Reimbursement News

3 Hard Reimbursement Questions Physicians Are Afraid to Ask

“Younger physicians are less than confident than older physicians."

By Jacqueline DiChiara

- Physicians sought answers to many pressing reimbursement questions this year.

revenue cycle management physician reimbursement

2015 saw heightened anticipation of reimbursement delay and claims denials once ICD-10 kicked into gear, ongoing discussion among physicians nationwide about how a practice can best achieve value-based success, and ongoing fear that more physicians will be forced to permanently close their doors.

Here are 3 top revenue cycle management questions physicians found themselves grappling with this year.

What ICD-10 challenges will be the most financially burdensome to overcome?

  • PhrMA: 340B Hospitals Reimbursed 3X the Amount Paid for Drugs
  • Considering MACRA’s Effect on Future Meaningful Use Changes
  • Slow and Steady Still the Motto for Value-Based Reimbursement
  • Eighty-six percent of over 200 surveyed physicians said ICD-10 implementation takes away from patient care, according to a SERMO poll.

    “I expect the [third] parties and government to reduce our reimbursements using [ICD-10] and citing quality measures (which they will set to maximize their own profits),” stated one surveyed physician.

    “ICD-10 doesn’t do anything in terms of changing how a physician practices medicine. It has everything to do with how the encounter/treatment gets coded and billed,” commented Michael Clark, Chief Operating Officer at Evariant, to RevCycleIntelligence.com.

    “If the physician doesn’t appropriately document, then it won’t get appropriately coded. If it doesn’t get appropriately coded, there is risk of reimbursement and cash flow to both the physician and the health system whereby everyone works harder and adapts to the regulation to find reality is limited or there is no benefit.”

    “At the end of the day, the heavy burden is on the physician with little to no meaningful immediate benefit to spend time documenting. He or she knows what the patient’s condition is and in a referral situation – when done effectively – the receiving physician is well aware of specificity through other verbal and non-verbal conveyance.”

    “With ICD-10, physicians are the ones treating the patient and the expectation is they need to document a greater level of specificity for appropriate care, professional appropriate reimbursement, and medical/legal/regulatory compliance consistent with the expanding ICD-10 code set, and that takes time.”

    How are physicians defining value-based payment success?

    According to research from the American Academy of Family Physicians (AAFP), lack of staff time, investing in health information technology, a lack of data reporting and validation resources, and weak levels of revenue stream predictability all hinder value-based payment success levels.

    Ninety-two percent of 600 surveyed physicians confirm value-based payment model success directly stems from 4 leading factors: practice sustainability, clinical outcomes, physician and staff morale, and patient care coordination. 

    One in 3 surveyed practices confirm they are “actively pursuing” value-based payment. But, another 1 in 3 stated they were "not aware” how their practice manages payments.

    Is low revenue going to force too many physicians into early retirement?

    Physicians are reportedly becoming increasingly overwhelmed by falling profits.

    Key physician concerns for 2015 include dropping reimbursement levels, rising personnel expenses, and issues regarding supplies, claims the Practice Profitability Index (PPI).

    There may soon be up to 31,000 fewer primary care physicians and up to 63,000 fewer non-primary care physicians, according to estimates from The Association of American Medical Colleges (AAMC).

    Within the next decade, it is reportedly quite feasible there will be 90,000 fewer physicians nationwide. 

    “Since so many practices and hospitals were already operating on razor-thin margins prior to the implementation of the ACA, ensuring that their operations are as efficient as possible will be very important going forward,” explained Chris Franklin, Executive Vice President of LocumTenens, to RevCycleIntelligence.com,

    “Physicians will also need to follow how the reimbursement landscape is changing from that of a fee-for-service to outcome-based reimbursement.”

    Among those physicians who have already stopped caring for patients within an active medical practice, half allegedly quit because of regulatory and administrative burdens, according to research from the Texas Medical Association (TMA).

    “Younger physicians are less than confident than older physicians,” asserted TMA’s July survey of over 900 Texas physicians.

    “Physicians employed in hospitals are least likely to be very confident their practice is prepared to transition to ICD-10. … Even among physicians who feel very confident their practice is prepared to transition to ICD-10, only 42 percent report their practice has begun transitioning extensively.”

    Forty-six percent of physicians who are least 61 years old are more likely to retire early because of denied or delayed claims, said TMA. Twenty-two percent reportedly quit because of ICD-10.