Post ICD-10 Changes to the ACA and its Implications

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The coming year will bring along change for practices. The ending of the ICD-10 grace period will bring rising problems for practices if they are not prepared. Apart from nearly 2700 new codes that are coming out, there are also significant changes in old codes as well.

With the introduction of ICD-10 it was decided that there would be a year’s time where all unspecified codes would still be accepted and not sent into denials mostly because many practices were unprepared. With this changing, the denials rates of practices will be rising to a huge extent. To combat this, practices need to have a medical billing software which is well equipped with the recent changes and the updates.

It is predicted by many experts that the denial rates will be moderately higher for practices come October 1st, however, they will be significantly higher for practices that do not have medical billing software, and are not prepared. Of course, the full wrath of the changes will be felt differently, depending upon which family of codes a particular practice gets often. Hence it is important to see the relevant changes concerning your practice, and then deciding what is needed.

The problem is that a relatively small practice will need such software much more, because it is harder for a smaller practice to hire an entire billing department, and hence in some cases (learn more) the doctor himself/herself ends up doing the coding, which basically results in a couple of extra hours every day. Instead, this time can be utilized in taking care of more patients which can result in not only a higher profit for the practice but better care for the patient. This way it all comes down to specialization, the doctor should be doing what the doctor knows best, which is to practice, and the coder should do what the coder knows best, which is to code. Now when the doctor takes the time to start doing other tasks ultimately it is a waste of resources.

The changes and the new codes that are being introduced are very important, and one should be fully prepared not just for the updates of the ICD-10, but for other factors that will be affecting the medical industry in the long run. One of these things is the upcoming election, which will have major implications on healthcare. The healthcare industry was revolutionized with the “Affordable Healthcare Act,” (ACA) ever since it became part of the constitution. Similarly, with the front runners of the both the major parties decided it would be interesting to see what potential effects they will have on the healthcare industry in the foreseeable future.

Hillary Clinton has exclaimed that she would not be for repealing the affordable health care act and actively “defend” it and even build on its success, whereas Donald Trump wants to completely repeal the act, and instead bring in “something great.” Now basically what does this mean for the healthcare industry, will the upcoming elections bring about a paradigm shift, and change the way things are done entirely?

    Now changes to the ACA look likely whether Clinton or Trump take the white house; however, this could be harder to do especially since the Supreme Court upheld it in 2012 and it is firmly a law of the land. It is estimated by the Obama administration that it would add around $137 billion to the federal budget to repeal the ACA.

Below we will be discussing the federal health care plans of both major party candidates, although neither candidate has outlined a detailed comprehensive plan as far as health care is concerned, they have suggested certain policies which provide a generic outline on which we can make an analysis.

Recently at the DNC Hillary Clinton talked about how she wants to defend and further add changes to the ACA to make sure that affordable health care is provided to as many Americans as possible. She also talked about how she would protect Roe v. Wade which was a landmark decision as far as abortion is concerned. As far as Clinton is concerned it should be protected and the decision of abortion should clearly lie with the mother.

Mike Pence who is Donald Trump’s running mate, actually talked about putting Roe v. Wade to the ash heap of history where it belongs. The republicans are pro-life, and would repeal the aforementioned case which would mean a huge tassel in congress.

Now here is the direct impact that the industry will have as far as practicing doctors are concerned. A Hillary Clinton presidency brings more of the same thing in a bigger package, more regulations such as HIPPA and HITECH in the industry, which means that practicing doctors will be treating more patients, relatively be getting paid the same amount that they are being paid currently with adjustments to inflation of course.

A Donald Trump Presidency would bring with it free market conditions, that could considerably increase the pay of doctors, and bring with it fewer regulations in the long term. This could lead to fewer people have access to good healthcare who cannot afford it; such is the law of the market. 

However whichever candidate gets selected, it is important to keep track of what is important, and for a practice, the most important factor should be how to keep afloat and turn in profit while helping the most amounts of people. To do this the practice needs to update about the changes that are coming, especially with the ICD-10 grace period ending.

Author Bio: Aiden Spencer is a health IT researcher and writer at CureMD who focuses on various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, electronic health records, Medical Practice management and patient health data. You can get in touch with him on Twitter: @AidenSpencer15

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