Ebola Scare in the US!

Wednesday, October 29, 2014 5:57
Posted in category Medical Billing
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The growing panic among the US citizens over the Ebola virus has become the recent buzz in the country. The US Centers for Disease Control and Prevention (CDC, Atlanta) has estimated that by August 2014, approximately 68 Ebola scares were handled by US healthcare facilities and state labs. The numbers have doubled and tripled in the months of September and October. The latest news is that the deadly virus could reach Britain and France by the end of this month (October). The approximate number of people infected so far by this rapidly spreading virus is 7,200. Let us take a look at when and where it all started and how scientists and healthcare workers are struggling to contain a full-fledged outbreak:

Inception and Facts:

The much-feared Ebola hemorrhagic fever originated from the region of Zaire in Central Africa.

Named after the River Ebola, from where the disease was said to have been discovered, the first Ebola human infection was reported in 1976.

Scientists claim that there are five different Ebola virus types out of which four can cause severe human illnesses, while the fifth virus known as the Reston affects only primates.

When debated whether the disease is contagious or infectious, scientists describe the Ebola virus to be highly infectious and less contagious. It means that even a single Ebola virus has the ability to trigger a fatal infection and it is not an airborne disease like measles.

Ebola is transmitted to a healthy person when he/she comes in contact with body fluids of infected persons and contaminated objects used by them.

Symptoms vary from fever, headache, muscle pain, sore throat, vomiting, diarrhea, impaired kidney and liver functions, along with internal and external bleeding in some cases.

The most disturbing fact is that no cure has been found so far.

Ebola Scare in the US:

There was not even a single Ebola case reported in the US until August 2014. It was on Sept 30 that CDC announced that a Liberian named Thomas Eric Duncan visiting Texas was diagnosed with the Ebola virus. While Duncan died on October 8, the news spread ‘virally’ through the nation panicking the citizens. Adding to the panic was the news of the nurse who cared for Duncan also testing positive for Ebola on October 11. On October 15, another nurse who cared for Duncan, Amber Vinson was also diagnosed with the Ebola virus. Though there were so many speculations, the two nurses were declared free of the deadly virus on October 24. While that is good news, the fear of the deadly virus is still lingering in every part of the US.

Steps taken by the US:

To contain a full-fledged Ebola breakout, the nation is taking several precautionary measures,

A thorough airport screening is performed on all travelers traveling from West Africa.

Individuals who might have come in direct contact with infected persons will be isolated in quarantine for 21 days.

The Ebola scare has widely disturbed the normal working conditions of the US healthcare industry.

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Why is India a Better Offshore Destination?

Monday, March 24, 2014 6:31
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Lately, outsourcing medical billing has become a common practice in the US healthcare domain. To streamline the medical billing activities of a customer, US medical billing companies partner with offshore medical billing companies located in various countries, including India. Though there exists a variety of offshore medical billing companies in several countries around the world, India has always been the most sought after outsourcing destination for US medical billing companies. The following factors will substantiate why India is considered as a better offshore destination in the world:

Optimal Time Difference: Geographically, India and the US are placed at an optimal distance from each other with a 9 to 13-hour time difference. It is this favorable time difference that helps in the smooth flow of work between the two countries. As the US medical billing companies are closed during the US nighttime, offshore medical billing companies in India complete all healthcare outsourcing services precisely, during the daytime in India.  When the staff at the US medical billing companies arrive for work the next morning, most of the work is completed and can be processed further.  This results in faster submission of claims and cash flow to the Providers.  Sometimes, the work gets completed ahead of the scheduled TAT, which makes India a favorite offshore destination for US medical billing companies.

No Language Barrier: English is the most important language and preferred medium of learning in India’s education system. Unlike other countries, that have very less English-speaking population, India has a vast populace which speaks and writes English fluently. It is another major advantage that makes India a better offshore medical billing destination. As there is no language barrier, US medical billing staff find it easy to communicate their medical billing requirements to the staff working in offshore medical billing companies in India. With easy two-way communication, problems are escalated on time and resolved, enhancing the productivity.

