How Obamacare Will Affect the Medical Billing Industry

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You would have to search far and wide to find someone in the United States who disagrees that a radical healthcare overhaul is absolutely necessary. The same person would have to search equally hard to find someone who wasn’t thoroughly confused by all 2,000 plus pages of the Affordable Care Act and all the news whirling through the media on the subject.

Frustration appears to be the sentiment of the moment as Obamacare, on some level, affects the U.S. population in its entirety. Whether the effect is good or bad depends on a number of factors, which include age, the patient’s current state of health and geographic location.

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Furthermore, to state the obvious, it isn’t just the individuals on a patient level that are in the throes of change; it is entire companies, hospitals, and millions of professionals that will be restructuring the way they handle medical billing aspects.

Many medical professionals feel the new act piles on unnecessary problems regarding billing and reimbursement tasks, and this perceived atrocity has a good portion of those professionals extremely upset. The medical billing industry will be hit hard – no doubt about that – but the vast majority of experts are only coming up with vague ideas at best as to what the actual impact of the changes will be.

Some are concerned with position cuts in the industry. Still more people are fairly certain that not only will the current positions remain, but we will see a surge of available medical billing jobs due to the need for new billing expertise to comply not only with Obamacare regulations but also to comply with the eventual rollout of the new ICD-10 medical billing codes.


More Doctors Will Outsource

The processing of medical billing claims will undergo a new set of rules regarding the Affordable Care Act. The act aims to improve the timing of reimbursements and revenue management, but practices and hospitals who handle their own billing as well as medical billing companies will be under scrutiny to streamline their end of the process.

Critics are under the impression that these new rules will only provide for increased expenses and confusion, resulting in more billing errors and the necessity to re-submit claims. While this is likely to overwhelm medical billers, it is a good indicator that the profession will stay in high demand.

medical-advocacy_149342003The Human Resource side of the medical industry as a whole seems to be grasping at proverbial straws to come to compliance with the Affordable Care Act. Many providers still hold that the guidelines they must follow develop confusion regarding the billing, thus making them more likely to make billing mistakes. They claim that even though they are mandated to make such changes (as well as absorb the cost and headache of them), the rules are ambiguous at best, leaving too much room for error.

Plenty of already-publicized frustration with new billing procedures is likely to entice the doctors who previously rejected the idea of outsourcing their billing to give it a second thought. Why is this? The Affordable Care Act appears to be forcing these providers to bill on a trial and error basis, billing for quality over quantity.

This is a confusing rule to many of these providers, and they are beginning to feel as if their reimbursements will be compromised because of this. Who better to handle the grunt work than a trained professional?


More People Will Be Insured

Nearly four out of ten adults in the United States did not go to a doctor when they felt they should have due to their lack of health insurance coverage. Sometimes the lack of coverage was by choice. Other times, the patient had been dropped or denied due to a factor that may have been out of their control like age, gender or health history.

medical-advocacy_171547334Obamacare requires individuals to obtain coverage for themselves, and it also requires insurance companies to cover them regardless of pre-existing conditions, age or gender. So with the boom in health insurance enrollment, more people will be able to go to the doctor, and this means a greater need for medical billing services is likely to arise. Just imagine what might happen if even half of the adults who don’t go to the doctor because of lack of coverage finally end up going.

Since more claims will need to be processed, more trained staff will likely be in demand. So while the Affordable Care Act supposedly focuses on quality over quantity, quantity will be an issue when these once-denied individuals begin pouring through the doors.

Yes, there are many people who absolutely loathe the very sound of the word Obamacare, but there also millions who just couldn’t get coverage before, and those are the ones that will likely be utilizing it the most. They are also the ones that will require that the medical billing industry stay strongly staffed and competent in new billing procedures as they will likely present bills with more costly illnesses.


Medicaid Expansion

The government will be paying for more people to be covered by way of Medicaid expansion in certain states. Because of this, there are fears that tighter pricing regulations may be put into place across the board. If this happens, a trickle-down effect could occur, resulting in lower salaries and budgets, thus lowering what doctors are able and willing to pay for outsourced services, namely medical billing.

Since the extra work due to all the changes is likely to overwhelm so many, there is still a good chance that medical billing companies may not actually have to keep their prices competitive. The demand may very well exceed the supply for quite some time. There’s no better time than now to implement the services of a medical billing advocate. However, medical billing advocates that only charge the client if errors are found and moneys are saved will be the most trusted medical billing advocates during this period.

medical-advocacy_153880862The worst-case scenario, following total immersion in Obamacare, seems to be increasing job dissatisfaction among medical billing professionals.  Such is the case of many current health professionals on the brink of all this change.

If such dissatisfaction continues, medical billing employees may turn to other careers, leaving gaping holes in the industry’s staffing, while new people who have less of the old ways to “unlearn” come in to take their place.

Adopting a single-pay system may be the only thing that would really shake up the medical billing industry enough to cause devastating job cuts, but that’s a distant doomsday situation (medical billing-wise). For the time being, though, it is safe to assume that medical billing professionals may experience an overload of work and tension on the job while acclimating to the new policies and procedures.

As long as the Affordable Care Act doesn’t wind up funneling everything through such a system, we can be pretty sure that medical billing will remain complicated enough to be its own industry.

Along with the massive billing changes due to the Affordable Care Act, the switch to ICD-10 medical billing codes (an increase from 13,000 to nearly 70,000 codes) will create a steep demand for trained personnel. Since the two seem to be riding side by side in their implementation, some of the changes will likely blur into each other, and it may not always be clear as to which one is responsible for any particular major change to the medical billing industry.

It is recommended that management include training for the Affordable Care Act changes and for the transition to ICD-10 billing codes to minimize shock and confusion when the two are both up and running.

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One response to “How Obamacare Will Affect the Medical Billing Industry”

  1. Kazumi says:

    Just a comment on what I belveie is a “current” result of Obamacare. I have Medicare coverage via an Advantage plan. This year, not only did my “co-pays” increase for specialists and ER services, but the real zinger is that MANY services which once had co-pays that were flat dollar amounts, e.g. $20.00, changed to “percentages.” Whereas last year (and those preceding) I would pay $20.00 on a $400 dollar bill, I now must pay $80. Not so bad you may say, but my only income is Social Security which did increase slightly this year (following two or was it three years of no COLA), but the increase in my income would quickly be devoured by medical expenses should I suddenly develop a serious illness. It is my understanding that several hundreds of millions of dollars were “redirected” from Advantage Plans with the advent of Obamacare, and I suppose these major changes in my plan are intended to recoup those losses. (See next)