Anesthesia Coding Alert

Get insider opinions from some experts in your field.

What does the latest news regarding the Patient Protection and Affordable Care Act (ACA) mean for the future of your anesthesia practice? Read on for opinions from three industry experts.

Background: A landmark decision was announced on June 28, 2012, when the United States Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA). The Court also ruled that the requirement that all individuals have health care coverage or face a penalty was a tax -- not a penalty, which meant it was allowable under the Federal taxing authority.

Compliance preparation: "This is hard -- there are so many pieces to PPACA," says Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions, Inc., in Leesburg, Fla. "From a business perspective, there is an intent to make compliance plans mandatory. Nursing homes are first, and other specialties should follow. This will add expenses to a practice that may not currently have compliance plans in place."

Relationship impact: "I believe the Affordable Healthcare Act law will have an impact on the doctor-patient relationship," says Catherine Brink, BS, CMM, CPC, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. "Remember the law's emphasis is on health insurance and for those who can't afford to buy health insurance, their coverage will be Medicaid. Therefore, the Medicaid program will get larger with more people (patients) on Medicaid. Who is going to care for these Medicaid patients? There a lot of practices, right now that don't accept Medicare or Medicaid and some even third party insurance. Will they be mandated to accept a certain percentage of Medicare and even Medicaid patients? Will providers who don't accept third party insurance be mandated to accept some or all policies?"

Billing changes: "Don't forget the effects of PQRS," Brink adds. "Providers will be mandated to comply with entering patient medical data, which translates to more administrative time for providers, which means less time for patients. The procedures for claims submission and processing by insurance companies undoubtedly will be impacted by increased volume. Billing staff time may increase to track claims and monitor reimbursement. Again, more billing staff may be needed " which will have a financial impact on practices."

Further interpretations: "There are certainly some good components of the bill, but also some pretty complex components," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. "It's a case of wait and see what happens -- time will tell if it will be good or not."

"Since the U.S. has never had a healthcare law that mandates everyone must have health insurance, I believe it is difficult to know or predict the effects it will have on providers and their practices," Brink agrees. "It is anyone's best guess right now."