Cost Efficient and High-quality Output: It is estimated that US medical billing companies save up to 60% of their revenue by outsourcing to medical billing companies in India. It means that there is no need for US medical billing companies to invest on high-end healthcare software and systems. Also, they can save huge revenue on staff training and automation. Even though offshore medical billing companies from other countries could provide slightly better cost savings, there is no guarantee that they will render quality work. However, most Indian medical billing companies follow extreme quality control processes to ensure maximum accuracy in the work delivered. Thus, India is considered the most cost-efficient and quality offshore medical billing destination in the world.

For more than a decade now, eCare India has been a favorite offshore medical billing company for many US medical billing companies. ISO 27001:2005 and 9001:2008 certified and HIPAA compliant, this medical billing company in India has acquired a respectable place in the US healthcare domain.

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It is Insurance Eligibility Verification time!

Friday, February 28, 2014 7:45
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The effort taken by most healthcare entities in minimizing claim denials has become remarkable in the recent times. They pay more attention in documenting patient demographics, entering ICD & CPT codes, updating current charges, performing regular AR follow-up and more. However, their claims still get denied by the Payer. The reason is that Providers and medical billing companies fail to pay attention on the insurance eligibility verification. Most importantly, it has to be done even before a patient visits a Provider. If all the steps in the insurance eligibility verification are followed perfectly, then denial management would become much easier. Let us have a brief review of this process:

Basic Verification: Insurance eligibility verification can be done at two levels and the first one is the basic verification. In this level, healthcare entities verify general information like patient details and insurance coverage period & services. In addition, co-pay, co-insurance, and deductible details are also checked. Verifying all these details in the first 3 months of a year is very crucial. The reason is that most patients fail to meet their calendar-year deductible, which gets renewed every January. This information must be communicated in advance to concerned patients whose calendar-year deductible is outstanding. Only when this deductible amount is paid does the insurance company starts paying for the covered medical expenses. Therefore, Providers must carry out the insurance eligibility verification process prudently to avoid claim denials.

Advanced Verification: It is an in-depth insurance eligibility verification process which includes the basic verification details and in addition also checks the insurance plan’s code-specific benefits, which may have ‘Annual Maximum’ or ‘Lifetime Maximum’ limits. An insurance plan with Annual Maximum benefits states that patients are responsible for bearing medical expenses that exceed the specified limit in that particular calendar year. Lifetime Maximum is the total expense borne by an insurance company until the plan’s specified limit is reached. Once this limit is met, then the patient has to pay out of his pocket. In case, healthcare entities fail to check these details before providing care, then they will have a tough time receiving their payments from patients whose Annual Max or Lifetime Max limits have been reached. This in-depth verification is ideal for Healthcare Specialty Units like Cardiology, General Surgery, Physical Therapy, and specialties that have high $ value services. It helps in effective denial management and faster reimbursements.

Be it basic or advanced level insurance eligibility verification, a renowned offshore medical billing company like eCare can do it perfectly. eCare recently has deployed a dedicated team to carry out the insurance eligibility verification process. The team’s highly skilled professionals do this job efficiently and deliver the benefit details before the turn-around time (TAT).

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Pros and Cons of Offshore Medical Billing

Monday, February 17, 2014 5:46
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We all know that Healthcare Providers are trying their best to sustain their practice, especially after the  new healthcare reforms. It is the same scenario with US based healthcare outsourcing companies as well. Since their end-clients are facing the changes, the healthcare outsourcing companies also face the same concerns. It is to surmount these challenges that offshore medical billing companies are in existence. Like there are two sides to every story, medical billing outsourcing to offshore medical billing companies has its own pros and cons. Lets discuss a few of them:
Pros: On the positive side of offshore medical billing, there are several advantages to discuss,

