Medical Reimbursement Issues Push Physicians to Flee Hospitals Triggering a Teverse Trend

For over a decade, US healthcare has seen hospitals integrating with primary healthcare physicians across all the states of the US, challenging the traditional notion of primary care as a separate set of services from hospital healthcare, to provide all types of healthcare services under one roof and ensure mutual benefits that help all the sides involved in a treatment cycle and healthcare operations – access to physicians to a larger pool of healthcare opportunities; availability of all healthcare services ,etc.

Although the practice of independent primary healthcare providers joining hospitals has existed in the US healthcare for some time, the introduction of various payment modules, including bundled payments, accountable care organizations (ACOs) and medical home, by the Obama administration has made this alignment unavoidable, thanks to the common feature of these payment modules which is delivery of healthcare services based on a collaborative approach.

However, this collaborative nature of treatment leaves hospitals to do more of what they should be doing less, financial administration. And as financial administration – preparing insurance claims, following them up with insurers, etc. – is neither the core competency nor concern of healthcare providers, they are ill-equipped to handle the situation.

This leads to physicians having to do non-clinical activities, like paperwork, and additionally results in an upshot in claim denials- resulting in the healthcare providers mounting unrealized account receivables and the primary healthcare physicians not getting their dues. This phenomenon is predominantly responsible for triggering a reverse trend in US healthcare – disgruntled primary care physicians dissociating themselves with hospitals and returning to reoccupy their traditional position in the healthcare industry outside the sphere of organized hospital healthcare.

According to a report published by The Physicians Foundation, regulations and administrative responsibilities brought by the Patient Protection Care Act (PPCA) have caused physicians to spend more time on administrative responsibilities and less time on patients, impacting their relationship with patients.  “In 2012, physicians will need to vigilantly monitor their administrative burdens and take steps to minimize any further impact on their relationship with patients,” the report warned.

While healthcare providers can’t ignore the exigencies of a changing industry neither can, they lessen their focus on delivery of quality healthcare services. This makes the role of medical billers and coders more pronounced than earlier in the US healthcare industry, in a post reform scenario. One way, to meet this post-reform challenge and is by bringing the benefits of outsourcing financial administrative responsibilities by a care provider to a medical biller and coder who has a sound knowledge of the healthcare industry and its changing trends, latest technologies and experience in handling technical details involved in healthcare claims and a proven track record to show for its capabilities.

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By combining the above competencies,, the largest consortium of medical billers and coders in the US, has been able to ensure seamless claim realization and greater control over operating costs for healthcare providers resulting in redirecting of internal healthcare staff to core activities, leading to enhanced focus on healthcare and saved costs. These benefits, if seen vis-à-vis the challenges brought about by the healthcare reforms, cited by the report discussed above, are necessary to arrest the reform-triggered trend of physicians parting ways with hospitals.