February 26, 2014
Overhaul of codes, forms, rates and standards: the current year is going to be very eventful for care providers from a billing and coding standpoint. But whether you will emerge through these challenges 11 months later with your revenues stronger or weaker - depends on how well you can prepare your practice to meet the challenges.
If you closely look at the four challenges cited at the beginning, you will understand the wide-ranging impact they will have on cross-sections of your practice. This article will closely look at the specific issues, but it will first explore Healthcare exchanges (HIXs).
HIXs are meant to implement the principle of Affordable Care Act (ACA) which seeks to expand the base of insured Americans by making insurance policies cost effective. In practice, HIXs will allow a large number of insurers to sell policies at affordable rates to American citizens increasing the number of insured Americans to 40 millions.
This is highly commendable, but how HIXs will set the lower rates of insurance policies to facilitate this huge leap in number of insured Americans is not known; but that this will lead to plummeting reimbursement rates for physicians is easy to foresee. And this follows a two percent slash in Medicare rates, affected in April 2013.
But the good side of this rate decrease is that it’s going to a huge base of Americans (about 35 to 40 millions) to the current patient increasing the number of patients per care provider substantially.
Additionally, transition to ICD 10 from the ICD 9 platform has kept care providers concerned, especially with the effective date of 1st Oct. 2014 nearing. The wide-spread concern is justified for various reasons. ICD has 13000 diagnostic codes while ICD 10 includes 70000, which leaps to 155000 if you include the procedural codes. Not only that. Medicare & Medicaid Services introduced a new form which practices have to use to submit their claims.
Moreover, ICD 10 will also require practices to move to a new HIPPA platform, which means additional operational adaption and cost for them. No wonder ICD 10 is being seen as the biggest CD code overhaul in years.
MBC has been helping many care providers, both in small and big cities of the US, to overcome their billing and coding challenges. We have guided many practices in setting up EHR so that they can handle larger number of patients and leverage the current HIX-caused patient influx. We have also helped practices with ICD 10 transition.
Our Revenue Management Consulting services can help you to fix and optimize your revenue management cycle. To help you do this, we assess it and identify it through training, installation of proper software applications etc.
Medicalbillersandcoders.com the largest consortium of billers and coders in the US, has also been helping many practices to overcome challenges of slashed rates and ICD 10 with its outsourcing medical billing services handling the entire range of activities involved in billing and coding, starting from preparation of claims through submission to post-submission follow-ups. Our service modules are flexible and you can pick and choose only those pieces of our services that meet your coding needs so that you can avoid paying additional cost.
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