Providers Acquiring Medical Billing Services To Handle the ACA Impact on Revenue

The Affordable Care Act has left the healthcare providers in the US worried. A survey conducted sometime back reported that 55% of hospitals expect a dip in their revenue while only 28% think that there would be an increase in revenue. But the survey also revealed that a considerable number of those who are informed about the impact of the healthcare reform (about 58 %) plan to become accountable care organization to reap financial benefit of the reform and improve the quality of care.

The 58 percent that revealed their plan to become ACO organization are well informed about the finer points of The Affordable Care Act as the law aims to set up a national pilot program to encourage care providers of various stripes (doctors, physicians etc) to coordinate and work together to improve quality of care so that they can be reimbursed through a flat fee (bundled payment) for a singular episode of care which the law supposes will lower expense and promote quality of care.

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However, the concerns of the 55% hospitals that expect a dip in revenue can’t be dismissed either. The insurance authorities propose to pay a flat payment to healthcare providers of different stripes who have come together and formed an ACO. The problem with this model is that it requires sound coordination among the various providers involved in a treatment episode to ensure a centralized collation of medical data which would be used to prepare claims and appropriate codes assigned to them.

Another concern that has worried healthcare providers is that this reform has a punitive nature to it. Millions of tax paying Americans eligible for government-subsidized healthcare coverage but without government-mandated health insurance coverage will be penalized with higher taxes unless they get an insurance policy within a year.

This is indeed good because it will induce more and more Americans to get health insurance bringing them into the net of national healthcare security. Albeit, the problem is this will require healthcare providers to assess insurance eligibility accurately, handle instances of unrealized partial payments where the patient’s bill exceeded his/her coverage, and of course a phenomenal increase in non-medical activities for healthcare providers to handle. Additionally, under ACA insurance providers will provide more coverage for preventive services and these services would have to be coded using separate CPT codes with enrollee-costs waived.

These concerns have sparked a trend where healthcare organizations that were handling their billing and coding responsibilities themselves until now are hiring the services of professional billers and coders. However, it’s important to remember that to handle the above challenges brought by ACA, a billing and coding organization needs to be familiar with the current procedures; be able to handle medical details coming from varied medical practices for preparing claims for bundled payments; be able to negotiate the additional red-tapism in submitting claims; and ensure timely payment of claims through post submission follow-ups.

MBC’s revenue management consulting has been helping physicians by performing a thorough analysis of the Revenue Management Cycle and ensuring that there is sound coordination between various components of healthcare leading to smooth flow of medical data. Our RCM services also involve identifying gaps in the process and addressing them by advising physicians while replacing, if necessary, old software applications with new ones, blocking areas of revenue leakage and identifying areas of staff training.

Medicalbillerandcoders.com, the largest consortium of billers and coders in the US, has also been helping several small to medium size healthcare providers with its Outsourcing services. MBC handles the entire range of activities involved in billing and coding starting from preparation of claims through submission to post-submission follow-ups, along with regularly updating themselves about the changing healthcare industry trends.