Reimbursement Ethics and Compliance: Impact of Health Care Reform on Medical Coding and Billing
"Medical billing and coding lays the foundation for any successful healthcare provider," yet its common practices are undergoing significant changes under the recent proposal for health care reform (Griffey, 2013). The nature of medical coding and billing is increasingly becoming more and more complicated. The recent healthcare reform legislation, passed in 2010, promises to complicate the situation even further. Such reforms will undoubtedly have a huge impact on medical billing and coding processes.
The reform bill was a monumental piece of legislation passed by Pres. Obama and his Democratic supporters in 2010. There are a number of stipulations which aim to help increase access to appropriate health care for millions of Americans who are currently without any coverage, helping lower the cost of premiums too much more affordable rate for most Americans but also increasing the coverage of Medicaid and Medicare. Additionally, the statutes presented in the Health Care Reform Bill would essentially help "reduce the deficit by $143 billion over the first ten years" (Jackson & Nolen, 2010). Most significantly, the reform is helping put a stop to insurance companies denying coverage for those individuals who have a pre-existing condition. This is a huge move, one which will help stop some of the discriminatory practices currently commonplace within the healthcare insurance industry. However, it is an incredibly costly endeavor, at a price tag of about $940 billion over the span of ten years (Jackson & Nolen, 2010). The reform will undoubtedly impact a number of areas within the healthcare industry, including medical billing and coding. The final components of the healthcare reform laws are set to begin in the start of 2014.
The nature of medical billing has been changing dramatically in recent years. Medical billing previously used ICD-9 as the standard for coding medical reimbursements. Yet, this has morphed into a new process which is being taught by most school today, which uses ICD-10. According to the research, "with over five times as many codes, going from 13,000 to 68,000, the...
So many more codes allow for much more streamlined process, where there is much less paperwork and much clearer medical billing processes. The current health care reform will also facilitate the decrease in paperwork involved both in terms of the patient and the medical billing professionals. The number of coding systems will obviously continue to increase as "coverage expands and new rules for pre-existing conditions come into effect" under the health care reform (Eastaugh & Sternal-Johnson, 2010). These changes are only increasing with the upcoming developments of the healthcare reform stipulated in the Healthcare Reform Bill, recently passed in 2010. In regards to the ban on insurance companies denying coverage for pre-existing conditions, this will open up a whole new genre of reimbursement claims for medical billing professionals. Billing will have to implement new codes and coding procedures to deal with pre-existing conditions, as well as expanded Medicaid and Medicare coverage.
There are a number of implications of the healthcare reform on medical billing. According to the research, "regulatory reform in the healthcare industry may leave you asking how the medical billing and coding world will change, but the goals and responsibilities remain the same: handling accounts receivable and revenue cycle management" (Griffey, 2013). As such, the primary and goal will be the same, yet the practices used to get to that goal will be increasingly different than seen in previous generations. Essentially, the workload for medical billing professionals will become increasingly complicated, as more and more individuals claim reimbursements for a wider variety of conditions and ailments. Thus, "the only things that change other processes for handling reimbursement requests, the complexity of the needed coding and privacy requirements mandated through HIPAA" and the upcoming changes presented in the Healthcare Reform Bill, which are going to be finalized by 2014 (Griffey, 2013).
Increasing coverage under Medicaid and Medicare mean a lot of changes within medical billing practices as well. The research…
