The Affordable Care Act (ACA) is now a reality, for both patients and health care providers, who have either dreaded or eagerly anticipated its arrival. For those of you who feared the worst, take heart – read on for a few ways the ACA can actually improve your practice’s reimbursement rates:

1. A survey of independent and employed physicians showed that administrative expenses, including hiring and managing staff, accounted for a whopping 87 percent of total practice operating costs. By incorporating streamlined medical front office procedures to simplify administrative operations, staff can create and track claims more efficiently and reduce waste – a primary goal of the ACA.

Reimbursement rates will increase for practices with an eye to clinical documentation improvement (CDI) to meet new coding and other updated requirements. Hiring or training your CDI personnel with the skills and experience necessary to perform top-notch documentation should be a priority of every practice administrator.

Enlisting the help of nurses with solid coding experience may help to bridge transitions in clinical documentation improvement; if this is not an option, consider utilizing the expertise of a professional organization specializing in billing, coding and documentation.

2. One of the ACA’s aims is setting up pilot programs that support cooperation between physicians from all specialties to obtain reimbursement through these bundled programs. Creating patient care teams with other physician colleagues for participation in bundled (flat fee) payment programs, such as accountable care organizations (ACOs), and other incentive programs, can result in improved patient care, reduced waste and fraud and ultimately, higher reimbursement rates.

Kocher, Emmanuel and DeParle wrote, in part, in their 2010 article: “The most successful physicians will be those who most effectively collaborate with other providers to improve outcomes, care productivity, and patient experience.”

3. To meet ACA criteria, implement an expanded electronic health records (EHR) system that includes not only updated coding and other billing criteria but has capabilities for drug guidelines and related support. While many smaller practices have understandably balked at the initial outlay, studies have shown that when spread over time, these changes pay for themselves with increased revenues thanks to more accurate and transparent documentation.

One recent study determined that per-physician costs of initiating EHR, including hardware, software, printers and other peripheral devices to be around $32,400 during the first 60 days of launching. Despite that, reports the Medical Group Management Association in their 2009 survey, the savings accumulated over time, with practices using EHR reporting operating margins of 10.1 per cent higher after five years than during the first year of use.

4. Another goal of the ACA is to improve the public’s access to preventive as well as primary health care. Because of the unique CPT and related codes used, it is critical that your billing and coding staff be trained in the latest coding updates, including ICD-10. Documentation is the name of the reimbursement game, so their skills need to be up to date. If training classes aren’t an option for smaller practices, consider outsourcing the practice’s coding and billing to a professional organization, such as M-Scribe Technologies, LLC.

5. Increased accountability for verifying patient insurance or other coverage is critical for success of the ACA. Make sure that all of your front desk personnel are familiar with the procedures for verifying coverage, as well as deductibles, out of pocket charges and other costs, if any, and that they effectively communicate this information to patients, especially any balances payable by the patient.

For help with achieving compliance with the ACA, contact M-Scribe Technologies, LLC for a consultation to learn how your practice can save your staff time while increasing reimbursement rates.

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