Top 5 Medical Billing Challenges Impacting Doctors in 2014

Healthcare practices need to streamline their medical billing tasks in order to enhance revenue collection. Medical documentation was much simpler a decade and a half ago. 2014 is predicted to be a challenging year with more medical billing and reimbursement challenges. Physicians should be prepared for the impending changes to the current billing practices.

The biggest challenges of 2014 are the transition from reimbursement based on volume to reimbursement based on value that many providers are experiencing.

HealthLeaders Media survey titled Industry Survey 2014 stated that a full 91 percent of respondents identified low reimbursement rates as an immediate threat to their organization's revenue.

Additional regulations and declining reimbursement make it necessary for physicians to stay updated with the changes in medical billing practices.

What Doctors Should Know?

Let us take a look at the top five medical billing challenges physicians should be aware of.

ICD 10 transition: The long-anticipated, new International Classification of Diseases code set will finally take effect on October 1, 2014. Most other nations have already adopted ICD-10, if only for record-keeping purposes. ICD-9 codes will get replaced with new billing systems using ICD-10 codes.

This new code set replaces the outdated terminology and requires more specific documentation as well as more details about the service that was provided. Real-time documentation with ICD-10 is expected to increase the quality of care. Use of ICD-10 codes requires medical billing and coding personnel to have extensive knowledge of medical terminology as well as anatomy and physiology than was required under ICD-9. Even more time for administrative paperwork will be required by doctors doing the billing tasks themselves.

Health Insurance Exchanges (HIX): With focus on all Americans having access to affordable health insurance options, the Obamacare Health Insurance Exchange that opened on Oct 1, 2013 provides an online marketplace for health insurance. The Health Insurance Exchange implements State specific marketplaces for health insurance. However, HIXs payment rates for doctors remain an uncertainty though some states are already aligning with Medicaid prices, resulting in lower reimbursement rates for doctors.

The latest report is that average premiums offered on the new individual government healthcare exchanges are comparable to and sometimes less than their employer-sponsored counterparts.

Implementing the latest technologies such as EHRs (electronic health records) and comprehensive practice management solutions can streamline physician’s workflow and help handle the patient flow faster, a quality that will be vital when your patient base increases.

Quality reporting: The Centers for Medicare and Medicaid Services (CMS) has developed several quality initiatives that provide information on the quality of care across hospitals, skilled nursing facilities, home health agencies, and dialysis facilities for end-stage renal disease. Non-compliance with these measures will result in penalty.

Physicians who do not participate in Physician Quality Reporting System (PQRS) in 2014 will incur a 2 percent penalty in 2016.

Billing staff members must comply with the quality reporting measures to avoid penalties in 2015 and 2016. In 2015, Eligible Professionals who do not successfully report quality data during the designated quality reporting period will be subject to a Medicare fee-for-service payment reduction of 1.5% that would rise to 2% in 2016 and each subsequent year.

Revised CMS 1500 form: The Centers for Medicare and Medicaid has released a revised 1500 form that is available for use beginning Jan. 6, 2014, to submit claims for reimbursement of services. Use of the revised form is optional until March 31, 2014 and will become mandatory by April 1, 2014. The new form has been designed to accommodate ICD-10 codes and allows expansion of additional diagnostic codes from four to twelve. It is crucial for healthcare providers to ensure that their claims are filed on the appropriate claim forms.

CPT coding changes: 2014 will be seeing the largest CPT code modification in a long time. The American Medical Association (AMA) announced 175 new and 107 revised CPT® codes for 2014, with 25 percent of the changes falling on a single specialty—gastroenterology. A total of 47 codes have been deleted. Keeping up to date with the new codes is crucial to obtaining proper reimbursement for provided services. 

Can You Handle Current Billing Tasks Yourself?

Busy physician practices could consider partnering with reliable medical billing and coding companies to handle these challenging and crucial tasks effectively. The complex medical billing processes require the specialized skill of billing and coding professionals who are AAPC certified. A professional medical billing company:
  • Stays up to date with the changes in healthcare regulations
  • Ensures accurate coding compliant with the latest federal regulations
  • Effectively follows up unpaid and delayed claims
  • Helps smooth transition to ICD-10
  • Provides assistance with obtaining high rates of reimbursement.