All posts by Stephen Brighton

HIPAA: Why You Need It

As an urgent care provider, you need to be quick in everything you do. From service to patient care and yes, even to billing — how you handle your processes can make or break your business. And with competition so high these days within your industry, you can’t afford to fall behind. One of the most important factors with your business, as you know, is customer satisfaction. Another factor is your own bottom line. With urgent care medical billing, you can achieve both goals: satisfying your customers and improving on how you collect payment.

However, it’s not enough to just have a good urgent care medical billing service in your corner. They must also know the ins and outs of HIPAA and how to apply them to their daily operations. HIPAA (Health Insurance Portability and Accountability Act) made history in 1996 when it provided the first nationally-recognizable set of regulations for the use and disclosure of patient health information. Since then, those regulations have formed the basis of healthcare, from doctor’s offices and ERs to ambulatory services and hospitals. Privacy is at HIPAA’s heart, and nowhere is privacy more important than in urgent care settings.

Emergency room medical billing is complex, with services being rendered at any one time by radiologists, cardiologists, respiratory therapists and all staff members. That’s a lot of patient information to keep straight, let alone safe and secure. That’s why you need an experienced HIPAA-compliant medical billing company to offer value-added support AND put confidentiality at the forefront. With so many ER and ambulatory services happening at one time, it’s impossible to stick to just one area of coding. Knowing all the coding specialties is a must, which is why any medical billing service worth its salt will have certified coders on staff who are experienced in a range of specialties.

Some sample services may include:

  • Hospital/inpatient coding
  • Payer-specific coding
  • Emergency room services
  • Hospital coding protocols
  • Audits
  • Temporary emergency medicine coding services to cover staff on vacation or sick leave
  • Physician documentation training
  • Compliance reviews

From patient enrollment and insurance verification to audit and claim submission, there are many balls to keep in the air, especially in an urgent care setting. Payment posting, accounts receivable collection and analysis, insurance authorization: all of these areas require dedicated professionals to ensure that no step is missed. Breaches in patient confidentiality can be a direct violation of HIPAA rules and regulations. Your organization can be hit with heavy fines and disciplinary measures, cutting into your bottom line. As an urgent care provider who can’t afford a hit like that, it’s in your best interests to ensure you have a dedicated team of professionals handling your medical billing. Leaving this up to your already-overworked staff means that mistakes can be easily made.

Many safeguards must be in place to ensure correct HIPAA compliance every time.

Some of those safeguards include:

  • Thorough checks on every employee who enters and leaves the premises
  • Password-protected computers
  • Firewalls and antivirus software installed on all computers
  • Regular backups of computer systems

Medical Healthcare Solutions Inc. is comprised of HIPAA-compliant coders and can help you more efficiently and safely run your urgent care operation.

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How to Wow Your Patients During Their Next Visit

Patient engagement is key in attracting and retaining people to your practice. Without it, and you’re just another faceless business that doesn’t do enough for your customers. Standing out in your industry takes more than friendly service and accommodating hours. It takes full engagement of patients in your care, providing them with the tools they need to more readily connect with every facet of their experience.

Staying connected is important. But, sadly, it isn’t readily achieved across all healthcare platforms. However, this should take support found outside your team to connect all available resources. You need products that integrate with solutions across your healthcare enterprise no matter what type of individual software you may use. The result? Improved patient care, satisfaction, loyalty, outcomes and the impact to your bottom line.

Streamlined Processes

User-friendly…easy navigation…secure…these are all words to describe the ideal patient portal system. When it comes to medical billing, people expect those processes to be as streamlined as possible. In a world of one-click ordering on consumer marketplaces like Amazon, people are used to instant gratification. They want to pay and manage their medical bills quickly and easily. This trend is moving toward patient financial responsibility, empowering a sense of “consumerism” to healthcare, points out The Beryl Institute. Bottom line is, people want simple, easy-to-read bills that they can pay out just as readily as they can their mortgage. Make it hard for them, and you may not see a payment at all.

Studies show that a patient’s payment experience influences their overall feelings about their doctor’s visit or hospital stay. That’s why a streamlined medical billing strategy is imperative.

A Patient Portal That Works

As a healthcare provider, you want a patient portal that’s easy — for your patients to navigate, sure, but also for you to navigate as well. Open-platform solutions like Allscripts FollowMyHealth® tailors options to your specific practice’s needs, blended with superior connectivity and robust population health capabilities. Never before has access to information, health plans, care teams, and patient history been so readily available. It’s also the most secure it’s ever been, as well.

