Medical Billing Forum

General Category => General Questions => Topic started by: tallmanusa on November 07, 2012, 10:23:17 AM

Title: Is Obamacare Good for Billing business?
Post by: tallmanusa on November 07, 2012, 10:23:17 AM
Regardless of your political affiliation, as of this morning, Obamacare is here to stay. Doctors have to adopt EMR by 2015; their pay would be cut, and they would have tons of new patients.
Is all of that good or bad for the billing business?
To me it would appear good for our business, not necessarily good for the doctors.
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 09, 2012, 06:56:08 PM
Maybe.. maybe not, I think only time is going to tell us that. The BULK of my consulting in last year has been evaluating and auditing practices to remove them from Medicare/Medicaid.  In regards to Billing, I don't think it will effect it right away, it really is going to be determined by how much physicians are going to put up with before leaving medicine, going to cash only practices or concierge care.  I do think we'll see a drop in Medicare/Medicaid/Tri Care billing as more physicians move away from govt sponsored plans. I also think we will need to be MORE diligent in eligibility and benefit checks as many enter into the private sector.   I think in regards to the big picture it's going to be a game of chance.  To stay afloat I think billing companies better be diverse, they better be ready to use any software, do credentialing and other consulting type services to stay afloat.   JMHO.   PS.. I also predict they will put off EMR mandates due to issues such as Cyber terrorism, and patient rights, I myself have an attorney drafted Opt out of EMR where as my physicians will not be able to force EMR on me. I think you will see more patients really care about how their information is used, stored and shared.  Many of the issues on privacy have not been addressed in regards to EMR. I do believe we will see it put on hold AGAIN and AGAIN.
Title: Re: Is Obamacare Good for Billing business?
Post by: DMK on November 12, 2012, 11:02:21 AM
Doctors will be retiring, dropping insurance and going to work in hospital type clinics.  Private practice will be changed forever if Obamacare continues to plow through.

Doctors will have "tons of new patients" that they will have to provide more services, in less time, for less reimbursement, and people still won't pay their bills because "health care is free now, right?".

We're getting the recommendations now for more restrictions on tests, fewer paps, fewer mammograms, fewer PSA's, longer waits for MRI's, CT's etc.  The insurance companies will be denying more and more care because for every 10 of those tests, only 1 "really needed it".

People thought they were going to get free health care for all.  Now the people who want tests will pay for them, and the people who NEED them won't be able to get them authorized.

Hide and watch folks.
Title: Re: Is Obamacare Good for Billing business?
Post by: tallmanusa on November 12, 2012, 11:21:10 AM
I don't have any political affiliations, only business interests. For our business I think this is very good.
As the Speaker of the House said " Obamacare is the law of the land ", that is the way it is, people have already spoken. It is water under the bridge. Learn to live with it.

My goal is to steer my business so that it is profitable under the circumstances.
One way is to offer EHR to every provider, as Obamacare mandates it.
Another way is to increase efficiency, so that we can deliver the provider at reasonable costs to them. Improvement in technology and elimination of Super bill are others.
Title: Re: Is Obamacare Good for Billing business?
Post by: rdmoore2003 on November 12, 2012, 03:46:43 PM
I don't have any political affiliations, only business interests. For our business I think this is very good.
As the Speaker of the House said " Obamacare is the law of the land ", that is the way it is, people have already spoken. It is water under the bridge. Learn to live with it.

My goal is to steer my business so that it is profitable under the circumstances.
One way is to offer EHR to every provider, as Obamacare mandates it.
Another way is to increase efficiency, so that we can deliver the provider at reasonable costs to them. Improvement in technology and elimination of Super bill are others.


ok, I can't resist.   First, people have spoken, however, not ALL people said the same thing.  Second, I have been using EHR for about 6.5 years now and if you have the thought that eliminating superbill (and things of that nature) and the improvement in technology.....all that tells me is that eventually technology will completely do everything and there will be no reason for billers and/or coders.  Since most insurance companies are and have already went "green", the "improved technology" will run you out of business since the computers will do it all.
Title: Re: Is Obamacare Good for Billing business?
Post by: tallmanusa on November 12, 2012, 04:40:55 PM
In a democracy, the majority, even by 1% decides the issue, the issue has been decided. It is over.
Good that you have been using EHR for 6.5 years; I believe only 20% of the providers use EHR currently.
Technology will do mundane things, like duplicating the information from a Super bill; but it would never eliminate the need for humans.
Banks are a business that uses technology extensively but still uses people and lots of them.
My pitch is to the doctors who are using considerable sums ( 8 - 10 % by many estimates, in house billing); we will do for 5%, everything including the cost of software. And yes, no super bill.
Actually the coding is simple in EHR, the provider should do it. Most billers don't do any coding.
Title: Re: Is Obamacare Good for Billing business?
Post by: rdmoore2003 on November 13, 2012, 09:39:27 AM
I do not agree.  I have seen with my own eyes.   
Title: Re: Is Obamacare Good for Billing business?
Post by: Michele on November 13, 2012, 09:46:33 AM
It is hard to talk about Obamacare without getting into Political discussions.  Personally, I do not believe that we can even anticipate how this will play out.  JMO, I hate the way laws are passed these days.  It's never just one law.  Obamacare is so much more than strictly healthcare.  There is so much other cr@# in there it's just not even funny.  It's so ridiculously long and complicated that the average person cannot read it and understand it.  I understand the intentions, etc, but I do not believe they accomplished what really was needed.  I don't voice my opinion often because I don't have a better solution or any suggestions.  I don't believe in just whining and complaining without offering something.  But I am honestly afraid of the ramifications of this bill if it stands as it....both professionally and personally.
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 13, 2012, 01:19:29 PM
Quote
I don't have any political affiliations, only business interests. For our business I think this is very good.
As the Speaker of the House said " Obamacare is the law of the land ", that is the way it is, people have already spoken. It is water under the bridge. Learn to live with it.

