Before we understand how technology can improve your Value-based reimbursement we have to understand what a value-based reimbursement means for hospital billing. Hospital revenue is currently going through a turmoil of value-based reimbursement you have to satisfy the following criteria
- Risk-adjusted mortality
- Risk-adjusted readmission rates
- Low-cost structure
Along with this, we have to stay in-line with Centers for Medicare and Medicaid (CMS) rulings for 2015 hospital inpatient prospective payment systems (IPPS) in value-based reimbursement the regulations will hold the financial impact for your hospital.
Value-Based reimbursement for the hospital is divided underpayment models
Medicare is looking towards quality patient care with low cost. To see this across all providers, CMS opened a new submission period from Jan 2014 and closed it in April. During that period organizations completed bundled payment applications for an entire episode that included financial and performance. Four models were created in which model 2 and 3 received maximum applications.
Physician payment system
An individual or group of physicians are affected by the physician payment system. The regulations would mean that the physicians would have to meet the required quality of patient care. The significant part that would decide the reimbursement number is requirements of Physicians Quality Reporting System (PQRS) because adjustments would mean a -4.0 percent penalty.
Hospital Inpatient prospect payment system
CMS for hospital inpatient laid down the final structure through different programs: – Hospital Reduction Program (HAC), Hospital Value-based purchasing program (HVBP), Hospital Inpatient Quality Reporting Program (IQR) and Hospital Readmissions Reduction program.
Commercial payers are looking to shift towards value-based reimbursement. Commercial payers would lay down a mix of deductible and co-pay in value-based reimbursement. According to the study, 90 percent of the payers and 81 percent of hospitals have shifted towards a mix of value-based reimbursement.
As the shift takes place from fee-for-service to value-based reimbursement hospital would now be shifting towards more sophisticated billing software to keep track of claims. This would mean a better tracking and proactive approach towards data. Data Analysis can shine through almost all aspect of healthcare you see- for provider performance, cost, procedure, and in a procedure review. Data Analysis could help the innovative growth of the delivery strategies, high-performance provider organization, and integrated clinical services.
As providers are struggling to define the data-enabled outcome and its after-effects. Doctors are also troubled by how do we collect the data, analyze and draw conclusions. The major challenge today in technology is interloping the developments through them into our practice.
Dr. Soris who is a leading physician in Ohio and also holds a board member in one of the major hospitals in Ohio said that “Though Data can really help you in analyzing how your hospital is performing the major problem for us comes when we have to really make the use of data. Doctors today feel that through technology can help how can they extract the real meaning.”
Currently, Hospitals are utilizing the data to predict the average reimbursement for each claim according to the procedure. They also analyze various factors due to which patients seek a provider and which of the procedures need improvement. Data standardization through Electronic Health Record (EHR) will help better analysis and prediction for doctors.
As the new innovation takes place through data it’s time for you to reduce your claims errors and channelize hospital billing. Medical Billers and Coders (MBC) with 18 years of experience in hospital billing with team certified coders and skilled billers to reduce your average AR age.