The Demands of Value-Based Reimbursement Model to Be Met With Medical Billing Specialists by medicalbillers


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          The Demands of Value-Based Reimbursement Model to Be Met With
                             Medical Billing Specialists
       With many of the healthcare reforms set to take effect shortly or having already been in force, providers may have
       entered a different phase of operational model, which is called value-based model. The unique feature of value-
       based model is that providers will get reimbursed for delivering superior medical care at a progressively lesser cost.
       As the public plans such as Medicare, Medicaid, and most of the commercial plans are likely to adopt value-based
       reimbursement models, it may be inevitable for providers to shift over or find a balance between fee-for-service
       model and value-based model in order to sustain profitable clinical practices.

       To being with, you have Medicare's value-based payment modifier that will be launched for physicians in groups of
       100 or more in 2015. The unique thing about this modified value-based payment model is that it works on the
       principle of ‘carrot and stick’ theory, meaning physicians may either be eligible for either positive or negative
       payment adjustment depending on their level of compliance with care quality and reporting. To prepare for the
       eventual 2015 model, it may even be necessary to demonstrate capability for PQRS reporting, beginning as early as
       2013. Furthermore, the performance post 2015 will be significant as most of the value-based returns will start
       yielding from 2017 based on the PQRS reporting post 2015.

       While Medicare and Medicaid reimbursements have already begun experimenting with ACO model as a superior
       form of reimbursing physicians for their services to public healthcare plan beneficiaries, commercial payers, sooner
       or later, too will be obliged to adopt modified versions of reimbursements. Therefore, providers will have to plan, be
       prepared and resourceful enough to realize their reimbursements from both public as well as commercial insurance

       As far as planning goes, it should all start with:

                  •   Thorough evaluation of payer market to find out what value-based payment opportunities
                      await down the line. It may also be important to know the dynamics of payers’
                      reimbursement methodologies.

                  •   Assessment of your current documenting, coding, and billing practices against the requisite
                      standards, dictated by the changing payment models.

                  •   Planning progress to the expected level through a phased manner.

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End to End Medical Billing Solutions

       Once you have the plan in place to progress to value-based payment model, providers may actually start
       implementation with:

                  •   Value addition to care delivery: It means minimizing the possibility of recurrence of medical
                      conditions. When providers are able to minimize the recurrence, it would contribute to
                      substantially savings in reimbursements that might happily shared by payers with responsible

                  •   Better care coordination: Coordinated care, involving physicians and support staff will likely
                      facilitate better clinical outcomes, which are often deemed fit for specials incentives along
                      with regular reimbursements by payers.

                  •   Extending patient reach and engagement: When providers begin exploring opportunities to
                      increase their and involvement, it is definitely going to improve care quality, which is the
                      fulcrum for deciding the value-based reimbursements.

                  •   Forming new clinical alliances: The value that clinical alliances bring to clinical quality is really
                      unquestionable and the providers’ success as value-based providers will largely depend on
                      how best they network their clinical services with competent specialists.

       As providers find themselves engrossed with value-based clinical activities, it may require a dedicated medical billing
       to look after the process of documenting, coding, and billing claims for value-based reimbursements. – with a nation affiliation with resources (medical billing specialists) that can own and
       execute medical billing functions on behalf of providers stuck in the process of migrating from fee-for-service model
       and value-based model – offers to mediate the deployment of competent, experienced and versatile medical billing
       specialists that could effectively look after the operational side of value-based reimbursement model while
       providers concentrate on the clinical aspect.

       Browse All: Medical Billing Updates

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