Why Deregulation Means A Need for Medical Coding Outsourcing

Healthcare revenue cycle leaders are headed into uncharted territory under the new administration, but there are a few signs that can be useful in charting a path forward. 

The first Trump administration featured a range of reductions in restrictions and loosening of prior regulations. For the healthcare revenue cycle, it’s impossible to know exactly what’s coming this term, but we can make a few predictions. 

Deregulation Will Drive Coding Complexity

Healthcare providers can expect an overall increase in revenue cycle complexity thanks to the likely rise in variations between states. For many revenue cycle departments, this might not have much of an impact, but for any team that is navigating medical coding services across multiple states (especially those supporting telemedicine), there will be greater variation in medical billing and coding. This increases the demand for staff training, updated workflows, and revised policies. 

To keep up, many organizations will need to conduct a thorough medical coding audit and make sure their documentation and compliance practices are still sound. Those already using medical coding outsourcing partners may be better positioned to scale expertise quickly.

Medicaid Changes and Patient Access Pressures

Patient access could also take a hit. Changes to Medicaid will mean shifts in reimbursement rates and even alterations in how individual states are structuring their programs. Some cuts could potentially trickle down to eligibility, impacting the front-end revenue cycle and causing ripples in payments and collections. 

Cutbacks to Medicaid will also likely mean an increase in uninsured patients and a need to keep a close eye on associated KPIs and the overall impact on revenue cycle health. This will be complicated by a proposed rule that will require Affordable Care Act (ACA) marketplaces to check consumer eligibility for special enrollment periods, making eligibility more burdensome. 

Opportunity Amid Uncertainty

But it won’t all be bad. In some areas, this new administration may usher in a less restrictive compliance environment. We’re looking at a time of more complexity, but also more opportunity. 

However, adapting to that complexity and capitalizing on opportunity isn’t something revenue cycle leadership should try to tackle alone. The pace of change demands outside perspective and support. Working with experienced partners in medical coding in USA can provide the high-level insights needed to navigate deregulation and stay ahead of evolving regulatory demands.

To learn how a partnership with 3Gen Consulting can help you respond to a new era of deregulation and uncertainty in medical coding services, contact us today.