9 Tips to Handle Prior Authorization in RCM
October 4, 2024
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Email: info@prgmd.com | Call: +1 (630) 242-6474
Business hours: 9:00 to 5:00 | Monday to Friday
Value-based reimbursement, according to the Centers for Medicare & Medicaid Services (CMS), means rewarding healthcare providers with extra payments for providing quality care to people with Medicare.
This change means moving away from paying doctors for each individual service or visit, and instead, they get paid based on how well their patients recover.
CMS started emphasizing quality healthcare instead of just the number of visits in 2008 when they introduced the Medicare Improvements for Patients and Providers Act (MIPPA). This act partially rewarded eligible healthcare providers for using electronic prescriptions.
The next year, in 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) became a part of the American Recovery and Reinvestment Act. HITECH created programs under Medicare and Medicaid to give incentives to eligible healthcare providers who make “meaningful use” of certified electronic health record (EHR) technology.
A value-based reimbursement model means hospitals and doctors get paid based on their patients’ health. They are rewarded for making their patients healthier, reducing chronic disease symptoms, and helping them lead healthier lives overall.
This model differs from the traditional fee-for-service approach, where doctors get paid based on how many healthcare services they give.
Patients are more content when doctors prioritize their overall well-being rather than treating symptoms.
By using the value-based reimbursement approach, doctors can take into account pre-existing health conditions, diet, and surroundings to provide comprehensive treatment. This, in turn, strengthens the bond between doctors and patients
By reducing the costs of managing chronic illnesses, more budget will be available for better workflows. Technology like EHR and telehealth can enhance the efficiency of both doctors and patients.
As the workflow becomes smoother, physicians can dedicate more time to preventive care instead of dealing with readmissions constantly.
1: Healthcare payment models are changing, and medical billing services providers can use advanced technology to improve the revenue cycle management process. Medical billing can be improved by integrating EHR and billing systems, promoting investments in population health, and incorporating new accounting methods. Hospitals can also design billing systems aligned with healthcare payment models.
2: To improve healthcare billing, EHR and billing systems should be integrated using HIPAA-compliant solutions. Healthcare organizations need to consider their specific goals when choosing a reimbursement model. They should opt for a model that aligns closely with their objectives.
3: Customized healthcare solutions should be developed to address billing and coding issues. The chosen value-based CMS and billing systems should aim to reduce costs as much as possible. Integration with medical claims management systems and a successful track record through prototype models are essential.
4: Collaborative solutions can significantly enhance value-based reimbursement in healthcare. Strategic data sharing and integration policies can also improve healthcare billing and reimbursement. By exchanging information, administrative and billing processes can be streamlined, keeping preventive healthcare costs low.
5: Selecting the best healthcare reimbursement model involves evaluating the patient population and using patient risk classification with CMS’ value-based. Additionally, creative remittance software solutions can enhance population health management, which is a form of preventive care.
6: Adopting sufficient healthcare credentialing solutions while shifting to a value-based reimbursement model can reduce the organization’s financial risk. Automated care management measures can help alleviate the burden on providers as they bear more financial risk.
7: Integrating personal healthcare goals with payer and provider network goals can be advantageous, along with further integration with value-based to improve quality.
Value-based healthcare is no longer a distant concept but a present reality. Organizations must adapt to changing conditions and transition to value-based models. Integrated EHR, practice management software, and advanced medical billing systems can make this transition beneficial for all healthcare entities.
The advantages of value-based care and enhanced medical billing are significant, including high-quality outcomes, greater patient involvement, and handling a higher volume of patients. Successful adoption of these measures can lead to decreased healthcare expenses and fewer medical errors.
The aim is to improve care. Under this model, providers get paid depending on how many patients they have and the tests they order. More tests mean higher payment. However, value-based care focuses on providing better quality, affordable, and preventive patient care.
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