Impact of Federal Debt Ceiling on Medicare Payments to Physicians
Debt ceiling on Federal Debt is a perennial topic for debate in the US healthcare scenario. Debt ceiling
or Debt limit is the brink to which U.S. Federal Government can raise debts to fund its budgetary
Although there have been instances in the past that allowed for raising debts well over the statutory
limit, yet the present scenario is such that it has put a question mark over the Federal Government’s
ability to borrow. Consequently, despite the talk of an additional $2.2 trillion borrowing through
governmental securities, the fear of imminent debt ceiling effects across the spectrum of healthcare
industry looms large.
With the national debt having approached its statutory limit of $14.29 trillion, there is an imminent set
of repercussion waiting to engulf the Federal Government’s economic sectors. As the eventual debt
ceiling is going to trigger off default or delay in payments to Federal Government commitments, there
is a growing degree of anxiety among interest-groups: creditors, beneficiaries, vendors; military staff,
social security and Medicare, and unemployed beneficiaries.
Among the many interest-groups that are likely to be impacted by the Debt ceiling, Healthcare sector
– which accounts for a majority of share in the Federal Budget – is going to feel the heat more.
Consequently, its stakeholders – physicians/hospitals, patients, insurance carriers, and medical billing
professionals will all be forced to rethink their operational efficiency to stave off the negative impact of
Federal Government, already faced with the impending Sustainable Growth Rate (SGR) problem, will
be pushed to float unprecedented radical reforms to its popular Medicare and Medicaid programs, such
Increase in the Medicare eligibility age and a jump in co-pays and deductibles
Lowering benefits to low-income individuals under Medicaid
Cuts to Medigap insurance, which would limit supplemental insurance plans for the elderly,
and the implementation of a policy requiring high-earning seniors to pay higher premiums for
Reduction in spending by $1.2 trillion across a wide array of federal programs, including a 2
percent cut to Medicare provider payments starting in 2013.
A possible threat of 29.5 percent cut to Medicare payments if the Congress doesn’t alter the
Sustainable Growth Rate, in which case payments to doctors would drop so low that many
would be forced to stop seeing Medicare patients.
In such a scenario, physicians – whose patient composition happens to be a majority (nearly half of
their total patient composition) of Medicare and Medicaid beneficiaries – will be forced to operate at
less than break-even point, which is hard to sustain.
Faced with such imminent consequences, physicians/hospitals – who are already grappling with a
highly competitive healthcare market; stringent compliant environment: ICD 9CM to ICD 10 compliant
coding and HIPAA compliant reporting; and failed in-house medical billing experimentation, where in
either in-house staff reporting it to be detrimental to their core function of supportive medical care, or
underperforming despite heavy investment on training and system-implementation –
physicians/hospitals will inevitably have to look up to qualified and competent medical billing
management experts, who ensure operational efficiency and revenue maximization.
Medicalbillersandcoders.com (www.medicalbillersandcoders.com), the largest consortium of medical
billing professionals, can prove to be an ideal ally in complementing its clients’ cost-minimization and
revenue-maximization endeavor through a proactive medical billing management.
Our medical billing experts – who are adept at accurate charge-capture, intricate procedure coding,
electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and
compliance standards – have been preferred choice of a majority of physicians/hospitals groups across
the U.S. Proficient in using advanced medical billing and coding softwares and an impressive track-
record of efficient reimbursement with the leading private insurance carriers such as United health,
Wellpoint, Aetna, Humana, HCSC, Blue Cross Group, and Government sponsored Medicare and
Medicaid as well – our medical billing professionals carry an extra edge in the industry.
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