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Elevating RCM Success By Embracing Value-Based Healthcare

03 Jun 2016, Posted by Jocelyn Gaddie in Billing, Healthcare, Revenue Management

“Consumer-driven” and “value-based” are the buzzwords you’ve been hearing from every corner of the healthcare community, and it makes sense. Throughout 2016, the Centers for Medicare & Medicaid Services are leveraging the “value-based payment modifier” in the physician fee schedule and beginning to tie reimbursement to overall quality of care, rather than simply services rendered.

But what does this mean for revenue cycle management (RCM)? In simplest terms, it means rethinking RCM as a simple back-office function and making it part of an end-to-end process—an idea we began to champion long before the value-based healthcare conversation began. By extension, this trend also demands that we rethink our payor relations and make way for bundled payments.

Patient Intake Remains the RCM Frontline

As patients begin to occupy a more consumer-centric role in healthcare, it actually means they’re dealing with a greater financial obligation up front, particularly in the way of high deductible plans. For this reason, it is becoming more important than ever to communicate openly with patients at the time of registration and intake and collect all applicable co-pays and deductibles up front.

Thoroughness upfront achieves two things. First, it presents a golden opportunity to develop a comprehensive patient profile, which will contribute to an overall quality experience—something no one can afford to overlook. Second, as it always has, upfront collections will help physician offices and surgical facilities maintain cash flow, even as they work to find their place in this new value-based system.

Partnering With Payors & Making Way For Bundles

As healthcare facilities transition toward fee-for-value models of care and reimbursement, elements of the existing fee-for-service model are going to coexist in the same space, which means RCM has to be able to reconcile both forms of reimbursement.

The key here will be consistent communication with payors—talk to payors to learn about new requirements when filing claims and posting payments and confirm with key payors that your facility or physician office is providing proper documentation and verification with regard to value-based reimbursement.

As for bundled payments, they’re happening. And they will require healthcare facilities to demonstrate efficiency and quality, which means documentation will be of utmost value. Furthermore, because payment will be tied to an entire episode of care, rather than individual services that can be coded as such, it will once again be important to maintain open communication with payors.

Change Awaits Us All & The Healthcare World Knows It

As with all change in healthcare, the transition to fee-for-value will simply require communication, observation and a willingness to adapt. It’s part of the medical industry and certainly part of the RCM realm. But if your healthcare business office is feeling unsure about how to navigate the changes ahead, contact in2itive Business Solutions and let us help guide you toward sustainable success.

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