Ahh.. you would think right.. but I think when he said that he forgot again what country he was in.. The states can hold up implementation with their re appeals. There is also nullification. I kind of scratched my head when he said that and remembered.. Oh that's right, he was only a lawyer on paper for a short time. Seems he forget the way the legal system works.   There's I think (DON'T quote me on the exact number) 12 states with re appeals filed either before or after the election. Several states have also threatened non implementation. Sure the feds will try to.. but they won't be able to until all legal avenue's have been explored. So Buckle up, it's going to be a LOOOOONG ride.

I also think that if you are a billing company ONLY doing billing/PM, then yes, you MIGHT see a decline in obtaining new clients. That was one of the big reasons a few years ago I decided to diversify, I don't use just ONE PM solution, I use whatever one the provider wants to use, I provide consulting which pays much better than billing, I do credentialing and DE-credentialing and also fee-schedule negotiations and contract reviews.  So now actually billing is only about 25% of my business. 

I also have a prediction... They will postpone EMR implementation. Right now there are too many published reports on cyber-terrorism to warrant a postponement.  I think the East Coast (NY/NJ) area is already seeing it. There were several hospitals in NY/NJ that came to a standstill from Hurricane Sandy, There was NO access to the patient records.. It was a nightmare and actually still is out there.   If you research you will already see that the Middle East has allready hit us with cyber attacks.  Also patients still maintain the final say on their health records. Physicians will need to disclose those things to patients and patients can exercise their opt-out.  Interestingly enough physicians and Office managers need to be trained on how to deal with those privacy concerns of patients, my own family physician argued with me telling me I had no choice, but my attorney presented evidence to the contrary, his office will need to know how to deal with those issues. 
Title: Re: Is Obamacare Good for Billing business?
Post by: tallmanusa on November 14, 2012, 06:33:42 AM
President Obama has one characteristic, and history has proven it. He does not compromise, and does not change his views. He has said that he would not change a single word, even a coma or a period, in his health plan. It would be futile not to believe him.
Whatever is in the law would be implemented, including EHR by 2015, those providers who have not converted by then, would be shut out of the system.

Here is a comment about a public medical management company
I quote;
 "AthenaHealth is shaping up as a prime beneficiary of recently-passed Affordable Health Care Act, as hospitals and physicians will be pushed to put down the pen and paper, and pick up the computer (or tablet as the case may be)."

Full article can be seen here.
http://seekingalpha.com/article/1003031-as-the-market-tumbles-these-4-stocks-are-beating-estimates?source=yahoo
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 14, 2012, 11:11:18 AM
Quote
President Obama has one characteristic, and history has proven it. He does not compromise, and does not change his views. He has said that he would not change a single word, even a coma or a period, in his health plan. It would be futile not to believe him.
Whatever is in the law would be implemented, including EHR by 2015, those providers who have not converted by then, would be shut out of the system.

Here is a comment about a public medical management company
I quote;
 "AthenaHealth is shaping up as a prime beneficiary of recently-passed Affordable Health Care Act, as hospitals and physicians will be pushed to put down the pen and paper, and pick up the computer (or tablet as the case may be)."

Full article can be seen here.
http://seekingalpha.com/article/1003031-as-the-market-tumbles-these-4-stocks-are-beating-estimates?source=yahoo

How long have you been doing this?   Me, since 1996 (prior to that I worked for insurance companies)   Obama can say whatever he wants.. And yes your right, stubborn is ONE word, one might use to describe him.. me, I have other words ...BUT anyway.. again.. the legal system always proves delays.  The "RULE of the land" will go through lengthy court processes and possible state nullification.. IT will PROLONG implementation.. Remember that in ANY business the ones who are always guaranteed to work and make money no matter what......................Attorney's. ;0   Law school entrances OVER top medical school by a HUGE number.. we are already seeing a healthcare shortage.. by 2015 we WILL be in a total collapse mostly due to Obamacare.    Those of us who've been in business know what happens when they announce a law in advance.. usually 2-4 delay's follow and they don't include the ones that are hung up in the legal system like this one will be. States like Virginia and Florida and MORE will find those legal loopholes, they always do.. at least long enough to "Hang things up"
Title: Re: Is Obamacare Good for Billing business?
Post by: DMK on November 14, 2012, 12:33:00 PM
Thank you Linda for stating things so well.  The post I started was foaming at the mouth a little  ;).  Thankfully our systems is full of checks and balances so we don't get TOO many half baked ideas crammed down our throats.  The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product.

