Medical Credentialing

Medical Credentialing is Important for Building a Successful Practice

Medical credentialing is the process of ensuring that healthcare organizations are in compliance with certain regulations. In most cases, this means communicating with insurance providers so that medical providers are able to accept third-party reimbursement for their services. Credential services specialists work closely with hospitals, physician offices and ambulatory care facilities in addition to insurance companies and credential verification organizations.

Some healthcare professionals see credentialing services as unnecessary or even a hindrance to their day-to-day operations, but the truth is that they are more important to the healthcare industry than ever before.

The Importance of Insurance

There was a time not too long ago when credentialing service specialists were considered optional to medical practices. Some patients would use their health insurance to cover treatments and procedures, but there were also plenty of people who were willing to pay out of pocket. That time is long gone. Presently, the vast majority of Americans have health insurance, and they are far more likely to use it than in the past. This is also due to the broader scope of many of today’s health insurance plans, which cover a wider range of treatments and procedures than before. Insurance plans cover more mental health and behavioral health treatments, there are fewer restrictions when it comes to pre-existing conditions, and even supplemental services such as physical therapy and holistic healing services are now covered.

Unfortunately, the changes that have been made to health insurance coverage over the last few years has also made credentialing services more complicated. While many healthcare facilities could perform these duties themselves before, hiring a credentialing specialist or doing business with a credentialing service is essential today. The right credentialing service can ensure that your medical practice is always in compliance with billing regulations and they can act as mediators between yourself and insurance companies. This can save you a lot of time and energy that would be better spent providing services to patients.

Making Your Job Easier

More than anything else, a medical credentialing specialist will give you peace of mind. Insurance is an increasingly large aspect of operating healthcare services, but it is far from the most important. Your staff needs to be able to provide services to your patients, and they shouldn’t have to feel like they’re spread too thin if they have to solve an insurance issue. Hiring the services of a credentialing specialist helps make your job easier, even as medical insurance becomes more complicated.


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Reduce Costs Using Electronic Health Records

Reduce Costs Using Electronic Health Records

Reduce Costs Using Electronic Health Records

In the medical world, Electronic Health Records (EHRs) have revolutionized the way medical personnel document and track patients’ records. This new approach for data management has made time management easier for medical institutions.

At the same time, medical institutions have been able to save a lot of money by reducing expenses normally spent on stationery and hiring people to help manage files and documentation. Based on a study, EHRs take only 10 minutes to process a patient’s medical records. This means hospitals can instead make use of their staff in better roles rather than waiting to manage files and place them in record rooms.

Electronic Health Records can reduce cost while increasing a patient’s awareness.  Patients will be able to access their medical reports in electronic versions online: they will not need hard copies.  Giving patients easier and immediate access to these documents will educate them of their current records in a paperless manner.

Defining EHR

EHRs are medical data that include the patient’s complete medical history (including multiple consultations by different physicians in the same medical facility), medical investigations and diagnosis. This ensures easy access to the patient’s medical records in real-time, and at any time.

Decades ago, medical documentation was manual which required handling documentation with care. In larger hospitals, managing hardcopies required having record rooms with filing codes, and resulted in a large margin of error. This led to much time wasted while tracking files, and duplication of files. Often, in an attempt to save time, administrators would create new files which caused multiple files for one patient. The list of available resources wasted in this scenario is quite extensive.

Digital information or EHRs reduce inefficiency of the documentation process. Having instantaneous access to these records, improves decision-making when it comes to administering treatment and eliminates the need for paper work. Moreover, EHRs ensure error-free medical records, avoid unnecessary requests for diagnostic tests and they improve patient care.

The Impact of EHRs

From a patient confidentiality perspective, the use of electronic medical data has improved. Now, electronic files mean limited access to sensitive information. Unauthorized medical personnel cannot access any patient’s file. This complies with the HIPPA laws and has refined various health insurance policies as well.

Since there are medical codes for almost every medical condition, the concept of medical coding has also taken medical documentation protocols to a new height. Medical coders continuously work with codes and electronic health record systems have made this easier to manage. Now, medical coders can make claims without flaws and within the appropriate time, before it is too late.

Today, large medical hospitals and medical centers easily handle medical records in real-time, and the credit for this goes to EHRs. They have reduced the amount of time wasted by medical professionals as well as decreased the cost of stationary and office staff.  In fact, there is a lot more to learn through EHRs, making the future of medical documentation  brighter.

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What You Need to Know About Meaningful Use

What You Need to Know About Meaningful Use

“Meaningful Use” refers to the use of electronic health records (EHR) throughout the healthcare industry to provide patients with better quality, more coordinated care. There are numerous electronic systems available that healthcare professionals and hospitals can choose to implement into their practice with some being much more user-friendly and comprehensive than others. Many of these facilities that make the transition to an EHR system do so according to the guidelines required to qualify for Centers for Medicare and Medicaid Services Incentive Programs.