  • Cost Factor: Performing all kinds of billing operations by incorporating new changes in-house is not an easy task. It requires a lot of spending on space, overhead costs, recruitment, training, and technology. When a part of medical billing and coding operations is outsourced to an offshore medical billing company, there is a good chance for a medical billing company to save money.
  • Volume: The volume of medical billing operations has increased a lot as medical billing companies handle multiple Healthcare Providers at a time. Medical billing outsourcing happens to be the best option as it reduces the burden of medical billing companies by sharing most of the mundane repetitive work.
  • Accuracy: As mentioned earlier, when medical billing companies handle huge volumes of billing operations, the accuracy level declines. However, with an offshore medical billing company’s help, they can perform medical billing and coding functions precisely without any compromise on quality.
  • Bandwidth: When part of the work is sent to an offshore medical billing company, it liberates the bandwidth within the organization.  Instead of handling day-to-day operations, only guidance and audit needs to be performed.  The liberated extra bandwidth can be utilized to acquire new clients and on-board them with very less ‘transition bumps’.

Cons: Instead of calling them as disadvantages, it can be termed as ‘fear factor’ of healthcare outsourcing companies about offshore medical billing companies,

  • Data Security: It is the first main ‘fear-factor’ that most medical billing companies have about offshore vendors. They hesitate to share the confidential information (PHI) with the offshore vendor and thus, eliminate the idea of healthcare outsourcing.  What they fail to understand is that the new changes to HIPAA mandate the same level of punitive actions for breach on offshore medical billing companies that are applicable to them. Some vendors like eCare have pro-actively acquired ISO certifications both for processes and Information security and have better security measures than even some of the US based companies.
  • Choosing the Right One: Some medical billing companies fear that they might end up partnering with the wrong offshore medical billing vendor and rightly so.  There are many instances where a choice is made in haste without proper due diligence that results in a horrible experience. With proper research and due diligence they can find a good, reliable medical billing company in India like e-Care.

By partnering with the right offshore medical billing company, US based healthcare outsourcing companies can easily eliminate these fear factors and enjoy great benefits that offshore medical billing companies have to offer.

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Benefits of ERAs/EFTs

Friday, February 7, 2014 10:11
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The introduction of ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) created a revolutionary change in the healthcare billing domain by replacing traditional, paper-based EOBs (Explanation of Benefits). Though the facility has been available for many years, even today only 46% of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Patient Protection & Affordable Care Act (PPACA) under section 1104 has mandated that all healthcare plans adopt and support EFT/ERA operating rules before the deadline – January 1st, 2014. Before adopting ERAs and EFTs in your system, get to know their benefits:

  • Cut-down Processing Time: The major benefit of implementing ERAs/EFTs in one’s system is that it considerably brings down the medical claims billing processing time. While payment postings are done electronically, the time involved in posting paper EOB payments manually gets reduced. The electronic way of posting payments has quickened and accelerated the cash flow of Providers to a significant level. Also since everything is electronic, the time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.  EFTs transfer the funds directly into the Provider’s bank account or a lock box.
  • Reduced Manual Effort: By adopting ERAs and EFTs, Providers and healthcare billing companies can reduce manual effort significantly. Therefore, there is no need for recruiting new employees who are adept at payment postings. Also, it is not necessary to train the existing employees on the payment posting method. This manual effort can be used for other complicated medical claims billing functions.
  • Auto Posting Efficiency: EFTs/ERAs allow the use of auto posting feature, which enables posting of payments on to the system automatically. The error rate of the automated posting method is less than that of manual posting. The manual effort involved in correcting these minimal errors is also less.
  • Cost Efficient: Healthcare Providers and outsourced medical billing companies can save a considerable amount of money by implementing ERAs and EFTs. The cost involved in recruiting new employees and training the current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be achieved. Therefore, the electronic payment posting method is not only time efficient, but also cost efficient.
  • Environmentally Friendly: The adoption of ERAs and EFTs has encouraged several healthcare billing companies and Providers to ‘Go Green’. Approximately, 2.5 billion pieces of paper can be saved by using the eco-friendly electronic payment process.

