Obamacare – Considerations for Physician Practices

by | Published on Nov 28, 2012 | Healthcare News

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The patient protection and affordable care act (PPACA) or Obamacare as it is more popularly known, was signed into law by President Barack Obama on March 23, 2010. After Medicare and Medicaid, this Act is a very significant regulatory revamping of the U.S. healthcare system. It aims to reduce the number of uninsured Americans and bring down the overall healthcare cost. To increase the coverage rate it offers subsidies, tax credits and mandates. The Act also has the objective of improving healthcare and healthcare outcomes. More significantly, the PPACA mandates insurance companies to provide coverage for all applicants and provide the same rates irrespective of gender or pre-existing conditions.

Medical practices would do well to adapt to the new requirements. Here are some considerations.

  • There is bound to be an increase in the number of patients on account of the extension of coverage and the new requirement to cover people with pre-existing conditions. Physician practices would need more staff and extended office hours.
  • Medicare and Medicaid cover only approximately 81% of private insurance reimbursements. Physicians will have to decide whether they will accept payments via Medicare/Medicaid, or seek other means to make up the cost difference.
  • Implement EHR or electronic health records because Medicare requires this by 2015.
  • Obamacare ensures certain incentives for practices providing services in rural and other underserved parts of the U.S. Doctors starting on their career could consider this option and enjoy the benefits.
  • Government payers are going for ‘bundled payments’ rather than reimbursing physicians, labs and hospitals separately. This means that physicians will have to collect reimbursement from a mutual association instead of receiving it directly from Medicare. Therefore physicians may have to change the way they bill for 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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