Obamacare Protection Plan – Action Steps for Patients, Pt. 2

Obamacare Protection Plan – Action Steps for Patients, Pt. 2

The Healthcare Insurance Marketplace has officially opened and many are rushing to discover what coverage and subsidies are available. For millions of families, Obamacare provides them with the opportunity to see clinicians and have long ignored medical problems addressed. For other consumers, Obamacare means the potential for fines.

ObamacareThe good news is that there are some steps and strategies that patients can employ to help avoid penalties and still obtain the type of healthcare they’re used to receiving.

Information is always the best defense, and it pays to take advantage of incentive programs and the array of free services under Obamacare.

Free Preventative Tests

Obamacare makes certain tests and screenings available at no charge to patients with an insurance plan and it just makes sense to take advantage of them.

However, if a policy has been granted a “grandfather” clause, those tests won’t be free and patients will pay the normal costs dictated by their policy.

Rewards And Incentives

To reward healthy lifestyles, Obamacare encourages employers to offer wellness, reward and incentive programs. Rewards can include cash or discounts on co-pays, deductibles and premiums.

Those who can’t meet the program’s standards should request a special opt out so they won’t be penalized with higher costs than their fellow employees.

Swimming In The High-Risk Pool

Coverage for adults with pre-existing conditions doesn’t begin until Jan. 1, 2014. Consumers can gain temporary coverage under a high-risk pool created by Obamacare.

Retires, Begin Planning Now

ObamacareEarly retirees under the age of 65 will probably lose their insurance.

Employers are dropping coverage and sending early retirees to the Marketplace to save companies money, but Marketplace policies may actually prove to be less expensive for some.

Seniors participating in the Medicare Advantage program could find their providers dropping out and leaving them to find supplemental coverage on their own.

Consult An Accountant

High earners will want to speak with their accountant about the new Medicare contribution taxes as they relate to hospital insurance and investment income.

Individuals making more than $200,000 a year will be paying more than in the past and an accountant will know how to best deal with the new taxes.

The Cost Of Hiring

Small business owners receive a tax credit if they employ 25 or less people and companies employing fewer than 10 people reap additional financial benefits through Obamacare.

Expanding a firm’s workforce may not be the best financial move for businesses in the coming months or years.

Obamacare offers healthcare services to millions of Americans who didn’t have it before, but it also imposes financial penalties on people that don’t have some type of coverage.

Obamacare is a mixed bag and is still in its early stages of implementation.

There are steps patients can take to protect themselves from the worst elements of Obamacare, but it’s imperative that consumers stay informed about future changes and modifications to help them get the most from Obamacare.

Obamacare Protection Plan – Action Steps for Patients, Pt. 1

Obamacare Protection Plan – Action Steps for Patients, Pt. 1

The Affordable Health Care Act, known as Obamacare, is already bringing change into the lives of millions of individuals across the nation. Some view those changes in a positive light, while others are facing the potential for penalties, loss of employer-based insurance and even cuts in jobs and hours.

ObamacareThere are actions that individuals can take to protect themselves from the downside of Obamacare, and measures that can be implemented to reap the most benefit from the legislation.

It requires effort on the part of consumers, but the results could be well worth it.

Medicaid Eligibility Expansion

One of the initiatives under Obamacare was the expansion of Medicaid to millions of patients who previously wouldn’t have qualified, though a handful of states have refused to expand their programs.

It pays to check anyway, as some people who don’t qualify for Medicaid may still receive some type of assistance.

In states that expanded Medicaid programs, a family of four making $29,327 (per 2010 statistics) will be able to enroll.

Residents in states that already had generous income eligibility levels above that current Obamacare mandated amount could be eliminated from the program and referred to the Health Insurance Marketplace.

Low-income earners are eligible to receive financial subsidies to help offset the cost of coverage on the Marketplace.

Avoid the Individual Mandate Tax (IMT)

The IMT is a penalty imposed on those who don’t purchase insurance and collected through income taxes. People covered by an employer-based policy are in compliance and won’t be charged.

Those without insurance may be eligible for Medicaid or subsidies for purchasing coverage on the Marketplace.

ObamacareBefore writing a check to pay the IMT, taxpayers may want to wait and see if collection of the IMT is actually going to happen.

