Recent changes in the US medical industry are posing challenges for independent practices. To keep your behavioral health practice running smoothly, stay aware of the changes and learn how to navigate them.
The US Government required medical practices to transition to the International Classification of Diseases—10th revision (ICD-10) by October 2015. Transitioning to ICD-10 is a requirement for every practitioner to comply with the Health Insurance Portability and Accountability Act. ICD-10 was introduced to update the 30-year-old previous system — and facilitates collection of more information regarding patients’ medical conditions.
This newer version of ICD allows providers to be more specific in their diagnoses. It does not contain diagnostic information. It is a listing of disease names and their corresponding codes.
Practices that have not yet made the switch are risking claims denials. Another challenge with the new system is the cost of implementation. The American Medical Association estimates that a practice could spend between $56,639 and $226,201 to get the new system.
Affordable Care Act (ACA)
Affordable Care Act (ACA) is affecting the way private practices get paid. The Act has spurred the shift in reimbursements from fee-for-service model to a value-based payment model. The ACA now requires physicians to participate in the Physician Quality Reporting System (PQRS). Those who fail to comply face a 2% penalty in Medicare payments. This new method has pushed some physicians to stop accepting insurance to avoid claims submission hassles. Some practices are finding themselves suffering financially from the reduced income.
Physician Quality Reporting System
The Physician Quality Reporting System (PQRS) is a Center for Medicare and Medicaid Services (CMS) quality reporting program. PQRS originally offered payment incentives to Medicare providers who reported quality performance measures. However, 2015 was a turning point – with penalties assessed to providers who failed to report. All eligible professionals (including psychiatrists) participating in Medicare must submit data to avoid negative payment adjustments to their Medicare reimbursement. To participate, practitioners must report designated administrative codes on billing claims. This can be performed through a certified electronic health record (EHR) system, or through a qualified registry.