It’s practically undebatable that vast financial pressures are affecting most U.S. doctors negatively – one of these is the need for ever more expensive malpractice insurance, along with current guidelines for medical care that some doctors feel are unfairly based on strict conditions related more to avoiding liability than to actually curing the patient. While this kind of economic and philosophical problem is a huge one for doctors, it’s not the only reason that many of them are choosing to shutter their practices and move into other jobs. There’s also the explosion of complicated protocols and contractual obligations related to billing insurance companies, which is becoming a greater share of accounts receivable for the typical doctor’s office. Then there are the many growing issues with collecting from patients, as American families continue to feel the sting of the 2008 financial collapse and the subsequent recession, along with high unemployment.

But although there are a number of very real reasons for doctors to give up their independent practices, there’s also a large emotional side of this choice for many of the doctors who decide to leave their profession, or get into an employee situation, such as a hospitalist’s job, with less responsibilities for managing provider administration. Doctors simply feel overburdened and overwhelmed, and in some cases, they may not be relying on partners that could help them rejuvenate a struggling practice. Third-party medical billing consulting firms and other enterprises are built to help doctors outsource some of the headaches of the medical profession, so that they can focus on healing patients, while benefiting from best current practices for billing and collecting money. This is definitely something to think about for doctors to really don’t want to stop doing what they have been doing, and who feel invested in the medical profession. It’s a scary world for today’s physician, but many doctors are finding that by using competent and competitive third-party services, they don’t have to go it alone.

In addition to all of the medical billing changes projected for this year, and entitlement reimbursement legislation that's challenging America's physician practices, there's another item that many doctors are paying attention to that is related to Medicare and Medicaid. It's called a RAC audit and involves recovery audit contractors who work on behalf of entitlement programs to spot Medicare or Medicaid fraud or other types of overpayments.

It's no secret that Medicare and Medicaid fraud are massive problems within the American healthcare industry. However, for the majority of physician practices that operate honestly, RAC audits are less likely to turn up actual fraud but more likely to turn into a huge hassle for a struggling medical business that's trying to treat patients every day, collect accounts receivable and comply with all of the extra work of identifying payers and maintaining patient records.

The Daily Practice Blog, a resource for physicians, offered some tips late last year about how to handle these RAC audits including:

• Have an up-front policy and a strategy for responses to external inquiries. Most physicians know that these auditors can pull a certain number of patient charts, and forward thinking physicians are directing staffers on how to do this if it should become necessary.
• Doctors who are anticipating this kind of audit will also think about when it makes sense to appeal an auditor's decision and when that appeal may be more trouble than it's worth.
• Another big step provided regards medical necessity, which, as many physicians know, is a frustrating, subjective term that can often seem like an unfounded attack on a physician's judgment. But as experts in these types of audits point out, problems are often related to a lack of documentation or explanation rather than an actual challenge to the medical necessity of any given procedure, especially since the great majority of physicians are extremely likely to go by the book in terms of diagnosis and subsequent treatment.

So, as medical businesses get ready for 2012 and the Centers for Medicare and Medicaid Services prepares to ramp up RAC audits, go forward boldly, developing a competent response plan, so that you can rest easy about this eventuality and get back to treating patients. Good patient documentation will help you with audits, and will also help with all of the many potential problems related to medical billing to insurance companies, entitlements and patients, leaving your medical office better able to accomplish its goals in the new year.

With all the other pressures now directed at doctors in the form of medical malpractice insurance requirements, medical billing problems, and the push toward more sophisticated electronic health record systems, there are also big changes coming along in terms of government reimbursement for medical procedures. One of these proposed changes comes in the form of Accountable Care Organizations or ACOs that may replace other reimbursement models for government entitlement programs like Medicare and Medicaid.

In government materials presented to the public by the U.S. Department of Health and Human Services on the Healthcare.gov website, the federal government describes the adoption of Accountable Care Organizations as “paying physicians based on value, not volume.” This goes along with other recent descriptions of these Affordable Care Act provisions by legislative and executive political figures. The debate over Accountable Care Organizations has been somewhat vigorous: some government figures and others contend that these changes will help to provide medical offices with incentives to perform more applicable treatments to patients depending on their specific health conditions. Critics of the programs say that they could lead to “rationing care” as doctors evaluate the mandates of the affordable care act in a down economy.

According to Healthcare.gov, these changes are expected to be effective January 1 of 2015. This gives offices just three years to anticipate what ACOs would contribute to the overall climate of medical billing and reimbursement for their practices. The creation of Accountable Care Organizations by the new healthcare reform act is only part of what worries many providers about taking on Medicare and Medicaid patients. It seems like each year, physicians struggle with changing reimbursement models and potential delays or downgrades in payments. Many doctors fear that the fundamental changes proposed in the new legislation may compound this difficulty, but like all of the other pressures related to medical billing, forward thinking doctors can meet with staff to plan detailed responses to issues around Medicare and Medicaid billing, in order to develop intra-office strategies that will help to streamline the payments that the medical provider can expect, not just from government programs, but from private insurance companies and patients alike. It takes creative and proactive measures to get a practice’s medical billing activities running at full speed, and the doctors with the most successful accounts receivable outcomes usually work hard at encouraging their staff to work smarter, and in many cases, harder, to resolve billing issues. This holiday season, doctors with qualms about upcoming health care mandates should take a page from this playbook, even if it means a few extra hours at the office.