Bundled Medicare Patients for Obamacare

Bundled Medicare Patients for Obamacare

Obamacare seeks to reduce medical costs by 700 billion between 2013 and 2022. One of the ways the federal government plans to do that is through bundled Medicare payments.

ObamacareThe system removes the fee for service model and replaces it with a bundled plan for inpatient hospital stays and post discharge services.

Clinicians who don’t participate in bundled payment options will lose patients and revenues to competitors who do.

Bundling For Savings

One-fifth of the funding for Obamacare comes through savings obtained by reducing Medicare reimbursements, reducing the length of hospital stays and readmission rates, and bundling payments.

There’s also a push for in-home care to reduce expenses.

The Bundled Payment for Care Improvement Initiative was launched on Jan. 31, 2013 to grade the financial and treatment performance for patient care episodes utilizing a team care model.

With bundled payments, a team of healthcare professionals oversee a patient’s care and a dollar amount for reimbursement is assigned. The team is responsible for providing the patient with needed treatment, while remaining within the monetary target.

Teams are rewarded financially for accomplishing their goals. Clinicians that don’t choose to participate will lose the most as fees are cut.

Working With IPAB

The Independent Payment Advisory Board (IPAB) is a 15-member panel appointed by the president and charged with the task of finding ways to reduce medical costs. Any recommendations made by the board automatically become law unless Congress chooses to overrule.

The board is a more powerful version of the Medicare Payment Advisory Commission.

There’s a big push by Obamacare to identify and evaluate treatment methods that are efficient and cost-effective. One of those techniques is by providing in-home care that employs technology to monitor a patient’s state of health in the home instead of at a hospital or care facility.

Depending on the type of monitoring being conducted, readings could be transmitted to a practitioner’s office electronically or could include home visits by a healthcare professional.

ObamacareThe bundled care initiative was designed to reduce costs among Medicare patients.

Unfortunately, it will also limit reimbursement revenues for clinicians who choose to offer independent care at their practice and not participate in a physician team for bundled care.

As the pressure to reduce costs associated with Medicare patients continues to increase, many medical professionals will find their choices are limited.

There are options, but all are untenable for those in private practice.

Clinicians can choose not to join a healthcare team, lose patients to competitors who are part of a team, become resigned to a reduction in Medicare payments, accept bundled payments and reduced revenues, or stop seeing Medicare patients at all. The choices clinicians make will have a dramatic and long lasting impact on their patients and practice.

The Impact of Obamacare on Medicare and Medicaid Patients

The Impact of Obamacare on Medicare and Medicaid Patients

Obamacare is changing Medicare and Medicaid in many ways. Some are good for patients, but not for practitioners. One of the main objectives of Obamacare is to reduce healthcare expenses.

ObamacareThe economic reality for some patients is healthcare where none existed before, while others will see more out-of-pocket expenses.

Obamacare taps Medicare funds heavily to support the legislation, while reducing reimbursement amounts to clinicians.

Becoming more efficient in treating patients and office processes is critical and there are cost effective software programs that will increase efficiency and save money.

Software programs like In Touch EMR and In Touch Biller PRO have tools to automate and accelerate marketing, documentation, billing and reimbursements.

Clinical Contact and Therapy Newsletter software provides practitioners with done-for-you solutions to increase referrals and retain established patients.

Medicare Ups And Downs

Obamacare is closing the donut hole in Medicare for prescription drugs and reduced the cost of many medications. Patients can now obtain a lot of free wellness services, screenings, tests and vaccines.

Patients with Medicare Advantage programs will see increases in their co-pays, deductibles or both. Obamacare reduces expenses by reducing payments.

Medicare won’t go away, but patents will wake up to the reality of higher costs and fewer practitioners willing to treat them.

Expanded Medicaid

Under Obamacare, states that agree to do so will expand Medicaid eligibility requirements. That means people making $15,800 in 2013 will be able to get Medicaid.

However, states don’t have to participate in the program, which could lead to a substantial number of people still without coverage.

The Congressional Budget Office estimates that 12 million new patients will be added by 2015. That’s a lot of additional patients and the problem is that in 2011, one out of four clinicians refused to take Medicaid patients.

