If 2014 was Busy, 2015 will be Busier for Healthcare

2014 taught us many lessons. We went back and forth in ICD-10 preparations, training, testing and implementation. Some of us heaved a sigh of relief by the delay, whereas others felt they wasted a lot of money to speed up the preparation. In other areas like meaningful use, electronic healthcare records, and other healthcare reforms and policies, healthcare professionals have had a fair amount of things to muddle through.

Here are some of the lessons 2014 taught us, along with a few predictions for healthcare professionals in 2015.

ICD-10 Delay

Without doubt, ICD-10 always garners the greatest amount of attention from the users. Originally set to switch in October 2014, the bill, ‘Protecting Access to Medicare Act of 2014’ signed in April 2014, pushed it back a year to Oct 1, 2015. The switch to ICD-10 would have put the United States on par with other leading nations who have already implemented ICD-10.

What the delay meant to the providers?

Dealing with 68,000 ICD-10-CM codes in place of the 14,000 ICD-9-CM codes is no mean feat. The delay of ICD-10 has thrown the plans of countless U.S healthcare organizations for a toss, who had been working feverishly to prepare for a deadline of Oct. 1, 2014. In contrast, the providers who were seriously behind in preparation breathed a deep sigh of relief.

The excuse for not being ready for ICD-10 is OVER now. The providers now have less than 10 months to prepare for this monumental change.

Modifier 59

Due to misuse of modifier -59, the Centers for Medicare and Medicaid Services (CMS) have created a new series of modifiers which would provide more specificity of the distinct procedural service. Currently, some providers are using it incorrectly “to bypass” National Correct Coding Initiative (NCCI), resulting in considerable abuse.

Effective January 1 2015, these changes would affect medical billing submissions and provider reimbursements tremendously. The CMS has established the following four new HCPCS modifiers (-X {EPSU} modifiers) to define specific subsets of the -59 modifier:

Modifier XE (Separate encounter, a service that is distinct because it occurred during a separate encounter)

Modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure)

Modifier XP (Separate Practitioner, a service that is distinct because it was performed by a different practitioner)

Modifier XU (Unusual Non-Overlapping Service: A service that is distinct because it does not overlap usual components of the main service)

In light of this major change, all practices should monitor the use of modifier 59 to ensure that it is currently being utilized in the appropriate manner.

Meaningful Use and Electronic Health Record

For physician’s, getting rid of unhelpful EHR systems and unachievable meaningful use requirements should be the top priority for 2015. The Centers for Medicare & Medicaid Services (CMS) released a data in December, stating that more than 50 percent of eligible professionals will face payment penalties next year because they could not fulfill meaningful use requirements.

Also, the American Medical Association (AMA) is currently working on a new framework for EHR usability that it developed with the help of practicing physicians and health IT experts. AMA is focusing on EHR improvements that can advance the delivery of high-quality, affordable care.

Impact of Affordable Care Act on Medical billing in 2015

Although, Affordable Care Act went into effect four years back, we are only just learning about its impacts on medical billing in hospitals and physician’s offices. As we prepare for the “employee mandate”, which goes into effect in 2015, there are also some major developments that are happening, for instance, medical billing outsourcing is expected to increase in 2015. Physicians and hospitals are likely to outsource their medical billing because of medical coding requirements resulting from Obamacare. Bureau of Labor Statistics estimates that the medical billing industry will increase by 22% from 2012 to 2022. The simple reason behind this growth is Affordable Care Act, as more people will have access to healthcare, resulting in more coding and billing requirements.

The Medicare physician payment system

In 2015, Congress will need to act early to avoid a 21 percent pay cut scheduled to take effect on April 1 under the sustainable growth rate (SGR) formula. As Congress missed its chance last year to repeal the SGR formula using a bipartisan legislative framework, the AMA and physicians will continue communicating with lawmakers to make reforming the Medicare payment system a priority for the new Congress.

Plus, the AMA will also undertake other issues related to the Medicare fee schedule, value-based payment modifier, elimination of the global surgical period and potentially mis-valued codes.

If 2014 was busy a year for healthcare professionals, 2015 is only likely to be busier. Obviously, nothing will come to a grinding halt but the focus should be now to overcome these challenges. It is highly recommended, you be in tune with the changes and updates. Healthcare knowledge providers such as AudioEducator can help you get expert insights and advice directly from nationally recognized experts to help you thrive in the year ahead.

Source: American Medical Association (AMA)

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