The Effects Of Value-Based Payment On The Medical Billing Process

Value-based payment medical billing

As more and more providers march down the path toward fully implementing health plans with value-based payment models, the billing process will evolve dramatically. Within the next five years, many predict that more than half of all health plans will be reimbursing providers based on quality of care, rather than operating a fee-for-service payment model. This is intended to shift priorities from volume to value.

Many physicians expect to have challenges with regards to this new payment model, especially when it comes to their reporting systems and new methods of exchanging information.

Under a value-based payment model, providers must meet stringent quality requirements and reduce readmissions or face reductions in their reimbursements. Because Medicare and other payers are encouraging more medical groups to emphasize results rather than volume, physicians need to be prepared. To avoid the risk of declining reimbursements, practices will have to make changes so that this shift does not put a kink in their revenue stream.

Things to consider in transition to value-based payment:

  • Providers must assess the payer market and evaluate the new billing, coding and documentation processes that come with changing payment models.
  • In order to improve the quality of care, physicians will need to spend more time with their patients, leaving less time to focus on the operational requirements of their practice.
  • The new payment model will create changes in revenue cycles, demanding more concentration on coding and billing processes for timely reimbursements.
  • A reduction in the cost of healthcare services will result in an increased number of patients, which will inevitably increase documentation, coding and billing for the practice.
  • These operational changes will require extensive training of the in-house staff.

Wondering how your practice will fare? On September 16, 2013, group practices with more than 25 eligible physicians will have access to CMS Quality Resource Use Reports (QRURs) for 2012. These reports will illustrate how a practice will perform under their Value-Based Payment Modifier (VBPM) and provide data based on the group’s Physician Quality Reporting System (PQRS) measures, VBPM outcomes and cost measures. The QRURs will also include data on the patients associated with the group for the purpose of these reports including hospitalizations, among other details.

While you spend more of your time with patients in order to provide higher-quality care, a dedicated billing partner can streamline your transition to value-based payment by maximizing revenue and handling operational tasks such as coding, billing and documentation. Our team of expert billers will make this daunting transition much simpler for your practice, allowing you to focus on what really matters – your patients.

Contact MBA Medical Business Associates today to find out how we can make this transition a smooth one for you and your practice.

Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

  • Anesthesia Billing
  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
  • Learn More

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Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

  • Anesthesia Billing
  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
  • Learn More

MBA In The News

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P.O. Box 821350
Vancouver, WA 98682

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360-687-5221 Vancouver, WA

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