Revenue Cycle Management (RCM)

How Will the Change From Fee-for-Service to Value-based Care Affect the Revenue Cycle?

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Adoption of Value-based care form of reimbursement over Fee-for-Service form sure is a giant leap forward towards quality health care. However, we can’t forget the gamut of financial challenges that plague our Revenue Cycles with this paradigm shift in policy. This turn in billing procedures allows providers to bill the whole value of care they deliver instead of being reimbursed for services like the consultations and tests. Value Based Care Programs like Medicare Shared Savings Program and Pioneer Accountable Care Organization (ACO) Model etc suggested by  Centers for Medicare & Medicaid Services (CMS) aim to revolutionize the way doctors are paid for their services.

With this herculean shift from Fee-for Service Model of Reimbursement to Value Based care Model a change in the Revenue Cycle Management can be expected. Here are the ways the new payment model might affect the financial front of your business:

RCM is going to be more detail Oriented and Demanding

When it comes to value based care patient experience comprises of services more than just clinical care. This requires the office staff to fill in shoes of customer service agents in order to manage the patient intake in such a way that the whole treatment experience is profitable for the care seeker. This might involve spending time with each patient to help them understand the details of their treatment, especially in case of recurring patients. Ascending interaction, patient education and assistance when all clubbed together can improve the patient experience dramatically, which will show on your revenues.

RCM Needs Trained Technicians

With Value Based Care model the front end RCM is going to be a little more complex comprising of exercises like collecting the correct patient data before service to evade denials. If the motive is to improve revenue, care providers should emphasize upon eligibility checks, management of co-payments, and collection of patient deductibles. A fitting solution is to hire highly trained clinicians to enable accurate and timely assessment of patient status. This will prevent denials and increase overall efficiency.  

Adopting Bundle Payment Method for Care Cycle is a Gamble for RCM

Bundle Payment Method is believed to work best when it comes to Value Based care that focuses on wholesome care. Bundled payment arrangements are devised to pay multiple healthcare providers for coordinating amongst themselves the total amount of services they provide for a single, predetermined episode of care. A well formulated Bundle Payment mechanism encourage teamwork as well as runs successful in ensuring high value care of the payer. During an ongoing ‘episode of care’; if the operational cost amounts to less than the predetermined Bundled Payment price than the medical unit can keep the difference. However, if the cost exceeds the set price, the unit may suffer losses. The model is known to prevent providers from financial risk contracts though.

Slow Spending is a Thing

In case of patients that suffer from chronic diseases, such as diabetes and congestive heart failure, the care providers need to spend most of their resources when providing care. This is because their medical condition forces them to be repeatedly admitted into the hospital and frequently visit the care centers. Caring for such patients incur heavy expenses. To reduce hospitalization and operational costs in such cases, doctors must focus on providing care with a preventative approach. This entails a shift in focus to high value care so as to reduce total-care spending and increase the value of care by omitting chances of unnecessary read missions, and thereby increasing revenue for providers.

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