Medicaid Reimbursement
With a new influx of lives being added to the Medicaid pool of patients, many PCP and Internists are going to see a large increase of new patients. So in order to compensate physicians for the new workload, fees for evaluation and management services as well as immunization services will be increased to 100% of Medicare allowables for 2013 and 2014.
Supply and Demand
With more patients being added to our system, due to the individual mandate and the increase of Medicaid qualified individuals, some physicians will see a heavier load of patients in their practice. Adding the fact that many of these patients are new to the system and therefore will require more work, practices need to have a plan in place as to how they will be adapting.
OIG 2013 Work Plan
The OIG will be taking a close look at claims from 2002 to 2011 billed with G modifiers (GA, GY, GX and GZ) to determine erroneous payments issued to physicians. These modifiers are used by practice when submitting claims to Medicare, indicating that a denial is expected for these services. However, in a review performed by the OIG, they found that a significant amount of claims submitted with these modifiers were paid in error. There is potentially $4 million of erroneous payments.
ICD-10
What was to be an effective date of October 1, 2013 has now been extended to October 1, 2014. However, practices will need start preparing for the changes soon or at least have an implementation plan in place. Many practices will wait until the last minute to start the planning and preparation because the deadline may once again be extended. However, with the complexity of the new coding system, there are certain areas that your practice may want to consider preparing, to aid in a smoother transition.So what do these four issues have in common? They all have a potential to impact your practice financially. Too often medical practices choose to ignore changes to the until it is too late. The time to prepare your practice is now.
