Practice Management Alert

How will you and other billers be affected? Review the opinions of these expert billing professionals.

Throughout the healthcare industry, people have been abuzz about the United States Supreme Court's June 28 announcement that it had made a decision about the Patient Protection and Affordable Care Act (ACA). In the decision to uphold the constitutionality of the ACA, the Supreme Court also ruled that the requirement that all individuals have health care coverage or face a penalty was a tax, rather than a penalty, and therefore allowable under the Federal taxing authority.

So what does the upholding of the ACA mean for the future of your practice? Here's what a few billing experts have to say on how this will affect practices:

• "Since the U.S. has never had a healthcare law that mandates everyone must have health insurance, I believe it is difficult to know or predict the effects it will have on providers and their practices. It is anyone's best guess right now.

"I believe the Affordable Healthcare Act law will have an impact on the doctor-patient relationship. Remember the law's emphasis is on health insurance and for those who can't afford to buy health insurance, their coverage will be Medicaid. Therefore, the Medicaid program will get larger with more people (patients) on Medicaid. Having been involved in administrating medical practices for over 35 years, I have never known any doctor who participates with Medicaid. So the question is who is going to care for these Medicaid patients? Mandatory provider participation?

"Over the next 5-10 years more baby boomers will be on Medicare. There a lot of practices, right now that don't accept Medicare or Medicaid and some even third party insurance. Will they be mandated to accept a certain percentage of Medicare and even Medicaid patients? Will providers who don't accept third party insurance be mandated to accept some or all policies? I believe internal medicine and family medicine providers will be hardest hit financially since their "volume of patients" will increase to cover costs which could mean their staff will increase due to administrative needs -- processing patients and insurance claims -- which means more expense. Specialty surgical practices may feel the same effects since their insurance reimbursement for large dollar surgeries may decrease.

"In an article in the Wall Street Journal, the CEO of a chain of hospitals was interviewed about the new healthcare law. Since this law is expected to cut compensation by $150 million, hospitals (and you have to include providers), he stated "will make up for it in volume" (meaning patients).

"Don't forget the effects of PQRS. Providers will be mandated to comply with entering patient medical data which translates to more administrative time for providers which means less time for patients.

"The procedures for claims submission and processing by insurance companies undoubtedly will be impacted with, again, volume. Billing staff time may increase to track claims and monitor reimbursement. Again more billing staff may be needed -- financial impact on practices.

"Also remember that, as of now, ICD-10 kicks in Oct 2014. So there will be a lot of 'learning and changes' for providers and staff.

"There is no doubt in my mind this law will have a definite impact on the doctor-patient relationship since the emphasis of the law is health insurance."

Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J., www.hrminc.com

• "Many challenges still exist in implementing the ACA. Experts agree that all sorts of people will be exempt from the mandate. For example, Native Americans with access to free tribal healthcare (and therefore exempt from the mandate) may choose to utilize services outside of that care that would create a situation of being self-pay.

And while individual insurance will be more accessible to the uninsured, those that consider themselves healthy could opt for the penalty instead of coverage. Additionally, there may be many uninsured people that will not be eligible for Medicaid based on their income; so uninsured patients will continue to be a factor for hospitals and medical practices.

There will also be more patients with Medicaid coverage and financially, these low payment reimbursements will become an issue for practices. Further issues arising from a shortage of Physicians treating Medicaid patients will result in long delays in obtaining appointments.

While practices should see an increase in healthcare claims (both private and Medicaid), they may see an even bigger increase in the number of self-pay patients, requiring additional time and effort to collect. And then there is still the wild card of states that will opt out of Medicaid expansion. So I think we're going to see a lot of uncertainty and changes going forward."

Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association in Davis, Okla.