Stages of Meaningful Use

To qualify for EHR incentive payment, the healthcare provider must show that they are using their electronic health records to meet thresholds for a number of specified objectives. These are set up in three stages, each with increasing requirements to be met during the period of that phase. In order to receive the incentive payment, the provider must demonstrate meaningful use each year.

Stage 1 of meaningful uses focuses on data capture and sharing in a standardized format. This information is used for tracking key clinical conditions and using the data for coordinating care. During stage 1, patients and their families will begin to take a more active role in their health care.

Stage 2 of meaningful use focuses on advanced clinical process, including more rigorous health information exchange. Requirements for e-prescribing and incorporation lab results as well as transmission of patient care summaries will be made electronically across multiple settings.

Stage 3 of meaningful use focuses on improving outcomes by making healthcare safer and higher quality. Support for those with high-priority conditions and providing patients with self-management tools will contribute to the increase in patient data through the health information exchange.

Benefits of EHR

While the apparent financial benefits of EHRs for medical care facilities are obviously from the Meaningful Use incentive programs, there are many additional benefits that come from meeting the thresholds outlined in each stage of the program. Increasing the ability to share patient information across all channels and have the ability to bring up a patients entire medical record in a matter of seconds gives doctors better tools for diagnosing and treating patients without the risk of ordering repeat tests or over-prescribing medications. At the end of the third stage, there will be much greater coordination of care between the primary care physician, specialists, pharmacists and other types of care givers contributing to each patient’s treatment.

Another way that Meaningful Use will help healthcare providers financially is by making their practice more efficient. Eliminating repeat tests and unnecessary diagnostics and treatments will time and money while still providing patients with a higher quality of care.  Patients will also have access to their medical information and play a greater part in their healthcare so they know what is being done to treat them at all times.

Once Meaningful Use is fully implemented, all of the medical information of a patient will be instantly available to healthcare providers, even when they are seeing a patient for the first time. They will be aware of any allergies, previous injuries or conditions, and the medications the person is currently taking. The world of digital technology is increasingly becoming the standard method of sharing information to give patients the best possible care.

If you have questions about Meaningful Use or to see if you qualify please contact the Medical Billing professionals at Medical Healthcare Solutions.

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What Is ICD-10?

What Is ICD-10?

ICD-10 is the tenth revision of the International Classification of Diseases, or ICD. The ICD is the standard diagnostic tool for health management, clinical and epidemiological purposes, and it is used by doctors, nurses, policy makers, researchers and other health care experts to classify diseases and other health issues. It’s also used to monitor the general health situation of population groups.

The ICD-10 was endorsed by the 43rd World Health Assembly in 1990, and it has been in use in World Health Organization states since 1994. Despite this long history, the ICD-10 is still being updated through an ongoing revision process. Transition to the latest version of ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act, or HIPAA. The release date of ICD-11 is scheduled for 2017.

Differences Between ICD-9 and ICD-10

The biggest differences between ICD-9 and ICD-10 is in the diagnosis code set. Where ICD-9 had five positions in its code set, ICD-10 has been expanded to include seven positions. The number of diagnostic codes has also been increased from 13,000 codes in ICD-9 to 68,000 codes in ICD-10. These updated codes are far more accurate than they’ve been in the past and allow for more specific reporting and diagnosis.

The problem with companies that still need to make the transition to ICD-10 from ICD-9 is that there is no clear mapping between the two. There are some codes in one system that corresponds to others, but for the most part any organization that needs to upgrade to using ICD-10 will need to do so almost from scratch.

Why the Change Needs to be Made

The medical field is changing drastically all the time. New disorders and diseases are being discovered, new treatments are being developed and new medical devices have been put into use. The changes made in just the last 25 years have been incredible, and things will continue to change more quickly than ever before. The ICD-9 system was not designed to keep up with that kind of progress, so a newer system such as ICD-10 needs to be put into place.

However, staying HIPAA compliant and upgrading to ICD-10 isn’t enough. As we said before, ICD-10 is constantly under revision, and that means that organizations that use it have to keep it updated. That has become easier now that ICD-10 is available online, but it still takes a lot of work to stay up to date.

We at Medical Healthcare Solutions know how important it is that any organization covered by HIPAA has the latest version of ICD-10. We do our best to stay on top of all forms of medical coding even as they are constantly changing, and we always do what we can to be aware of changes and updates before they are made. We also do our best to remain HIPAA compliant in every way, and we can help other organizations do the same. If you would like to know more about how we keep ICD-10 properly updated and implemented, contact us today or visit us online.

If you’re interested in learning more about how Medical Healthcare Solutions can prepare your practice for the upcoming ICD-10 changes please contact us at 1-800-762-9800 or by filling out this form.


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