Several small healthcare providers and facilities are still using the traditional paper-based method of payment posting. Consequently the US based outsourced medical billing companies follow the same process. However, with the new legislation mandating the use of electronic payment method, there is an exigency for them to implement ERAs/EFTs as quickly as possible for these Providers and facilities. Doing so can consume a lot of productive time affecting the normal work and cash flow. Therefore, outsourcing medical billing functions to an offshore billing company like eCare India would be the right choice.

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How soon can you start saving when using Offshore Medical Billing?

Monday, February 3, 2014 8:18
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Due to the recent changes in the US healthcare domain, the onus of providing medical billing services with consistent quality has increased for the US based medical billing companies.  The offshore medical billing model has become a ‘hard to avoid’ option in recent times. Evidently, many outsourcing medical billing companies in the US consider it a better option than to expand their team of employees. However, they have to wait for sometime before the workflow kicks off and follows a steady pace. Most US medical billing companies expect savings immediately after outsourcing to an offshore medical billing company which is not realistic. Let’s analyze how soon outsourcing medical billing companies can save in offshore medical billing:

  • Learning Curve: The initial transition is the most crucial stage as a considerable amount of time and effort will be consumed for both the outsourcing and the offshore medical billing companies. This stage emphasizes the learning curve for the teams of the offshore medical billing company. The team gains knowledge of the work and TAT requirements of the outsourcing companies. Patience is indispensable during this time as the normal workflow might slowdown a little.
  • Productivity Factor: During the learning phase, offshore medical billing companies cannot contribute 100% productivity as the teams are still getting acquainted to the work assigned. The productivity of the US outsourcing medical billing companies might also get affected as the staff devote time in explaining their requirements to the offshore team. Therefore, it is highly essential that they understand this fact and wait patiently to reap great benefits in the near future.
  • Adapting to Work Change: Once a part of the medical billing and collections is outsourced to offshore medical billing companies, the in-house billing team is assigned with some other work. Mostly, the work involves administering and providing front-end support to the offshore team. This change in job nature will consume a considerable amount of the in-house billing team’s time until the employees adapt to their new roles. Here again there is chance of the normal workflow getting affected.
  • The Kick Start: Once the billing team of the offshore medical billing companies gets a hang of the work, then they will render better medical billing solutions with 100% productivity. Also, the accuracy level increases reducing claim denials. Gradually, outsourcing medical billing companies will start earning huge savings which will continue to progress as time passes. However, to enjoy these benefits, they have to assist and ‘hand-hold’ the offshore team and help in sorting out issues that may happen in the initial stages of offshore medical billing.

If you are looking for a highly-experienced offshore vendor that requires minimal ‘hand-holding’ during the initial phase, then look no further than eCare.

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EDI Set-up – Save Time and Money!

Monday, January 27, 2014 11:31
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Working effectively and efficiently is crucial when it comes to performing medical billing functions. Several factors help in the enhancement of medical billing functions of a provider to save money and time. Among them, EDI set-up plays a key role in promoting faster medical claims processing and quicker reimbursements. Though EDI (Electronic Data Interchange) has been around for some time now, its adoption rate is still less. To emphasize its efficacy, the Health Insurance Portability and Accountability Act (HIPAA) had mandated the EDI set-up. Once EDI is set-up, the Providers can send their claims and also receive the payments and denials electronically which reduces the revenue cycle time to a large extent. There are two ways in which this complex process can be set up for one’s practice and they are as follows:

  1. Clearing House: EDI set-up can be done using the help of a clearing house. To accomplish this process, Providers or medical billing companies will have to submit an enrollment form initially. An agreement emphasizing the fulfillment of HIPAA security and privacy requirements are signed between the Provider and the clearing house. Once it is done, Providers can start exchanging their patient information with the clearing house for further medical claims processing. Clearing houses help in promoting faster reimbursements, reducing denied claims and offer more medical billing solutions. They act as a bridge between the payer and the Provider. To ensure auto payment posting, clearing houses use ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) instead of paper EOBs and checks.
  2. Direct Approach: It is another way of setting up EDI where all EDI transactions are done directly to the payer. Here again, a Healthcare Provider or Facility will be expected to submit an enrollment form. Following the enrollment, it has to sign an agreement binding to HIPAA security and privacy requirements with the payer. EDI can also be set-up during provider credentialing. The process of collecting and verifying a Provider’s credentials is known as provider credentialing. Providers who are already in the payer’s network can also subscribe to EDI set-up during re-credentialing.

