Submitted by Antonio Arias, MBA, CHBME on Tue, 01/31/2017 - 8:00

medical billing issues

The Top 3 Medical Billing Issues to Watch in 2017

With the new year underway, there remain a multitude of question marks for medical billers and other members of the U.S. healthcare system. As 2017 marches onward, organizations need to continually pay mind to the trends, issues, and updates that will affect the effectiveness of their revenue cycle over the course of what is sure to be an eventful year.

To set your practice up for success, we’ve highlighted three major areas of concern for billers, coders, practice managers, and providers. If you’re struggling to prepare for these and other oncoming evolutions in 2017, consider outsourcing your back office operations to a trusted medical billing service with a strong background in your specialty.

ICD-10’s Consequences Continue

Now that the CMS’ grace period is over as of October 2016, the shift from ICD-9 to ICD-10 is already a reality. But even though the updated code set is now fully in play, the repercussions of the change are still reverberating (with more new concerns continually coming down the pike).

Many practices that struggled with the ICD-10 transition received a welcome reprieve this January when the CMS announced it had experienced a ‘glitch’ in the quality reporting measures brought upon by the changes in the ICD-CM (Clinical Modification) and ICD-PCS (Procedural Coding System) updates. Mindful of the glitch, providers affected by the ICD-10 issue will not be subject to the 2% fee-schedule penalties for 2017 or 2018 that otherwise would have been applied.

But diligence and caution in ICD-10 coding, reporting, and management remains warranted: CMS has released the ICD-10-CM updates for 2017, which are to be used for patient encounters from October 2, 2016 through September 30, 2017.

MACRA Makes Waves

Despite uncertainty over the future of the Affordable Care Act, most healthcare industry experts expect the Medicare Access and CHIP Reauthorization Act (MACRA), a landmark payment system for Medicare physician fees that replaces the sustainable growth rate formula, to survive intact.

The problem: Few healthcare organizations have a handle on what MACRA entails: According to recent survey results, 84% of medical personnel are unsure of MACRA's requirements. Yet that isn’t stopping 85% of providers from saying they will participate in MACRA ‘to the best of their ability’ – making now a wise time to get familiar with the program’s policies, penalties, and guidelines.

Earning MACRA incentives will require providers and their medical billing teams to adhere to a broad set of documentation, reporting, and quality measurement requirements. As MACRA takes hold among medical practices, it may breed even more changes to watch: Some experts predict MACRA may result in further healthcare industry innovations around technology use and ‘process redesign’ around the revenue cycle.

Insurance Plan Changes Abound


As we mentioned earlier, the uncertain future of the Affordable Care Act is creating concern for medical professionals of all stripes. Is a full repeal imminent, leaving thousands of Americans uninsured? Will legislators create an alternative program, or push to keep Obamacare largely intact? At present, no one knows for certain.

No matter what changes come to pass, medical practices should be prepared for potential changes in their patient base should certain plans be shut down. Now may be a good time to revisit your sticker-price rates, or to reconsider what preventive services you may be willing to offer to uninsured patients (and at what prices).

Amid oncoming plan changes, it’s also worth considering whether your practice could benefit from having someone at your organization available to help patients understand their insurance coverage. An experienced medical biller may be the ideal candidate to serve as a full- or part-time insurance advocate as your patients navigate a new era of uncertainty in the healthcare space.

 

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Topics: Practice Management, Medical Billing Company, Meaningful Use Stage 2

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