“Protecting Access to Medicare Act of 2014” Comes as a Relief to Physicians

by | Published on Apr 23, 2014 | Healthcare News

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On April 1, 2014, President Barack Obama passed the legislation, Protecting Access to Medicare Act of 2014 that enacts a 13-month temporary patch for the sustainable growth rate (SGR) formula and delays the transition from ICD-9 to ICD-10 until October 1, 2015.

The U.S. Senate had approved the bill in March with a voice vote of 64-35, where 60 votes are enough for passage. This new administrative development is a temporary fix for the intimidating 24% cut to physicians’ Medicare reimbursement and their medical billing woes. It also provides more time for ICD-10 compliance preparation, which is a great relief for healthcare organizations that has not yet finished their ICD-10 implementation tasks. However, the American Medical Association (AMA) is not happy with this as they are looking for a permanent fix and wants to stop ICD-10 implementation altogether.

It may be very difficult for physicians to deal with the 24% cut in their reimbursements as they will have to cut corners (for example, cutting down staffs) and refuse taking Medicare patients. As more than 100 million Americans hold Medicare and Medicaid coverage, physicians will lose a significant number of patients through this. Also, the physicians will get very less time to spend with their patients after performing the paperwork related to billing tasks for Medicare and other insurers in order to receive maximum reimbursement. Overall, it will drastically affect physicians’ productivity and revenue. The Protecting Access to Medicare Act of 2014 avoids the payment reduction scheduled for April 1 and replaces it with a 0.5% increase in payments through December and freeze payment rates from January to March of 2015.

Now, let us take a look at ICD-10 compliance. The ICD-10 Readiness Survey conducted by the Workgroup for Electronic Data Interchange (WEDI) in 2013 revealed that the U.S. healthcare industry is much behind the key ICD-10 compliance milestones specified in the WEDI/NCHICA timeline for providers, payers and vendors, considering the survey earlier conducted in February. As per the survey, one-half of the healthcare providers are expected to start the external testing for ICD-10 implementation in the first half of 2014. Delay in ICD-10 compliance can provide the following opportunities for the medical practitioners who are not yet prepared to adopt the new medical coding system.

  • They will get more time to fully test systems and processes
  • Focus on their work again during the transition
  • Expand their relationships with other organizations, vendors and payers to improve their productivity
  • Extend their training process

However, this does not solve the complexity of the ICD-10 coding system, which will increase the diagnosis codes from around 14,500 to around 69,700. There should be experienced and ICD-10 ready coders for the smooth transition. A good revenue cycle management is unavoidable for medical practitioners to improve their productivity and revenue even with the temporary fix. A professional medical billing and coding company is the right choice in this regard as it provides the service of trained, AAPC-certified coders and great support for billing tasks.

Rajeev Rajagopal

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.

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