Obamacare empowers the Internal Revenue Service to collect the IMT by deducting it from any refund to which the taxpayer may be entitled, but they can’t take personal property.

The IMT is extremely difficult to enforce and may be changed in the future.

Over-The-Counter (OTC) Medications

Families with a Health Savings Account (HSA) or Flexible Spending Account (FSA) can pay for OTC remedies if a physician writes a prescription for them.

Those who take OTCs that include products such as Tagamet or Tylenol should ask for a prescription in anticipation of future needs.

Obamacare offers new hope for many individuals and families. For some, it may be an opportunity to receive treatment for potentially life-threatening conditions.  Others aren’t as enthusiastic about Obamacare. They’re waiting and remaining vigilant to see what Obamacare has in store for them in the future.

Coders or Billers: What Does it Take to be One?

Coders or Billers: What Does it Take to be One?

Medical coding and billing aren’t mutually exclusive, but the terms are often used interchangeably. In larger practices, coders collect documentation and insert codes on reimbursement claims, while billers transmit the claims and monitor their progress.

In smaller practices, a single individual fulfills both coding and billing functions. In this article, Nitin Chhoda discusses the important roles and factors to consider when deciding to be a professional biller or coder.

codersCoders don’t have to endure years of training and can enter their profession in fairly short order, but they do undergo intensive education in a variety of specialties.

As they pursue their passion, they will be called upon to perform a variety of duties and will have multiple venues from which to employ their skills.

With mandatory implementation of EMR or electronic medical record technology, the job outlook is excellent for billers and coders.

Acquiring Education

A diploma or associate degree for billers or coders opens the door to a wealth of educational opportunities for entry level positions. Billing or coding diploma and certification programs are available at learning institutions throughout the U.S., along with online education from reputable professional organizations.

Education will cover compliance issues, industry codes and procedures, medical practice management, ICD-9 and CPT coding, technology systems and clearinghouses.

A majority of coding programs require students to be proficient in medical terminology and anatomy, while others include it as part of the program to become a Certified Professional Coder®.

Abbreviated and condensed education plans can be completed in as little as nine months, but the average is from 15 to 18 months. Billers or coders course fees run the gamut, from $600 to $2,000. Add approximately $500 for textbooks or CDs and accompanying materials.

Knowledge in Coding Basics is a Must

Those who pursue to become a coder will be required to know CPT and ICD-9 codes. The alpha-numeric codes provide a description on claims that supports a clinician’s diagnosis and treatment for his/her patient. ICD-9 codes will soon be updated to the ICD-10 standard.

The codes tell insurance companies the services they’re paying for on behalf of their subscriber.

Coders are also fact checkers. They will need an understanding of medical terminology and anatomy to code accurately and ensure practitioners receive the fees they’re due.

Coders will confer with clinicians to clarify any data that appears to be in error or if there’s any uncertainty associated with the available documentation.

The Software to Use

Professional coders will enter coding information into specialized software programs or electronic medical record (EMR) systems. Electronic medical records will soon be the mandated method of communication for healthcare professionals and facilities.

EMR technology has the advantage of functionalities that can assist coders in identifying potential coding difficulties before the claim is transmitted to clearinghouses. Such advantages which can help coders and billers with their EMR system are the following:medical billing and coding

  • Online eligibility verification function
  • Auto patient chart creation
  • Create custom templates
  • Scrub claims
  • Automatic posing of ERAs
  • Generate patient statements and much more…..

Billers and Coders Employment Opportunities

Coders and billers are in high demand and the trend is expected to continue unabated. They may find themselves working in a clinician’s office, hospital or pharmacy. Any medical office or entity that provides patient services will need a coder.

The transition to EMR technology has accelerated the need for coding professionals. In a less than optimal economy and a healthcare climate in which insurance carriers are reluctant to pay even for covered services, coders are on the front lines in the battle to obtain reimbursement for healthcare professionals.

Is Obamacare Preventative Healthcare? Does it Make Americans Healthier?

Is Obamacare Preventative Healthcare? Does it Make Americans Healthier?

