When is the Family Medicine medical billing and coding process at its most critical crossroad? Right now, because the Affordable Care Act (ACA) is here and impacting Family Medicine revenue cycle management.

The ACA has its benefits, especially for Family Medicine practices. According to Melinda Abrams with the Commonwealth Fund, one “hidden” benefit [to Family Medicine practices] of the ACA is its potential to make primary care more accessible. She adds that “Health care reform aims to expand and train the primary care workforce, improve provider reimbursement and patient incentives for primary care services, and support innovative approaches to delivering care.”

Along with the benefits comes a flurry of changes to Family Medicine practices resulting from the emergence of Accountable Care Organizations (ACO). The federal government, in tandem with commercial insurance companies, is in the midst of changing the way patients pay doctors and hospitals. This payment reform puts a growing emphasis on shared-risk models vs. fee for service.

In June 2012, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most pressing practice management challenges. No. 2 was: Preparing for reimbursement models that place a greater share of financial risk on the practice.

That’s because within the next five years Family Medicine physicians will be adopting this shared-risk model for revenue reimbursement as they transition to population health management (defined by the Care Continuum Alliance as a collection of physician-supervised interventions, implemented for populations defined by a healthcare need or condition, that help patients and caregivers optimize care, prevent future complications, and maximize opportunities for wellness.)

According to a Health Dialog survey of 100 primary care [Family Medicine] practices nationwide, as reported in Yahoo! Finance in October 2012, the following key findings (excerpts) reveal some of the issues they face with this transition:

  • The majority of practices surveyed recognized the importance of population health management, but lacked the knowledge of and familiarity with how to deploy these strategies in practice.
  • Major challenges to implementation included increased administrative burden, cost, and time, yet practices showed openness to short-term disruption of patient care for the longer-term benefits of improved patient experience, improved population health, and reduced healthcare costs.
  • Practices see population health management as a way to successfully move forward but need guidance and support.

With all the transitions that Family Medicine practices face, including the newer revenue reimbursement model, a precarious financial transition period results, especially as it pertains to healthcare revenue cycle management. Proper Family Medicine medical coding and billing, including attention to accounts receivables, is vital to maintaining a strong pulse. Family Medicine revenue cycle management is an exacting science that requires in-depth, insider industry knowledge of a myriad of new medical coding, billing and compliance regulations that only an independent third party Family Medicine medical billing and coding specialist with decades of expertise can provide to ensure nothing falls through the cracks and revenues are optimized.

revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in medical coding and billing that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 25 years, revMD.com partners with medical practices in Arizona and throughout the U.S. to optimize revenue for hospital based and practice based physicians.

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