Medical billing and coding changes happen every year. With the change in U.S. presidency from Barack Obama to Donald Trump, big changes are expected in the healthcare industry this year. According to a recent survey by Capital One Spark Business, cash flow and reimbursement for patient treatment are the two most pressing business issues physicians will face in 2017.
Experts foresee 2017 as a year of great change along with great challenges for physicians. Here are the top challenges physicians could face.
- MACRA Final Rule – Unlike the ACA, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is likely to stay, so physicians will need to adapt to new incentives and requirements rolling out this year. Though MACRA implementation is scheduled for January 1, 2019, CMS has proposed to use performance data from 2017 to determine payment adjustments in 2019. To comply with the rules, physicians are advised to:
- Document and report every treatment through a certified EHR or other approved method, which is the only way physicians can get paid for their services.
- Choose one of two reimbursement paths: advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS). Most small practices probably will opt for MIPS, which measures quality, advancing care information (meaningful use) and clinical practice improvements to start (resource use will be included later).
- Ensure that every diagnosis is part of the billing for that patient, and that all ICD-10 codes are attached to the bill. With focus on patient wellness, make sure the plan includes scheduling annual wellness visits and transitional care management (TCM) visits, when appropriate.)
- Pre-authorization requirement – CMS believes using a prior authorization process will help ensure that the services are provided in compliance with applicable Medicare coverage, coding, and payment rules before services are rendered and claims are paid. This allows providers and suppliers to address issues with claims prior to rendering services and submitting claims for payment, which has the potential to reduce appeals in the case of disputed claims. Prior authorization requirements have increased steadily in recent years. Patient eligibility verification services from experienced medical billing companies are now available for medical practices to speed up the prior auth process. However, it is also predicted that the growth of value-based payment models will limit the growth of prior auths.
- EHR interoperability for successful care coordination – Electronic transfer of information is getting more importance. A study released by KLAS Research in October finds that only a mere 6% of healthcare providers can effectively and efficiently share patient data with other clinicians who use an electronic health record (EHR) system different from their own. Experts recommend that doctors should
- Maximize the functions they have within their EHRs to better enable data exchange.
- Make electronic data exchange part of their practice workflow by maximizing the use of the functions already included in their existing software systems, which helps them move closer to the goal of interoperability.
- Patient satisfaction matters – Patient satisfaction reflects the job that a physician is doing. Patients are easier to serve if they feel their needs are being met. This results in happier staff and patients. Satisfaction scores are often calculated via online reviews in Yelp, RateMDs and Healthgrades.com. Physicians must listen to their patients and be empathetic. They can even ask satisfied patients to post reviews, which is a great way to boost online scores and stay ahead of value-based payment.
Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.
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