Embed Size (px)
Citation preview
It is expected that FFS payments from both Federal and commercial payers
will decrease by about 24 percent by 2017
$Group Practices & Value-Based
Federal/Commercial Policies!
Where healthcare financing is heading and how group practices can get there?
Fee -For-Service
Value-Based
The reimbursement results from federal and commercial
Payers offering risk based arrangements
What are the tools required?
$
Volume-based, fee-for-service (FFS) payment models are unsustainable
Providers have little experience operating in a risk environment
Shifting landscapes of healthcare finances
90 percent of Medicare payments to be tied to value-based models by 2018
MSMGs and IDSs support this transformation
MACRA of 2015 mandates healthcare providers to take on payment risk over the next several years
$
Group practices would need at the least 2-4 years to start accepting these risk based systems
Commercial / Federal Payment
Models & Regulations
Reimbursement Revenue & Payment Model
Organizational demographic
Payer-driven impediments and provider-driven issues
All risk arrangements to increase more than twofold by 2017
Popular payment models:
FFS, shared risk, shared savings/ACO, partial capitation, bundled payments….
Commercial Setting challenges
Lack of access to full administrative claims data
Lack of transparent cost/ quality data feedback
Insufficient information technology (IT)/analytics infrastructure
Bundle Payment will be playing a larger role by 2018
Popular payment models:
FFS, Medicare Advantage, Medicaid managed care, Accountable Care Organizations (MSSP/Pioneer/Next Generation)…
Federal Setting Impediments
Ineffective attribution methodology
Lack of a standardized data submission and feedback process
Business of medicine is being used to change the delivery of healthcare, and
it’s being driven directly by the government.
Value-based payments improve care and reduce healthcare costs
Value-Based Reimbursements
Transition from FFS to value-based payment
Payer types vary in accordance to geographic locations
Alignment between Federal and commercial settings on value-based payment
With right automation tools group practices will be able to streamline
their cash flows, determine precise eligibilities, collect patient payments up front,
and fill clean claims to the payers.
Few ways group practices can make this
transition smoother
Getting educated on tracking the quality metrics
Setting up a system that can help shrink AR delays
Developing reporting solutions that will help them communicate it to the payers
Revised financial benchmarking and risk-adjustment methodologies
What tools do providers need?
(Value-based system)
Tools both the Federal government and commercial payers can provide
Operational in nature
Standardized data submission/feedback process
Meaningful patient engagement incentives
Apart from these, the system must develop a fine collaboration between
the government, the payers, group practices and the patients; this should
smoothen out hindrances and make the transition from fee-for-service into
value-based system a success on all fronts.
Also check this out..2016 RCM Whitepaper For Group Practices
Call toll free no 1-888-571-9069 for effective transition from FFS to value based..
Billing Paradise,732 N. Diamond Bar Blvd, STE 110,Diamond Bar, CA -91765
