For many years cardiologists received generous reimbursement for their office based testing services. Nowadays, reimbursements have decreased, not only for tests but also other areas of cardiac medicine, creating new challenges and issues for cardiology medical coding, billing and collections. Truth be told, they may not be fully prepared to manage their practice and revenue cycle management in this new era of lower reimbursement. Add to that the uncertain world of healthcare reform, ICD-10 and HIPAA, and cardiologists are faced with an increasing number of challenges that threaten financial success.
While these issues may be familiar to you, it may be news to learn that new developments in the Patient Protection and Affordable Care Act (PPACA), also known as the Accountable Care Act (ACA), and physician-hospital consolidation are slated to intensify in 2013.
The following is a list of the top five issues (excerpted) affecting doctors in 2013 as compiled by The Physicians Foundation in December, basing its predictions on what they reported in 2012 surveys:
1. Ongoing uncertainty over PPACA. In 2013, physicians will need to closely monitor developments around the implementation of these critical provisions, to understand how they will directly affect their patients and ability to practice medicine.
2. Consolidation means “bigger.” But is bigger better? Large hospital systems and medical groups continue to acquire smaller / solo private practices at a steady rate. As the trend toward greater medical consolidation continues across 2013, it will be vital to monitor for possible unintended consequences related to patient access and overall cost of care.
3. 12 months to 30 million. In 2014, PPACA will introduce more than 30 million new patients to the U.S. healthcare system. As the 12-month countdown to 30 million continues across 2013, physicians and policy makers will need to identify measures to help ensure a sufficient number of doctors are available to treat these millions of new patients – while also ensuring the quality of care provided to all patients is in no way compromised.
4. Erosion of physician autonomy. Many of the factors contributing to a loss of physician autonomy include problematic and decreasing reimbursements, liability / defensive medicine pressures and an increasingly burdensome regulatory environment. In 2013, physicians will need to identify ways to streamline these processes and challenges, to help maintain the autonomy required to make the clinical decisions that are best for their patients.
5. Growing administrative burdens. In 2013, physicians and policy makers will need to work closely together to determine steps that will effectively reduce gratuitous regulations that negatively affect physician–patient relationships. According to a recent Foundation report, the creation of a Federal Commission for Administrative Simplification in Medicine could help reduce these regulations by evaluating and reducing cumbersome physician reporting requirements that do not result in cost savings or measurable reductions in patient risk.
At the core of these issues, and challenges, is your healthcare revenue cycle management. Any more, it is critical to the lifeblood of your practice to have a highly specialized cardiology medical coding, billing and collections process in place that will not only help mitigate these pressures by navigating the choppy waters of uncertainty in cardiac medicine that can impact your reimbursement and hence, your cardiology practice’s financial health in the wake of these growing challenges.
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