Value-Based Care Vs Fee-for-Service

As healthcare regulations change, so do healthcare provider reimbursement models. Understanding different forms of reimbursement and their advantages and disadvantages can help you better figure out your healthcare organization’s revenue cycle management. The two main models between which the American healthcare network has been fluctuating are fee-for-service (FFS) and value-based care (VBC). Fee-For-Service In the […]

Uninsured COVID-19 Patients with Limited Reimbursement

According to a recent report from the Kaiser Family Foundation (KFF), a program intended to balance the costs of uninsured COVID-19 patients during the coronavirus emergency has paid out limited reimbursement to providers. The Trump Administration announced the COVID-19 treatment reimbursement program for uninsured patients in April 2020. The program has been in place from […]

Use of Modifiers 54, 55, and 56

Using Modifiers, the service or procedure can be altered by some specific conditions but has not been changed in definition or code. The intention of modifiers is to give more specific information about a specific procedure or service that is not already contained in the code definition itself. MBC is sharing more information on Use […]

Effective Cost-of-Care Conversations with Patients

Patients face significant financial side impact from their care when their out-of-pocket cost is high. To release the financial burden of patients, providers have to keep proactive communication and engagement with patients. Out-of-pocket costs such as high-deductible health plans have expanded over the past 10 years. In CY 2018, almost 29% of patients with private […]

How to keep your independent practice strong during COVID-19?

The economic fallout of COVID-19 may accelerate acquisitions of independent practices unless practice leaders consider new, but not necessarily novel, ways of doing business. “The jury is out, but COVID is probably going to exacerbate larger systems buying up independent practices because a lot of folks just aren’t going to be able to weather the […]

Strategies to Advance Value-Based Care

Health insurers are struggling to get success in an Advance Value-Based Care reimbursement model. This may benefit from population health management, patient engagement, and healthcare delivery reform. When payers started to transition to value-based care reimbursement from the traditional fee-for-service payment system, some healthcare executives and financial experts might find that it takes longer than […]

Optimize Patient Payment Collections during Pandemic

Improving your patient payment collection during a pandemic should be your top priority in your financial plan this year. You may think why to focus on patient collection, because with half of the employers pushing high deductibles plans onto workers. Patients are facing bigger medical bills, one they never prepared to pay. If patients deny […]

The BPCI Advanced Clinical Episodes, Prices

CMS is going to make key changes to Bundled Payments for Care Improvement (BPCI) Advanced next year to stop the model from generating financial losses of close to $2 billion over the model’s ten performance periods. Model year 4 will begin on Jan 1, 2021. CMS’s Innovation Center will modify target pricing calculations using an […]

Post Pandemic: Will Telehealth Reimbursement limited for Value-Based Providers?

The Medicare Payment Advisory Commission (MedPAC) is the latest group to evaluate telehealth reimbursement expansions post COVID-19 pandemic. In a meeting held virtually in the start of September 2020, MedPAC analysts Ariel Winter and Ledia Tabor shared some policy ideas for keeping telehealth coverage and reimbursement expansions post the pandemic now that providers across the […]

Are you in confusion over COVID-19 coding and claim requirements?

According to a new survey that confusion over COVID-19 medical coding and insurance claim requirements is one of the top effects the pandemic has had on revenue cycle management in the healthcare industry. Alpha Health conducted a survey through the Healthcare Financial Management Association’s Pulse program, they inquired 587 chief financial authorities and revenue cycle […]

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Revenue Cycle Management (RCM)