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Top Medical Reimbursement Trends for 2018

January 4, 2018

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A recap of 2017 highlights

It’s time once again to dust off the crystal ball as we take a quick peek into the future while looking back on the highlights of the past year and their effects on healthcare reimbursement. Billing trends over the past year saw increased use of EHR and complementary technologies, including Cloud computing, block chain ledger technology and the move toward nationalized (electronic) patient data bases. CMS added new CPT codes for certain E&M services as well as changes in pathology, laboratory, biochemical and cardiovascular surgery codes.

2017 also saw higher healthcare costs and spending: ranges have been projected to increase from 2.4 percent to 7.5 percent between 2015 and 2020. Operational costs will continue to increase, with reduced returns, as practices and other organizations cope with rising overhead costs. Here are just a few of the trends expected to impact 2018 revenues:

Increased patient financial responsibility 

With patients and their families asked to assume an increased share of healthcare costs, plus the potential loss of coverage through cutbacks or elimination of the ACA, more consumers are asking for transparency of charges up front for cost comparison and budgeting for anticipated  medical expenses. Patients are being offered comparison-shopping tools by some systems, such as those offered by Anthem, which will spur further transparency in pricing and outcome information as patients demand more choices for their healthcare dollars. Unfortunately, lacking insurance or other assistance, some patients may end up foregoing needed treatment due to the inability to pay.

The upshot of this financial burden could be an increase in bad debt for practices due to patients defaulting, unless providers become pro-active by developing more transparency of costs, creating workable payment strategies for lower-income patients as well as improving communication with patients beforehand about their payment responsibilities.

Innovations in billing and revenue-cycle technology

Upgrading billing and documentation technology to reduce duplication of services, incomplete documentation and other risk-adjustment solutions will boost practice revenues. Technology will further improve the revenue process with payment options that are easier for patients to understand and mobile-friendly. Innovative operating partners will be transitioning toward solutions promising to track and manage the entire revenue cycle from end to end, automating routine repeatable ­­processes and lowering costs, for positive patient experiences at all touch points of the revenue cycle.

More mergers of insurers and healthcare organizations

With the merger of mega-payers like CVS Health acquiring Aetna and the merger of 15-hospital Aurora Health Care with the 12-hospital Advocate Health Care system, questions arise about the effects on previously customized revenue system technologies. Potential conflicts with differing technologies, with one company using Epic while another uses Cerner, can create cycle disruptions and affect future planning, with possible solutions including consolidation or outsourcing.

Related Article: Reimbursement Changes: Prepare for Future Challenges

Value-based care is (still) a thing

With CMS leading the charge on whole-patient, value-based care, the older fee-for-service model is becoming a thing of the past, with more payers moving into capitation, bonus payments and bundled payments for many post-acute services chronic conditions, and orthopedics. Payers will continue to encourage maintaining care quality while containing costs by the use of outpatient facilities and freestanding imaging centers.

The role of a full-service medical billing company for 2018 and beyond

The takeaway for 2018 is continued emphasis on value-based documentation, aided by technological improvements, with rising costs posing revenue challenges. As a leader in the medical billing industry, M-Scribe has been providing practices of all sizes and types with coding, billing, credentialing and other practice management services since 2002.

Contact us today at 770-666-0470 or email for a no-cost evaluation of how to meet your practice’s revenue goals while saving money and time for the important tasks of caring for your patients.


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