Are Medical Practices Moving Forward at the Same Pace as Healthcare Reforms?


Healthcare Reforms or Obamacare that had been facing a few political hurdles may have finally broken through all shackles and assumed greater acceleration. While healthcare reforms or Obamacare are largely perceived to pro-patient, physicians or medical practices have no option but to move with the requisite adaption. Amongst a host of reforms, the recommendation of the Affordable Care Act, which seeks to make medical care affordable to every US citizen, may possible be the most demanding adaption ever to have been undertaken by medical practices. This ominous burden plus the pulls of other reforms may have actually impeded their progress, which is currently way short of the expected. In fact, the industry sources believe that medical practices across the US are still struggling with implementation stage of adaptation to healthcare reforms mandates.

What makes these healthcare reforms so daunting is that:

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  • Medical practices would find themselves treating more number of Medicare patients than ever before. The extension of Medicare to pre-existing cases as well as dependents under the age of 26 could prove to be exhausting of physicians, who are likely to be disproportionate or short against the patient population. According to a reliable estimate the extension of Obamacare could leave the primary care sector short by 90,000 physicians by 2020!
  • The likelihood of reimbursements being progressively reduced for specialties – contrary to the general feeling of reimbursements improving with patient volume, the proposed Medicare cuts would reduce physicians’ reimbursements by as much as $700 billion. Because the Medicare and states-specific Medicaid account for nearly half of the nation’s health insurance, qualitative appreciation under ACO model of care can only help off-set the Medicare cuts with incentive-based collaborative healthcare delivery.
  • The compulsory implementation of EHR under the HIPAA-5010 mandate, which is likely to disrupt operational flow, consume considerable capital expenditure, as well as train or source staff to conduct EHR systems in the way that best supports patients’ privacy and security norms.
  • There could be considerable change in billing and coding under ICD-10. While ICD-10 may help in streamlining the entire process of reimbursements, physicians will still have to deal with coding-specificity.
  • Fee schedules will get more and more constricted under the new healthcare reforms. While Medicare and Medicaid fees schedules will set the trend of rationalized fee-schedules, it may eventually be followed by the commercial payors as well. Physicians, amidst such dual-impact, may well be forced to optimize their billing efforts to avail maximum reimbursements. And, the process of migrating to a higher system of medical billing may be costly as well as gradual.
  • Under ACO care model, physicians’ reimbursements will happen through bundled fee for services. Therefore, because ACO involves coordinated services among several doctors, there needs to be systematic appropriation of reimbursements based on the involvement of each of the doctors.

While it is true that the face of adapting to the healthcare reforms may have been and likely to be impeded by the reasons highlighted above, they can still be overcome with competent services. – which offers inclusive Medical Billing Services to a range of medical practitioners across the 50 in the US –promises to help medical practices maneuver through, and adapt effectively and efficiently to the pace of healthcare reforms.

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