There are several key public policy issues that could have an impact on ambulatory surgery center billing and coding next year. Here are five key updates on the PPACA marketplace, ICD-10 implementation and the sustainable growth rate.
1. Only 46 percent of PPACA marketplace enrollees say they're getting a subsidy to help cover their premiums, but the official number shows 85 percent receive a subsidy. Additionally, of those who know they are receiving a subsidy, 47 percent don't know the amount, according to a Kaiser Family Foundation report.
2. The ICD-10 implementation date has been delayed twice, and it could be delayed again. The current deadline is October 2015 — a one-year delay from the October 2014 deadline — but several physician groups are pushing for an additional two-year delay, according to the Journal of AHIMA.
3. The AMA stands behind its initial estimates that ICD-10 will cost $22,560 to $105,506 per practice depending on the size and location. This includes resources towards researching the implementation, educating coders and physicians and updating billing software. Practices could also see a loss during the first few months after implementation if their staff is slower to code and process claims.
4. 59 percent of healthcare providers expect the ICD-10 process to be difficult and the transition to slow their claims processing, according to a RevCycleIntelligence report. Only 6 percent expect their revenue to improve after the ICD-10 transition completes.
5. The sustainable growth rate has been a controversial topic for several years, as physicians stand to see huge cuts in reimbursement rates without Congress passing continuous bills to prevent them. Some hope the new Republican Congress can repeal and replace the SGR, but NASS advocacy chair John Finkenberg, MD, said in a recent interview the topic is two controversial to attack in the next six months before the 2016 election campaigning cycle begins.
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