Whether Providers follow the clearing house or direct payer approach of EDI transactions, they must make sure that the normal medical claims processing workflow is not affected in any manner. For successful EDI set-up and uninterrupted medical billing, Providers or medical billing companies can get help from a reputed offshore medical billing company like e-Care. This ISO certified and HIPAA compliant offshore vendor will take care of the complete EDI set-up process.

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What is your Claims First-pass Ratio?

Monday, November 18, 2013 7:30
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Healthcare Facilities, Providers and the US medical billing companies that handle their billing, have faced a lot of complexities during medical claims billing. As they already have too much to handle, adapting to the new changes introduced by the Affordable Care Act is truly burdening. The claims get denied by the Payers before they can get a handle on the new coding updates and this result in a poor first-pass ratio. So, what is this first-pass ratio? See below to learn its importance:
What happens after billing a claim? There are two stages at which claims can possibly get denied and it is essential that Providers and outsourced medical billing companies understand the first-pass ratio and its importance.

  • Claim Rejections at Clearing House: When the medical billing software finishes billing a few batches of claims, they are uploaded to the respective clearinghouse accounts of the Provider or the US billing company. Then, the clearinghouse checks for errors in the claims uploaded. The error-free claims are securely transferred to the concerned Payer electronically (meeting HIPAA standards – 837), while the erroneous claims get rejected and sent back to the Provider or the US billing company.
  • Claim Denials at the Payer Level: The next stage where claims can get denied is at the Payer level. The insurance carrier analyzes the claims once again, looking for errors that were overlooked by the clearinghouse. When an erroneous claim is detected, then a claim denial status message is sent back either via the EOBs or ERAs, which then gets updated to the Provider’s medical billing software.

First-pass Ratio: When a Provider or an outsourced US medical billing company uploads say, for instance 100 claims, to the clearinghouse and if 20 claims get rejected, then the first-pass ratio is 80%. If this claims rejection is eliminated, then the claims can easily pass through to the Payer level accounting for quicker reimbursement. On the other hand if erroneous claims are submitted, then they will get denied at the Payer level, causing more work like AR pile-up and TFL issues.
To Improve First-pass Ratio:

  • The medical billing staff or the software (edits) must work exceptionally well to avoid trivial errors, which will be hard to find out if claims get denied.
  • The clearinghouse claim rejections must be analyzed and worked frequently, finding better solutions to avoid errors occurring in the future.

Many US medical billing companies are at risk of losing their hard earned goodwill from clients due to poor first-pass ratio and re-work, due to the changes in the healthcare domain.  They also lose a big chunk of their profit margins, if a higher % claims need to be re-worked or handled by AR as Denials.  One of the best solutions would be to outsource medical billing functions to an offshore medical billing company that has a higher first-pass ratio. One such company is eCare!

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Medical Records Indexing

Wednesday, October 30, 2013 12:44
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Among the several factors that determine the success of US medical billing companies and Healthcare outsourcing Providers, indexing medical records is one piece that has a great significance. Since it keeps track of key information such as patient demographics, clinical history and medical reports in one place for easy access later, maintaining and securing such medical records is highly imperative. Indexing medical records is not as simple as fishing in a barrel. It requires a lot of knowledge and experience. From patient demographics and medical charts to insurance bills and EOBs, everything has to be indexed with extreme care. Let’s discuss the importance of indexing medical records.

