Impact of Obamacare on Senior Citizens

Impact of Obamacare on Senior Citizens

According to Health and Human Services Secretary, Kathleen Sebelius, 11,000 seniors are becoming eligible for Medicare each day. As new elements of the Affordable Healthcare Act are introduced, seniors will see changes in their Medicare coverage, out-of-pocket expenses, and even the physicians they see.

Obamacare to Senior CitizensKnown as Obamacare, the Act reduces payments for those with Medicare and who are enrolled in the Medicare Advantage program.

A significant amount of money to fund Obamacare over the next 10 years is being taken from Medicare coffers.

The Congressional Budget Office (CBO) estimates that reimbursement for Medicare-related services will be cut by approximately $716 billion between 2013 and 2022.

Seniors participating in the Medicare Advantage program will see cuts in that as well.

Seniors will face additional cuts through the creation of the Independent Payment Advisory Board (IPAB), which will have control of the Medicare budget in coming years. Insurance companies will be allowed to continue charging seniors and other groups higher rates for their healthcare.

On the plus side for the 49.5 million seniors on Medicare, Obamacare caps the amount seniors will pay for Medicare premiums. It also expands coverage for prescription medications and some preventative care services.

Reducing Payments to Control Costs

Medicare already pays less for services than many commercial carriers and those amounts will be reduced further in the coming years. Facing the prospect of decreasing Medicare revenues, many clinicians are either selling their practice, retiring early, taking employment at hospitals, or refusing to see Medicare patients at all.

A Deficit of Doctors

According to the Association of American Medical Colleges (AAMC), there will be an estimated deficit of 130,000 physicians by 2025. Fewer clinicians mean less access to healthcare for seniors and a longer wait for appointments.

Seniors could be forced to locate a new practitioner, be limited to clinicians within specific networks, and required to travel further distances to receive healthcare.

Medicare Advantage and Excise Taxes

Changes in Medicare Advantage programs could potentially eliminate or drastically reduce vision and hearing coverage. Obamacare raises taxes on medications and medical equipment. Patients will pay an excise tax on medical devices, ranging from wheelchairs and joint replacements to hearing aids.

Funds collected through the tax increase won’t be used for Medicare. The money is earmarked to pay for and sustain Obamacare programs.

The Act assumes that seniors will use the dollars previously used for Medicare Advantage plans to purchase insurance through commercial companies.

IPAB Controls Future Cuts

Obamacare for Senior CitizensFurther measures to control costs in the future will be in the hands of the IPAB. The 15-member board will have the power to cut Medicare spending where it sees fit to reach specific spending goals.

Cuts will automatically take effect unless Congress moves to counteract the changes with a super majority vote of three-fifths by the Senate. IPAB members are appointed and can’t be voted out of office.

The board essentially provides protection for Congress, absolving them of any responsibility for Medicare cuts.

IPAB will be charged with setting reimbursement rates for clinicians and deciding which medications, treatments and procedures will be covered.

IPAB will determine the most effective treatments for specific maladies and the cost for each treatment and procedure.

Most people agree that some type of healthcare reform was needed, but seniors fear Obamacare will limit their access to physicians, medications and treatments at a time when they need them most. One thing is certain. Obamacare will definitely impact the financial health of seniors.

Obamacare – The Problem it is Trying to Solve

Obamacare – The Problem it is Trying to Solve

The goal of the Patient Protection and Affordable Health Care Act was fourfold: to increase access to healthcare, reduce healthcare costs, institute more consumer benefits and protections, and improve efficiency. As different portions of the Act go into effect, it will have a major impact on virtually every individual in the U.S.

ObamacareThe Act has both a human and financial component.

According to the Center for Disease Control (CDC) more than 45 million people had no type of health insurance in 2012.

Individuals at the lower end of the financial spectrum were the most likely to lack coverage.

The Congressional Budget Office estimates the Act will reduce the number of uninsured by 27 million between now and 2023, but will still leave approximately 26 million Americans uninsured and financially unable to purchase coverage.

Increasing Access to Healthcare

Obamacare establishes healthcare exchanges and provides subsidies for low income individuals to help them purchase coverage. Millions of Americans can stop living in fear of becoming ill.

They will no longer be turned down for a preexisting condition and children can remain on parental policies through the age of 26.

