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Physician Payment Reforms and the Medical Billing Challenge

by | Oct 5, 2013 | Medical Coding News, Resources | 0 comments

The National Commission on Physician Payment Reform has come to the inference that the way doctors in the U.S are paid “is one of the most significant drivers of escalating health care costs.” Accordingly, recommendations have been made to transform the way doctors are paid, with a view to control spending and improve quality of healthcare. The fee-for-service payment model was identified as the major contributor to the growing healthcare costs and therefore a quick transition to new payment models that would reward value over volume was found to be the need of the hour. Bundled payments, pay for performance and financial risk sharing are some of the effective payment models to be implemented. The payment reforms along with the affordable care act (ACA), ICD-10, and various other industry and regulatory changes will have a significant impact on physician reimbursement over the next four years.

More Focus on Physician-Patient Interaction

With quality of care assuming supremacy over the amount of services provided, the focus is more on the time you spend with your patients, strengthening and managing the relationship with them. This is to help prevent unnecessary costs that may be incurred later from an illness or condition that could have been avoided via proper counseling and preventive care. You will also have to advise your patients about medical costs with the use of latest technology. As is evident, you need to help your patients work in perfect co-ordination with you and thus manage their health in a better way.

Impact on Reimbursement — Changes You Can Expect

The recommendations regarding payment reform focus on recalibrating the fee-for-service payment model and thereby addressing the existing payment discrepancies while rewarding services that can improve patients’ health.

  • The positive aspect of the new payment model is that you will be paid more for certain services, such as Evaluation and Management Services (E&M services) that have remained undervalued.
  • Separate services will be bundled into a single payment and the amount reimbursed will also depend on the cost and amount of services that will be provided by other providers.
  • Certain services may receive lower reimbursement because money is shifted to new payment systems.
  • New services may be reimbursed inadequately.
  • You may experience a shortfall in revenue on account of fewer referrals or low service utilization.
  • You may have to invest considerably in implementing new payment systems.
  • You will have to collect comprehensive data from Medicare and other sources to ensure timely generation of clinical data and accurate cost.
  • You may find it difficult/impossible to access the data you need for establishing accurate reimbursement rates.
  • To ensure effective implementation of alternative payment models, you will also have to improve the quality of cost measures.

How to Meet the New Requirements and Challenges

Given that you need to prepare for the various challenges on the road to appropriate financial reimbursement without compromising the all-important aspect of patient care, your solution is an effective medical billing service. A reliable medical billing and coding company will help you take the challenges in your stride and make a successful transition to the new system. Apart from helping you meet the requirements pertaining to the new payment model and the ACA, a competent medical billing service will also enable a smooth changeover to ICD-10. With a busy practice to run and more patients, you can easily choose not to reel under the pressure created by complex coding and increased documentation requirements. Avoid delays in reimbursement and claim denials resulting from erratic coding and billing procedures with the help of professional medical coders and billers. Associate with a medical billing company that can ensure flawless coding, accurate documentation, claim filing, follow-ups with payers and effective handling of claim denials. Reliable and timely medical billing services will help you secure accurate payments for the services you provide your patients. Professional medical billers and coders stay updated with even the minutest changes in the medical coding and billing scenario, and can therefore assist you in identifying the specific practice management areas you need to work on to reap the due benefits from the new payment models.