Before 2017

The year hasn’t completed ended yet but the healthcare industry has been bombarded with changes. The recent ending of the ICD-10 grace period has been the first major change leading into 2017. It has effected many practices in a number of different ways. It should be remembered that in the long run going electronic will benefit the entire industry. 


The possibilities are endless in the future, collaborative studies using patient data, the entire industry coming together to create something that could very well change the way the industry has worked for many years. 

Of course in the short run there will be certain problems especially as practices get used to the changes. Many physicians have even expressed concerned over productivity dropping because of all the regulations that have been imposed. These are minor setbacks in the grand scheme of things, and productivity is bound to rise in the long run.

Conclusion of Grace Period

The ICD-10 changes are something that every practice needs to know about. There have been almost around 3000 code changes starting October 1st. The biggest problem for practices is how to deal with the advent of these new codes. It is important to have a medical billing software to get through the paperwork. Whether your service provider has complied with the recent updates is a good question to ask. However if there hasn’t been an automatic update than you need to think about changing your service provider.

There are practices which still do not use a medical billing software, and it is important for them to know which family of codes has been changed and whether the changes affect your practice. The practices that aren’t totally electronic yet are going against the tide, and it is recommended that they shift if they wish to keep afloat in the long run especially with Medicare Incentive Payment System, and the changes that will entail. 

Claim Denials

The new ICD-10 codes, and the end of the grace period means that a practice can no longer use unspecified codes. This many have said will increase claim denials in the short run, and this could upset the budgeting of many practices. However practices that have medical billing software from reliable companies and vendors will not have to worry about claim denials going drastically up. Practices that aren’t using a software, should make sure they know the code changes especially the ones that effect their practice.

Elections

There are other changes that a practice needs to be aware about. The upcoming elections will truly decide the fate of the healthcare industry. Both the candidates are going in different directions. While Hillary Clinton wants to ‘tweak’ the Affordable Care Act (ACA), and keep going in the same direction, the Republican nominee Donald Trump wants to repeal the ACA. 

It is imperative that a practice be prepared for both outcomes. Whether that means more regulations, or less. In a Trump presidency, not only will the ACA be repealed, but insurance would be sold across state lines. This could potentially open up companies to more competition. Whereas a Hillary Clinton presidency would support state-based public option, and even limit covered consumers out of pocket liability.

Both the parties have disagreed on a problem of fundamentals. The future of healthcare industry hinges on the basic problem of how much spending should be done on federal level? The republicans have the view that there is too much spending currently on healthcare and not enough revenue. They plan to fix this by relying on the private market, which through competition would reduce costs.

The Democratic Party suggests that the amount of spending is not too much, it is however a problem of extracting revenue. This could be done according to the democrats by improving current government programs.     

What does this mean for a Physician?

For a practicing physician there isn’t much of a change as far as the elections are concerned. This is because it is important to first see the results of the elections. However one rule of thumb that we can go with is that there will always be regulations. This would mean that a practice should have meaningful use and HIPPA compliance. There are many Electronic Health Records (EHR) software that have integrated all updates, including the changes in the ICD-10 codes.

With the addition of Medicare Incentive Payment System, or MIPS, there will be a significant increase in transparency since reporting on performance measures will begin in 2017. Although the composite performance score (CPS) will be calculated and posted in 2019 it is important that all practices pace themselves along with these changes. The future of the healthcare industry is electronic, and regulated. Thus physicians should prepare accordingly. However after November 8th we will have a clearer picture as to which direction the healthcare industry is going towards. 

The article has been published here with the Authors permission.