More Jobs for Billers & Coders as Practices adapt to new Payment Models!
With the introduction of new payment models, physicians face a dilemma. Irrespective of the benefits, payment reforms will complicate the process of preparing claims and increase administrative costs. In order to overcome billing challenges and ensure timely reimbursements, practices will require skilled coders and billers.
Industry facts
| Physicians can obtain bonuses up to 5% every year from 2017 to 2022 for transitioning to “alternative payment models” |
| 15 of the 16 key provisions of Affordable Care Act will be taking effect in 2014, impacting numbers of patients physicians see and the way they get paid for medical services |
| According to a poll conducted of 140 healthcare providers by KPMG LLP, the audit, tax and advisory firm, 44% providers said they have started using bundled payment model, 29% remained undecided and 7% didn’t want to implement the same |
Payment reforms to impact reimbursement:
Practices might face several challenges due to payment reforms and only a strong billing team will ensure timely reimbursements.
- Physicians might end up getting inadequate payment for new services
- Payment will reduce for certain services for shifting money to new payment models
- Practices will have to bear high administrative costs if they wish to implement new payment systems
- Their revenue cycle will get affected due to few referrals and low service utilization
- In order to establish accurate rates, they might face difficulties in accessing required data
- They will have to devote sufficient time in offering counselling to patients about medical costs by using latest technology
- Quality of cost will have to be enhanced and data from Medicare and other sources will have to be improved for accuracy in cost and clinical information
Why practices will need expert billers and coders?
- Average and marginal reimbursement of practices will be affected due to the shift from fee-for-service to new payment models. Therefore, effective medical billing services will be required to help practices sail through billing challenges
- Providers will look for certified billers and coders with know-how and experience of managing diverse payment models as they wouldn’t want to lose out on revenue
- In order to make the shift, providers will have to invest in necessary infrastructure, technology and access to data. For this, they will require billers who have the expertise to use the latest technology and systems
- If physicians will not have enough patients with a given condition to produce standard measures of performance, it will be difficult to reap benefits of new payment models. In such a case, expert billers and coders will be required to help them get paid for all services offered
In order to overcome these challenges, certified and experienced coders and billers will be high in demand.
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