Approximately 22% patients in a typical family medicine practice are Medicare beneficiaries. Due to this, a 10.6% cut in Medicare fees translates into a reduction of approximately 2.3% in practice income for family physicians. This is a significant reduction if we consider the margin at which many family practices are currently operating. In case private payers also plan to cut their payment rates based on Medicare rates, family practices will suffer to a great extent.
In 2014, CMS will be issuing a physician fee schedule that will reduce payment by 20.1% for which the American Association of Family Practices has expressed disappointment. This schedule will be reflecting the flawed SGR formula that dictates Medicare payment for medical services.
Medicare rate cuts will affect the financial health of family practices:
- In the months to come, Medicare rates are expected to dip further, creating financial issues for family practices
- There will be a series of impacts caused due to cut in Medicare rates such as shift from pay-for-performance to value-based payment model
- New coding and family practice medical billing changes will be introduced due to bundled payments
- Not just billing and coding but various procedural changes will also take place due to Medicare cuts, causing underscoring, low reimbursements and reimbursement denials
- With rise in number of patients, the physician and patient ratio will widen, increasing workload with less fee and less time for handling administrative tasks
- With the transition from ICD-9 to ICD-10, coding complexities will increase, causing inaccuracy in claim submissions
What measures should be taken?
Due to these issues, it has become essential for family physicians to realize their payments from insurance companies with greater regularity. They need to focus more on documentation and spend time and money on hiring and training certified billers and coders who will ensure that the revenue cycle management of the practice is healthy.
However, constraint of time and money caused due to Medicare cuts and rise in number of patients, family practices are seeking help from family practice medical billing companies that specialize in handling family practice billing tasks with precision. This is helping them eliminate the headache of balancing their time and attention on administrative tasks and patient care.
Medicalbillersandcoders.com offers the largest consortium of trained billers and coders, helping small and medium sized family practices across the US tackle the challenges related to payment cuts. Our team can offer assistance to you in identification of gaps in your processes and also provide help in solving issues, if any. From handling areas of revenue loss and replacing old software with new ones to identifying areas of staff training and preparing them to handle complexities of EHR, EMR and ICD-10, MBC can help you get your practice back on track.
We offer assistance to family physicians in avoiding modifier omission, inadequacy in claim submission, underscoring or issues in supporting documentation. You can either take the entire suite of our billing and coding services or choose parts of services that suit coding and billing needs of your practice.
FAQs
1. How do Medicare rate cuts impact family practices?
Medicare cuts lead to a direct reduction in practice income, impacting financial stability and increasing administrative challenges for family practices.
2. Why are coding complexities increasing in family practices?
The shift from ICD-9 to ICD-10 and changes like bundled payments increase coding complexity, which can lead to claim inaccuracies and lower reimbursements.
3. What are the benefits of hiring certified billers and coders for family practices?
Certified billers and coders ensure accurate claim submissions, effective documentation, and a healthier revenue cycle, helping practices maximize reimbursements.
4. How can medical billing companies support family practices?
Billing companies assist with precise billing, updating systems, staff training, and tackling revenue loss areas to keep practices financially healthy.
5. How can MBC help family practices manage payment cuts?
Medicalbillersandcoders.com offers tailored billing and coding services to help family practices avoid errors, manage documentation, and enhance overall revenue.
