General Surgery Coding Alert

You may experience short-term 'preventive care' bonus.

Now that the Supreme Court has upheld the constitutionality of portions of the Patient Protection and Affordable Care Act (ACA), you'll need to make sure your practice is ready for changes that could affect your bottom line.

Our experts have identified five hot topics that the law does -- and doesn't -- address that could impact your general surgery group:

1. Look for Preventive-Care Uptick

Based on the Supreme Court ruling, "there will continue to be a 'push' on preventive care," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. in The Villages, Fla.

That means you might see an increase in services such as screening colonoscopies for colon cancer.

"Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law," said HHS Secretary Kathleen Sebelius in a statement.

2. Anticipate Demise of 'Fee for Service'

How you get paid for services might see a major shift starting with ACA enactment. The delivery system reforms rooted in the law will begin to usher in a change from fee-for-service payment to incentive-based reimbursement.

You can expect to see many more restrictions as part of this shift, according to Padget, such as frequency limits (Medically Unlikely Edits), bundling restrictions (Correct Coding Initiative), coverage constraints (fewer covered ICD-9 codes), and higher penalties for failing to meet "quality measures."

3. Heed Your Own Healthcare Costs

Just like any business, you need to anticipate ACA's impact on your bottom line.

General surgeons need to be thinking about their own practices and how the law impacts their companies. "Employee healthcare costs will increase significantly for them too, even if they have fewer than 50 employees," Padget says.

4. Don't Expect Fee Schedule Relief

Medicare payments are set to drop by 27 percent in 2013, unless Congress acts. Readers have asked if the Supreme Court decision changes that. The answer is "no" -- the ACA has no impact on the proposed Medicare Physician Fee Schedule, which sets payment for physician services, including general surgery.

"The Sustainable Growth Rate (SGR) formula is not addressed in the ACA and is not affected by the ruling," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. "Congress is expected to act to keep rates frozen for the foreseeable future. This is a political hot potato that Congress just does not want to touch."

5. ACA Doesn't Impact ICD-10

Maybe you're wondering if the Supreme Court's ruling impacts the proposed ICD-10 implementation delay. The answer is, "no."

The requirement to move toward the electronic format of 5010 and the ICD-10 code set was actually part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, says Suzan Berman, CPC, CEMC, CEDC, Senior Director of Physician Services at Healthcare Revenue Assurance Associates based out of Plantation, Florida.

"Parts of [HIPAA] have been implemented since then. With different push backs, the newest version of ASC 5010 was implemented Jan. 1 ... to set the stage for ICD- 10 with its new proposed implementation date of October 1, 2014 (still officially October 1, 2013 until an announcement is made)," Berman says.