Redefining the Role of Billers and Coders in the Wake of Ensuing Accountable Care Organization (ACO) Act

Amongst the many farsighted health reforms that the Patient Protection and Affordable Care Act of 2010 (PPACA) has floated is the concept of Accountable Care Organization (ACO).

Believed to be a cost-controlling measure on public health expenditure, ACO is a health care model that ensures healthcare providers incentives from the savings made on a pre-assigned group of patients. Therefore, it is mandatory that a consenting group of medical professionals – comprising physicians, specialists, and support staff —form an alliance that caters to comprehensive needs of the pre-assigned group of patients while also keeping the standard high. Thus, all along with having incentive to a portion of savings made from a strategic alliance, Accountable Care Organizations will also be under constant vigilance for quality.

Convinced with ACO’s far-reaching benefits, many hospitals, physician practices and insurers across the U.S. are serious about forming their own ACOs much before its official launch in January 2012. What is still more interesting is they are in favor of extending ACOs – originally conceived for Medicare patients – to patients of private insurance as well.

Although there is an apprehension that propensity to consolidate healthcare services under ACOs lends undue advantage to large players to influence insurance carriers and eventually drive up healthcare costs, yet, given the controlling measures to put a seal on the quantum of healthcare operations by each ACO, it out-weighs demerits. Consequently, in addition to ensuring quality healthcare at minimum cost, ACO – with streamlined healthcare services — will also promote an efficient reporting system in compliance with HIPAA norms.

Significance of Medical Billers and Coders

Quite expectedly, the role of medical billers and coders will assume greater significance as they will also be required to map their services to ACO environment, wherein the quantum of billing tends to be usually large, but the fee is highly competitive. Presumably, medical billers and coders will be forced to consolidate into bigger entities to serve the comprehensive billing needs of these ACOs — accurate charge-capture, intricate procedure coding, and electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards of HIPAA. the largest consortium of billers and coders in the U.S., is best poised to handle such a scenario, and assume the mantle of being the promoter of cost-effective billing services.

Thus, being an integral link in the healthcare system, medical billing and coding entities too will experience the impact of one of the important constituents of the Patient Protection and Affordable Care Act of 2010 (PPACA): Accountable Care Organization (ACO)