{"id":5921,"date":"2016-01-06T12:19:51","date_gmt":"2016-01-06T12:19:51","guid":{"rendered":"http:\/\/www.medicalbillersandcoders.com\/blog\/?p=5921"},"modified":"2026-05-11T11:18:25","modified_gmt":"2026-05-11T11:18:25","slug":"top-4-reimbursement-questions-physicians-must-ask","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/top-4-reimbursement-questions-physicians-must-ask\/","title":{"rendered":"Top 4 Reimbursement Questions Physicians must ask"},"content":{"rendered":"<p style=\"text-align: justify;\">With underpayments galore, and incentives that are not so very attractive, Medicare is proving to be adept at what it does best \u2013 lower the fees further with providers. Although the behemoth that Medicare turns out in its favor while bludgeoning down physicians\u2019 fees, it may turn out to be its Achilles heel after all. Let&#8217;s discuss questions about reimbursement quedtions.<\/p>\n<h2 style=\"text-align: left;\">Here are a few reimbursement questions:<\/h2>\n<h3 style=\"text-align: left;\">Contending with the question of underpayments<\/h3>\n<p style=\"text-align: justify;\"><b><\/b>Underpayments are the bane of practitioners and hospitals, especially when Medicare reimburses just about 81 and 71 percent respectively of prevailing private rates. With Medicaid, it is worse at a dismal 56 percent. With such low rates approved by the Federal government, it is a losing proposition for most hospitals. According to American Hospital Association\u2019s data compilation, hospitals are consistently losing <a href=\"http:\/\/www.medicalbillersandcoders.com\/articles\/emr-ehr-health-it\/Have-medicare-and-medicaid-pay-cuts-in-2015-been-a-huge-challenge-for-physicians.html\">Medicaid and Medicare<\/a> patients.<\/p>\n<h3 style=\"text-align: left;\">Rates not keeping up with galloping inflation<\/h3>\n<p style=\"text-align: justify;\">With inflation looming large on the horizon, Medicare\u2019s national regimen of reimbursement is far behind, and not keeping up with the rate of inflation. With staffing costs and overhead expenses mounting relentlessly, physicians need to work extra hard to see more patients in order to maintain the balance.<\/p>\n<p style=\"text-align: justify;\">If the same scenario continues, resources will become scarce, leading to a marked decline in care. The sustainable growth rate (SGR) maintained by Medicare for physician reimbursement is woefully inadequate and needs to be reworked.<\/p>\n<h3 style=\"text-align: left;\">More regulations are a burden<\/h3>\n<p style=\"text-align: justify;\">There is no denying the fact that the health care sector is burdened with the most number of regulations already, and can ill afford further regulations. Although these regulations are formulated by the powers that be with the best of intentions, they ultimately do more harm than good, ultimately jeopardizing patient care.<\/p>\n<p style=\"text-align: justify;\">This often leaves doctors with less time to devote to their patients. Further reforms in the healthcare sector will certainly not help reduce such regulations.\u00a0 Legislation can only lead to increased red-tapism, what with a plethora of agencies, committees, and bureaucracies coming between the doctors and their patients.<\/p>\n<h3 style=\"text-align: left;\">VBPM \u2013 Value-Based Payment Modifier<\/h3>\n<p style=\"text-align: justify;\">Protection and Affordable Care Act (PPACA) has established the Value-Based Payment Modifier (VBPM) under section 3007 of the Act. This helps in adjusting physician reimbursements based purely on the quality of care given, as per the definition of the Secretary of Health and Human Services (HHS). This lays the arbitrary cut-off that is acceptable to physician costs, and those going over this threshold are liable for punishment.<\/p>\n<p style=\"text-align: justify;\">This can only penalize physicians who do not conform, leading to dissatisfaction as it will put tremendous pressure on them. With the threat of recrimination looming large, doctors will find it rather difficult to practice medicine in a healthy manner.<\/p>\n<h3 style=\"text-align: left;\">The general shortage of physicians<\/h3>\n<p style=\"text-align: justify;\">Patients will have to contend with the increasing decrease in the supply of physicians, thanks to the new set of regulations, stubborn bureaucracy, the burden of extra paperwork, and decreasing autonomy leading to a general sense of dissatisfaction in the job. This could lead to several doctors putting in their papers earlier than necessary, or looking for alternative careers.<\/p>\n<p style=\"text-align: justify;\">If <a href=\"http:\/\/www.medicalbillersandcoders.com\/articles\/aca-hipaa-reforms.html\">healthcare reforms<\/a> were to be pushed forward aggressively, the number of doctors wanting to stop practicing medicine is set to increase drastically, leading to an acute shortage, which can be catastrophic.<\/p>\n<h5 style=\"text-align: left;\">About Medical Billers and Coders<\/h5>\n<p style=\"text-align: justify;\">We are catering to more than 40 specialties,\u00a0<a href=\"https:\/\/bit.ly\/2n6LrjA\"><strong>Medical Billers and Coders (MBC)<\/strong><\/a>\u00a0is proficient in handling services that range from\u00a0<a href=\"https:\/\/medicalbillersandcoders.com\/revenue-management-services.aspx\">revenue cycle management<\/a>\u00a0to\u00a0<a href=\"https:\/\/www.medicalbillersandcoders.com\/ICD-10.aspx\">ICD-10<\/a>\u00a0testing solutions. The main goal of our organization is to assist physicians looking for billers and coders.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>With underpayments galore, and incentives that are not so very attractive, Medicare is proving to be adept at what it does best \u2013 lower the fees further with providers. Although the behemoth that Medicare turns out in its favor while bludgeoning down physicians\u2019 fees, it may turn out to be its Achilles heel after all. [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":13210,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[3511,587,34,795,27],"class_list":["post-5921","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue-cycle-management","tag-medical-billing-services","tag-rcm-services","tag-reimbursement","tag-reimbursement-questions","tag-revenue-cycle-management-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.9 (Yoast SEO v27.9) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Top 4 Reimbursement Questions Physicians must ask<\/title>\n<meta name=\"description\" content=\"Here are a few reimbursement questions that physicians need to ask themselves.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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