Top Challenges Medical Practices Face

by | Published on Jan 12, 2015 | Healthcare News

Top Challenges
Share this:

With new regulations, increased administrative burdens, technology changes, and new reimbursement models, physician practices face myriad challenges. As diagnosis codes become more specific with ICD 10, additional resources will have to be allocated to medical billing and coding tasks to achieve maximum reimbursement. Here are some of the major challenges that physician practices currently face even as they strive to reduce costs and improve medical care.

    • Complying with the Government Mandates
        • Shift to ICD-10 – Physicians have to upgrade their systems to incorporate the new diagnosis codes and documentation requirements. Practices that are not prepared for the ICD-10 transition are likely to incur claims rejections and denials that will affect their cash flow.


        • Meaningful Use Reporting Stage 2 – This requires the EHR providers to prove a greater range of system utilization and interoperability and the requirement for more structured data documentation for each patient.


        • Changing PQRS Requirements – The changes in the physician quality reporting system has increased the pressure to use Registry and EHR reporting methods instead of paper-based claims reporting. The 2014 Physician Quality Reporting System program comprises 110 individual quality measures eligible for claims-based reporting.


      • HIPAA Updation – The Health Insurance Portability and Accountability Act’s final rule necessitates practice document changes to strengthen the privacy and security protection for individuals’ health information.


    • Implementation Milestones of the ACA – The Patient Protection and Affordable Care ACT has created an impactful changes that will affect the healthcare practices, such as Medicaid expansion, coverage of pre-existing conditions, and more.


    • Ambiguity of Medicare Reimbursement Rate – The threat of significant cuts in Medicare reimbursement troubles the physicians and hinders their planning and assessment abilities of their financial condition.


    • Rise of Alternative Payment Models – This puts an increasing pressure on the need for quality data collection and sharing of data across care settings.


  • Growth in Patient Population – Because of Medicaid expansion and other provisions of the Affordable Care Act, a new patient population has been introduced and the proportion of self-pay patients with patient payment responsibilities has increased.

Running a medical practice is just running any other business, which is why physicians cannot neglect their medical billing and coding tasks even in the face of these new challenges and increased responsibilities. A professional medical billing company with a team of certified, well-trained medical coders and billing specialists can help physicians manage their revenue cycle with speedy and error-free processing of claims. This will help keep the practice viable, ensure compliance, prevent physician burnout, and enhance patient care.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

More from This Author