The downside is an influx of new patients to practices that are already working to capacity. A poll for the Physicians Foundation showed that 40 percent of medical professionals intend to sell their practice or retire early due to Obamacare, resulting in a shortage of available clinicians and longer wait times to obtain an appointment.

Reducing The Cost of Healthcare

One of the tenants of Obamacare was the control and reduction of skyrocketing healthcare costs. The Act reduces the amounts paid by Medicare to practitioners, but allows hospitals to collect more for the same services.

The inequity is prompting many clinicians to stop accepting Medicare patients, further limiting access to care.

Clinicians are under pressure to reduce the number of tests they order and utilize the least expensive modes of treatment whenever possible. Many healthcare professionals fear the drastic reductions in reimbursements will drive potential physicians into other fields.

Healthcare costs also come in the form of copays, premiums and deductibles. Patients are already seeing an increase in all three, as insurance companies raise prices in response to the services the Act forces them to reimburse for.

With insurance companies placing limitations on reimbursements, pharmaceutical firms are reducing or eliminating medications as unprofitable to produce.

The cost of Obamacare comes in other guises. In 2018, a 40 percent tax will be placed on healthcare plans, dependent upon their value, and collected through tax returns. Fines will be assessed on individuals without insurance.

Employers with more than 50 workers must offer insurance or face financial penalties for each person they employ.

Benefits and Protections

Obamacare provides patients with some perks along with coverage. Insurance companies can’t place an annual limit on benefits, nor can they cancel policies for frivolous reasons, but the Act limits the amount individuals can place in Flexible Spending Accounts (FSAs) and purchases that can be made with the funds.

Improving Delivery and Efficiency

The Act’s components are intended to increase the overall efficiency and delivery of healthcare services. To accomplish that goal, the Act mandated use of an electronic medical records (EMR) system.

The technology is expected to allow clinicians to treat a greater number of patients per day and eliminate paper records.

ObamacareAccountable Care Organizations (ACOs) encourage networks of providers, with financial incentives for clinicians that provide a better level of care.

The focus of healthcare would begin a transition to a system of preventatives measures rather than reacting to treat disease after it occurs.

The Act also creates a panel of individuals to determine and recommend preferred treatment options.

Obamacare has four major goals through the Affordable Healthcare Act. In an effort to solve the glaring problems in the healthcare system, it will change the way clinicians practice their profession and deliver care. Patients will have greater access to clinicians, but only time will tell if Obamacare creates a nation of healthier individuals and more efficient practitioners.


Medical Billers: The Ever Expanding Field of Medical Billing

Medical Billers: The Ever Expanding Field of Medical Billing

Medical billing specialists are in high demand and the need won’t be slowing anytime in the near future. The transition to ICD-10 codes, federally mandated electronic medical record (EMR) software systems and a flood of new patients into the marketplace have all combined to create a perfect storm for skillful, experienced and certified medical billers. In this informative article, Nitin Chhoda examines the expanding field of medical billing.

medical billersWork Environments

The biggest draws for medical billers is the ability to start their own business with low overhead, work from home, and a career that can be employed from any location.

Medical billers working from home can set their own hours and the profession doesn’t have the physical requirements demanded by other healthcare fields, making it ideal for those with disabilities and stay at home parents.

Many medical professionals are outsourcing their billing activities, but the need for certified medical billers still isn’t being met. The need for medical billers is expected to increase faster than any other occupational field. A career in billing provides individuals with a decent income in a profession that’s almost recession proof.

Billers can work from home, in clinics, insurance agencies, hospitals, nursing homes and government operated public health facilities.

Easy Education

Individuals will find numerous online educational and certification opportunities that can be completed in as little as two to three months. Many professional organizations for medical billers offer courses, certification and chances to practice what they’ve learned, along with opportunities to learn about EMR technology.

New and Aging Patients

The Affordable Health Care Act changed the playing field and opened up a wealth of new opportunities for medical billers. The legislation is providing health care for millions of potential new patients, leaving providers with less time to deal with the intricacies of “paperwork”. An aging population in need of medical care is contributing to the need for medical billers with knowledge and experience of private and government-operated insurances.

EMR Technology

The use of EMR system software has been federally mandated for any entity that works with patient medical data. EMRs provide advanced methods for meeting the HIPAA standards designated for storing, retrieving and transmitting client information. The technology is changing the way billing is handled and provides medical billers familiar with the software with a multitude of opportunities.