When Medical care costs more to provide than the income it generates (and it's close, right now!) no one will choose that profession.  Tort reform would do more to lower medical costs than anything else they could do.

When they wrote the Affordable Care Act, it sure doesn't seem like they asked the right people for input!
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 14, 2012, 03:39:28 PM
Quote
When they wrote the Affordable Care Act, it sure doesn't seem like they asked the right people for input!

BINGO!!!!!!

They certainly didn't ask health care providers, or company owners!!    I have only met ONE provider who thought this was a good thing, he was an ER physician ONLY.. he gets a paycheck no sweat off his back  ::)   IF there are practices out there in favor of the ACA.. just wait. they won't be.  I paid the $240's to have the entire bill printed and I have gone through it. I love being approached by a potential with a question about the ACA :)
Title: Re: Is Obamacare Good for Billing business?
Post by: QueenAlicia on November 15, 2012, 09:50:41 PM
Just to add a little I read that with the new CMS fee schedule for 2013 that reimbursements will be lower so how will EHR be helpful for a provider that has to attest that will not receive the incentive?  Just something that I have been thinking about here lately.

IF the super bill will become ancient then how as a billing company will the actual receipt of information be received?  Will be just be done by reading off of the charts off of the EHR system? So if there is a secondary bill that needs to be sent out or if a claim needs correction that will be done on EHR too?  I think that EHR will play a big part in recording patients information but it won't eliminate the need for a super bill.
Title: Re: Is Obamacare Good for Billing business?
Post by: ruthie72 on November 28, 2012, 12:09:56 PM
HI Alicia
I think that is where my job comes in..I am a billing coordinator at a hospital and I get I review all of the charts for the ER physicians to make sure they are getting all of the information correct on there...(I am still trying to gain my experience to become and acutal biller)...Hope this helps... ;)))
Title: Re: Is Obamacare Good for Billing business?
Post by: RichardP on November 29, 2012, 02:01:38 AM
I'm confused by some of the statements above.  Am I missing something here?

1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.

2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?

The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.

3.  States can be granted waivers.  If the Republicans had won the White House, granting waivers to each state requesting them would have been the quickest end-run around the Affordable Care Act.  They didn't win the White House, so this approach will have limited, if any, use.

4.  Regardless of whether a State has requested and been granted waivers, or they simply refuse to comply - there is a deadline by which a State must fashion its response to the Affordable Care Act.  Under provisions of the ACA, which was upheld by the U.S. Supreme Court, if the State does not comply by the deadline, the Federal Government can (and probably will) step in and implement its own healthcare exchange (a "market" where anyone can buy reasonably-priced health insurance).  Given that the U.S. Supreme Court has already ruled on this issue, to whom are the lawyers going to appeal to stop the Federal Government from doing what the U.S. Supreme Court said it could do?

5.  Bureaucracies move at glacial speed.  There will probably be delays in implementing the healthcare exchanges and other parts of the ACA just because of the slowness with which bureaucracies move.  It is hard to see how legal wrangling will delay anything, given that the U.S. Supreme Court has spoken on the issue.

6.  tallmanusa said:  "In a democracy, the majority, even by 1%, decides the issue ...".  First, we are a Republic, not a democracy ("I pledge allegience to the flag, and to the Republic for which it stands").  Second, because we are a Republic, not a democracy, the court system serves in part to protect us from the "tyranny of the majority"  There are many instances in which the majority has spoken, yet the court has given the victory to the minority.  Never could understand why the "tyranny of the minority" is any more desireable than the "tyranny of the majority", but ...  In the case of the ACA, and regardless of what the majority may wish, the U.S. Supreme Court has ruled in favor of the Federal Government's position.

7.  If a biller is doing a proper job, they are going to catch coding mistakes on the part of the doctor.  Either he did not code for work that was actually done (a good biller can catch that, if doctor did "A", that means he also had to do "B", but he hasn't coded for that), or he coded the work incorrectly.  With a paper fee slip or superbill, you can send that piece of paper back to the doctor and have him make the changes on it.  Then, what the biller bills for matches exactly what the doctor has written on a piece of paper.  There will never be any question of the biller billing for things the doctor didn't order.  Consider an EMR.  How do the required changes outlined in this point get made?  Biller talks to doctor, maybe by phone.  Doctor says, "Oh, thanks for the heads up.  Go ahead and make the necessary changes before you send your file off to the clearinghouse" - and then forgets to make (or is locked out of making) changes to the EMR to reflect the new charges the biller submits.  Now, in an audit, the biller has billed for things that are not present in the patient's electronic chart.  That is a big no no for billers, and penalties can be stiff.  Not having a paper trail that matches exactly between what the doctor did and what the biller billed is laying the groundwork for some potential problems that not many people seem to be discussing.

