U.S. Health Spending Projected To Grow at 5.8 Percent Annually: Pros and Cons

The recent extrapolation by the economists in the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) – which has projected all health care spending in the United States to be at an annual average rate of 5.8% for the period 2010 through 2020, and at 19.8 percent of GDP by 2020 – should be cause for celebration as well as challenge for all stakeholders: physicians, patients, insurance carriers, and professional medical billing companies.

Looking at the healthcare market of $4.64 trillion by 2020, nearly half of which will be funded by the Federal Government for its popular Medicare and Medicaid programs, it is only natural that there will an unprecedented growth in medical practitioners vying for their share of the apple pie. Consequently, the medical service benchmark will get pushed up by a few notches as the patients will have options to choose from. Ultimately, with the Affordable Care Act’s Accountable Care Organization scheme coming into the picture, an enormous opportunity will actually get translated into quality-driven physician services.

Going by the expansion of health insurance coverage through Medicaid and subsidized private health insurance under the Affordable Care Act, as well as Medicare reforms – which will induct more baby boomers into Federal health insurance – nearly 30 million more will come under the ambit of health insurance by 2020. Consequently, there will be a considerable reduction in out-of-pocket spending on medical services by a majority of the underprivileged class.

Although insurance carriers can think of a substantial increase in premium inflow, the prevalence of government-funded Medicare and Medicaid (nearly half of the total health insurance composition), and the Federal Government’s extra vigil on controlling the undesirable increase in premium, and incidental charges, will only drive them to be even more stringent on medical reimbursements.

Medical Billing Companies, which otherwise would have stood to gain in terms of additional market share, will be required to be even more competitive in the wake of the ensuing ICD-10 and the HIPAA compliant 5010 standards for coding and reporting respectively – both of which demand a higher degree of competence as compared to the previous ICD-9 and HIPAA 4010 regimen.

The sum total of all these consequences will eventually reflect on physicians/hospitals’ ability to effectively and efficiently conduct medical billing, which is crucial to their sustenance and growth. But, judging by the historical experience of failed experiments with in-house medical billing practices – either in-house staff reporting it to be detrimental to their core function of supportive medical care, or underperforming despite heavy investment on training and system implementation – it is anybody’s guess that physicians/hospitals will eventually be forced to avail competent medical billing services.

In such a scenario, Medical Billers and Coders – the largest consortium of medical billing professionals, who are adept at accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, compliance standards, and ride on a paralleled set of pre-qualifiers: certified by the American Association of Professional Coders (AAPC).

These proficient Medical Billers and Coders are trained to use advanced medical billing software such as Lytec, Medic, Misys, Medisoft, NextGen, IDX, etc., and the latest coding software such as EncoderPro, FLashcode, and CodeLink.

Their expertise in applying standard CPT, HCPCS procedure and supply codes, and ICD diagnostic codes has earned them an impressive track record of maximizing client reimbursement of medical bills with leading private insurance carriers such as United health, Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government-sponsored Medicare and Medicaid.

These Medical Billing and coding specialists will be an ideal ally in complementing their clients’ cost-minimization and revenue-maximization endeavors through proactive medical billing management.