In today's healthcare environment, practice managers have to face important financial issues they did not struggle with 10 years ago. One of those is with the billing of healthcare, since so many different methods and options are appearing today (Morgan, 2012). Online billing choices, different types of software, and other facets of the financial environment are changing the face of healthcare and making things confusing for practice managers. The codes that are used for medical billing and the way those codes are used also change frequently, and learning the new codes means that mistakes will inevitably be made. These mistakes can result in major billing errors for patients and can cost the practice time and money to sort out (Morgan, 2012). Additionally, incorrect coding can mean that a person will end up with a diagnosis (for billing purposes) that is not accurate, so that is something that should also be corrected.
It is very important that proper medical billing practices are utilized, so that financial problems do not become the normal state for any medical practice (Pizzi, 2013; Young, 2013). Many of the billing and other financial issues being addressed by medical practices today are handled through third-party vendors. This was seen 10 years ago, but certainly not in the concentration it is seen today. That is important to note, because there are many third-party billing companies that can and do make mistakes. That is not to imply that they are deliberately careless, but only that a large volume of patients and billing information can mean more mistakes. Additionally, any time there is a third party involved it is much more likely that there will be errors at some point, simply because the information has to be coded in by people more than once, information has to be transferred, and records have to be verified.
The ICD-10 coding transition that has taken place in coding is a big issue for third-party vendors and also for medical practices in general (Pizzi, 2013). It has significant implications for the financial health and well-being of practices, and also affects the practice managers and how they do their jobs. Adapting to the codes is important, but it is also significant that there has to be testing done externally for ICD-10 (Pizzi, 2013). Some of this testing could be costly, and could also lead to errors being discovered that have not yet been noticed. With that in mind, it is vital that practice managers are ready for the ICD-10 coding changes, and that they are also prepared for many of the difficulties that could appear with those changes. When there are coding concerns and third-party billing issues, it can be possible for a practice to lose money -- and to not be aware where that money is being lost from. Naturally, that is a serious concern that could eventually bankrupt a medical practice.
Billing companies are buying one another, and that is lowering the number of third-party billing companies that are available for medical practices to use (Young, 2013). While that might seem as though it would lower the level of confusion, it is actually a problem because it lowers the number of companies a medical practice manager can choose from if he or she has difficulties with a different company. In other words, not all practice managers like, trust, or want to do business with all medical billing companies. Having choices is a good thing, but if there are few choices it can become a serious problem. Too much of a monopoly is created, and that restricts the value that companies can provide (Young, 2013). It also causes problems with the rates that the third-party medical billing companies charge, because they know they do not have much competition. That can lead to excessive fees and companies that charge much more than they should, which is a losing proposition for medical practice managers...
Now there are a lot of different financial considerations that practice mangers have to struggle with, because the landscape of healthcare overall is changing. The biggest financial problem is ICD-10 coding, because it has not been externally tested (ICD-10, 2013). That is a problem, since it might not work the way everyone thinks it will. Not only could that be a major issue for the diagnoses of patients and how they are categorized, but also for the billing department and the third-party companies that work on billing the patients on behalf of the medical practices. When a medical practice wants to bill a patient, that practice generally goes through a lot of effort to make sure the patient is billed correctly. The initial setup of the billing program or software requires time, and then learning the coding takes more time. That is part of the reason third-party billing companies are so popular, because they take a lot of the work off of the practice manager.
However, when there are coding changes like ICD-10, mistakes are more easily made (ICD-10, 2013). When there has not been enough external testing, the mistakes are even more significant and can cause problems for the medical practice, the third-party billing company, and the patients. It can be difficult to do external testing for something as large as a new coding system, but that opens the door for problems when the system is used for the first time. Compliance is important, though, and required (ICD-10, 2013). This level of coding and compliance was not in place 10 years ago, so there were fewer difficulties practice managers had to face. Now that they are seeing more and more requirements come into play, they have to work harder at their jobs and the compensation has not risen accordingly. That increases the stress practice managers face, based on the financial burdens they must juggle for the medical practice they work for.
Student 3: Practice managers in healthcare are facing a far different financial "ball game" than they were seeing 10 years ago. Now they have to address a lot more complicated issues, and they do not always know how to handle them properly. They cannot, however, take risks with not understanding what they should be doing. They have to find the proper routes to take in order to make sure they are handling billing and coding issues in the right way. Working with third-party medical billing companies is the way to go for this, but the recent ACOs have made things more difficult (Lund, 2012). The ACOs are Accountable Car Organizations, and they are focused on helping move Medicare healthcare delivery forward (Lund, 2012). More medical practices are shying away from taking Medicare patients, though, because they generally do not get paid as much for these patients. The profit is important to them so they can keep their practice moving forward.
ACOs are becoming part of the micromanaging of healthcare that is starting to take place, along with HIPAA laws and related issues (Lund, 2012). These were not problems 10 years ago, and practice managers did not have to struggle to determine what they were going to do about all the changes taking place in their industry. While change is vital for growth and development, the combination of ACOs and third-party medical billing companies is one that is not working out well (Lund, 2012). The ACOs will have to decide which service companies they are going to use, but that can be a daunting task when there are a number of different physicians in the ACO. It is likely that many of the physicians used different third-party medical billing companies, and once they form an ACO they must choose only one of those companies to work with (Lund, 2012). That can open up an entire host of problems, but it is an issue that has to be dealt with in order to ensure that each of the physicians gets what they need and remains happy with the process.
There is a lot to be learned from this question. Most importantly, it is notable that there are a number of changes taking place in the medical billing and medical finance fields. These include ACOs, ICD-10 coding, and a number of others, but they all make a difference in how practice managers do their jobs. Since these managers have to work with the doctors and also with the patients and the billing companies, it is necessary to "keep the peace" as much as possible while still paying close attention to doing things legally and properly. As HIPAA and other rules and regulations have changed the landscape of medical billing, it has become increasingly more important for medical practices to make sure they are in compliance with federal, state, and local regulations. This information is all very important in the workplace, because anyone who works in the medical field at all needs to know how to handle compliance issues,…
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