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Medical Insurance Update Roundup

By July 12, 2017 No Comments

The healthcare industry is constantly changing, especially in the department of medical billing. With the influx of new codes brought by the ICD-10 revisions and a shift to value-based care, it’s hard to keep up with all the updates.

We’ve compiled a few medical insurance updates that have come up this past year.

Implementation of ICD-10

Since October of 2015, practices have had time to prepare for the addition of 68,000 new medical codes. This includes a 2016 update that caused a glitch and impacted the physicians’ quality reporting system (PQRS). Many physicians were almost fined for it. CMS took responsibility for the glitch and decided against penalizing, but the jury is still out on when they’ll be fixing the update.

CMS Final Rule on Two-Midnight Rule

While finalizing the Medicare payment rates last year, CMS filed to permanently remove the adjustment of compensation for inpatient services related to the “two-midnight rule.” That’s an estimated $220 million payment cut related to this policy, and increase of $746 million in inpatient hospital spending.

Emergency Department Surprise Billing

Recently a hot button topic, “surprise bills” are sent to patients getting care by physicians who are out of their network. It has been a huge problem for Texas, between 41 and 68 percent billed at in-network facilities were billed as out-of-network emergency room physician services. This policy change will be something to look out for in 2017.

Open Enrollment Numbers

Since November 1, 2016, almost 9 million Americans have signed up for health insurance through HealthCare.gov. Compared to the previous year, this is 200,000 more people who signed up. CMS says that this is a clear message that Americans demand affordable, quality insurance. What will this mean pending the repeal of ACA? We’ll soon find out.

At MRC, we are committed to assisting clients through their medical business challenges. That’s why we stay ahead of the curve on any updates regarding medical coding, billing and regulatory compliance. Talk to us today about how we can help.