Finding a practitioner that accepts Medicaid is already a problem.

Now there will be more patients competing for fewer practitioners, along with overcrowding in hospitals and practices that do take Medicaid. Many clinicians have said they’re going to close their practices or refuse to treat those on Medicaid and Medicare due to reduced reimbursements, and no one wants that.

Making Opportunities

This is an opportunity for clinicians to ask themselves what they can do to be part of the solution instead of the problem. More patients and less reimbursement provide an incentive to get patients well faster, which is another goal of Obamacare.

Clinicians can present patients with programs that will help them get better quicker and save them money.

ObamacareFor example, consider group wellness and preventative programs.

Charging patients $30 per session incurs less cost for patients, while increasing the number of individuals that can be treated at one time.

Be creative in identifying opportunities that benefit the practice that also provides an environment that’s financially appealing to patients.

Clinicians must be aware of the changes in the Obamacare economy and be prepared for them with alternatives that generate more referrals and retain established patients.

Obamacare – How the 40 Percent Tax on Policies Affects Patients

Obamacare – How the 40 Percent Tax on Policies Affects Patients

A wealth of new taxes appeared when the Affordable Health Care Act (Obamacare) was signed into law. The taxes affect a wide range of businesses, products and services, from tanning salons and medical devices to name brand medications.

Penalties were placed on investment income, health savings accounts, people without healthcare insurance, and “Cadillac” insurance plans.

ObamacareWho Pays The Insurance Tax?

One of the penalties that generated the most concern among taxpayers is the 40 percent tax on what’s known as Cadillac insurance plans that feature low co-pays, deductibles and premiums.

Contrary to popular belief, the tax on “luxury” policies won’t be assessed against consumers.

The penalty will be levied on companies that offer the plans, but consumers will certainly experience repercussions as a result.

The tax officially takes effect on companies in 2018, but many employers are already taking steps to avoid paying the penalty. The tax affects all employer-sponsored health insurance that exceeds a value of $10,200 for individuals and $27,500 for families.

It hits any high-end gold or platinum policy that’s not purchased on the government’s Healthcare Insurance Marketplace.

Employers are assessed the tax if they provide workers with benefits considered too expensive by the authors of Obamacare.

Many employers are scrambling to rid themselves of the policies they’ve offered workers in the past and replace them with plans that increase the cost of deductibles, premiums and co-pays to employees.

Learning The Value Of A Dollar

Obamacare was written with the assumption that workers didn’t know or care about the true cost of their healthcare insurance, and that employer-provided policies encouraged overutilization of benefits and unnecessary tests.

With Obamacare, workers will know the exact cost of the policy when it’s included on their W-2s, when their deductibles increase, the cost of their co-pays double or triple at the doctor’s office, and dental/vision care is reduced or eliminated.

Obamacare is concerned with the physical health of patients. Dental and vision care aren’t considered essential.

By raising patient costs, Obamacare hopes to limit/reduce the number of visits people make to their physician as a means of reducing healthcare costs and curbing overutilization of expensive tests and services.

Trading Lower Wages For Insurance

In many instances, taxing employers that offer exceptional healthcare policies actually penalizes employees who have chosen to work for lower wages in exchange for better healthcare.

The taxes on businesses could add others to the pool of Marketplace purchasers, as employers stop offering benefits and dump workers and retirees into the Marketplace to find insurance.

Exemptions For Some

Exemptions from the tax have been negotiated for those in certain industries that include law enforcement, paramedics and first responders, and those providing out-of-hospital emergency services.

Also included in the exemptions are individuals doing longshore work, mining, construction, people in the fishing industry, forestry and agriculture (excluding food processing).

The Positive Aspects – A Mixed Bag

The other side of the Obamacare coin is that free preventative tests and screenings encourage people who already have insurance to use the services of their physicians, along with an estimated 30 million new patients who will be covered through Marketplace policies.

Medical professionals fear the influx of that many patients will seriously compromise the level of patient care and effectively reduce access to healthcare overall.


Businesses offering “Cadillac” insurance policies will shoulder the burden of Obamacare penalties on those plans.

As patients, employees will experience the trickle-down effect in the form of higher co-pays and premiums.

