MEDICARE 2019: IMPACT ON BILLING AND CODING

As the healthcare expenditure in the United States is skyrocketing with every passing year, so is the number of Americans getting themselves covered under health insurance policies. These health insurance policies regulated by the federal government keep evolving with the situation and the ever so evolving needs.

While these healthcare reforms have a profound impact on the payer, another sector significantly impacted by these reforms is the medical billing and coding. With payers becoming more curious and enlightened with the financial and qualitative aspect of the treatment being dispensed to them, they no longer are at the mercy of healthcare organizations and insurance companies to access whatever healthcare related information they are looking for. This also helps them to decide upon which healthcare service provider would best fit their budget and where they might have to sign up for a loan.

Americans now have the tools to make a more informed decision regarding the healthcare expenses. With the escalating need for medical specialists across the nation, an increasing number of private clinics are being made a part of a large hospital organization. This has led to billing and coding services being outsourced to medical billing and coding companies like Medphine which is a team of certified and trained billers and coders, who have been assisting healthcare organization efficiently manage their revenue cycle management, adhering to HIPAA policies and aligning their services per latest reforms.

Going deep into our discussion above, let’s delve into two of the pivotal announcements made by The Centres for Medicare and Medicaid Services that will impact the processing of healthcare provider’s billing and coding environment:

VALUE-BASED CARE :

We all are well aware of how health care, the second largest sector in healthcare is also one of the most expensive sectors in the nation. With World Health Organization ranking the United States at 37 and Commonwealth Fund placing the United States last in the list of countries industrialized for healthcare, with the driving cost of healthcare be it due to the political reasons, administrative reasons or the escalating prices of treatment, it has become pivotal that the healthcare spending is controlled.

With the aim to curb the healthcare spending, The Centre for Medicare and Medicaid, in its American Health Association Annual Health Meeting decided on shifting the healthcare industry approach to value-based purchasing. The motive behind this initiative is to lower the drug pricing and burden that administrative cost puts not only on the patients but the healthcare service provider.

To materialize the value-based care and payment model, CMS had also has allocated nearly $5.4 billion to implement 37 payment models that use value-based methods to reimburse Medicare and Medicaid providers.

Per the Government Accountability Office Report, this value-based payment model has been successful in accomplishing its objective of enhancing the quality of care being dispensed and lowering the cost of drugs and treatment. The value-based care and payment model is still a work in progress since implementing it requires massive investment, and its results are not immediate, but integrating value-based payment model does have the potential to minimize the administrative and financial burden on healthcare providers.

With the shift in quality approach, healthcare providers are also contemplating shifting the reimbursement model to bundled payment, wherein providers are paid a single fee for treating the patient within a defined set of time. The model aims at enhancing the quality of care patient gets in their time of the treatment, but providers are apprehensive of this approach, because of the technological and financial risk involved in this model.

HEALTHCARE TRANSPARENCY RULE:

Mid-2018 was abuzz with the speculation of price transparency being enforced on the healthcare practices and providers, which turned out to be true with CMS proposing healthcare price transparency rule for hospital via the online portal, early January.

As per the update in the healthcare transparency guidelines, hospitals across the nation are to make the list of their standards charges public on the internet. A rule to further promote the value-based system, apart from enhancing the quality of care being dispensed to the patient, healthcare transparency rule aims to help the patient take a more informed decision and lessen the financial and administrative burden on the providers so that they are able to better focus on patient care.

The enforcement of making healthcare pricing information public sent United States healthcare provide a structure into a frenzy, with critics emphasizing on how it will aggravate the existing ambiguity in the healthcare system regarding the cost and quality battle.

While this is overwhelming for the healthcare service providers, who are associated with several healthcare insurance companies and insurmountable insurance coverage, which is why their contention is understood. But CMS’s emphasis on enhancing patient care and bring transparency throughout the healthcare system for the benefit of the patient as well as the healthcare providers is a “now seeming to be a back-breaking and skeptic task,” which has the potential to make the exorbitant healthcare system of United States affordable and accessible to all.

For the concerned healthcare providers who are reluctantly giving in to the rule, we would suggest corporation with CMS which can be made possible by adequately understanding the intricacies of this rule such as the various payment models, educating the staff about it and making use of pricing transparency tools for ensuring compliance.

As the circumstances changes and the situation arises, CMS keeps reforming Medicare and Medicaid policies. For someone operating a healthcare practice and to be able to fully concentrate in dispensing quality treatment to the patient in need of medical care, it is essential that they are not stressed about their practice functioning in compliance with the latest rules and regulations. Furthermore, creating and training a team for healthcare finances would be a strenuous task, draining your practice of valuable internal resources and time, which you could have otherwise invested in enhancing he qualify if your facility’s care and treatment. This is why it is suggested that while healthcare practitioner concentrates on keeping people in their health self, the financial health of their practice is being taken care by medical billing and coding experts like Medphine.

Medphine has over a decade of experience in efficiently managing billing, coding and other critical aspects of the revenue cycle with utmost accuracy and adhering to latest reform enforced by the designated authority. Our team of certified billers and coders are periodically educated about the latest development and trained with the latest software and technique to make sure your healthcare practice flourishes and revenue generation only escalates. From account receivable to specialty-specific medical billing, Medphine’s billing and adroit coding staff will make sure that once you outsource our services, staying compliant with a competitive edge will no longer be just an aspiration.

Reach out to Medphine billing and coding experts, today!