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?

  • Doctors will have to face huge loss in terms of revenue due to slash in Medicare payment rates
  • The fee cut will also affect insurance companies and private health insurers that have a contract with Medicare
  • Slash in payment rates will force physicians to leave health plan networks as it will harm the payments doctors can get from the plan
  • Hospitals and nursing facilities will also have to operate at a loss due to the reduction in Medicare rates. According to experts, under the new law, reductions in Medicare payment will result in hospitals, home health agencies and nursing facilities to operate at 15% loss by 2019, 25% by 2030 and 40% by 2050
  • If liability insurance carriers are not paying you for the services on a regular basis and patients are pursuing legal actions to recover their civil liability claims, your practice maybe in serious trouble. You will have to ensure that immediate corrective measures are taken such as auditing of documentation and coding or auditing of your marketing strategies.
  • You are being considered a fraudulent provider if your liability insurance carrier is taking pre-litigation depositions of you or your patients. Also, if multiple complaints have been filed against you with the state licensing board, you need to invest time in assessing the complaints and finding ways to comply with the state laws.

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.

Published By - Medical Billers and Coders
Published Date - Dec-10-2013 Back

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