A string of healthcare reforms announced by the Federal Government over a year or so have changed the landscape of the healthcare industry nationally. The expected extension of insurance coverage for more than 30 million people, removing pre-existing condition clause, and an incentive based healthcare regime are going to influence and alter the equation for all the stakeholders concerned, more so the medical billing management companies/professionals. While the extensive coverage of health insurance should open avenues for more business and revenues, the ensuing stringent billing regimen – the mandatory EMR System Implementation, ICD-10and HIPAA 5010 compliant coding and reporting norms, and highly rigid insurance carriers – is going to test Medical Billers’ ability to adapt to the changing landscape. Never before has the role of medical billers been more debatable than now.
As the healthcare reforms take effect, Medical Billers will be called upon to redefine their role in as far as:
- Ensuring compliant EMR Systems for physicians: As a seamless EMR System is the foundation for apt medical coding, medical billers will be called upon to advice their clients’ on the efficacy of implementing EMR System as part of their effective and efficient medical billing management.
- Upgrading their competence to ICD-10 and HIPAA 5010: As the new coding and reporting regimen takes over shortly, medical billers – to avoid being outdated and obsolete – need to make a successful transition to the ensuing ICD-10 and HIPAA 5010 requirement.
- Helping physicians on public and private insurance composition: With the healthcare reforms deciding to minimize reimbursement on Medicaid and Medicare policies, physicians/hospitals are rethinking on what should be the composition of public and private insurance holders in their patient population. Consequently, medical billers’ role assumes greater significance in recommending a judicious mix of public and private health insurance holders in their clients’ patient population.
- Establishing a mutually respectable relationship with insurance carriers: Forging a cordial relationship can go a long way in ensuring fast, and delay free reimbursement of physcian’s medical bills; medical billers would do well to build a rapport with heterogeneous insurance carriers.
- Educating physicians about internal preparation for medical billing: Apart from ensuring a compliant system of billing, submission, and realization, medical billers will also be called upon to educate physicians about the efficacy of upgrading internal system of data recording and filing for complimenting comprehensive needs of medical billing management.
- Approaching Medical Billing as a wholesome exercise: Above all, medical billers will be asked to view physician’s medical billing from a complete revenue cycle management perspective rather than one-off billing exercises. Such a comprehensive approach improves the probability of positive outcomes immensely.