decisionhealth Newsletters, Part B News - 2018 Issue 1 (January)
Providers take on risk, OCR goes after ‘juicy’ violations, MIPS habits change and more
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Article Overview
This Part B News article compiles expert predictions for how physician practices may be affected in 2018. It covers broad changes in Medicare Advantage, outpatient surgery site-of-service, MIPS participation trends, calls for quality payment reform, practice mergers and acquisitions, HIPAA enforcement, fraud and overpayment scrutiny, adoption of new preventive and behavioral health codes, movement toward risk-based contracting and ACOs, interoperability efforts, and the impact of ACA-related policy changes. It is most relevant to physicians, practice managers, compliance teams, coders, and revenue cycle professionals tracking payment and regulatory shifts.
Why This Topic Matters
The article helps practices anticipate policy, reimbursement, compliance, and operational developments that could affect reporting workflows, payment strategy, risk exposure, and organizational planning in the coming year.
Article Sections
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Medicare Advantage participation growth
Discussion of expected enrollment and revenue trends in Medicare Advantage and related payer behavior.
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Ambulatory surgical center changes
Coverage and site-of-service policy developments affecting outpatient orthopedic procedures and hospital outpatient settings.
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MIPS competition and reporting behavior
Predictions about participation patterns, performance targets, and reporting intensity in the quality payment program.
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Calls for MIPS reform
Expected debate over the structure and future of MIPS, including cost-related program changes.
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Medical practice mergers, acquisitions, and diversification
Industry consolidation trends, private equity activity, and expansion into non-traditional ancillary businesses.
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OCR enforcement and HIPAA risk
Heightened privacy and security enforcement expectations, including cybersecurity and breach-related concerns.
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Overpayments, fraud, and enforcement
Use of analytics, audits, and fraud actions to pursue overpayments and alleged violations.
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Adoption of new preventive and behavioral health codes
Expected practice uptake of newly available reporting options tied to preventive care and behavioral health services.
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Movement to risk-based models and ACOs
Growth in downside-risk arrangements, accountable care organizations, and advanced payment models.
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Interoperability policy efforts
Federal activity aimed at improving electronic health information exchange and defining interoperability.
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ACA mandate repeal and state responses
Potential market, premium, and program impacts from changes to the individual mandate and possible state-level responses.
What You Will Learn
- How major payment and delivery trends may affect physician practices in 2018
- What types of compliance and enforcement issues practices are being warned to watch
- Which broad reporting and risk-based care themes are expected to shape provider strategy
- How policy changes may influence practice consolidation and market behavior
Who Should Read This
- Physicians
- Medical practice managers
- Certified professional coders
- Revenue cycle staff
- Compliance officers
- Healthcare consultants
Codes Discussed
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