If we consider the budgetary formula enacted in 1997 by the Congress, Medicare reimbursements might get reduced by 25% by 2014. A large number of doctors are already refusing to see Medicare patients due to low payment and with this further reduction, more doctors might refuse to accept Medicare patients.
It has been estimated that by 2019, doctors under Medicare will get lower payment than doctors under Medicaid. Due to lack of effective solutions, practices are either opting out of Medicare or limiting the number of Medicare patients.
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How is Medicare fee cut affecting healthcare providers?
There is no doubt that Medicare rates are getting difficult to survive but some physicians or medical practices cannot opt out of Medicare as they are more dependent on it than others. In order to make ends meet, these practices have to see at least 30 or more patients in a day which increases their work pressure.
New coding and billing changes have come up due to the transition from fee-for-service model to value-based payment model. This has also impacted doctors under Medicare. With an increase in coding and billing challenges, cases of low reimbursement and payment denials are also rising. Since Medicare is very restrictive in claim approvals, it is likely to reject a claim more than private insurance plans.
To make sure that no disruption is caused to the revenue cycle it becomes essential for practices to deal with insurance companies regularly. Quality training is also required to ensure that the in-house staff is submitting claims with accuracy, error-free billing and coding is being done and timely follow-ups are being made to maintain steady cash flow.
How to survive these challenges?
Slash in payments rates amidst increased patient number and medical coding and billing complexities has become too much to handle for small and medium-sized practices. They are seeking help from a billing partner to overcome Medicare rate challenges and to handle vital tasks like claim submission, coding, billing, follow-ups, documentation and compliance to HIPAA.
Medicalbillersandcoders.com has the largest consortium of billers and coders who have been helping practices focus on patient care while they handle important administrative tasks including coding and billing for Medicare patients. Apart from streamlining billing operations, MBC also helps with staff training and provides assistance in dealing with complexities of EHR, EMR and ICD-10.