Medical Billing and Coding and Healthcare Reform

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By DeVry University

April 29, 2021
5 min read

If you've kept up with the current healthcare discourse in the United States over any length of time, you've likely heard people bring up the idea of healthcare reform. As you may have already guessed, medical billing and coding and healthcare reform closely relate to one another, perhaps even more than you'd expect.

To give you a sense of the impacts that healthcare reform could have on the medical billing and coding field, we'll take you through some of the different healthcare reform options that are being proposed.

What is Healthcare Reform?

Healthcare reform, sometimes known as health reform, refers to any significant change to the existing healthcare model of the United States. One example of healthcare reform in recent history was the passing of the Affordable Care Act (ACA), which expanded coverage for both public and private insurance and made it affordable to more people.

Because healthcare reform includes anything that meaningfully affects any part of the U.S. healthcare system, it can be difficult to identify how various reforms directly impact any particular sector of the medical industry. For instance, a piece of healthcare reform that increases the number of insured Americans by expanding private companies’ responsibility to pay for health insurance may not have a significant impact on medical billing and coding. On the other hand, a more far-reaching reform, such as Medicare for All, would likely result in major changes to how health insurance is administered, and would be more likely to have an noticeable impact on many medical billing and coding careers.

How is Healthcare Reform Expected to Impact the Medical Billing and Coding Profession?

As with many things related to healthcare reform, it's hard to determine exactly which acts will pass and which won’t. Here's a quick overview of some proposed healthcare reforms that are either highly discussed, recently passed or in the political pipeline and how they could affect the medical billing and coding field:

No Surprises Act: Congress enacted the No Surprises Act effective as of January 2022. This piece of legislation more thoroughly defines the act of surprise billing in an effort to protect patients from unexpected medical charges. Additional rules are still being written to define exactly how this will impact both patients and care providers.

Because this piece of healthcare reform specifically affects medical billing, people in the medical billing and coding industry should pay close attention to the development of the regulations associated with this healthcare law. Some immediate impacts are the addition of new notice and consent requirements, rules regarding the billing of post stabilization care at hospitals and requirements to provide good faith estimates for uninsured patients.

Ensuring Lasting Smiles Act: The Ensuring Lasting Smiles Act is a piece of upcoming legislation that would require private insurance groups and health care plans to cover any medically necessary services resulting from a birth abnormality. In particular, this bill focuses on dental care and only includes medically necessary, non-cosmetic procedures.

From a medical billing and coding perspective, this bill would likely change how certain procedures are billed to insurance providers by expanding the number of procedures that fall under the patient's coverage plan.

Medicare for All (M4A): One of the most significant of the healthcare reforms being discussed may be Medicare for All. Medicare for All is the concept of applying Medicare coverage to all Americans, resulting in a system where a significant number of healthcare procedures are directly covered by the government.

Because of the scope of M4A legislation and the many ways it could be implemented, it's difficult to tell how healthcare reform and medical billing and coding may be affected, although an initiative of this scale would have major implications on the entirety of the healthcare industry in the United States, including medical billing and coding.

Learn More about Healthcare Reform and Laws in Our Medical Billing and Coding Undergraduate Certificate Program

If you're interested in learning more about healthcare reform and medical billing and coding, our online Undergraduate Certificate in Medical Billing and Coding program is a great place to start. You'll learn about concepts such as health insurance and reimbursement processes, how to classify medical data and current procedural terminology. You'll also have the chance to learn more about the existing healthcare system in the United States and the healthcare laws surrounding it. Classes start every 8 weeks.

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