Mounting pressure is being felt by small medical practices universally. This leads to making them join hospital staff, join larger groups, or even just fade away. The Medicare Access & CHIP Reauthorization Act of 2015 is quoted to be one of the crucial causes for this hardship and the struggle to survive. This new law dictates how physicians are to be paid by Medicare!
Basics of MACRA
The Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 is considered to be an attempt aimed at changing the health care in such a way that payment toward services is based on quality of service rather than quantity. It replaces the earlier system of reimbursement that was not satisfactory to physicians. Doing away with the supposedly wasteful spending of over a third of the whole health care budget, this new system is being received well. There are risks involved, however.
How does MACRA work?
There are two broad payment systems under MACRA, out of which physicians need to choose one. The first one is associated with doctors exceeding the standards of care quality and it offers a bonus of up to 4% on the Medicare reimbursements. This is expected to go up to 9% by the year 2022. Those physicians who score below the standards set will have to face penalties.
The second method, called Alternative Payment Models (APM), determines care quality through the physician in the organization itself. In this, doctors receive an annual bonus of 5% from 2019 through 2024. The physicians in the facilities will continue getting payment adjustments from 2026 onwards.
The intention behind pushing physicians into larger organizations is the view that better care delivery will be possible at lower cost. This is made possible as they have better revenue cycle management processes, more resources in hand, and expenses may be brought down by seeing increased number of patients. The flip side is that it leads to the end of smaller medical practices with one or two physicians.
How would be the future of MACRA?
One issue with MACRA is it penalizes doctors for limiting the number of Medicare patients they see or avoiding Medicare entirely. Moreover, practices in rural areas may not be able to support larger physician practices. It would lead those in rural areas to leave for joining hospital staff in cities or joining larger organizations.
Reporting physician care to government involves the burden of additional layer of paperwork that costs hefty amounts of money. There is no system in place as of now, necessitating creating one – adding to the general burden in health care. Making this law functional will involve considerable efforts and the impacts will be realized after years.
MACRA is no doubt of controversial nature. It might lead to the end of small physician practices as being perceived presently. However, concerns expressed by various doctors will be addressed and the necessary modifications are likely to be carried out. MACRA is expected to have a telling impact over health care of Medicare patients.
Health care industry is faced with several challenges such as tightening margins and declining cash flows. What with increasing bad debts, maintaining a steady stream of income has become one of the primary concerns of medical practices and physicians!
Vital Role played by Revenue Cycle Management (RCM) in Medical Practices
Properly managing the revenue cycle of your practice is the foundation upon which financial stability is built. RCM is considered one of the crucial factors that determine the financial well-being of practices. With practitioners being trained to manage patients’ health and being occupied most of the time in treating patients, there is no wonder they lack the financial background essential for managing RCM efficiently. On the other hand, rising costs and demands necessitate greater emphasis on productivity and waste reduction – here’s where the need for effective RCM is felt.
Beginning at the time a patient schedules a visit and extending till you obtain reimbursement for services provided, revenue cycle process needs to be managed efficiently. Including several components that may complicate the entire process, it requires building business side of the practice and improving effectiveness in order to boost profitability and revenue of the practice.
Ways of Improving RCM
Coding & Denial Management
o Accurate coding is essential to avoid denials and delayed reimbursements – it is necessary to avoid claim resubmission and appeals process as far as possible
Right Collection Process
o Although every practice will have its own collection process in place, it is necessary to explore better and more effective processes that facilitate collection from insurance providers and patients – it is essential to have a cohesive collection strategy that is measurable
Front office staff
o Office staff must be capable of running your practice efficiently-practices need to work out the costs of internal billing staff and check whether they are within allowable limits-cost of outsourcing must be compared
Audit & Compliance
o Practices must have proper programs in place for determining whether procedures and policies are being followed -compliance needs must be properly adhered to
Significance of Taking the Right Steps
Healthcare sector is constantly evolving; technological advancements and innovations are on the rise. Not to mention the frequent barrage of payor and governmental regulations. It is imperative to take the right steps toward understanding and enhancing RCM. Outsourcing proves to be most efficient choice for several busy practices with resource constraints.
Numinatrans has been providing effective and reliable medical billing services to health care facilities and physician practices since more than a decade. You may contact us for improving your practice RCM. Visit us on http://www.numinatrans.com/