New Medical Codesmedical billers at work

The transition to the new ICD-10 codes has many healthcare providers worried about delays in claim reimbursement. Experience with EMRs is going to be a plus for medical billers.

Familiarity with the software will allow medical billers to transmit claims without interruption and keep the flow of cash coming into the practice.

Medical billing is a quickly expanding field that demonstrates little indication of abatement. The need is obvious, with multiple online opportunities for training and certification available. As insurance companies become more determined to avoid or delay reimbursements, skilled medical billers are essential to ensure that medical professionals obtain the payments they deserve.

Government Healthcare Programs: Learn Federal and State Run Insurances

Government Healthcare Programs: Learn Federal and State Run Insurances

There’s a great debate going on in the medical community about the financial viability of treating patients covered by government-backed healthcare insurance.Many providers have said publically that they can’t afford to see those patients and will send them elsewhere for treatment.

In this timely article, Nitin Chhoda examines why it’s imperative for clinicians to learn about state and federally operated healthcare plans.

healthcare programs Incentive Payments

The list of federal health insurance plans is impressive. It includes Medicare, Medicaid, Tricare, CHAMPUS, Workman’s Compensation and Medigap plans.

Federal healthcare programs are in operation that provides incentives for clinicians in areas where a shortage of healthcare providers has been demonstrated.

The programs provide payments to recruit and retain practitioners, and awards incentive payments to providers who are already established in those areas. Some states have their own incentive healthcare programs.

Quality healthcare is at a premium in rural areas and patients are often woefully underserved. Clients tend to be older, poorer and have more health problems than their urban counterparts. Medicare maintains supplemental reimbursement healthcare programs for practitioners and clinics in rural areas.

Federal Health Programs Advantages

Each healthcare program has its own set of advantages and federal healthcare plans provide clinicians with a significant patient pool from which to draw. There are 9.64 million patients enrolled in the Tricare program alone.

Medicare pays 80 percent of patient costs and payment for practitioners participating in the Medicare healthcare programs receive reimbursements that are 5 percent higher than non-participating clinicians. Ninety percent of clean claims are processed within 15 days and payments are made within 30 days. Providers can join the Medicare network or accept patients on a case-by-case basis.

State Healthcare Programs

A majority of states operate their own healthcare programs for women and infants, along with children up to a specific age. Plans may offer prenatal and obstetric care for women and infants, along with a myriad of services for children and teens.

Coverage typically includes well child visits, dental and vision care, vaccines, prescriptions and medical supplies, mental health and substance abuse coverage, surgery and hospitalization, and diagnostic tests.

Participating in state run healthcare programs increases a clinic’s client base and many of the services can be accomplished quickly, giving simpler physical therapy documentation process, allowing practitioners to see more patients.

healthcare programs - government

Many practices are choosing to employ nurse practitioners to see this particular demographic. Even after salaries, clinics can double the number of patients being treated and revenues.

Practitioners participating in state and federal healthcare programs increase their patient base and their overall revenues.

Providers practicing in rural areas can further stimulate income through supplemental and incentive programs. Government-operated healthcare programs serve millions of individuals throughout the nation, providing practitioners with a steady stream of revenue.

Modifiers Beyond the Treatment: The OTHER Ways to Legitimately Stimulate Cash Flow

Modifiers Beyond the Treatment: The OTHER Ways to Legitimately Stimulate Cash Flow

Practitioners are always seeking new sources of revenue and skilled medical billing specialists can obtain those additional funds through entirely legitimate means. Medical billing isn’t confined to simple coding procedures alone and in this insightful article, Nitin Chhoda examines ways billers can create greater cash flow for the practice.

modifiersNeedful and Medically Necessary

There exists a wide range of procedures and modifiers that insurance companies don’t cover. They’re considered cosmetic and viewed as elective treatments.

Depending on the procedure, it may be possible to obtain reimbursement for some of those procedures, such as reconstructive surgery. Obese patients who have lost massive amounts of weight may require loose and excess skin to be removed.

Other clients may need dental work that can be billed as a covered expense, along with rehab services. Practitioners should remember that health concerns aren’t limited to the physical body. Patients may need the services of counselors, psychologists and psychiatrists to treat the mind.

Equipment and Pharmaceuticals

Modifiers are essential if more than one medical provider is involved and can qualify for additional payment. If it’s necessary to obtain lab work, an x-ray, MRI or similar diagnostic services, chances are the patient will be sent to another provider or facility. Equipment owned and maintained by another entity can be billed using modifiers.

