After reforms, the American healthcare industry is seeing a curious change: healthcare providers are adjusting their practice models to suit the needs of Affordable Care Act. A quick look at some of the factors that are provoking these changes will bring about how the changes have not left (or will not leave) any aspect of healthcare operations untouched.
The reforms will completely alter the mode of payment in which healthcare providers are paid by insurance authorities. The mode of payment will go from pay-per-service to per-visit or per service mode. Additionally, the provider will be paid in the form of bundled payments so that there is scope for promoting quality even as costs are driven down.
As far back you can see Medicare’s Physicians’ Quality Reporting System (PQRS) was around as a quality reporting standard which laid down quality parameters for physicians to report on. Albeit, now this reporting is going to become more rigorous: unlike until recently when physicians used to report only on data, now their reports would have to show that they meet each quality metric.
Bundled payment is perhaps the biggest change driver of the reform. Because bundled payments require coordination among various care disciplines involved in providing care, the reform gives the physician’s role prominence over that of the hospital.
As a result of this, surveys have revealed, 70% of hospitals are expanding the number of physicians on their staff to position themselves such that they can handle any initiatives resulting from the reform law. Additionally, bundled payment is also making care providers to either join or set up their own Accountable Care Organizations (ACOs).
Whether it is the mode of payment, the reporting methods, expansion of physician employment in hospitals, the singular area that the changes seem to gravitate towards is insurance reimbursement – how claims are made, medical data gathered to make them, codes (CDT) used, insurance claims paid, etc. And this is not a surprise as the reforms are focused towards bringing down the cost of care; promoting the number of people insured, and improving quality of care.
So equally unsurprising is the fact that the last few months have seen an increase in the number of care providers approaching professional billers and coders to help them sort out their post-reform concerns. However, you would require billing and coding organizations that can combine traditional knowledge with keen awareness of the current changes and how they affect the billing and coding processes and practices.
Following reforms, MBC has helped several healthcare providers to be equipped to face the challenges of reforms either by strengthening their internal operations or by handling their complete billing and coding responsibilities.
MBC’s Revenue Management Consulting services helps providers by assessing their in-house revenue management cycle and ensuring that there is sound coordination between various components of healthcare facilitating smooth flow of medical data for ACO operations and otherwise. We also identify gaps in your process and address them if necessary.
Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, are constantly updating themselves with current healthcare industry trends. In addition serving all 50 US states across varied specialties for more than a decade, MBC experts have the required expertise and experience in Medical Billing and Coding to help clients handle the upcoming reform challenges effectively.