One of the stated goals of the Affordable Health Care Act was to improve the overall health of Americans. As part of the goal, Obamacare created a National Prevention, Health Promotion and Public Health Council to manage the government’s goals and promote personal wellness.

ObamacareThe Council will make recommendations on how to move toward those ends and help people avoid serious health problems.

Obamacare includes a variety of provisions designed to promote a healthier lifestyle.

Many of those options may have little effect on individuals who already have serious or chronic health problems, nor do the initiatives take free will into account.

Obesity is of particular concern and has been designated as a security threat, based on a study conducted by retired military chiefs that make up the Mission Readiness group.

No Co-Pays For Preventative Services

Obamacare has created a list of government approved preventative tests and vaccines that will be available for free. They’re part of the guaranteed essential health services under Obamacare and no co-pays of any kind will be required from patients.

Free tests run the gamut, from mammograms, colonoscopies and those for STDs to immunizations and screenings for heart disease, high-blood pressure and cancer.

Counseling rounds out the array of no co-pay services provided under Obamacare. Individuals can avail themselves of consultations and advice from medical experts on diabetes, smoking, birth control and HIV, along with domestic violence, breastfeeding, depression and dietary needs.

Vaccines will prevent the spread of disease and screenings are valuable tools for identifying existing and potentially dangerous heath concerns.

Counseling provides patients with information they need to manage their health, but if individuals don’t act on the data to change detrimental habits they’ll still end up being treated for those illnesses.

No Behavior Goes Unrewarded

Obamacare approves and supports employer-based incentive programs to steer workers toward health and wellness lifestyles. Incentives can take the form of cash, funds deposited into a flexible spending account (FSA) to pay for medical expenses, or discounts on insurance costs.

Employers also have the ability under Obamacare to penalize workers that engage in behaviors deemed unhealthy, from smoking and weight gain to lack of exercise.

It’s a form of negative reinforcement that’s long been frowned upon as a method for disciplining misbehaving children, yet Obamacare gives the behavior a green light in the workplace.

Medicare Spending And Prevention Counseling

In addition to the free services accorded to others through Obamacare, Medicare recipients can work with their clinician to formulate a preventative health plan customized to their specific needs.

Plans will address current and future medical issues and condition management.

Healthy Choices When Eating Out

Fast food, restaurant cuisine and vending machines have been cited as primary sources that passively promote obesity.Obamacare

Beginning in 2011, all restaurants with 20 or more locations were required to provide nutritional data and calorie counts on menus to aid people in making healthy choices.

The mandate also extends to vending machines.

Obamacare offers an array of beneficial services and is a step in the right direction, but health can’t be legislated.

Obamacare doesn’t address many of the critical issues that can lead to the development of health problems or the element of free will. Only time will tell if Obamacare has been successful in creating a nation of healthier people.

Medical Coders – What are they?

Medical Coders – What are they?

Medical coding is often associated with medical billing, but the two are entirely different career paths. Coders use the information provided by the medical provider for treatment rendered and assign the appropriate codes for billing purposes.

The duties of a biller and coder may be combined in smaller practices and performed by the same individual. Nitin Chhoda shares the main responsibilities of medical coders and the attributes that they must have.

medical codersEducation Always Counts … Of Course!

A thorough knowledge of medical terminology and anatomy is essential for a medical coder. The average medical coder’s course is 15 months long and costs approximately $2,000.

Online training is available from a variety of professional organizations and at multiple colleges throughout the country.

A prerequisite is college-level human anatomy and physiology.

Students will learn how to assemble documentation and interpret guidelines for accurate coding. Courses will address the upcoming transition to ICD-10 codes, along with maintaining compliance and the ethical and professional standards required of a certified coder.

Medical Coders Must Be Familiar with Legalities

Remaining in compliance with government rules, regulations, guidelines and laws will play a major role in a coder’s every day duties.

Medical coders are in contact with confidential information that’s protected through regulations established by the U.S. Office of the Inspector General (OIG).

The OIG rules are designed to prevent fraud and abuse in billing.

Medical coders must also maintain compliance in the usage, dissemination and transmission of patient information as set forth in the Health Insurance Portability and Accountability Act (HIPAA). Known as the Privacy Act, it dictates how to handle sensitive patient data.