Unbundling Advantages

Procedures that require extra skill, effort and time may qualify for additional reimbursement. Medical billing staff can billed specific services separately through the application of the appropriate codes, edits and modifiers. Practitioners may find that they must perform a second procedure while conducting another. Sometimes the two can be linked, but not if the second procedure is essential to the first.

Modifiers and Edits

Sometimes the difference in reimbursement is as simple as adding the correct modifiers to explain the full extent of the clinician’s services.

For instance, clinicians who make a simple diagnosis of a head fracture will receive much less in reimbursements than a practitioner that enters a diagnosis of a closed head fracture with contusions and lacerations. Each diagnosis is correct, but one provides greater detail and modifiers, allowing billers to enter that information in a way that generates a larger reimbursement.

Same Day and Multiple Treatments

Patients no longer rely on a single healthcare provider for all their needs. When a client sees multiple clinicians on the same day, modifiers  are sometimes necessary to indicate each practitioner provided different services

Modifiers indicate a change or alteration in how a procedure or service was delivered. When use of modifiers is justified, it can mean a difference in hundreds and even thousands of dollars each year in additional revenues. They must be utilized judiciously. If not, it can result in paybacks and even legal action.

Supplies, Consultation and Time-Based Coding

A bandage may seem like a small concern, but some clinicians are depriving themselves of income by not including medication and supplies that are dispensed in the office.

modifiers systemThe same is true when practitioners provide patients with counseling about medications, treatment options, and coordination of care that accounts for 50 percent or more of the patient encounter.

A complete accounting for the time spent must be documented to prove the service was necessary

One of the largest concerns of payers is fraud and inflated claims. They’re job is to find ways not to pay claims, or as little as possible, which often leads to underpayment for clinicians. With justified use of modifiers and edits, unbundling and hour-based billing, billers can legitimately stimulate significant cash flow for any practice.

Medical Billing Professional Groups and Associations – A Useful Tool

Medical Billing Professional Groups and Associations – A Useful Tool

Professional groups are an important element for medical billing specialists. They provide professional information, support and assistance, allowing billers to remain cognizant of rules, regulations and changes within the profession. In this informative article, Nitin Chhoda examines the advantages of biller-related associations and groups.

medical billingEducation Opportunities

There are a number of organizations with a focus on the medical billing profession.

The groups offer an extensive array of services, from classes to achieve certification to continuing education for those who have already attained employment.

The organizations advocate for higher wages and conditions within the work place.

Many classes are provided online, allowing medical billing staff to study when it’s convenient without interrupting their employment. Those working to become certified medical billing professionals can attain their credentials through accredited classes and programs.

Aspiring billers can familiarize themselves with terminology, legal issues, anatomy and physiology, and dealing with payers.

Industry Changes

Standards can change quickly within the profession and the groups distribute industry information to help medical billing professionals keep abreast of the latest updates and changes. One of the most important changes is the transition from ICD-9 codes to ICD-10 coding and billers can learn how the changes will affect them, accepted medical billing practices and the benefits. Some groups even provide online trainers, along with in-depth information on maintaining HIPAA-approved security.

Conferences, Conventions and Supplies

Professional medical billing associations conduct an extensive number of conferences, conventions, seminars and webinars, and exhibitions on all aspects of the industry. The special events provide medical billing people with information and demonstrations on new products, methods and industry trends, along with educational opportunities and technology.

Budding billers have access to starter programs, medical billing software, and practice programs to familiarize novices with the type of forms and information with which they’ll be working. Books and manuals on HIPAA compliance and associated computer tools are offered.

EMRs and Technology

The Affordable Health Care Act has mandated the use of electronic medical record (EMR) technology to maintain patient records and facilitate medical billing. Professional biller organizations offer extensive data on EMRs, their benefits and information on what to expect when working with the integrated software systems.

medical billing processProfessional medical billing associations and organizations assist individuals obtain credentials and provide ongoing information on all facets of the profession.

The groups provide essential services and products for billers at all levels of expertise.

The groups are committed to providing recognition for member contributions, continuing education, networking among peers and advocating for wages appropriate to the individual’s level of education and experience. They’re important resources for those considering a career in medical billing and those who are already professionals in their field.