Healthcare management is a growing field. The requirements of the Patient Protection and Affordable Care Act of 2010 (PPACA), require professional knowledge of every aspect of the provisions described by the law. As the industry undergoes changes, healthcare management professionals need to keep abreast of developments and take advantage of the career possibilities that present themselves. In three fields in particular, the opportunity for advancement through the mastery of skills is positive.
By keeping ahead of industry trends, healthcare administrators make themselves valuable to employers. Healthcare providers are not always enthusiastic about the administrative aspect of delivering medically necessary services. By mastering current issues in the field, administrators ensure demand for their knowledge and skills.
The big news in healthcare administration is the conversion from the current standard of ICD-9-CM and ICD-9-PCS to ICD-10. This new coding methodology greatly expands the number of codes used to describe medical diagnoses and services in order to submit accurate healthcare claims. The U.S. Department of Health and Human Services (HHS) has set the conversion date at October 1, 2014.
While the extension is welcomed by the healthcare industry, administrators need to be fluent in ICD-10 coding in order to ensure that software systems can process the new codes. In addition, certified ICD-10 coders must train other members of the healthcare team, both providers and back office staff, on the changes about to revolutionize the medical reimbursement process. As the medical coding landscape changes with the addition of thousands of new codes, proficiency with ICD-10 will be required by managers and staff alike.
The Center for Medicare and Medicaid Services (CMS) has increased the use of Recovery Audit Contractors (RACs) to ensure appropriate payment for medical claims and prevent healthcare fraud and abuse. As RAC audits become more commonplace, there is an increased demand for medical documentation specialists to review medical records both pre- and post-payment. As increased scrutiny is brought to health care claims both by CMS and by private third-party health insurers, the compliance aspect of medical billing and coding is becoming an essential component of health care administration.
Administrative professionals who pursue credentials as a certified medical auditor will see increased opportunities to provide continuing education to providers and ancillary staff to ensure that documentation standards are effectively utilized to support medical claims for payment. The consequences of being noncompliant can result in legal penalties and fines that can put a health care institution out of business.
Even in a large inpatient hospital, it is rare to find specialists who have the time to study all the ever-changing issues and updated publications that govern healthcare administration. The opportunity to consult on specialty services as they are reported in code for statistical and billing purposes is an opportunity to work for oneself. The provisions of the PPACA, of ICD-10, and of increased RAC audits affects every medical specialty. Health care administrators who have experience in one field can set themselves up as professional consultants to provide valuable insights to a medical practice’s operations, while citing relevant literature from CMS and commercial third-party payers.
Administrators employed full time by a physician or a hospital do not have the time to research all the applicable issues legal involved in compliant healthcare administration. As a consultant, a qualified freelance administrator can detect deficiencies and make recommendations for improvement to the benefit of his or her clients. In the field of healthcare administration, consultants consistently report higher annually salaries than coders and billers who work for other entities.
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Anita Granberg is a healthcare manager and guest author who contributed to the guide to the Top 10 Best Online MBA in Healthcare Management Degree Programs at MBA Healthcare Management.