8.  tallmanusa said:  "Doctors have to adopt EMR by 2015".  A bit more complicated than that.  A doctor who doesn't meet Medicare requirements by 2015 will have Medicare payments reduced by 1%.  That increases to 2% in 2016, 3% in 2017, 4% in 2018, and maybe up to 95% depending on future adjustments.  This is a big non-issue for doctors who are not Medicare providers.  If these penalties are actually imposed, I think we will see a significant exodus of doctors from the Medicare program.  Maybe to be replaced by PAs taking over the care of Medicare and Medicaid patients.

9.  tallmanusa said "offer EHR to every provider, as Obamacare mandates it".  First, the ACA does not mandate the use of EMRs.  It simply reduces payment to Medicare providers as discussed in the previous point.  Second, EMRs add about 1 1/2 hours to the work-day of those doctors that I know are using them.  EMRs have never been about increasing efficiency (they don't).  They are about collecting patient outcomes so that the Federal Government can aggregate them, data mine them, and come up with best practices for any given health issue.  Each doctor who chooses to use an EMR gives up about 1 1/2 hours of income every day just so the government will be able to collect this data (I've talked with data aggregator companies that are doing this right now).  Be careful about possible backlash if you don't make sure your potential client knows this before he takes on an EMR for the first time.  If you oversell the benefits to the doctor of an EMR (the benefits accrue to the government, not the doctor), you may lose him as a client.

10.  rdmoore2003 said "the computers will do it all".  For those who think that technology is what gets doctors paid for their work, I invite you to read through the points I make on this page: http://www.medicalbillinglive.com/members/index.php?topic=6930.30 .  One who knows how to bill properly is who gets the doctor paid.  Wetware, not software.
Title: Re: Is Obamacare Good for Billing business?
Post by: rdmoore2003 on November 29, 2012, 09:30:44 AM
I'm confused by some of the statements above.  Am I missing something here?

10.  rdmoore2003 said "the computers will do it all".  For those who think that technology is what gets doctors paid for their work, I invite you to read through the points I make on this page: http://www.medicalbillinglive.com/members/index.php?topic=6930.30 .  One who knows how to bill properly is who gets the doctor paid.  Wetware, not software.

yes it is very obvious you are missing a heck of alot
Title: Re: Is Obamacare Good for Billing business?
Post by: rdmoore2003 on November 29, 2012, 09:37:13 AM
IMO, the last month or so I have noticed alot of new members voicing their political views.   This is a billing forum, not a debate.   Everyone has their own opinions on how things will go.  I posted a "sarcastic" reply and then political views are then put to the test,( so to speak).   PAY ATTENTION....ENOUGH WITH POLITICAL ISSUES...LETS RETURN TO OUR BILLING FORUM....THANK YOU
Title: Re: Is Obamacare Good for Billing business?
Post by: DMK on November 29, 2012, 11:36:27 AM
I'm confused by some of the statements above.  Am I missing something here?

1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.

2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?

The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.



My first comment about people thinking they were going to get free health care is from listening to patients who come through our office.  The general public does actually think they will get whatever they want, whenever they want, and not have to pay anything.  When we start to to discuss what the ACA actually is, most people are shocked.  That's not what they "heard" on the news or the story they "read" on the internet.  Don't get me wrong, I think everyone should get to go to the doctor when they need to, and people shouldn't have to die because they can't afford the care they need.  It's a well intentioned attempt to fix a problem, it just wasn't thought all the way through.  The poor who use the ER are usually immediately enrolled into Medicaid (which we all pay for in one form or another) so their bill gets paid in some form for pennies on the dollar. That can't last forever as we all know.  The middle class / working poor are going to suffer far more than the truly poor, who have had a "system" of sorts in place for a long time.

"Requiring" people to buy health insurance or be "taxed" IS a mandate.  And they are already running up against religious groups who view insurance as "gambling" who refuse to buy insurance and will not pay the fine.  I don't know the answer this problem, the concept is that if we ALL pay in and participate that costs will go down.  But that's not logical, and doesn't take everything into account.  My personal health insurance (I'm a business owner, not in a group, and have paid for my own high-deductible plan for many years) has doubled in price in the last 2 years, I'd consider dropping my health insurance but now I'd be taxed.  My insurance company cites the upcoming expansion of health care and how they have to absorb all the people with pre-existing conditions as well as "increased physician fees".

My big problem with the mandate or fine is that if people couldn't afford insurance before, how can they afford it now?  And if there's no money in the family budget for insurance premiums, how can they pay the tax?  Again, it's well intentioned, but not thought through. 

Your posts are great, and your points are very well stated and thought provoking.  I keep coming at these issues from 4 different perspectives, as a provider of services, a patient, a biller, and as a business owner / tax payer.  I'm surrounded with health care discussions every day, and the public perspective is truly fascinating.

Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 29, 2012, 02:27:42 PM
While I do think there's a time and place for political talk, there are MANY political discussions which do impact our businesses and industry a great deal. The Affordable Care Act is one of them. I don't know about the rest of you, but it's part of my job to educate my clients, I can't do that w/out talking about this healthcare bill because our industry is about to change DRAMATICALLY. This is NOT just about people getting "affordable coverage" as much as our politicians would like us to believe, it's much more and if you don't get that, you will find yourself chasing your tail in the next few years and never catching it.    With that said, I'm going to weigh in on the many statements/questions given:

Quote
1.  DMK said  "People thought they were going to get free health care for all."  The Affordable Care Act requires everyone to purchase health insurance or else pay a fine.  How does that reality lead people to believe that there is going to be "free health care for all"?  The reality is that someone (you and me?) is already paying big bucks for all the poor folks who use hospital ERs and then never pay anything towards their care.  Theoretically, requiring everyone to have insurance will reduce this expense - which should be reflected in lower health insurance premiums.  Probably won't be, tho.

I'm sure the Affordable Care act was supposed to be logically "affordable" .. WHO it's affordable to is "key" to understand that you have to know to whom the discounts are available to and how it impacts those it does not make affordable to (PROVIDERS)   

Let's take a look at the patient / family affordability.   We don't know yet what premium's will come but I can tell you this..2014 - ,the annual penalty for taxpayers NOT obtaining health insurance will be $95 per adult and $47.50 per child, up to a family maximum of $285 or 1 percent of family income, whichever is greater. Now what do you think a premium on say a family of 4 will be? NOW you tell me.. pay penalty or premium??  I CAN also tell you this as a FACT.. Premium coverage WILL be as much as 25-60% HIGHER than the penalty.     It should also be noted that if you OPT to pay the penalty there are still many ways to adjust your tax return/status (withholding) to OFFSET that cost and ultimately pay NOTHING <g> (See IRS isn't so bad)  .. PLUS...  because the Supreme court says this isn't a TAX the IRS will have NO means to FORCE this penalty aside from deducting it from your refund if one is due, but again, you can adjust withholding to offset it.  The ACA also makes note that the IRS is NOT allowed to assess penalties, interest OR apply liens, or seizures to collect this penalty.  So now let's look at this from a COMMON sense point of view and again from a consumer / patient prospective.   Pay $5000 a year premium (probably will be a high deductible OOP plan or managed care plan) or pay the penalty?   Which do you think the majority of consumers who are already uninsured are going to pick? 

Now let's broaden this to include those that are employed and have coverage through their company/group sponsored health plan (contrib or non contrib)
Employers with 50 or more lives, will ONLY pay a penalty of $2,000 for every employee in the company if even one employee opts to obtain insurance through an exchange. However, the first 30 employees are not counted in calculation of the penalty. Example: an employer with 75 employees would pay the penalty for 45 workers, or $90,000 (45 x $2.000).
So the next question I would ask if you were the owner of business, would you rather pay $2000 penalty OR $5-10K premium?? Now you see why Obama said over and over.. "YOU can keep your existing health care plan" he just failed to mention that companies were given that INCENTIVE to force you into the exchanges !   

So that covers premiums even assuming they don't increase (which we know is a crock of ..&*^^



Quote
2.  DMK said "The legal system indeed will hold all this up because you can't MANDATE a purchase of a private product."  Actually, the United States Supreme Court ruled a few months ago on this issue.  The Affordable Care Act was ruled legal, and the Federal Government can fine each individual that does not purchase health insurance.  There is nothing more the legal system can do to hold this up.  Given that the U.S. Supreme Court decided the issue, who is any lawyer going to appeal to?
       

Well this is going to make lots of lawyers more money.. and there are states who've started nullification processes.. how this plays out is anyone's guess. States that don't create exchanges will have them created for them by the federal govt <shiver>  And then some states will find legal loopholes that may even HOLD up the process.. we all know how court's and the legal process runs, add to that govt regulations and the many times they are pushed off.. This isn't going to be smooth sailing by any stretch of the imagination.

Quote
The Federal Government is not going to "force" anybody to purchase a private product.  That is not, and has never been, the issue here.  The reality is that the U.S. Supreme Court said it was legal for the Federal Government to "tax" you if you fail to purchase health insurance.  At some point, it will be cheaper to purchase health insurance than to pay the fine.

No the Supreme court said they could not uphold tax provisions so "poof"..wave the magic executive order want and that's not a "penalty" read above on how that penalty will go.

Quote
3.  States can be granted waivers.  If the Republicans had won the White House, granting waivers to each state requesting them would have been the quickest end-run around the Affordable Care Act.  They didn't win the White House, so this approach will have limited, if any, use.

