Value-based care is gaining traction inside the US healthcare system. Furthermore, the role of medical billing in ACOs is central in offering the main push for steering the industry away from FFS (fee-for-service) and towards value-based care. Regarding medical billing services, ACOs present an exciting model for care services.
It is where groups of hospitals, doctors, and other healthcare providers offer high-quality care voluntarily to patients. Such facilities and organizations achieve their goals through help from universal budgeting systems and value-based reimbursements.
Moreover, with adequate care coordination and a mutual/shared savings payment model, the ACOs are improving patient outcomes. This is in addition to a steep improvement in population health management while keeping costs to a minimum.
What should you know about medical billing in ACOs as a medical practitioner? Let’s look into this in detail:
As understandable from the structure of the ACOs, many program providers share in the losses when these groups fail to meet the targeted ACO requirements. In a Medicare-associated program, the participant practices can choose whether to indulge with a one-sided risk or two-sided model.
What is a one-sided risk model?
In a one-sided risk model, sharing is probable where 50 percent of the cost savings are achievable for Medicare patients.
What is a two-sided risk model?
It is where the sharing of 60 percent of the cost savings and losses is agreed upon.
Note: It is essential to weigh your options before making your practice revenue vulnerable to any financial hit through the two-sided approach. Your practice needs to consider whether or not your bottom line can sustain the impact.
The ACO is a unique model – in it, physicians, other medical providers, and hospitals come together to deliver coordinated care to patients.
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