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How Obamacare Affects Medical Billing and Coding

January 21, 2014

ACA affects MBCWith all the concern and required training for the new ICD-10 complex coding system, the potential effects of the Affordable Care Act (ACA) on medical billing was overlooked until the last quarter of 2013. It’s clear that healthcare reform is not coming without considerable pain, however.

While the supporters of so-called Obamacare were jubilant as the signup and implementation dates approached, most are jubilant no longer. The national and many local healthcare online marketplaces have been an almost total disaster. Healthcare marketplace websites were crashing faster than a Division III Community College football team playing Florida State or Alabama.

Medical billing staff who have focused on ICD-10’s over 60,000 treatment and diagnosis codes must now pay close attention to ACA features. According to, the general public is still immersed in a “fog of miscommunication” about the new healthcare rules. Unfortunately, medical billing firm staff does not enjoy this “luxury.”

The confusion and despair over the President’s decision to renege on his oft-made promise, “If you like your healthcare plan, you can keep it,” generated an overwhelming backlash from citizens around the US. This immense pressure forced the White House to take action to allow people to keep their non-compliant health insurance plans, but only for the next 12 months.

Unfortunately, the White House did not reinstate its promise until after most insurers sent policyholders formal cancelation letters, further confusing the already misunderstood process. Physicians, practice managers and other medical providers are as confused as the public about “affordable healthcare.”

Among the most common questions from medical providers and billers, the following are important examples. Medical billing staff, whether in-house or team members of top third party firms, such as M-Scribe Technologies, will need answers for physicians, patients and others.

  • How reliable are eligibility verifications? Medical billing staff submitting claims near year’s end received numerous denials further hurting practice cash flow and angering many patients. In most cases, practice staff verified coverage at the time of rendering service. While this historically occasionally occurs when premium payments post to the wrong insured’s account, medical providers and billers worry that government-administered healthcare may result in even more eligibility errors and denials.
  • Will there be more “precertification” problems or less? Physicians, patients and medical coding staff have endured precertification delays and errors from private insurance companies for years. Will the “governmental connection” increase the length and inefficiency of the precertification process, already a point of negative focus? Replacing one inefficient bureaucracy with another, with more intense and complex one, may not be a workable solution to an existing problem.

These are but two of the numerous issues affecting medical billing and coding staff with ACA implementation. When combined with the plethora of problems afflicting government-sponsored websites for patient signup–before the ACA became law–the medical provider and billing industries cannot be faulted for harboring grave concerns about implementing ACA healthcare reform provisions successfully.

The effects of the past few months have embarrassed, disturbed and angered even the most outspoken proponents of Obamacare. While few, even medical providers, would argue against affordable healthcare, medical billing and coding staff, fearing the possible effects of the ACA, need appropriate answers to physician, patient and/or public questions.

Some medical providers, according to, are referring to Obamacare as a “diversion with false concern for the health and well-being of the American people.” While this belief, if true, is sad–potentially dangerous–our medical billing professionals still need to get the information they need to do their jobs.

To date, the potential long-term effects of the Affordable Care Act remain unknown. Healthcare reform, while needed, must involve the efficiency to allow physicians, practice staff, and medical coding and billing professionals to perform their responsibilities effectively. Patients deserve this respect and fair treatment, as do medical providers and their billing entities.


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