Analysis of Medical Billing and Coding updates
, changes & news from year 2014 to date.
Medical Billers and Medical Coders are healthcare trained experts that document all the information related to patients visits, their medical charts and everything about treatment in the form of medical codes for the reference of the patients and provider and particularly insurance payers. Medical coding jobs are in high demand and Medical Billing is an excellent career.
Medical Billing and Coding Updates
However, since this is a dynamic field which requires being regularly updated. Let's, look at the most important Medical Billing and Coding Updates, Changes & News of year:
CPT Code Changes and Updates
The American Medical Association's current procedural terminology code set will experience a massive overhaul at the start of next year. In September, 353 changes were announced, many of which pertain to technology improvements. As Ardis Dee Hoven, M.D, President AMA said:
The CPT code set is the foundation upon which every element of the medical community; doctors, hospitals, allied health professionals, laboratories and payers; can efficiently share accurate information about medical services. The latest annual changes to the CPT code set reflect new technological and scientific advancements available to mainstream clinical practice and ensures the code set can fulfill its vital role as the health system's common language for reporting contemporary medical procedures.
This is considered to be the largest CPT code modification in years. The CPT codes and descriptors can be purchased and imported directly into existing claims and billing software using this downloadable CPT Data File
Revised CMS 1500 Form
The Centers for Medicare and Medicaid have released a revised claims form
that will be distributed for use on January 6 and become mandatory by April 1. The new form has been created to accommodate ICD-10 come October. Check with your payers for their projected effective dates.
The biggest change on the new claim form
is the inclusion of eight additional areas for healthcare providers to list diagnosis codes associated with the claim. The current version only allows four spaces per claim to list related diagnosis codes. Other fields have been removed or changed as well. For example, the new claim form will no longer ask for marital status, employment status or the insured’s employer/school name.
Healthcare Exchanges (HIX)
How HIXs will set payment rates is still an uncertainty, but some states are already aligning with Medicaid prices, resulting in lower reimbursement rates for doctors. Couple lower payments with an influx of thousands of new patients and practices are facing some serious jumps in costs.
Mitigate underwhelming reimbursements by implementing new technologies like an EHR/EMR and comprehensive practice management solutions that streamline your workflow and help move patients through your practice faster, a quality that will be vital as you look to take in more patients to cancel out decreases in revenue.
The quality reporting program managed by the Centers for Medicare & Medicaid Services will be able to levy penalties for noncompliance. Providers are required to complete checklists that review the quality standards of routine procedures and surgery for patients who are enrolled in Medicare or Medicaid.
Quality reporting. Penalties for noncompliance with CMS' quality reporting program will commence next year. The use of G-codes on Medicare claims for five types of adverse events started Oct. 1, 2012, and has grown over the last year to include safe surgery checklist use and volumes of certain procedures. Any ASCs that did not successfully report G-codes on at least 50 percent of Medicare claims between Oct. 1, 2012, and Dec. 31, 2012, will experience a 2 percent reduction in payments beginning in 2014.
Ambulatory surgery centers that failed to comply with G-code reporting standards between October and December 2012 will receive a 2 percent reduction in the reimbursement amount for Medicare claims. This penalty will also be applied to ASCs that fail to comply in the future, so it is essential for providers to be proactive about compliance.
The reimbursement reduction will be continual. Billing staff members must keep complying with the quality reporting measures to avoid penalties in 2015 and 2016.
Post ICD-10 Billing
The long-anticipated, new International Classification of Diseases code finally effective from October 1, 2015. The major fear factor. The insurances are lenient so far. But the provider and practice in the healthcare industry are still expected to have issues off and on. It will still take another year before ICD-9 Codes and their references become history.
ICD-9 codes have been used in the United States for more than 30 years. There are only about 13,000 codes for the entire gamut of medical services that can be provided. ICD-10 replaces the outdated terminology and requires more specific documentation as well as more details about the service that was provided. The requirements for greater documentation are expected to increase the quality of care. Experts say the type of documentation providers will be required to submit for billing purposes is the type of documentation they should already be using if they are providing proper medical services.
Medical Billing Software based on HIT
Changes in patient volume will force medical offices to move to digital Medical Billing Softwares
. While most offices have already switched to digital medical coding and billing, approximately 20 percent of hospitals and nearly half of physicians still need to make the change.
Expanded access to insurance is sure to increase patient volume significantly. Medical offices that struggle to manage paperwork will not be able to keep up with the change in volume without the help of computer programs. Outsourcing medical coding and billing is one way to benefit from digital processing without the need to purchase a software package or take the time to train administrative professionals on the changes in medical coding and billing.
Medical coding and billing changes in this year bring unique challenges for providers and their medical billing staff. Ultimately, physicians have to prepare for these billing changes if they want to keep receiving the appropriate reimbursements for services rendered. Make sure your billing department is updated in compliance with regulations put into place under the Affordable Care Act.