U.S. health care industry is characterized by multiple stakeholders \u2013 patients, care providers, and payers. The Federal Government, being the custodian of this priority sector, has had to keep each of these stakeholders in good humor. But, during the recent, there have been a multitude of reforms which have sought \u201cquality medical care at an affordable price\u201d. And, if there is one group that is little apprehensive about these seemingly patient-centric reforms is the \u201ccare providers\u201d.<\/p>\n
Care providers\u2019 fear is based on the premise that the proposed cuts to Medicare \u2013 which is still the largest player in the multi-payer system \u2013 would force them to forgo a major portion of their practice revenues. Incentive-based reimbursements (ACOs), mandatory EHR implementation, and ICD-10 too may have further escalated the apprehension. But, providers may have actually missed to discern \u201cthe value\u201d residing deep inside these seemingly pro-patient reforms.<\/p>\n
The Patient Protection and Affordable Care Act (PPACA), which was one of the earliest of recent health care reforms, promises to generate ample scope for practice growth and expansion. Even if it is certain that fees or cost of medical services would further get rationalized, providers would still be able to off-set or even make surplus revenues with Affordable Care\u2019s ambitious plan for extending Medical insurance to every uninsured U.S. citizen.<\/p>\n
Accountable Care Organization Model of Care, which seeks to incentivize providers on shared quality medical care, would help grow providers into more credible and competent. And, credibility and competence would essentially drive up practice volumes and revenues.<\/p>\n
The purpose behind EHR compliance is to document and exchange and clinical data in sync with privacy and security norms under HIPAA. By attesting to these norms, providers will be able to project themselves as responsible and avoid violation of privacy and security norms. Moreover, \u201cMeaningful Use of EHR\u201d could further qualify them for incentives under EHR Stimulus Package Scheme. Therefore, the cost of implementing EHR would prove to be less than its eventual returns.<\/p>\n
ICD-10, with all the hype surrounding its scope, has evoked a sense of great awe amongst a majority of providers. No doubt, ICD-10 requires a complete overhaul of billing and coding. Upgrading systems and training staff as per the new coding system would involve considerable expenditure; sourcing the right knowledge and system provider would be even more challenging. But, despite these inherent challenges, ICD-10 promises to be the most efficient coding system ever. When coding efficiency is destined to be the best, it should mean fewer denials and rejections. Therefore, providers should be able to recoup the investment faster than they actually estimate.<\/p>\n