Cost of healthcare in America has shot up due to the way healthcare providers are being paid for their services under the fee-for-service system, which has bought about an urgent need for health care payment reforms. However with the introduction of various new payment models; a medical practice needs to expand its capabilities to appropriately prepare for these payment changes.

Challenges posed by payment reforms-

There is no doubt that physicians will be paid more for certain services, they will be paid based on quality of their services and separate services will be combined into one single payment. Moreover payment will also depend on the cost and amount of services that will be delivered by other providers. However, these reforms will also pose certain challenges for physicians for instance:

  • They might get inadequate payment for new services
  • Less payment for some services for shifting money to new payment systems
  • They might experience decrease in revenue through low service utilization or fewer referrals
  • They might have to incur high administrative costs for implementation of new payment systems
  • They might be unable to access required data for establishing accurate rates

How practices need to prepare for these changes?

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With new payment reforms being implemented, practices need to prepare for the changes and challenges-

  • It will soon become essential to strengthen and manage relation with patients so that better healthcare can be achieved while unnecessary costs are avoided
  • Patients will have to be counselled about medical costs with the use of latest technology. The need is to help patients work in co-ordination with physicians to manage their health in a better way
  • Data available from Medicare and other sources should be improved so that timely and accurate cost and clinical information can be generated. This will help in effective financing and healthcare provision
  • The quality of cost measures will have to be improved so that alternative payment models can be implemented. This will again help in effective financing and alignment 

Need for an effective medical billing service-

Reimbursement for healthcare providers has shifted from fee-for-service to episode-based payment due to payment reforms. This has affected the average and marginal reimbursement. However, the challenges posed by the new reforms can be handled with effective medical billing services.

Benefits of an expert team with know-how and medical billing experience to easily manage diverse payment models cannot be denied at a time when; new healthcare reforms are increasing pressure on physicians and other care providers.

Additionally with the shift from ICD-9 to ICD-10, not only will coding become more complex; but a higher number of patients will result in more documentation. Increased documentation will create more room for errors, resulting in wrong coding and billing procedures. This will affect revenue generation for physicians, leading to delayed or no payment at all. has an expert team of billers and coders that can help you with documentation, error-free coding, claim filing, handling claim denials, following up with insurance companies and so on resulting in timely and accurate payments. MBC billers and coders with more than a decade of experience in medical billing and constantly updating themselves with industry changes;  also help physicians understand the practice management areas they need to work on in order to benefit from these new payment models.

Published By - Medical Billers and Coders
Published Date - Jul-17-2013 Back

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