Cash Flow and Reimbursement, the Top Challenges Physicians Face in 2017

by | Last updated May 16, 2023 | Published on Jan 11, 2017 | Healthcare News

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Medical billing and coding by itself is quite challenging with most physicians choosing to outsource these processes to reduce stress and improve efficiency. In the course of their practice, physicians have to battle with strict regulations and tight budgets among other challenges. This year is no different. According to a recent survey by Capital One Spark Business, cash flow and reimbursement for patient treatment are the two most pressing business issues physicians will face in 2017.

To learn more about the prime concerns of physicians and practice owners nationwide, this Fortune 500 Company surveyed 162 physicians at the 2016 Pri-Med Mid-West Annual Conference in Chicago. Results showed that:

  • 69 percent cited cash flow and reimbursement as their top concerns
  • 71 percent of respondents described “moderate” to “very severe pain” in waiting for payment for medical services
  • More than half of those surveyed said the biggest expense they shoulder is the cost of salaries and benefits for their support staff

Other concerns that rose among physicians and practice leaders were – 19 percent cited regulation and 12 percent singled out harnessing the latest technology as their biggest challenges for 2017.

Other challenges healthcare providers face this year include:

MACRA Compliance – Healthcare reimbursements are migrating from volume to value. MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was supposed to take effect at the start of 2017. But the Centers for Medicare & Medicaid Services (CMS) delayed full implementation until January 1, 2018, allowing practices to submit partial information or participate only for part of 2017.

Documenting and reporting every treatment through a certified EHR or other approved method is the only way physicians can get paid for services. Also, physicians must make sure that:

  • all services are billed properly
  • every diagnosis is part of the billing for that patient
  • all ICD-10 codes are attached to the bill

Prior authorization requirements – Like other years, prior authorization requirements also increased this year. However, patient eligibility verification services by experienced medical billing companies are now available for medical practices to speed up the prior authorization process.

Advanced technologies that integrate with electronic health record systems can also help to streamline the prior auth process. It is also expected that value-based payment models will limit the growth of prior authorizations.

Perfect EHR Usage – It has been found that only very few physicians have complete interoperability. According to a study released by KLAS Research in October, only 6% of healthcare providers can effectively and efficiently share patient data with other clinicians who use an electronic health record (EHR) system different than their own.

IT experts recommend doctors to start by working with colleagues to ensure they can efficiently move data locally. It is also recommended that doctors should make electronic data exchange part of their practice workflow by maximizing the use of the functions already included in their existing software systems.

A reliable provider of medical billing outsourcing services stays up-to-date with the medical coding and other changes that happen each year, and help healthcare practices with dedicated services.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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