Health Care Reform. PPACA. Obamacare. Affordable Care Act. No matter what you call it, the Patient Protection and Affordable Care Act (PPACA), which was signed by President Obama in 2010, is a sweeping overhaul of the U.S. health care system that has changed the landscape of health care in America.
Since the roll out of the PPACA law will continue for years, America is very much in a period of health care transition. A July 2014 study by The Commonwealth Fund found that 9.5 million adults have recently become insured under the Affordable Care Act. Further, according to the study of over 4,400 adults, “By June, 60 percent of adults with new coverage through the marketplaces or Medicaid reported they had visited a doctor or hospital or filled a prescription; of these, 62 percent said they could not have accessed or afforded this care previously.” The study also found that 78% of these newly insured adults were satisfied with their new insurance, meaning they will most likely continue to use it.
Additionally, most of those who previously declined coverage under the Affordable Care Act will probably join in the coming years as monetary fines continue to increase. In the first year, the fine for remaining uninsured was $95 per adult and $47.50 per child, or 1% of family income, which is still below the cost of paying for insurance. Many people opted to pay the fine because the price was not prohibitive.
In 2015, however, the penalty will increase to $325 per adult and $162.50 for child. Fast forward to 2016 and beyond, and the penalty for not carrying insurance will grow to $695 per adult and $347.50 per child, or 2% of family income, whichever is greater.
As you can see, these fees will encourage more Americans to join the health care exchange or an employer sponsored plan to take advantage of their insurance coverage while avoiding fines. Considering just the current numbers reflected in The Commonwealth Fund study, 5.7 million new people have accessed a health care service this year. And what do all of these new insured Americans and the doctors or pharmacists they visit have in common? Their transactions are all run through coding and billing programs, generating bills to be sent to the insurance company, government-sponsored program or directly to the patient.
These transactions are processed by labeling each with a code or a series of codes from the Current Procedural Terminology (CPT). The CPT contains thousands of codes and classifications, and is authored by the American Medical Association. These codes cover everything from office visits to surgeries and diagnoses. There is even a code for stitches on a one-inch long cut on the arm. Codes are very specific and change regularly.
How the Health Care Reform Affects Medical Billing and Coding Professionals
In addition to the quickly growing pool of Americans who are insured, another important factor is having an impact on medical billing and coding professionals: transparency for consumers. Previously, patients were at the mercy of doctors, billing professionals, labs, hospitals and insurance companies to ensure that all of their information and procedures were entered correctly. Now, there is a trend towards arming patients with more information so that they know the cost of all of the medical care ahead of time and can even comparison shop for the best price and care.
In 2012, UnitedHealthcare launched a “myHealthcare Cost Estimator” that would allow people to search for costs based on the procedure given. This one estimator alone yielded 900,000 downloads for $2.3 billion worth of estimates. In late July, UnitedHealthcare launched a free app called “Health4Me” that will help even more Americans make informed decisions about the costs of their health care.
For example, searching for an MRI on your knee in Salt Lake City Utah could result in a nearly $1,000 cost difference. Back surgery revealed a nearly $20,000 difference between different surgeons and locations. Or to consider a real life example, one user of the Health4Me app wrote, “This app was a Godsend when choosing a facility and doctor to perform my recent surgery. I was able to verify everything as ‘in-network’ prior to scheduling the procedure and estimate how much of a loan I would need to take out to meet the expenses not covered. Indispensable planning tool.” Never before have patients had direct access to this type of information.
Another impact that health care reform has on billing and coding is modifications in reimbursement rates and allowances for patients. Nearly all insurance plans, whether they were on the federal or state exchange, have changed coverage as a result of the Affordable Care Act. The government sought to offer insurance to more people, while simultaneously keeping costs down. It will take time and due diligence to help all of the parties involved know what those changes mean for them.
For example, when billing and coding for a physical therapist, a patient with a recently updated employer plan may no longer be covered for as many therapy sessions per plan or the reimbursement rate for those sessions may have been reduced. Communications with the patient and insurance company is critical; otherwise, the patient may receive therapy that is not covered, or they won’t take advantage of all of the sessions available. In another more common example, the type of blood work covered at an annual physical may have changed. If this is not discussed with the patient ahead of time, he or she could receive a large unexpected bill from the lab.
Another issue that will impact health sector is the aging of the largest generation of Americans: the Baby Boomers. As they age, the Boomers will shift from private insurance to Medicare and will need more medical attention, procedures, and care. It is estimated that over 65% of seniors experience multiple chronic conditions, all of which need a doctor’s specialized care.
In just sixteen years, 20% of all Americans will be senior citizens, nearly double the percentage of the populate that were seniors in the year 2000. To further compound the issue for health care professionals, Baby Boomers are living much longer, with life expectancy now at age 74 for both men and women.
Given the influx of new patients from the Affordable Care Act, as well as the tsunami of Baby Boomers living longer with more complex health care needs, it only makes sense that there is also a growing need for more doctors. A recent study estimates that the demand for doctors will grow 15% by the year 2025. In some states, specialty doctors are particularly needed. In Nevada, the need for cardiologists is projected to grow by 51%. How does this need for doctors impact coding and billing? If doctors are to care for their patients and manage individualized medical care, they will need skilled professionals to manage the coding and billing of those services, communicate with insurers, and run the business side of the practice.