4.  Regardless of whether a State has requested and been granted waivers, or they simply refuse to comply - there is a deadline by which a State must fashion its response to the Affordable Care Act.  Under provisions of the ACA, which was upheld by the U.S. Supreme Court, if the State does not comply by the deadline, the Federal Government can (and probably will) step in and implement its own healthcare exchange (a "market" where anyone can buy reasonably-priced health insurance).  Given that the U.S. Supreme Court has already ruled on this issue, to whom are the lawyers going to appeal to stop the Federal Government from doing what the U.S. Supreme Court said it could do?

I honestly don't know.. I just know that the "wheels of justice grind slowly" We are at the mercy of our Senators and Governors..

Quote
5.  Bureaucracies move at glacial speed.  There will probably be delays in implementing the healthcare exchanges and other parts of the ACA just because of the slowness with which bureaucracies move.  It is hard to see how legal wrangling will delay anything, given that the U.S. Supreme Court has spoken on the issue
.

You'd be surprised at what a party resistance can accomplish.. but I won't speculate.

Quote
6.  tallmanusa said:  "In a democracy, the majority, even by 1%, decides the issue ...".  First, we are a Republic, not a democracy ("I pledge allegience to the flag, and to the Republic for which it stands").  Second, because we are a Republic, not a democracy, the court system serves in part to protect us from the "tyranny of the majority"  There are many instances in which the majority has spoken, yet the court has given the victory to the minority.  Never could understand why the "tyranny of the minority" is any more desireable than the "tyranny of the majority", but ...  In the case of the ACA, and regardless of what the majority may wish, the U.S. Supreme Court has ruled in favor of the Federal Government's position.

Yes indeed, they rammed it down our throats, and down the throats of medical providers. Whenever that happens look for other ways for those "wronged" to get ahead, get even or find a way not to deal with it all.. which is what is going to lead us to a collapse.. My prediction.. by 2017 we will be in full blown crisis mode in the healthcare industry.


Quote
7.  If a biller is doing a proper job, they are going to catch coding mistakes on the part of the doctor.  Either he did not code for work that was actually done (a good biller can catch that, if doctor did "A", that means he also had to do "B", but he hasn't coded for that), or he coded the work incorrectly.  With a paper fee slip or superbill, you can send that piece of paper back to the doctor and have him make the changes on it.  Then, what the biller bills for matches exactly what the doctor has written on a piece of paper.  There will never be any question of the biller billing for things the doctor didn't order.  Consider an EMR.  How do the required changes outlined in this point get made?  Biller talks to doctor, maybe by phone.  Doctor says, "Oh, thanks for the heads up.  Go ahead and make the necessary changes before you send your file off to the clearinghouse" - and then forgets to make (or is locked out of making) changes to the EMR to reflect the new charges the biller submits.  Now, in an audit, the biller has billed for things that are not present in the patient's electronic chart.  That is a big no no for billers, and penalties can be stiff.  Not having a paper trail that matches exactly between what the doctor did and what the biller billed is laying the groundwork for some potential problems that not many people seem to be discussing.

Agree.. nothing there I don' t agree with. My clients will be advised to maintain the proper documentation trail, people also forget that CMS will issue penalties for not complying with EMR, however I won't have to worry about this, I won't have a single provider left in the Medicare/Medicaid program.

Quote
8.  tallmanusa said:  "Doctors have to adopt EMR by 2015".  A bit more complicated than that.  A doctor who doesn't meet Medicare requirements by 2015 will have Medicare payments reduced by 1%.  That increases to 2% in 2016, 3% in 2017, 4% in 2018, and maybe up to 95% depending on future adjustments.  This is a big non-issue for doctors who are not Medicare providers.  If these penalties are actually imposed, I think we will see a significant exodus of doctors from the Medicare program.  Maybe to be replaced by PAs taking over the care of Medicare and Medicaid patients.

Quote
Exactly..  I've already seen this. I have ONE client left in my billing company to transition OUT of Medicare. My consulting clients are mostly those transitioned or will be transitioned out of Medicare and Medicaid.


Quote
9.  tallmanusa said "offer EHR to every provider, as Obamacare mandates it".  First, the ACA does not mandate the use of EMRs.  It simply reduces payment to Medicare providers as discussed in the previous point.  Second, EMRs add about 1 1/2 hours to the work-day of those doctors that I know are using them.  EMRs have never been about increasing efficiency (they don't).  They are about collecting patient outcomes so that the Federal Government can aggregate them, data mine them, and come up with best practices for any given health issue.  Each doctor who chooses to use an EMR gives up about 1 1/2 hours of income every day just so the government will be able to collect this data (I've talked with data aggregator companies that are doing this right now).  Be careful about possible backlash if you don't make sure your potential client knows this before he takes on an EMR for the first time.  If you oversell the benefits to the doctor of an EMR (the benefits accrue to the government, not the doctor), you may lose him as a client.

