Challenges for Medical Billing in 2017

Challenges for Medical Billing in 2017

Medical billing changes occur each year. With the recent change in United States presidency from Barack Obama to Donald Trump, big changes may occur in the healthcare industry in 2017. According to a survey by Capital One Spark Business, reimbursement and cash flow for patient treatments are two of the most pressing business issues doctors will encounter in 2017. Here are the top challenges healthcare agencies and physicians may face in 2017.

MACRA Final Rule

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is likely to stay, so doctors must adapt to new requirements and incentives that occur in 2017. Though MACRA cmslogo1implementation is not scheduled until January 1, 2019, the Centers for Medicare Services (CMS) has proposed to use performance data from the year 2017 to determine what payment adjustments will be made in 2019.

To comply with the new MACRA requirements and rules, healthcare organizations and doctors should:

  • Document and report every treatment through a certified electronic health record system, which is the only way doctors will get paid for services.
  • Choose one of two reimbursement methods: advanced alternative payment models (APMs) or Merit-based Incentive Payment System (MIPS). Most small healthcare practices will opt for MIPS, which measures advancing care information and clinical practice improvements.
  • Ensure that each diagnosis is part of the patient billing, and that all ICD-10 codes are properly documented on the bill. The plan should also include transitional care management visits and annual wellness encounters.

Pre-Authorization Requirements

CMS has reported that using a prior authorization process will ensure that services are provided in compliance with applicable Medicare coding, coverage, and payment rules before claims are paid. This gives providers and suppliers incentive to address issues with claims before rendering services or submitting claims. These measures are proposed to reduce appeals in the incident of disputed claims.

Another important aspect of pre-authorization is patient eligibility verification. These services from an experienced medical billing company will speed up the prior-authorization process. However, experts predict that the growth of value-based payment models could limit prior-authorization growth.affordable-care-act

EHR Interoperability for Successful Care Coordination

Electronic transfer of information is becoming more important in regard for successful care coordination. A recent study by KLAS Research found that only 6 percent of healthcare providers effectively and efficiently share patient information with other providers who use an electronic system that is different from their own.

The medical billing experts have certain recommendations for healthcare providers. These include:

  • Maximize the functions you have within your EHRs to better enable data exchange.
  • Make electronic information exchange part of your healthcare practice workflow by maximizing the use of the existing software system’s functions. This will help you move closer to the goal of interoperability.

Documentation and Coding to the Highest Level

Not coding to the highest level is not always the fault of the medical biller. In many cases, bad physician documentation is to blame. The medical biller and coders’ job is to code to the highest level of specificity, which involves abstracting the most information from the healthcare reports and taking accurate notes. This also means the medical billers should know medical terminology for both diagnoses and procedures.

Coding to a general level is called “undercoding.” This can lead to a denied or rejected claim. The medical billing challenge involves giving the coder enough information regarding a procedure so she/he can properly bill for that visit. Providers should not leave any details about the procedure off the report.

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