You can use this user-friendly platform to encourage patient participation by adopting an active role in their healthcare experience. You can access it on the web or via an app, allowing patients to send their physicians messages in confidence, gain access to lab results, view updates on their account and renew prescriptions.

When it comes to monitoring and compliance, providers should be able to communicate with patients regarding their care management so they can better comply with their insurance companies. From simple assistance to navigating around the portal to patient engagement consulting services (PECS), smooth transitions should be part of your day to day routine.


Making a difference for your patients starts with the right medical billing provider and the right platform for delivering seamless integration. Make them stand back and say “wow”! Then you know you’ve done your job.

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What is Physician Burnout

What is Physician Burnout?

“Physician Burnout syndrome” is a real condition in which fatigue, cynicism, and professional inefficacy associated with work-related stress becomes overwhelming and debilitating, according to the Association for Psychological Science. While some level of stress is expected, particularly in the medical field, at some point these stressors can become overbearing, leading some physicians to contemplate leaving the profession or worse.


Physicians are the ones on the front lines of patient care. While other types of professional burnout can be devastating, this is particularly true of doctors because they tend to suffer it more severely. According to Definitive Healthcare, physician burnout manifests itself in many ways, such as:

  • Lack of enthusiasm for work
  • Growing cynicism about patients or career
  • Low sense of self-worth

As a result, these feelings can lead to poor job performance, abandonment of the profession, and in rare cases even suicide. Healthcare researchers are trying to pinpoint the root causes and manage this physician burnout at the organizational level. Some types of physicians experience more burnout than others. Those in critical care experience the highest, followed by emergency medicine, family medicine, internal medicine and general surgery.

The Patient Side

Burnout doesn’t just affect the doctor, but the patient as well. That’s because this condition can negatively impact a doctor’s mental state and career, leading to a decrease in patient care quality. Not only are higher rates of medical errors reported in those with burnout, patient access, and overall experience are negatively impacted. Physicians suffering from burnout say that they are quick to cut down on office hours and even respond in a negative or clipped manner when interacting with patients.

Causes of Physician Burnout

The causes of physician burnout are highly individualized, and many doctors feel multiple sources of burnout. Medscape says the following are the top causes for physician burnout, in order of importance:

  • Too many bureaucratic tasks
  • Too many hours at work
  • Not enough income
  • Increasing computerization of practice
  • Impact of Affordable Care Act
  • Difficult patients
  • Too many appointments daily
  • Lack of professional fulfillment
  • Difficult colleagues or staff
  • Inability to keep up with current research

Also included in the Medscape report is that women (51%) experience burnout more often than men (43%) and those between age 46 and 55 are most likely to experience burnout. Physicians that are burned out report not exercising as much as they should, with low motivational levels. Sometimes, volunteering, doing mission work, or working with church groups adds to the stress of their lives rather than relieves it. A third of burned out physicians say they have minimal savings compounded by unmanageable debt.

In many cases, physicians reported feeling overwhelmed with administrative tasks that detract from their ability to spend time with their patients. Research shows the average physician spends two hours on administrative tasks for every hour that they interact with patients.

One way to mitigate this is to make office tasks more streamlined. Instead of handling billing issues, which can suck up a large portion of a doctor’s day, outsourcing this to a medical billing provider would be a better use of time. By decreasing time spent on mundane tasks, the physician is freed up to spend more quality time with each patient. This can take away a bit of the stress that so often overwhelms physicians on a daily basis.

Contact Medical Healthcare Solutions

We can help. From mobile medical billing solutions to revenue cycle management, Medical Healthcare Solutions can help physicians reduce their chances of burnout by handling the time-consuming tasks of running a practice. Contact us at 800-762-9800 or fill out our convenient online form.

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What to Know Now That CMS Has Released MACRA Final Rule

The Centers for Medicare and Medicaid Services (CMS) recently released its final rule regarding the Medicare Access and CHIP Reauthorization Act (MACRA), a revolutionary payment system for Medicare physician fees proposed to replace the sustainable growth rate formula in an effort to modernize the system and make it more streamlined. The ruling serves to finalize MACRA’s Quality Payment Program, the goal of which is to lessen the administrative stress placed on doctors so that they may be able to better concentrate on patient care and add more value to these newer models. The intent is to get all clinicians on board working together on this initiative so that they can implement this Quality Payment Program within a time frame that works for them.

MACRA’s rulings can understandably get a little complicated and convoluted, so let’s go over some key points and explain them all in detail.

