Health Care Reform Bill

How will the health care reform bill affect Medical Billing? A look at the impact the health care reform act will have on provider reimbursement. Following the developments this last year of the health care reform bill, I couldn’t help but think how this would affect medical billing and coding careers.

The health care reform act of 2010 has several changes that can impact the physicians we serve and the individual health care plans that account for most of their revenue.

As with any change in sweeping reforms such as the health care reform bill, there’s always opportunity. How will the health care reform bill affect medical billing and reimbursement? My opinion is with the potential for 32 million more Americans being covered by individual health care insurance or national health care insurance, the reimbursement to physicians will be positive.

Improved Medicare Remibursement
The increased reimbursement from Medicaid in the short term will also positively affect physician practice reimbursement. Many doctors now are reluctant to see Medicaid patients due to the pitiful reimbursement for procedures.

The changes introduced by the health care reform bill will benefit physicians revenue, which will benefit those of us who serve them. Here’s a summary of the changes introduced by the 2010 health care reform act.

Preventive care
Medicare will pay for annual checkups. The co-pays and deductibles for preventive care and screenings will be eliminated also.

Medicaid’s low reimbursement will be increased to the same level as Medicare. This means more health care providers will be more likely to accept Medicaid insurance. However in the long run I have a feeling the federal government will continue to reduce payments to physicians.

Believe me I’ve seen what Medicaid reimburses and it really doesn’t cover the cost of the procedure. The increased number of primary care physicians will also require support for billing and coding.

Insurer Profits
The health care reform bill contains a provision to limit the profit and overhead of the insurer. Carriers will be required to spend between 80 to 85 cents of every dollar on health care. The historic average is around 74 cents. Non-profit Blue Cross organizations will be required to maintain an 85 percent or higher medical loss ratio (money spent in relation to income) to take advantage of IRS tax benefits.

Expanded Coverage
An estimated 32 million Americans who are currently uninsured will no be covered. This includes coverage for high risk, pre-existing conditions and immediate help for the uninsured until health insurance exchanges are established.

More Primary Care Doctors
The Obama health care plan provides funds for training programs to Increase the number of primary care doctors and nurses. This program begins immediately in 2010.

The health care reform bill includes a number of improvements for payment of physicians that will result in notable increase in Medicare payments. These are:

  • 10 percent incentive payments for primary care physicians in internal, family, pediatrics or geriatrics for providers whose Medicare charges for office and home and nursing home visits are 60% or more of total Medicare charges.
  • 10 percent incentive payments in shortage areas for general surgeons performing general surgery in shortage areas.
  • 5 percent incentive payment for mental health services.

Fraud and Abuse
Additional funding (approximately $250 million over next decade) to combat health care fraud and abuse. Enhanced fraud abuse in the form of New screening procedures for DME suppliers will be implemented to help eliminate health insurance fraud and waste

With regard to Medicare and Medicaid, I think in the long run the federal government will be under pressure to reduce the cost of these programs. This could eventually lead to reduced payments to doctors for services – just like they tried to do a couple times lately with the 17% cut in Medicare reimbursement which was repealed.

Insurer Profit Impact
I can’t help but feel that the mandate on insurers to reduce overhead and profit will impact the reimbursement of physicians. I hope not but it seems like with these mandates the pain gets spread around affecting not only the insurance company but the patient and provider.

Some of the provisions of the health care reform act seem to target the insurance companies and their profits. Maybe some of this vilification of the insurance industry is justified, but the reimbursement to the physician could be impacted as well.

Fraud Measures Welcomed
Fraud and abuse measures are welcomed as initiatives to legitimate medical billing providers. Any efforts to rid our field of those who give it a bad name will benefit all of us. However as the federal government tends to do, this has the potential to generate more paperwork and bureaucracy for those of us who are following the rules.

Positive Impact on Billing
Overall, the changes introduced by health care reform legislation will result in significantly more insured patients which will benefit the revenue of physicians – especially primary care doctors – family, internal, pediatrician, and geriatric providers. Working with family providers in my billing business, I’ve seen the impact of the uninsured on family doctors revenue, and how much they have to write-off due to patients who are not insured. So from a medical billing business owner, the changes introduced by the health care reform bill are positive.

2012 Supreme Court Ruling
In the summer of 2012, the Supreme Court upheld the new health care reform bill provision requiring nearly all Americans to have health insurance. The court ruled that the mandatory insurance requirement is permitted under the tax authority of Congress. However the court ruling did limit one aspect of the law that intended to expand Medicaid to cover more poor and disabled. Medicaid is jointly funded by the state and federal governments. The health care reform bill required states to extend coverage to include new beneficiaries or risk losing federal money. The Supreme Court ruled that this provision was unduly coercive.

One of the biggest provisions of the new health act is the mandate that Americans have health care coverage by 2014. The administration’s argument that this is constitutional under the Commerce Clause of the Constitution was rejected by the court. However the court did agree that the requirement to obtain health insurance is considered a tax and is therefore permitted. Chief Justice Roberts explained that the government does not have the authority to require people to have health insurance. But the government does have the authority to tax those who do not have health insurance – which is basically another way of requiring it.

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