How will the Affordable Care Act Impact Cardiology Practitioners and Their RCM?

Healthcare industry has been undergoing steady reforms over the past couple of years and the changes are expected to continue. The objective of this ongoing transformation is to achieve improved healthcare services with increased focus on quality care. In such a scenario, Affordable Care Act is being viewed as a promising way of improving healthcare and strengthening financial conditions of the industry. However in addition to expansion of coverage, increased accountability of insurance companies, lowering of healthcare costs and enhancement of quality care for Medicare patients; ACA is expected to increase revenue risk for physicians as well. As a shift from fee-for-service to revenue and cost sharing model of ACOs (Accountable Care Organizations), Cardiology practitioners will face a lot of challenges in realigning their revenue cycles.

Some of the major RCM parameters that ACA will affect practitioners are –

  • Due to bundling efforts, cardiovascular coding will undergo additional changes
  • Medicare fee schedules will change for physicians in addition to the continued threat of reimbursement cuts by 30% due to SGR
  • Penalties for non participation in federal incentive programs like EHR, quality reporting system and e-prescribing
  • Government and commercial insurers will pay for value based services (pay for performance reimbursement model) instead of continuing with the volume based or fee for service model
  • Increased number of Medicare patients to be covered by Cardiology practitioner participating in ACO project, meaning more financial risk and heightened burden on RCM

With rising focus on quality care and expected collaboration between hospitals and independent medical practitioners under ACA, to cut down costs and enhance care coverage, Cardiologists will have to adapt their practices and RCM as per the imminent changes.

RCM or Revenue Cycle Management is the strength of any medical practice aiming to stay financially viable. RCM cannot afford to stagnate in its processes as the healthcare environment is changing on a continual basis. With industry changes, RCM of a Cardiology Practice must transform to better suit the needs of the practice. Given a high likelihood of ACO participation by most Cardiology Practices, some well planned changes in RCM can prepare a practice to absorb heightened risk and derive better revenue from ACO –

  • Compliance to changing regulations and participation in federal programs designed to incentivize practice performance can save your practice a lot of future costs and penalties. Thus RCM of your Cardiology practice must comply with new regulations and keep your practice up to date
  • Change in fee schedules and expected reduced reimbursements by Medicare would mean diminished revenues. Thus focus of your RCM must be to diversify the payers mix to absorb this inevitable decline in revenue
  • Coding and billing changes due to bundling must be tracked and updated in your system to avoid any claim denial or audit complications
  • RCM must strive to adopt value based reimbursement model for your practice and gradually shift away from fee for service payment model

As RCM and billing experts, delivering optimum medical billing and coding services across all 50 US States, can help add value to your revenue model and save you tremendous costs and expenses. Your Cardiology Practice can benefit from our billing and coding experts help and our accurate revenue cycle management can transform a high risk ACO project into a high return venture for you.