Alternative Payment Models Impact Revenue

While fee-for-service is not going away anytime soon that we can see, many alternative payment models are in play impacting how physicians manage their patients, document the patient encounter and manage re-visits. Many factors are now being considered to determine the amount of reimbursement the provider receives as we see the shift to determine payment moving from volume to value. Key elements of the changing environment include:                  Value Quality image

  • Current cost structure and global comparisons
  • Recent slowing of growth
  • Mandates of the ACA (“Affordable Care Act”)
  • Rate and profit pressure on insurance companies
  • Physicians turning from entrepreneurship to employment

Revenue opportunities will vary by specialty (and region) and will include new forms of reimbursement as well as incremental and performance-based opportunities. The payment plans aren’t just impacting the physicians. While ACOs, Patient Centered Medical Homes and Medicare Advantage may be impacting practice-based physicians, hospitals are being affected also with reimbursement tied to quality of care, bundled payments and penalties for readmissions under the Hospital Acquired Conditions (HAC) and Readmission Reduction Programs. While understanding and managing the payment models can be confusing working with an RCM partner that understands the changes and has the technology, expertise and resources to adapt quickly to them while keeping your staff up-to-date, gives your organization a distinct advantage in maximizing payments.