I happen to agree with this as well. I'll also add that I have no problem admitting to my clients (both billing and consulting) that I'm more comfortable referring them out to an EMR provider, I don't plan to have anything to do with implementation of EMR. I won't lose because of this.. I'll actually gain from this :)

One more note:   If you are a healthcare administrator, practice manager, physician, provider, biller or consultant, YOU will be behind the 8 ball if you don't LEARN and understand the ACA.   It cost about $200 (shop around) to have the full bill printed, It's in your best interest to have it in front of you so you can educate the providers you will be working with.
Title: Re: Is Obamacare Good for Billing business?
Post by: DMK on November 30, 2012, 11:24:34 AM
Once again, Linda, you astound me with your common sense and knowledge of this industry, and your ability to put it in terms without emotion.  (Something I can't seem to do, I'm pretty emotional about our income!)

Being prepared and well informed will help us educate others.  It's great for people to be optimistic, but they have to hear it ALL, not just what they want to hear.  There are big changes coming in health care, and they are not all going to be good.
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 30, 2012, 03:30:07 PM
Quote
Once again, Linda, you astound me with your common sense and knowledge of this industry, and your ability to put it in terms without emotion.  (Something I can't seem to do, I'm pretty emotional about our income!)

Hmm.. See I can't HELP but get emotional when it comes to this topic...But I thank you for the compliment if I'm hiding it well!!!  I do hold back a lot of things I could say.. My tongue has been very sour now for the last 4 years. LOL
Title: Re: Is Obamacare Good for Billing business?
Post by: RichardP on November 30, 2012, 04:36:51 PM
rdmoore2003 - you said "I posted a "sarcastic" reply ..."  I couldn't tell whether or not many comments were being sarcastic or serious.  Which is why I began my comment with the question Am I missing something here?  Thanks for clarifying your position for me.  Maybe other readers who don't know you will also think you were being serious, and will benefit from your response.

DMK - thanks for the heads-up about some religeous folks equating buying insurance to gambling.  Hadn't heard that one before.  Wonder if these folks also do not have car insurance.

My personal opinion is that the ACA is a very poorly-put-together piece of legislation.  Hopefully, over time, the bad stuff can be fixed piecemeal.  My political opinion is that the ACA was passed for the benefit of the healthcare insurance industry, not for the benefit of the common folk.  But I agree that this is not a political board, and I am not intentionally putting political opinion into my posts.

Finally, you said "My insurance company cites ... as well as "increased physician fees".  That one throws me.  The insurance carriers tell my clients what they will be paid, take it or leave it.  My clients do not begin to have the clout to tell the insurance carriers what they demand to be paid.  However, I do understand that doctors and doctors groups are begining to form into large affiliations so that they can indeed negotiate better payments for their member physicians.  Perhaps this is what your insurance carrier meant by what they said.

Linda - you seem to be saying that it is not a tax - the ACA "penalty" for not purchasing health insurance.  I don't have time to look it up right now, but I believe that was the pivot point of Chief Justice Roberts' opinion.  I think I remember the analysts saying that the genius of Roberts' opinion was that he carefully laid out all of the reasons why the Federal Government could not force folks to purchase something under the Commerce clause (this sets very clear boundaries on what liberal Federal governments can try to foist on the public in the future, but there has not been much focus on that part of the opinion).  Then Roberts affirmed the right of the Federal Government to levy taxes.  Basically, he said that the Federal Government had no constitutional ground to force you to buy something, but they could penalize you with a tax for not buying it.  If I remember correctly, there were mighty squeals when the opinion was released, and all of the sound-bites were hauled out where Obama - selling the idea to the public - kept insisting that the penalty was not a tax.  And then the ACA survived the U.S. Supreme Court only because Roberts labeled the penalty a tax, and then said the act was constitutional because the Federal Government has a constitutionally-given power to tax.  The President sold the act on the basis that he was not raising taxes, and then Roberts ruled in his favor by ruling that the penalty was indeed a tax.  Does any of that sound familiar to you?

This is border-line political discussion here.  But you have many readers passing by and I don't want them to be misled or you embarrassed.  When I have the time, I will research this (or someone else might beat me to it).  If I am remembering things incorrectly about the Roberts' opinion, I will be the first to admit to it.
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on November 30, 2012, 11:37:04 PM
Quote
Linda - you seem to be saying that it is not a tax - the ACA "penalty" for not purchasing health insurance.  I don't have time to look it up right now, but I believe that was the pivot point of Chief Justice Roberts' opinion.  I think I remember the analysts saying that the genius of Roberts' opinion was that he carefully laid out all of the reasons why the Federal Government could not force folks to purchase something under the Commerce clause (this sets very clear boundaries on what liberal Federal governments can try to foist on the public in the future, but there has not been much focus on that part of the opinion).  Then Roberts affirmed the right of the Federal Government to levy taxes.  Basically, he said that the Federal Government had no constitutional ground to force you to buy something, but they could penalize you with a tax for not buying it.  If I remember correctly, there were mighty squeals when the opinion was released, and all of the sound-bites were hauled out where Obama - selling the idea to the public - kept insisting that the penalty was not a tax.  And then the ACA survived the U.S. Supreme Court only because Roberts labeled the penalty a tax, and then said the act was constitutional because the Federal Government has a constitutionally-given power to tax.  The President sold the act on the basis that he was not raising taxes, and then Roberts ruled in his favor by ruling that the penalty was indeed a tax.  Does any of that sound familiar to you?

