With the changing trends in the healthcare industry, many physicians are closing down their small practices and joining multispecialty groups in large hospitals. Regulatory issues, financial management, shifting reimbursement models and declining revenues are the main causes. The multispecialty group which they join is usually a large group practice where physicians work in a wide range of specialties and are employed by the same hospital or clinic. It is also beneficial for the patients as they tend to receive comprehensive medical aid at one location without having to run for different ailments for consultations. The medical aid is proficient, meticulous, high-quality and follows a completely well synchronized patient care. It also affects physician reimbursements positively.
So how is medical billing and coding affecting group reimbursements for physicians? It is the main job of the billing/coding specialist to clarify with the insurance payer of the required coding applications before submission of claim forms. For e.g. some insurance payers require the coding team to use 99201-99215 for physicians for an entire group visit. For medical nutrition therapy, the code used should be 97804 and for health and behavioral intervention, it should be 96153. For self-management education and training, the coding for a standardized curriculum is 98961-98962. For physical educational services, code 99078 must be used. However, the payer needs to be asked in advance by the coding team if these services are covered or not.
Another alternate payment model for multispecialty practice is the bundled payment model. This also gives an impetus to patient-centered care and makes it easier to manage from start to finish. In this multispecialty setting, physicians need to get together to create a large size and scale. Insurers can then reimburse on per member per month network management fee. Also, under the Medicare Physician Fee Schedule, a value based payment modifier (VBPM) offers differential payments to groups of physicians based on the quality of care provided. Under this program, "CMS will use PQRS quality measures, total per-capita cost measures, and the per-capita cost measures for patients with four specific conditions to determine quality and cost scores under the program." (www.mgma.com). This modifier is applicable to physician group consisting of 100 or more EPs and is headed to apply in the beginning of 2017.
It is also convenient for physicians to join a multispecialty group as one can get a consultation from a specialist, benefit from the clout and obtain a share in supplementary revenues from labs and other such facilities while avoiding all the botheration of running a small business. Multispecialty physician groups also have a better hand at managing care plans. Though it could mean lower salaries sometimes as groups tend to invest in medical equipment and information systems, it offers physician the stability and a good market position along with lesser exposure to risks and good pay for productivity.
Multispecialty coders work out the financials and obtain accurate reimbursements. This lessens the chances of losing revenues and allows the physicians to concentrate on patient satisfaction.
