Navigating physician billing can feel like finding your way through a maze. It's crucial but complicated, connecting the medical services you provide with the financial payments you receive.
This complex process is affected by many things, like changing laws and tricky payer policies, and the administrative issues that can slow down the flow of money. For you, precision and accuracy are super important, and every step—from patient check-in to getting paid—needs careful attention.
Physician billing services go beyond sending invoices. Your internal physician billing team or outsourced physician billing companies always ensure the maximized reimbursements for the services provided by, enabling you to run a seamless operation and ensure satisfactory patient care.
For you, understanding these complexities is the key. As we go through this blog, we’ll look at the laws that have shaped it and how to adhere to these legislative regulations properly.
Legislative guidelines that you navigate in physician revenue cycle management:
You’ve seen how big changes in laws have made physician billing more complicated and required constant adjustments. These laws have changed how you handle the financial side of care, aiming to improve patient outcomes and make the healthcare system run more smoothly. Let’s take a closer look at some of these important legal changes and how they continue to affect physician billing.
1) Medicare and Medicaid guidelines:
When it comes to managing physician billing, we all deal with Medicare and Medicaid but do you know when they came in the US healthcare domain? It was 1965 when Medicaid and Medicare were introduced with the objective of giving coverage to senior citizens and specifically disabled people, while Medicaid, specifically aimed to assist low-income people and those who cannot afford medical care.
This was the first time the federal government stepped in to provide healthcare coverage, adding a new level of complexity to how you handle physician billing. Now, you have to deal with the billing rules and compliance standards set by these programs.
2) Paradigm shift to The Resource-Based Relative Value Scale:
In 1992, the Centers for Medicare and Medicaid Services (CMS) introduced the Resource-Based Relative Value Scale (RBRVS). This update was important because it aimed to make sure you were paid fairly for your work. It meant you had to change how you did billing to match this new system.
3) HIPAA guidelines:
In 1996, a law called HIPAA changed how doctor billing works. It set up rules for using computers to handle health information and gave everyone a special ID number. The law also made sure that your health information is kept private and secure. For physician billing, this meant switching to electronic methods to make things faster and easier, cutting down on paperwork.
4) Affordable Care Act (ACA):
The Affordable Care Act is a new law passed in 2010 making physician billing services more complex to navigate for physicians and other healthcare practices.
This law gave insurance to many more Americans and brought lots of new rules. The whole objective of this law was to creating Accountable Care Organizations (ACOs) and changing the way you are paid for the provided physician services. It puts more focus on leveraging Electronic Health Records in your practice. Because of this legislative guideline, physician started prioritizing on providing cost-effective and better patient care.
5) Macra and MIPS
The new law called MACRA came into the picture in 2015 and it changed the entire ballgame for physicians. Instead of considering the number of patients a physician visits daily, MACRA started giving major importance on providing rewards for ensuring high-quality patient care. It introduced two new systems: MIPS and APMs. This meant you had to adjust to new ways of billing and reporting to get the best payments possible.
Present legislative changes and suggestions:
Lately, new laws and proposed bills keep changing how medical billing for physicians works. There’s a big focus on making prices more transparent, possibly expanding Medicare, and changing how prior authorizations are handled. You need to stay updated and be flexible, often using advanced billing technologies to keep up with these changes and manage your billing effectively.
So, now that you might have realized that there are several legislative guidelines that you need follow carefully, furthermore, these guidelines change frequently. To avoid all the billing and legislative-related hassles, most physicians, nowadays, prefer outsourcing physician billing. You can also outsource your RCM process to a physician billing company to enjoy some excellent benefits like operational cost savings, improved revenue and better patient care.
