Are Physicians Prepared for the Changes in 2015?

December 17, 2014

Significant changes are reshaping the US healthcare system. 2014 was a mixed year for physicians in terms of compensation and other aspects of practice management. With 2015 round the corner, hospitals and private practices will have to be prepared for some big changes. Some developments will bring welcome news whereas others might be troubling for physicians.

Industry Facts

Physicians will have to face the issue of high deductibles of $1000 or more from next year
Providers will have to start testing and gearing up for implementation of ICD-10, scheduled on October 01, 2015
Participants of Accountable Care Organizations will start losing money as part of the initial three-year agreement with CMS program. This shared-savings contract will end in 2015
Enhanced Medicaid payments to Primary Care physicians will stop
Providers not adhering to MU program will start facing 1% penalty of Medicare payments from 2015

Significant changes in 2015 that will affect Physicians

  • Starting from January 01, 2015, significant changes will be introduced in the Medicare Value-Based Payment Modifier program. Bonus and penalties assessed in 2017 will be based on the quality and cost of data collected through PQRS in 2015
  • In 2015, providers will be allowed to bill for non-face-to-face care management services to patients who are suffering from two or more chronic conditions
  • Next year onwards, CMS will start collection of data related to the location where medical billing services were provided. Physicians and hospitals will be required to include a modifier in coding which will indicate whether a service was performed in a provider-based setting or off-campus. E.g. home care
  • The final Medicare Physician Fee Schedule of 2015 and Hospital Outpatient rules have been released by the CMS already. Cardiovascular professionals will see no significant changes in payment for the first three months due to the latest patch of Sustainable Growth Rate. Till SGR doesn’t take effect on April 01, 2015, they will have to face 21.2% cut in payments
  • Under the Medicare Physician Fee Schedule, various specialties will experience payment changes in 2015. While payments will increase by 2% for family practices and internal medicine, radiology will witness a -2% impact. Radiation oncology will face -4% impact whereas radiation therapy centers will see a -8% impact on their payments
  • For PQRS participation, eligible professionals will be required to report at least nine measures and cover at least three National Quality Domains. There will be no PQRS incentive payment for reporting in CY 2015. Failure to meet the requirements will lead to a -2.0 payment adjustment in 2017
  • From 2015, the number of quality metrics used for evaluating Medicare Shared Savings Program (MSSP) participants will increase from 33 to 37

According to a survey by Biennial Physician, shift to value-based payment model will force physicians to increase their patient time in 2015. The will also have to deal with increased paperwork and administrative tasks.

The survey indicates an increase in the rate of consolidation in 2015. This is likely to pressurize independent practices to join large medical groups. 70% of the respondents expressed their concerns over consolidation rates because it is affecting their decision-making abilities and the clinical autonomy. 44% physicians said that they will limit the access to care for patients due to workload and payment cuts.

In order to ensure sturdiness of your medical practice and its revenue challenges that 2015 will bring along, many providers are finding recourse in outsourcing their RCM. Medical Billing company like MedicalBillersandCoders.com have been helping many providers eliminate their worries about timely payments, claims denials, HIPAA compliance, ICD-10 and other healthcare reforms. It is currently serving 40 plus medical specialties across all the states in the US.


Category : Practice Administration