Security Factor: As we all know that Patient Health Information (PHI) is secured by the HIPAA (Health Insurance Portability and Accountability Act) of 1996, it is mandatory that indexing medical records also follows the same criteria. If a healthcare provider wishes to share the patient information with a medical billing company via FTP, email, fax or commercial cloud provider, then he has to strictly follow the Privacy and Security Rule of the HIPAA act. Not just that! The medical billing company that obtains the patient information should also be compliant to HIPAA standards. The same concept applies to medical record indexing. When a US healthcare entity chooses to outsource medical record indexing function to an offshore company, then it has to check whether the company is HIPAA compliant for security reasons.
Knowledge Factor: Indexing medical records, as said earlier, is not as simple as a walk in the park. It involves great complexities, which cannot be handled by any layperson. So, only a team of well trained and skilled professionals with knowledge of medical terminologies can index and maintain medical records in an accurate manner. Besides the indexing function, the professional team also has to periodically review the indexed medical records to ensure accuracy and consistency. Before partnering with an offshore medical billing company, a US healthcare entity has to check whether its employees have expert knowledge on the indexing medical record functions. If not all, at least a group of employees must be adept in understanding the nuances and carrying out indexing services skillfully. Many generic BPO companies claim to offer these services without understanding the HIPAA and knowledge requirements.

Checking for the aforementioned security and knowledge factors in an offshore medical billing company is extremely important for US healthcare outsourcing companies. By doing so, the outsourced revenue cycle management companies can be relieved of the complex medical record indexing functions and devote their time to other important medical billing functions for smooth running of business. Also, they can witness a positive cash flow and uninterrupted revenue cycle management. ISO 27001:2005 and 9001:2008 certified as well as HIPAA compliant, e-Care India is one reliable offshore company that performs medical record indexing in a professional yet accurate manner.

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ICD-10 Impact on the Revenue Cycle

Thursday, October 24, 2013 10:06
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Right from Healthcare Providers to medical billing companies, everyone in the US is looking forward to one major change, which is the ICD-10 implementation. Though the transition of ICD-10 code sets will come into effect only by 1st October 2014, Healthcare Providers and Facilities and onshore and offshore medical billing companies have already started preparing for the change. There is no denial that this transition has numerous advantages like improving patient care, increasing physician billing accuracy, enhancing clinical performance and more. However, it is predicted that ICD-10 transition is sure to impact the healthcare revenue cycle management badly in the first few months of its implementation. Let’s discuss them in detail:

Extra Time Consumption: Consequent to the ICD-10 implementation, every Provider and medical billing company will be expected to update their coding system with at least 200,000 new codes. With the increase in the coding complexity, the time taken to code each chart will also increase. So, coders will find it hard to complete their coding processes within the intended time schedule.
Increased Coding Cost: The cost of coding per chart increases eventually, as the time taken to code increases. It directly impacts the healthcare revenue cycle management of Healthcare Providers and dependant onshore and offshore medical billing companies.
AR Pileup: It is predicted that Healthcare Providers and medical billing companies will face a lot more denials in the initial stages of ICD-10 implementation. The reason for this claim denial would undoubtedly be the increased complexity of codes and insufficient documentation, which trigger a lot of errors. The Payers will also be adapting to the new code sets and there could be Denials made in error.  Again, the revenue spent in cleaning up this accumulated AR will rise, affecting the normal cash flow.
Impact on Medical Billing Companies: The ICD-10 transition eventually increases the training and new technology costs of physician billing companies. This rise in cost impacts the outsourced Healthcare Providers and Facilities badly.
Clinical Documentation Costs: The ICD-10 transition calls for new clinical documentation techniques, so physician billing staff will have a hard time getting adapted to them in the initial stage. Capturing clinical data as per the new techniques will definitely require some expertise for which training is necessary. Also, frequent audits are required to keep the documentation error-free. In both the cases, Providers and billing companies will be required to spend lots of money. Therefore, the overall healthcare revenue cycle management gets affected.
Preparing for the ICD-10 transition in a full-fledged pace while administering physician billing functions will be hard for Providers as well as medical billing companies. Therefore, outsourcing a part of billing functions to a reputed offshore medical billing company like eCare will be a good decision.

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