Many deductibles have increased to $5,000 and over, a figure that’s far more than many people will spend on healthcare in a year. Under Obamacare, the average person will now be paying for insurance with limited practical usage until they’ve already spent thousands of dollars meeting their deductible.

Obamacare Protection Plan – Action Steps for Patients, Pt. 2

Obamacare Protection Plan – Action Steps for Patients, Pt. 2

The Healthcare Insurance Marketplace has officially opened and many are rushing to discover what coverage and subsidies are available. For millions of families, Obamacare provides them with the opportunity to see clinicians and have long ignored medical problems addressed. For other consumers, Obamacare means the potential for fines.

ObamacareThe good news is that there are some steps and strategies that patients can employ to help avoid penalties and still obtain the type of healthcare they’re used to receiving.

Information is always the best defense, and it pays to take advantage of incentive programs and the array of free services under Obamacare.

Free Preventative Tests

Obamacare makes certain tests and screenings available at no charge to patients with an insurance plan and it just makes sense to take advantage of them.

However, if a policy has been granted a “grandfather” clause, those tests won’t be free and patients will pay the normal costs dictated by their policy.

Rewards And Incentives

To reward healthy lifestyles, Obamacare encourages employers to offer wellness, reward and incentive programs. Rewards can include cash or discounts on co-pays, deductibles and premiums.

Those who can’t meet the program’s standards should request a special opt out so they won’t be penalized with higher costs than their fellow employees.

Swimming In The High-Risk Pool

Coverage for adults with pre-existing conditions doesn’t begin until Jan. 1, 2014. Consumers can gain temporary coverage under a high-risk pool created by Obamacare.

Retires, Begin Planning Now

ObamacareEarly retirees under the age of 65 will probably lose their insurance.

Employers are dropping coverage and sending early retirees to the Marketplace to save companies money, but Marketplace policies may actually prove to be less expensive for some.

Seniors participating in the Medicare Advantage program could find their providers dropping out and leaving them to find supplemental coverage on their own.

Consult An Accountant

High earners will want to speak with their accountant about the new Medicare contribution taxes as they relate to hospital insurance and investment income.

Individuals making more than $200,000 a year will be paying more than in the past and an accountant will know how to best deal with the new taxes.

The Cost Of Hiring

Small business owners receive a tax credit if they employ 25 or less people and companies employing fewer than 10 people reap additional financial benefits through Obamacare.

Expanding a firm’s workforce may not be the best financial move for businesses in the coming months or years.

Obamacare offers healthcare services to millions of Americans who didn’t have it before, but it also imposes financial penalties on people that don’t have some type of coverage.

Obamacare is a mixed bag and is still in its early stages of implementation.

There are steps patients can take to protect themselves from the worst elements of Obamacare, but it’s imperative that consumers stay informed about future changes and modifications to help them get the most from Obamacare.

Obamacare Protection Plan – Action Steps for Patients, Pt. 1

Obamacare Protection Plan – Action Steps for Patients, Pt. 1

The Affordable Health Care Act, known as Obamacare, is already bringing change into the lives of millions of individuals across the nation. Some view those changes in a positive light, while others are facing the potential for penalties, loss of employer-based insurance and even cuts in jobs and hours.

ObamacareThere are actions that individuals can take to protect themselves from the downside of Obamacare, and measures that can be implemented to reap the most benefit from the legislation.

It requires effort on the part of consumers, but the results could be well worth it.

Medicaid Eligibility Expansion

One of the initiatives under Obamacare was the expansion of Medicaid to millions of patients who previously wouldn’t have qualified, though a handful of states have refused to expand their programs.

It pays to check anyway, as some people who don’t qualify for Medicaid may still receive some type of assistance.

In states that expanded Medicaid programs, a family of four making $29,327 (per 2010 statistics) will be able to enroll.

Residents in states that already had generous income eligibility levels above that current Obamacare mandated amount could be eliminated from the program and referred to the Health Insurance Marketplace.

Low-income earners are eligible to receive financial subsidies to help offset the cost of coverage on the Marketplace.

Avoid the Individual Mandate Tax (IMT)

The IMT is a penalty imposed on those who don’t purchase insurance and collected through income taxes. People covered by an employer-based policy are in compliance and won’t be charged.