You may have noticed that in your local area previously independent physicians’ offices have been purchased by hospitals. This also impacts billing, as hospitals move the physician’s billing in house or move to a third party billing company. Both of these factors translate to new job opportunities for those with medical billing and coding certification.
While much ink has been spilled about the politics and legality of the Affordable Care Act, there are many parts of the relatively new law that impact the administrative roles of coding, billing and reinforcement. These have been less popular to write and talk about, but they are important. The Health Care Billing and Management Association rightly points out that the law also impacts claim status reporting, Electronic Remittance Advices (ERA) and Electronic Funds Transfer (EFT).
Medical Billing and Coding Training
As patient load increases and patients become more well informed about costs and procedures, the field of medical billing and coding will most likely grow exponentially as well. Courses of study like the Medical Insurance Billing and Coding Diploma Program and training as a Medical Insurance Billing and Coding Associate of Applied Science (AAS) at Vista College are pathways to a rewarding career.
Vista College also offers career service assistance, which provides guidance throughout the employment process. It also includes resume and cover letter review, interview skill training, and a customized job-search strategy. These career service resources are also made available to graduates for the rest of their lives, which will be beneficial for future job placement. Financial aid is available for those who qualify; medical billing and coding training online courses are available.
A profession in billing and coding also allows for a career change or employment in a new field without the investment of years of schooling. The Medical Insurance Billing and Coding Diploma Program can be completed in as little as 50 weeks and can be done at one’s preferred pace. Coursework for this program includes classes on medical terminology, medical insurance, pharmacology, health information management, and computerized medical billing.
The Medical Insurance Billing and Coding Associate of Applied Science program could take less than two years for full-time students to complete. Coursework for this program includes anatomy and physiology, pathology, pharmacology, and an introduction to the ICD-10, the World Health Organization’s International Statistics Classification of Diseases and Related Health Problems.
The ICD-10 contains more than 16,000 diagnosis and treatment codes, as well as additional sub-classifications. The American health care industry will be transitioning to this edition in the coming years, and it will mean not only learning new codes, but also the updating of the electronic system used by the practice or hospital. While other countries are already using ICD-10, the roll out in the United States has been slow. The Department of Health and Human Services had first regulated those ICD-10 codes be used effective October 1, 2013. Congress has since delayed that implementation date to October 1, 2015, at the earliest.
The roll out and implementation of these new billing codes contained within the ICD-10 creates a perfect moment of opportunity for those who want to enter the field of medical billing and coding. There will be a need for trained personnel. According to www.explorehealthcareers.org, “Because physicians and hospitals depend on accurate coding to receive proper reimbursement, the role of the coder is becoming more valued.”
Beyond an interest in health care, attention to detail is particularly important in this position, as every patient’s chart must be carefully reviewed to ensure every service provided is listed. Additionally, those working in medical coding and billing must be able to adapt to change as new classifications and procedures are added regularly. As the Affordable Care Act continues to be implemented, new care programs, reimbursement models, and wellness incentives are commonplace. Those with professional medical billing and coding training will be able to adapt to these developments.
According to the Occupational Outlook Handbook published by the Bureau of Labor Statistics (BLS), the outlook for jobs in coding and billing for insurance reimbursement is very strong. In fact, the BLS projects this field to grow 22% by the year 2022 which is much faster than other professions. The national median salary for the field is $34,160 or $16.42 per hour. While wages will vary depending on location, according to the BLS the national salary range is $22,250 to $56,200.
Projections from the BLS released in late 2013 reveal that “Elderly Boomers will need more health care…The health care and social assistance industry will grow an average 2.6% a year and comprise nearly a third of the 15.6 million U.S. job gains during the 10-year period…Nearly half of the 30 fastest-growing occupations from 2012 to 2022 will be health care-related.”
Of course those with medical billing and coding certification have an impact on the running of the doctor’s office, clinic or hospital in which they work. That much is clear. But they also have the ability to help people when they are most in need: sick, facing a surgery, or worried about costs.
For example, a woman calls the doctor for whom you work nearly in tears because she received a test that she thought was covered but now knows is not. Your boss, busy with other patients and unfamiliar with codes and billing, hands the call to you. You are able to look up the cost of that procedure and help her understand the next step. By the time you get off the phone, she is calm and appreciative. Your boss is also happy because she is able to stay involved with patients and the clinical side of her practice instead of worrying about billing and codes.
Whether or not you agreed with the passage of the Affordable Care Act, also called “Obamacare,” one thing remains certain: Americans are going to continue to get sick and seek out health care. Once they receive that care, doctors will bill either the insurance company, Medicare, Medicaid or the patient to receive payment for their services. There is a fulfilling and growing career path within that process of helping to plan and budget for medical expenses.
The Affordable Care Act has greatly changed the professional landscape for medical coders and billers. There are ways to take part in the growing field of health care without scrubbing in every day and committing many years to advanced schooling. Those with medical billing and coding certification can make a real difference in people’s lives and in the health care industry.