Question

In-depth discussion & elaboration in all sections of the paper and clearly stated the ideas to reform the healthcare system. Also demonstrate that you fully understanding of the concepts in health care management.

Money Troubles: Changing Reimbursement Models Shake Up Physician and Outpatient Healthcare Industry

http://bok.ahima.org/doc?oid=302239#.W6gYWOhKjIU

Answer 1

Ans.) This paper mainly focused on the healthcare reform and its consequences for consumers. These changes mentioned here are basically meant to improve patient care delivery system, but still patients do not see any favorable outcome from it.

Nowadays, most of the medical practitioner are constantly working on billing and health information management (HIM) familiarizing themselves with new acronyms and requesting to the doctors to adopt the new technique. To ease the billing and reimbursement process government promotes The ACA and MACRA. To ensure the proper payments of medical bills, healthcare system increasingly relying on HCC coding, as well as other variables such as demographics. HCCs are diagnostic categories based on diagnosis codes on encounter claims and are primarily used in outpatient coding in physician practices. Initially, for the risk adjustment and quality reporting, only one code was expected on a claim, but now problem lists and HCC coding allows the addition of more codes to demonstrate severity of illness. Thus, now the perception is quite different from the reimbursement perspective that says the first listed diagnosis should be the condition that prompted the patients to come in the door.

But it is also observed that the introduction of MACRA, MIPS, and APMs are presenting a huge challenge for the people who work with physician documentation. It means that doctors still believe to follow the routine practices during the documentation of coding and reimbursement affairs.

It is also noticed that several challenge are also faced in behavioral and rural health practices due to above mentioned reforms. The payment changes, the coding and documentation adjustments that come with them have presented a steep learning curve for coding professionals, especially for providers who, like rural medical organization, have applied and been designated with rural health clinic status. It is observed that the behavioral health providers have done a great job learning the nuances of documenting their encounters, but coding professionals really have to “X-ray” the documentation and re-train providers to stop using unspecified codes.

In addition, it is also observed that home health is major the moving target for payment changes. Home health coding and documentation have seen many changes over the years and can expect plenty more to come. The Centers for Medicare and Medicaid Services has been discussing the implementation of a new prospective payment system in 2018 called the Home Health Grouper Model, which would be an update to the current Home Health Prospective Payment System currently in effect.

Hence, it can be concluded that HIM professionals should be given a chance to prove their mettle in these settings to helps everyone in the industry. The coding and documentation expertise of HIM professionals’ makes them invaluable in the outpatient setting.