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Affordable Care Act Has Immediate Impact on Physicians' Medical Practices

Picture of affordable care act bill passing on March 21, 2010

Most physicians, if they had a choice, would rather clean up a soiled bedpan than spend any amount of their valuable time digging through medical codes to submit insurance claims for procedures they've performed or advised.

Before getting their licenses, private practice doctors typically spend 8-10 years studying anatomy, pathology, pharmacology, and a host of other health-and-life saving information.

However, their first exposures to the nitty-gritty details of running an actual business are usually unlike anything for which medical school could have prepared them: residents and interns are rarely handed business books during shifts in ER.

It’s especially true when it comes to getting health insurance plan reimbursement. And that’s why most doctors hire administrative professionals to transcribe their medical charts, and then additional experts to transform those transcripts into codes for insurance (including Medicare and Medicaid) billing.

Affordable Care Act

In the United States, the 2010 Affordable Care Act legislation has introduced an urgent business necessity for private physicians to adjust to, in the billing and coding space.

Three main objectives of this law are:

❶ Make more people eligible for affordable health insurance. For households with incomes between 100% and 400% of the federal poverty level (FPL), the law offers consumers subsidies (referred to as "premium tax credits") that reduce costs.

  • If your income is higher than 400% FPL, you might still be eligible for the premium tax credit in 2022.
  • If your income is at or below 150% FPL, you may be eligible to sign up for or make changes to your Marketplace coverage during a Special Enrollment Period.

❷ Increase Medicaid coverage to include all adults with incomes less than 138% of the FPL. (Not every state has increased the scope of its Medicaid programs.)
❸ Encourage cutting-edge medical care delivery strategies intended to reduce overall health care costs.

October 1, 2013 was the deadline for all health care providers in the USA to begin using the new "ICD-10" protocol for coding, which includes among other things:

  1. Inpatient hospital procedures
  2. Diagnosis coding, and
  3. Procedure coding systems

So, What Are the Challenges?

There are 155,000 codes in the ICD-10 series (which is well over 5 times as many as in the previous version, ICD-9), and most of these new codes cover widely performed procedures in greater detail/specificity than ever.

Office managers, medical billers, and coding professionals are spending an average of 5 hours a week studying these new coding protocols, preparing for the quickly approaching deadline.

With that in mind, almost nothing within the new Affordable Care Act legislation has more immediate, short term impact on private medical practices than the new coding and billing compliance requirements.

Of course, one could make the case that the availability of insurance to formerly uninsured patients, the changes in beneficiary aspects within Medicare, insurability rules, etc., will have an enormous effect on the health care industry as a whole. But, in discrete practice, these aspects wouldn’t directly affect most physicians’ offices other than an increase in qualified patients.

Most of those changes are still more than a couple of years away, as well. With the currently increasing man-hours and costs, the ICD-10 coding changes, however, are directly affecting state and federal business and licensing compliance regulations. In addition, it’s something the average patient/consumer is unaware of.

Doctors are in a rush to meet the deadline, and that directly affects the availability of medical services in most localities. If you know anyone uncertain about their future career, tell them to consider Medical Billing and Coding (and medical transcription), which are rapidly growing fields.

There’s a definite shortage of qualified professionals. These are administratively necessary professions, people who get to be an integral part of the health care field… but they don’t have to clean any bedpans.

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⚠️ Disclaimer: The information provided in this article is for educational purposes only and should not be considered as medical advice. Please consult a healthcare professional for personalized advice.