Internal Medicine Coding Alert

Experts speculate how ACA could affect family physician groups.

June 28, 2012, marked a landmark decision day, when the United States Supreme Court upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA). As part of that decision, the Supreme Court also ruled that the requirement that all individuals have health care coverage or face a penalty was a tax, rather than a penalty. That meant the requirement was allowable under the Federal taxing authority.

If you've been wondering how the decision might affect your practice, read on for what some industry experts think.

Expect Doctor-Patient Relationship Changes

"I believe the Affordable Care Act 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. The question is who will care for these Medicaid patients? Will there be mandatory provider participation? Will providers who don't accept third party insurance be mandated to accept some -- or all -- policies?"

"I believe internal medicine and family medicine providers will be hardest hit financially," Brink adds. "Their 'volume of patients' will increase to cover costs, which could mean their staff will increase due to administrative needs, such a processing patients and insurance claims. That means more expense."

Look Ahead to Larger Patient Loads

"For family physicians, the current trajectory of the law, as upheld by the Court, means that many more folks will have insurance in a few years, which should increase the demand for primary care," says Kent J. Moore, manager of healthcare financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. "That, given the apparent shortage of primary care physicians, should mean a higher value placed on the services of family physicians and other primary care providers."

"The provision requiring parity with Medicare for Medicaid primary care services will also mean more money in the pockets of family physicians that treat Medicaid patients," Moore adds. "In short, the Supreme Court ruling may be good news for family physicians as physicians, as long as demand does not swamp supply. What it will mean for them as small business employers in relation to the insurance mandate is unclear to me."

Plan for Billing Changes

"It is not apparent that the Supreme Court ruling will have much impact on family medicine coders specifically," Moore says. That doesn't mean, however, that some things related to coding might not change.

"Don't forget the effects of PQRS," Brink points out. "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."

Prepare to Wait and See

"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."

"The next big hurdle for the law is the outcome of the Congressional and Presidential elections this fall," adds Moore. "Significant changes in the House, Senate, or White House could lead to legislative or executive action that might otherwise alter the law and its impact."  

"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."