the Supreme Court decided in  5-4 decision that Obamacare’s individual mandate was a constitutional “tax,” even though Congress did not consider it to be a tax but rather a penalty for not buying health insurance.   So in essence we're both right.."Penalty Tax"  where it will differ however is that if you owe for example back TAXES... the IRS can impose levy's and garnishments.. with this particular tax/penalty they won't be able to. So that's where it gets "fuzzy" on what we call it.. tax/penalty.  It's still a screw either way.  :P ::)
Title: Re: Is Obamacare Good for Billing business?
Post by: RichardP on December 01, 2012, 01:34:48 AM
Thanks.
Title: Re: Is Obamacare Good for Billing business?
Post by: DMK on December 03, 2012, 10:53:01 AM

DMK - thanks for the heads-up about some religeous folks equating buying insurance to gambling.  Hadn't heard that one before.  Wonder if these folks also do not have car insurance.


One of the groups were the Amish, so, no, they would not have car insurance.  ;D  But you see where I'm going with this!  If you can't make people buy (or keep) auto insurance (and they drive!) how are you going to keep track of purchasing and keeping health insurance?  And, don't get me wrong, I truly see the good intentions of the ACA, I just don't think it's possible for it to work the way they expect it to.
Title: Re: Is Obamacare Good for Billing business?
Post by: davidharvey on December 27, 2012, 07:20:20 AM
Chances are you haven’t read all thousand pages of the Patient Protection and Affordable Care Act.

If you did chances are you are one in a million. Give yourself a high-five.

For the rest of us slackers, we thought we’d take a shot at explaining just how ‘Obamacare’ will effect small businesses when it is fully implemented next year (an area of great contention).
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on December 27, 2012, 08:38:05 AM
Quote
Chances are you haven’t read all thousand pages of the Patient Protection and Affordable Care Act.

If you did chances are you are one in a million. Give yourself a high-five.

Do I get a double high five as I took it to Staples on flash drive and printed it out, went through it and used a color flag system through it. Every time I turn around someone is sending an email with all kinds of rumors and on what pages they are so it's easy to debunk them.. however the sad thing is there are things in there never brought up yet that will come out and bite us all on the nose.  For example, we think it's great there's no more pre-x right? well billers and those that verify benefits and do claim appeals get ready for a nightmare abound. 

Scenario:  Family of 3 decides they are fairly healthy, they decide not to purchase a plan right now, their kid has soccer camp and mom needs a new car desperately so they really can't afford the $3500 premium for a decent plan with fair deductible.. they make out slightly better with the penalty tax and well, they just don't have to pay it, if they can't.. no big deal.  Later on their kid gets sick so Dad says, we better get a policy, we'll get one now and worry about the cost later, they purchase and pay first premium, he has some doctor bills and then they drop coverage. Oiy vey can you see how this will go ?

There are a bunch of scenario's I can come up with, main idea is that since there is no pre-x, there's NOTHING to stop people from purchasing plans, canceling them, switching them, not telling providers their terminated or bills getting sent in after verifying they had coverage only to find out they didn't pay their premiums. If you have ever dealt with patient's on Cobra, you know that can be a pain, so imagine that with 25-30% of your patient load?? 

Title: Re: Is Obamacare Good for Billing business?
Post by: RichardP on December 31, 2012, 05:58:08 PM
When Congress passes a law, the relevant agencies must then write the regulations that will implement the law.  Most of those regulations remain unwritten at present.  I'm sure that the kinds of contingencies you referred to will eventually be covered by a regulation somewhere.  Look for the insurance carriers to create a loophole that will allow them to not cover folks who purchase insurance and then drop it.  Law only says you can't deny coverage because of pre-existing medical conditions.  Law says nothing about denying coverage for reasons other than medical conditions.
Title: Re: Is Obamacare Good for Billing business?
Post by: PMRNC on December 31, 2012, 09:17:40 PM
They publish to federal Register, yes of course I expect amendments, I bet there will even be delays.  My point is there were SO many loopholes it's further proof they had NO idea what was in this when they rammed it through.
Title: Re: Is Obamacare Good for Billing business?
Post by: RichardP on January 02, 2013, 03:09:46 AM
Linda said:  yes of course I expect amendments ...

Not sure about your word amendments.  Don't know if you thought I meant regulations were amendments.  They are not.  Maybe you already know that??

Laws are passed by Congress and the relevant agencies write regulations that state how the law will be implemented.  The law cannot actually be implemented until those regulations are written. The law is the policy, and the regulations are the tactics for how that policy will be implemented, if you will.  That is why States are so hesitant to set up insurance exchanges.  The regulations that govern that process have not yet been written and the States are leery of doing something that will be deemed incorrect by the regulations yet to be written.

The fun laws written by Congress are those that require the relevant agencies to spend money in order to carry out the law, but provide no source of funds for the agencies to do what they need to do.