Those without insurance may be eligible for Medicaid or subsidies for purchasing coverage on the Marketplace.

ObamacareBefore writing a check to pay the IMT, taxpayers may want to wait and see if collection of the IMT is actually going to happen.

Obamacare empowers the Internal Revenue Service to collect the IMT by deducting it from any refund to which the taxpayer may be entitled, but they can’t take personal property.

The IMT is extremely difficult to enforce and may be changed in the future.

Over-The-Counter (OTC) Medications

Families with a Health Savings Account (HSA) or Flexible Spending Account (FSA) can pay for OTC remedies if a physician writes a prescription for them.

Those who take OTCs that include products such as Tagamet or Tylenol should ask for a prescription in anticipation of future needs.

Obamacare offers new hope for many individuals and families. For some, it may be an opportunity to receive treatment for potentially life-threatening conditions.  Others aren’t as enthusiastic about Obamacare. They’re waiting and remaining vigilant to see what Obamacare has in store for them in the future.

Coders or Billers: What Does it Take to be One?

Coders or Billers: What Does it Take to be One?

Medical coding and billing aren’t mutually exclusive, but the terms are often used interchangeably. In larger practices, coders collect documentation and insert codes on reimbursement claims, while billers transmit the claims and monitor their progress.

In smaller practices, a single individual fulfills both coding and billing functions. In this article, Nitin Chhoda discusses the important roles and factors to consider when deciding to be a professional biller or coder.

codersCoders don’t have to endure years of training and can enter their profession in fairly short order, but they do undergo intensive education in a variety of specialties.

As they pursue their passion, they will be called upon to perform a variety of duties and will have multiple venues from which to employ their skills.

With mandatory implementation of EMR or electronic medical record technology, the job outlook is excellent for billers and coders.

Acquiring Education

A diploma or associate degree for billers or coders opens the door to a wealth of educational opportunities for entry level positions. Billing or coding diploma and certification programs are available at learning institutions throughout the U.S., along with online education from reputable professional organizations.

Education will cover compliance issues, industry codes and procedures, medical practice management, ICD-9 and CPT coding, technology systems and clearinghouses.

A majority of coding programs require students to be proficient in medical terminology and anatomy, while others include it as part of the program to become a Certified Professional Coder®.

Abbreviated and condensed education plans can be completed in as little as nine months, but the average is from 15 to 18 months. Billers or coders course fees run the gamut, from $600 to $2,000. Add approximately $500 for textbooks or CDs and accompanying materials.

Knowledge in Coding Basics is a Must

Those who pursue to become a coder will be required to know CPT and ICD-9 codes. The alpha-numeric codes provide a description on claims that supports a clinician’s diagnosis and treatment for his/her patient. ICD-9 codes will soon be updated to the ICD-10 standard.

The codes tell insurance companies the services they’re paying for on behalf of their subscriber.

Coders are also fact checkers. They will need an understanding of medical terminology and anatomy to code accurately and ensure practitioners receive the fees they’re due.

Coders will confer with clinicians to clarify any data that appears to be in error or if there’s any uncertainty associated with the available documentation.

The Software to Use

Professional coders will enter coding information into specialized software programs or electronic medical record (EMR) systems. Electronic medical records will soon be the mandated method of communication for healthcare professionals and facilities.

EMR technology has the advantage of functionalities that can assist coders in identifying potential coding difficulties before the claim is transmitted to clearinghouses. Such advantages which can help coders and billers with their EMR system are the following:medical billing and coding

  • Online eligibility verification function
  • Auto patient chart creation
  • Create custom templates
  • Scrub claims
  • Automatic posing of ERAs
  • Generate patient statements and much more…..

Billers and Coders Employment Opportunities

Coders and billers are in high demand and the trend is expected to continue unabated. They may find themselves working in a clinician’s office, hospital or pharmacy. Any medical office or entity that provides patient services will need a coder.

The transition to EMR technology has accelerated the need for coding professionals. In a less than optimal economy and a healthcare climate in which insurance carriers are reluctant to pay even for covered services, coders are on the front lines in the battle to obtain reimbursement for healthcare professionals.