It came down to the wire, but family medicine physicians narrowly averted a 26.5 percent cut in Medicare physician payments – temporarily – with a stop gap measure that provides for a Medicare payment extension through 2013. The cut was scheduled to take effect on Jan. 1 as a result of the Sustainable Growth Rate (SGR) formula overshooting budgeted Medicare spending. In addition, implementation of the Budget Control Act’s (BCA’s) sequestration provision measure, scheduled to take effect on Jan. 2, has been delayed for two months. The provision measure calls for a 2 percent cut in the Medicare physician payment rate and an additional 8 percent cut in discretionary funding for vital medical education programs. Expertise in family medicine medical coding, billing and collections has never been more critical to the continued viability of family medicine practices.

“[The] temporary patch to the Medicare physician payment is a reprieve for elderly and disabled patients whose health care security is jeopardized by continual threats to Medicare physician payment,” said AAFP Board Chair Glen Stream, M.D., M.B.I., of Spokane, Wash., in a prepared statement that appeared in the Jan. 3 edition of PharmPro. “This is a welcome relief, but it is not the solution. The current system, with its deeply flawed sustainable growth rate formula, generates an annual, semiannual, sometimes monthly crisis of confidence among elderly and disabled Medicare patients and their physicians.”

The AAFP continues to call on Congress to repeal the sustainable growth rate (SGR) formula. According to Stream, it’s important to find a permanent solution to the sequestration cuts called for by the BCA.

“Now is the time for Congress to follow through on previous promises and commit to permanently end the ordeal of temporary patches that ultimately drive up the cost of a meaningful solution and destabilize the Medicare system,” he adds. “Congress must make good use of these 12 months to repeal the SGR and put a sustainable payment system in place that helps rebalance the primary care physician workforce.”

While there are temporary stop gap measures in place and future permanent measures being called for, it’s essential to the continued viability of family medicine practices to continue to explore ways to offset the impact of Medicare cuts by transitioning family medicine medical coding, billing and collections to experts who support and champion new payment and delivery models.

One such model is the Accountable Care Organization which will become increasingly mandatory for care providers in the Medicare network. Family medicine physicians will be required to form a clinical network with the goal of providing better care at a lower cost to patients. Transitioning to these new models will bring challenges to physicians such as understanding fee schedules, negotiating and renewing payer contracts and being conversant with multiple payer policies. Family medicine medical coding, billing and collections will include keeping track of and analyzing an overwhelmingly large amount of new information such as: eligibility for Medicare, medical outcomes, Medicaid and private insurance and clinical compliance and reimbursement requirements to name a few.

In addition to these future Medicare reductions, mandatory EHR, PQRS, and ICD-10, and HIPAA 5010 compliant coding will be added to the long list of challenges that face providers. Now, more than ever, family medicine medical coding, billing and collections will require special expertise to collect and sort a plethora of data including compliance information, detailed billing and reimbursement records.

The right third party family medicine coding, billing and collections partner offers both experience and competence in stage-managing transformation to high-performance Medicare models as well as effectively managing compliant coding on behalf of providers who are focused on clinical efficiency.

It takes an industry insider with over 25 years of experience in family medicine revenue cycle management to enable family medicine practices to run more efficiently, cost-effectively and provide higher quality care to patients. revMD is the results-proven alternative for family medicine revenue cycle management based in Phoenix, Arizona.

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