New CMS Director May Shake Up Medical Billing and Coding

There are few government officials who have more influence on billing and coding professionals than the Administrator of the Centers for Medicare and Medicaid Services (CMS). As the agency that manages its namesake programs, most medical billing and coding professionals will at one time or another in their careers – if not daily – find themselves working with CMS or one of its related programs. Even if a medical billing or coding professional had the rare career that never intersects with CMS, this field is still strongly affected by the policies and prices which are set and normalized by CMS.

The current administrator of CMS has just recently announced she will be stepping down next February. Serving for just over three years – and about a year longer as the effective administrator – Marilyn Tavenner has presided over some important developments that have affected medical billing and coding professionals nationwide.

Tavenner was at the helm of the roll out of the Affordable Care Act and multi-state expansion of Medicaid, which has subsequently led to a rise in demand for medical coding and billing services. She was also in charge of a federal incentive program that encouraged medical service providers to incorporate Electronic Health Records (EHRs) and meaningful use into their practices while phasing out more cumbersome older methods. Tavenner was also overseeing the CMS transition to the ICD-10, which has been delayed until its currently scheduled debut in October of this year.

In just 38 months’ time, Tavenner has undoubtedly witnessed significant events for medical billing and coding professionals. What these professionals should be asking now is, what events will her replacement herald?

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Who will be the next CMS administrator

The current principal deputy of CMS is set to take over as acting administrator upon Tavenner’s resignation, however it is up to the Senate to confirm an official replacement, who must be nominated by President Obama. Considering recent history, this will likely be contentious.

Tavenner originally took over from her predecessor who had to step down due to an inability to be confirmed. This was in December of 2011 during the heated debate about the Affordable Care Act, when Republicans in the Senate were using confirmation hearings as political leverage. With the Senate unable to provide a filibuster-proof vote while under the control of the Democrats then, President Obama will need to be all the more careful now when considering a replacement nominee while the Republicans hold a majority.

Senate Majority Leader Mitch McConnell has already warned that the new CMS administrator will need to be someone who does not distract Americans with, in his words, “Obamacare.”

Given these circumstances, President Obama’s nominee will likely be someone who does not rock the political boat. This said, the new CMS administrator will not necessarily oversee events that are any less important to medical billing and coding professionals than did Tavenner. The adoption of the ICD-10 is approaching ever closer on the horizon and meaningful use EHR technology incentives are still in place. With significant changes having taken place over the last three years, the next administrator’s term will likely see more significant changes to come.

While the Affordable Care Act was indeed a political event, shakeups in the billing and coding field are just as often – if not more so – caused by their surrounding environment; the new CMS administrator is more likely to create waves by responding to something like changes in technology with a new policy than to do something that is politically controversial.