With the new year underway, there remains a multitude of question marks for medical billers and other members of the U.S. healthcare system. As 2020 marches onward, organizations need to continually pay mind to the trends, issues, and updates that will impact the effectiveness of their revenue cycle management over the course of what is sure to be an eventful year.
To set your practice up for success, we’ve highlighted three major areas of concern for medical billers, coders, practice managers, and providers. If you’re struggling to prepare for these and other oncoming evolutions in 2020, consider outsourcing your back-office operations to a trusted medical billing service with a strong background in your specialty.
Top 3 Medical Billing Issues to Watch in 2020
1. Government Compliance Changes
Healthcare providers and insurance companies must routinely cope with shifting regulatory requirements when it comes to medical services. Even setting aside the potential consequences of the latest court challenge to the Affordable Care Act (the controversial Texas v. U.S. case, which continues to wind its way through the courts), changes in Medicare, Medicaid, and the Veterans Affairs Administration can have an impact on patients and practices in every state.
The push for price transparency and the US Health and Human Services (HHS) proposals to modernize and clarify anti-kickback statutes could both have significant impacts on healthcare practices. While the HHS changes may streamline existing relationships between providers, the greater emphasis on price transparency could create a number of billing challenges for hospitals and other providers.
If pricing reviews need to be conducted more frequently, strict auditing and billing oversight will become more important than ever. Partnering with a medical billing vendor that understands the scope of these requirements and has a track record for managing billing relationships and practices may be the best way for independent and smaller group practices to meet growing regulatory demands and avoid medical billing issues.
2. The Ongoing Shift Towards Value-Based Reimbursement
Healthcare providers have long operated on the traditional “fee-for-service” (FFS) payment model. Under this system, providers are reimbursed by insurance companies and other third-party payers based on the services they perform. Over the last few years, however, the industry has been shifting towards a different reimbursement method known as “value-based care.” This approach takes a more complex approach to healthcare by incentivizing providers to take the quality, efficiency, and necessity of treatments into account.
Given the incentives associated with value-based reimbursement, it’s no surprise that many healthcare practices are looking for ways to deliver care in a more coordinated and effective fashion that improves patient outcomes and increase revenue. There are a number of payment models used by insurance companies to assess the efficacy of care, however, and failing to understand which metrics need to be met could lead to medical billing issues and pose a threat to profitability. Fortunately, experienced medical billing companies like NCG Medical remain on the leading edge of value-based reimbursement trends, allowing healthcare practices to remain focused on delivering quality care.
3. Rising Expectations Regarding Data Security
Patient data has the potential to greatly improve all aspects of healthcare delivery, from preventative care that helps head off health problems before they develop to streamlined billing that takes the headaches out of payment payments and collections. Managing and safeguarding that data, however, has become a massive challenge, especially for healthcare practices that outsource many aspects of their business operations to outside vendors. As LabCorp and Quest Diagnostics found out the hard way in 2019, working with a careless vendor can have severe consequences when something goes wrong.
With the California Consumer Privacy Act going into effect in January of 2020, healthcare practices need to pay more attention to data security than ever before. That means carefully vetting third-party vendors to ensure that they fully meet healthcare compliance standards like HIPAA as well as information security guidelines like ISO 27001. Partnering with a medical billing provider capable of meeting growing cybersecurity challenges and complex medical billing issues is often a necessity for many healthcare practices that simply lack the resources necessary to build out a robust data security solution capable of meeting the needs of their patients.
Confronting Medical Billing Issues in 2020...and Beyond!
While there may be some important issues to watch in 2020, the new year also brings with it new opportunities. For many healthcare practices, now is the perfect time to get out from under the burden of managing your medical billing in-house and transition to an outsourced solution using a trusted medical billing provider.
At NCG Medical, we bring four decades of experience helping practices of all sizes streamline workflows, overcome medical billing issues, and increase revenue with our proven approach to practice management. To learn more about how we can help address your medical billing challenges in 2020, contact one of our coding “techsperts” today.
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