July 15, 2013
According to CMS, internal medicine physicians will be enjoying an increase in reimbursement rates this year. However, along with this 2013 has brought in a series of regulatory changes for internists to deal with, which most internal medicine physicians are finding difficult to handle.
To be fair, all the changes are not financially negative in nature, the postponement of Medicare cuts by Congress being a point in case. But what is leaving internal medicine practitioners perplexed is the sheer range of regulations, the exceptions, and finally the uncertainty about when a change will come into effect and another will stop being in effect.
For example, Congress deferred implementation of Medicare payment cuts to 31st Dec. 2013, but they left Medicare vulnerable to two percent cut across the board. This explains how a single regulatory change has two contradicting aspects: relief from payment cuts until 2013 Dec. but a possibility of a two percent Medicare cut across boards – all at once. Among other things, these contradictions are leaving internal medicine practitioners confused preventing them from acquiring a clear view of the regulatory changes brought in 2013 and affecting their reimbursement outcomes.
Additionally, the points below will highlight some key changes in regulations as well as indicate their wide-ranging impact on billing and coding and revenues:
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The Geographic Practice Cost Index (GPCI) base of 1.0 for states outside of the six frontier states will expire this year leading to reduced Medicare payments for many rural areas
Critical care rates have very marginally changed from the previous year but Observation to has seen wider increases. For example, the total RVU rate for Initial Observation has increased from 2.77 in 2012 to 2.84 in 2013. And RVU being how hospitals and medical groups calculate bonus, the change in rate is going to affect the payments of internal medicine practitioners who have joined ACOs or hospitals to transition to the bundled payment mode
PQRS (Physician Quality Reporting System) will need reporting on 50 percent of qualified cases for three measures
There has been language change in each of E/M codes and similarly various other codes have changed
2013 regulatory changes have affected internal medicine practitioners more than other specialties because there is a huge swathe of independent internal medicine practitioners who handle their billing and coding without the aid of professional billers and coders. To handle the situation and minimize its impact, internists have to make sure that their billing and coding activities remain in compliance with changed rules and they leverage increases in payment rates instead of falling foul of changed regulations resulting in rejected claims.
In 2003, MBC has helped a number of internal medicine practitioners to suitably face the challenges of changed regulations either by strengthening their internal operations or by handling their complete billing and coding responsibilities.
MBC can strengthen your revenue management system by putting it through a thorough assessment and ensuring that there is sound coordination between various components of healthcare facilitating smooth flow of medical data. Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several small to medium size healthcare providers with its outsourcing services handling the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups.
ACA / HIPAA / Reforms