Understanding the Impact Affordable Care Act Will Have on Family Practitioners & Their Reimbursement Patterns

Affordable Care Act is the upcoming revolution, expected to change the face of the healthcare industry in the years to come. It will not only extend quality care to patients but also improve the way medical services are administered by healthcare practitioners on the whole. Financial advantages of the ACA are hard to ignore and value addition to medical practices is expected to prove beneficial for physicians as well as patients.

However, the comprehensive impact of the Affordable Care Act on family practitioners and their reimbursement patterns will only become evident in times to come. In addition to providing health cover to around 30 million uninsured Americans, ACA is also going to change the way patients pay medical practitioners. The objective of improving primary care by shifting away from the fee-for-service model and focusing on quality care is bound to increase the financial burden on the practices. This is also expected to totally re-align the billing and reimbursement patterns of family practitioners.

ACA is introducing many changes in the billing and coding practices and linking reimbursements with quality care. Predominant changes expected to emerge with ACA reforms are:

  • Bundling efforts to introduce new coding changes for medical billing
  • Government and private insurers to shift from volume-based or fee-for-service reimbursement models to pay-for-performance or value-based payment model, reimbursing family practitioners on the basis of quality care provided
  • Financial risk of the family practices is likely to increase manyfold as ACA will introduce cost-sharing and risk-sharing models intended to improve healthcare services and cut overall costs
  • Long term ambiguity due to greater financial risk will increase the importance of meticulous billing and reimbursement patterns to be observed by family practitioners
  • Medicare reimbursement rates are expected to decline by 25-30% in the months to come thereby increasing additional financial burden on ACA practices
  • Medicaid reimbursements to improve dramatically, coming at par with Medicare, thereby encouraging primary care providers to accept Medicaid patients. States are expected to raise reimbursement rates to the tune of 70-100% before January 2014 in order to build a primary care practice base large enough to the newly insured Medicaid patients

These significant changes would translate into a greater focus on Revenue Cycle Management and transform reimbursement patterns of most family practitioners. Family practitioners will have to:

  • Accommodate the latest changes in coding into the medical billing systems
  • Adhere to government regulations and ACA reforms
  • Realign the reimbursement cycles and fee schedules as per Medicare and Medicaid payment changes
  • Prepare the billing practice to adapt to the shared cost service model and value-based reimbursement model

Even though the prime objective of the Affordable care act is to substantially improve primary care and make it more accessible, the changes introduced by ACA would require primary care providers to adopt value-based reimbursements into their RCM.

Medicalbillesandcoders.com is a billing expert that can partner with your family practice and help you get equipped to face the changes brought on by ACA. We offer comprehensive services to your primary care practice, providing assistance and consultancy in helping revamp your reimbursement pattern and revenue cycle management in accordance with the Affordable Care Act.