-10.

Medical Billing Services: Urgent Care Clinics

Do you have many unpaid claims? You might need to have a billing person on call at least 24 hours a day and about 7 days a week. But, that is expensive especially if you are having to pay someone and are not getting paid yourself. If you are in Arizona then you might call Medcare MSO it’s just the rational thing to do. We have best practice staff that understand the absolute best way to get your revenue immediately. Working with Medcare MSO will ensure that you receive your checks and have a low cost for the billing services.

We work hard to provide our Urgent Care Medical Billing Specialists to your services. The services and medical billing products that we offer create a more conducive atmosphere which will help you to generate revenue. In fact the minute you schedule a demo with a customer service rep you will be able to get the revenue you need almost immediately.

Medical billing services we offer:
Accurate billing
EMR and EHR interface interactions
Customer service, available to meet your needs.
We support your Medical billing needs

Our staff ensure that your needs are met and we take that seriously. Each plan pays differently and we understand that there are some that offer more than others. We take those details into account and create a conducive atmosphere that will make your experience pleasurable.

Our experts at Medcare MSO offer you the best practices management the minute we begin working on your billing services. We are consistently on top of the service details. We will contact you with questions when we have them and we will contact you in order to ensure that you are being treated fairly.

Contact us at 1-800-640-6409 or email:

Payer Contracting: Have You Reviewed?

A payer contract might be harming your practice. The content and verbiage of the contract itself should be able to protect you from amendments that the payer can suddenly implement. There are many ways this could harm you and unfortunately many physicians frequently overlook this important component. There are many changes in the contract that can constitute the breaking of a deal. So you have to be aware of what your practice might be getting into with a payer contract.

Is your collections rate about 95% or more? You should be receiving at least that amount for the medical billing at your office. Many practices bleed money because there is not a proper understanding of payer contracts. To bill accurately you need to understand who you are working with.

Medcare MSO offers:
A fee schedule
A ruled payment
Measurable criteria
Submission time frames
The Payer Contract Dissected

As a physician you understand that many insurance companies often standardize the contacted rate based on the area in which you are providing services. The language of the contract should of course reflect this. But, it should also be able to portect you with changes that might happen when the payer decides to suddenly shift gears.
What You Need To Walk Away From:

Changes in the number of permissible visits and the service dates
The procedure reduction and changes

When the payer is not working with you correctly that should be a red flag. Medcare MSO’s medical billing service begins with the contract not the first submission, so ensure that you have evaluated these contracts completely before you have signed off on them.

Contact Medcare MSO today to get your free demo!