How an Obamacare Repeal could Affect Medical Billing and Coding

A stated goal of the incoming Trump administration is healthcare reform, specifically repealing Obamacare. Is this a good idea, and what would the possible effects be on the medical billing and coding industry? Here’s what we know so far.

Effects of a Repeal

According to the Centers for Medicare and Medicaid Services, an estimated 10 million people received coverage through the health insurance marketplace. Approximately 85% of those received an APTC or Advance Payment of Tax Credit, with the average amount being $291 per month. As a result, many experts claim that repealing Obamacare would effectively leave millions of people without coverage.

That doesn’t mean that those who are currently covered under through the marketplace should panic. According to Texas Senator John Cornyn, Republicans are leaning toward a strategy that would repeal a good bit of the Affordable Care Act, yet keep other parts of it. The effective dates of any actions would be as late as 2020 in some cases, giving enough time for an orderly transition to any replacement the GOP might come up with.

What this Means for Medical Billing and Coding

One of the biggest proposed changes involves allowing private insurers to sell across state lines. If this were to happen, medical billing and coding specialists could find themselves dealing with more insurance companies than they are currently. However, this proposal would also force insurance companies to become more competitive, in which case there might be more consistency between carriers.

Another idea is to provide a “block grant” for Medicaid payments. In other words, states would receive funds in a lump sum along with general guidelines to follow. This would eliminate some of the more restrictive rules currently in place, eventually leaving providers with fewer denied claims.

The individual mandate has long faced scrutiny, and is likely to be one of the first things scrubbed. The removal of the individual mandate along with a push toward health savings accounts rather than insurance means that medical billing specialists could be dealing with private individuals more often, and would therefore need to come up with a plan for monitoring and collecting past due accounts.

Proponents of Obamacare often tout the fact that healthcare costs have remained stable over the past year as proof of it working. Even so, the GOP hopes to reduce those costs even further by making it easier for pharmaceutical companies to introduce new drugs, and by requiring “price transparency” for many hospitals and clinics. This could mean fewer dollars billed, although whether or not that would actually affect a physician’s profit margin remains to be seen.

Keeping up with Changes

Any changes to Obamacare are not likely to be immediate, nor are they expected to affect the medical codes themselves. Here at Leeward Medical, we anticipate there will be plenty of time to react to new laws and come up with a plan for transitioning. As always, we are staying up to date with the latest information, and will be ready to implement the appropriate changes when and if the need to do so arises.