Who qualifies for the program? If you are a physician, PA, NP, anesthetist, or clinical nurse specialist that bills Medicare for more than $30,000 per year or provides care for at least 100 patients who have Medicare, you qualify for MACRA.

When does it start? January 1, 2017 was the initial start date, but you can begin anytime between now and October 2, 2017. Data collection is due to CMS by March 31, 2018, with payment adjustments taking place on the first of January, 2019.

What are the participation options? Provider participation can take two forms: the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM). MIPS is for health care providers who offer traditional, fee-for-service Medicare. Advanced APM is for providers taking part in value-based care models that are unique to their applications.

How can small practices participate? Because small, independent practices can often get left behind in these new rulings, CMS has made special requirements for them. Those who bill for less than $30,000 on Medicare or have fewer than 100 Medicare patients do not have to participate this year. Another available option is for small practices and solo practitioners to come together and submit combined MIPS data. Doctors who provide services in underserved areas or who operate in practices of fewer than 15 can take advantage of the allotment of $20 million a year for five years for training and education.

What makes the final rule so streamlined? The result of the final rule is a more unified program, featuring five critical changes, including:

  • Flexible first-year options
  • Allowance of low-volume threshold for small practices
  • Advanced APM as a standard to promote participation in value-based care models
  • Makes “all-or-nothing” EHR requirements easier to follow
  • Creates the medical home model in an effort to promote care coordination

Overall, the response to the final ruling has been positive, particularly in regards to the American Medical Association. To learn more about the above points, visit the Quality Payment Program here. The final ruling is still in its infancy stages, with the CMS still planning on hosting listening and learning sessions as a sounding board for future proposed changes.

Contact Medical Healthcare Solutions

To learn more about how MACRA affects your practice and how we can help you streamline your own business, contact us at 800-762-9800. We help providers in a variety of specialties, including cardiology, family practice, general surgery, internal medicine, obstetrics and gynecology, pediatrics, podiatry, psychiatry, pulmonary, gastroenterology, neurosurgery, ophthalmology, urology, student health services and more. We bring decades of medical billing experience and service to the healthcare industry to help ensure the highest standard of service.

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How Universities Are Benefiting From Student Health Billing Services

One of the main goals of school districts, boards, and administrators is to make more money for their college or university, in addition to ensuring the safety, well-being, and education of their students. If you’re not streamlining your billing processes through outsourced student health billing services, you could be leaving money on the table that could go right back into your business. Students need health services. That’s a given. They are away from home, often for the first time, they have their own insurance or are still under their parents’ insurance. When they visit the school nurse for care, whether a routine appointment or sick visit, there must be some sort of seamless process in place that can ensure high collection rates.

With student health billing services, schools can bring in more money overall. To achieve that, they need a medical billing service behind them driving this effort.

Benefits of Student Health Billing

Many schools’ student health services departments use a fee-for-service billing model, just like students would find at their primary care physician’s office back home. Anything from office visits and lab services to x-rays and pharmacy meds is billed to the insurance carrier, while basic services such as first aid, consultations, advice from nurses, and nutrition counseling are typically offered free of charge. There are many benefits to improving your bottom line with student health billing services, including:

  • More control: With an outsourced company handling all the time-consuming work and headaches associated with student health billing, you can concentrate on more important aspects of your department, mainly the quality of patient care. Such a service can make quick monthly and annual comparisons, while factors such as charge entry errors or payer reimbursement issues can be identified quickly before becoming a far-reaching problem. With such a team approach to achieving goals, less time is spent by your regular staff on tedious billing and clerical tasks.
  • Consistency: If you are billing in-house, you’re risking revenue interruptions when changes happen to your staff or someone calls in sick. Outsourcing your medical billing puts an entire team at your disposal who ensure claims get processed quickly and accurately. As a result, there’s less risk of cash flow disruptions. An outsourced medical billing service can also coordinate with your front-office staff to ensure co-payments are collected consistently from students, who are notoriously low on cash.  
  • Insider Knowledge: A medical billing service has a vast knowledge base from which to draw on, as they work with many other schools and practice networks to bring you leading-edge experience in real time for faster turnarounds.
  • Faster payments: The goal of any medical billing service is to bring in cash — quick. Time spent in revenue cycle time can make a huge difference on your cash flow situation. Outsourced medical billers can submit claims faster, with fewer mistakes, quicker payment turnarounds, and the highest reimbursement possible.

Medical Healthcare Solutions is your trusted partner in facilitating quick, consistent, effective student health billing services that improve the bottom line for your college or university. Call us today at 800-762-9800 to learn more.

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