Medical Coders Know the Requirements and Compatibilities When Coding the Bill

An extensive array of data is collected during each patient encounter and it’s up to the coder to decipher any clinician notes and gather the documentation necessary to accurately code the reimbursement claim.medical coding

This is where knowledge of anatomy and medical terminology comes into play.

Medical coders are responsible for assigning the appropriate alpha-numerical CPT and ICD codes to reflect the practitioner’s diagnosis and subsequent treatment.

Medical Coders Should Be Familiar with an Integrated Software Technology

All the assembled data must be entered into a specialized medical billing software program or an electronic medical record (EMR) system in preparation for billing.

In practices that employ a single individual who acts as both the coder and biller, he/she will transmit the claim electronically to a clearinghouse for examination before being sent to the payer.

Show Me the Money …

Medical coders who undertake both coding and billing duties will be required to monitor claims to ensure they’re paid, follow up on late or denied claims, and interact with insurance carriers to collect the clinician’s fees.

Certified medical coders also work with patients on their portion of healthcare costs and file appeals with payers when required.

Medical coders hold considerable power within a practice and are professionals in a specialized field. They use their knowledge and ability to keep the flow of funds coming into a practice. They hold the financial keys to enable clinicians to plan, expand and pay the bills.

What are the Medical Billers?

What are the Medical Billers?

Medical insurance billers (MIBs) are the lifeline of a well-funded practice and the connecting link between patients, practitioners and insurance companies.

Billers affect the lives of hundreds of people each week and are an essential link in the reimbursement process. They collect payments for clinicians and ensure that insurance companies pay their portion of the costs for their clients’ healthcare expenses.

medical billerMedical billers perform a variety of functions, from entering the alpha-numeric ICD-9 and CPT codes that tell insurance companies the treatment a practitioner provided to interacting with patients on the balances they owe.

Medical billing staff works with sensitive data each day that requires confidentiality, integrity and ethics.

First Step — Data Collection

An MIB often functions as a coder and a biller, though the jobs can be exclusive of each other. Medical billers gather all the information associated with a patient’s encounter with their healthcare professional.

That information provides the documentation that will be used to support the payment requested from insurance carriers.

They decipher the data to determine the patient’s complaint and the appropriate CPT code to reflect the treatment provided.

Medical Billers Should Have Good Communication Skills

Medical billers spend a considerable amount of time interacting with others as part of the data collection and payment process. Clinicians must be queried to clarify patient encounter information and patients contacted about their payment obligations.

Medical billers also interact with insurance company representatives on reimbursement issues.

MIBs Must Always Verify the Facts

Medical billers are responsible for verifying patient insurance information, the correct billing format for each payer, and assigning the codes and modifiers that result in the practitioner’s payments.

They work with hard facts about patient policies, physician services and insurance company protocols.

Medical billers may also transcribe a doctor’s dictation about the patient encounter. Billers are knowledgeable in medical terminology, which helps them in assigning diagnosis and procedure codes.

Medical Billers Must Have Computers and Integrated Software

Medical billers spend a majority of their time behind a computer screen, ascertaining the facts of each patient encounter. They work with specialized billing software, like In Touch Biller Pro,or electronic medical record (EMR) systems, like In Touch EMR, that assist them in coding correctly, meeting the many submission demands made by payers, and transmitting claims electronically.

Consistent in Following Up Funds

Medical billers track and monitor each claim to determine its position within the reimbursement process. medical billers' software

They submit claims to clearinghouses where they’re examined for mistakes, errors and inconsistencies.

Clean claims are forwarded on to payers for reimbursement.

Medical billers track and monitor each claim to determine its status, ensure payments are made in a timely manner, and deposited in the practitioner’s account.

They work with clearinghouses and carriers if a claim is denied to obtain payment, and interact with patients on co-pays, deductibles and balances owed.

IMPORTANT:  Medical billers ultimate responsibility is to ensure that clinicians collect the maximum amount of money to which they’re entitled.

Medical billers wear many hats in their profession. They’re often one of the first and last individuals with which patients interact on financial obligations, and they comprise the key element in the reimbursement chain.

Medical billers document, code, transmit and follow payments to ensure their client’s financial status remains in the black.