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Medical Billing Challenges and Their Solutions for OB-GYN Specialty in Value-Based Care

The terms and conditions of a value-based care payment might differ from specialty to patient diagnosis, but it challenges it possess is nothing less major medical billing issue. OB-GYN Speciality one of the most sensitive physician specialties, is constantly grappling through new payment mode of value-based care as the services rendered on the healthcare plan often don’t match up and leads to a down slide in revenue generation and revenue cycle management.

Here Are Some Critical Challenges and Their Solutions by OB-GYN Specialty in Value Based Care:

  1. Remain with PQRS which is the basis for the Value-Based Payment Modifier program. Understand how your profile fits within the six domains; also analyze meaningful use, clinical process/effectiveness; patient and family engagement; population/public health; patient safety; care coordination; and efficient use of healthcare resources.
  2. Access your practice Quality and Resource Use Report, QRUR, by obtaining an IACS number from CMS. This report was published by CMS last fall and compares your practice to peers on both quality and cost measures. This can be downloaded in both PDF and excel formats. It’s complex but worth spending time on to both understands and identifies your practice profile.
  3. Monitor Your Entire Patient And Provider Panel In Key Measures Such As:

Quality: A. Preventable Hospital Admissions:

  • Patients with acute episodes of dehydration, UTI, and bacterial pneumonia
  • Chronic patients with heart failure, COPD, and diabetes

B. All Cause Hospital Readmissions Cost Of Your Practice Status:

a. All Part A and Part B payments (Part D excluded)

b.For disease categories: COPD, heart failure, coronary artery disease, and diabetes

c. Medicare Spend Per Beneficiary, MSPB, for three days prior to and 30 days post discharge

d. Total Medicare Allowable per applicable CPT code

4. Report Monthly On What Is Occurring:

  • Your practice will not know the Medicare ranking until the end of period.
  • Rankings are determined by the eligible provider (EP) who has a “plurality” of primary-care codes assigned and the Medicare allowable charge amount assigned. Primary-care providers will be considered first, but any specialist may qualify.
  • A minimum of 20 episodes per measure (see quality above) hence the need to monitor your practice. If insufficient numbers are there, you may not see either the incentive or adjustment.
  1. Regular review and reporting will help lead the practice toward a more “quality” impact and focus. When all staff, not just providers, works together, the cumbersome nature of reporting will become easier and part of everyday practice life — since in many cases the impact is not significant this year. It will however become more impactful in the years to come, as not only VBPM programs come into play, but overall payment model reforms are implemented. There will be an eventual culture change!

Long term outcomes for practices should be improved patient care, compliance with the new paradigm, and an improved financial picture. How you approach it now may determine the long-term success and viability of your practice in the future.

In conclusion, we would like to add that even if the value based care in Billings OBGYN does observe a down slide in revenue collection and growth, it eventually ends up in the hands of your medical billing and coding to actualize the value of each service rendered, verifying t with the patients and eventually filing a clean claim.

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