Private insurers leaning towards Medicare and Medicaid to maintain profitability amidst healthcare reforms

Over the past 3 years, rise of 36% to 42% has been depicted in the share of large insurers’ revenues due to federal programs – Medicare and Medicaid. According to the research division of Bloomberg- insurers are likely to further increase their reliance on federal government post the implementation of the health-care law in 2014, when Medicaid will develop to cover an eventual 16 million additional low-income Americans and the government will begin subsidizing private-insurance policies for an projected 19 million more. Hence despite an economic slowdown US’s major health insurers have thrived by increasing their role in government programs such as Medicare and Medicaid.

A study states the five largest publicly traded insurance companies combined – UnitedHealth Group, Wellpoint, Aetna, Humana and Cigna — provide coverage to 42.3 million people, or about 17 percent of Americans with health insurance. In the last years 1st three quarters the combined operating margin of these companies averaged to 8.65% depicting the most favorable three quarter performance in the past 3 years, despite revenues from traditional private-insurance business remaining low since the end of 2008.

Government policy makers are increasingly outsourcing components of the Medicare and Medicaid programs in order to cut expenses, which commercial insurers take over. Hence even as insurers become increasingly reliant on government business with the changing healthcare environment, Physicians too need to prepare and get updated with the effects the healthcare reforms will have on their practices.

Physician administrative staff must be equipped to handle payments and negotiations with multiple payers whether government or commercial. Training a team of Medical billers and coders to interact with a large payer mix can be quite a challenge.

Physicians would benefit from seeking help from medical billing companies, who can provide consultancy for integrating this system of healthcare delivery and the changing healthcare environment. having capability of providing operational and revenue management to various specialties and being equipped with an insider-knowledge of the Healthcare Industry can help make the transitions due to healthcare reforms easier & simpler.