How Will Value Based Payment Models Impact The Medical Billing Process?

Medical billing process is evolving with new healthcare reforms and value based payment models being introduced into the healthcare industry. It is being forecasted that in the next five years, more than half of health plans will be supported by value-based payment models out of which more than 60% are already mid-way through its implementation.

Will physicians face challenges under value based payment models?

Even though value-based payment models are being supported by public plans like Medicaid, Medicare and other commercial plans, physicians might have a hard time striking a balance between fee-for-service and value-based models.

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When shifting to value-based payment, physicians will have to implement several changes in their practice. For instance, the value-based payment modifier of Medicare will be launched for physicians in 2015 for which practices will have to demonstrate their capability for PQRS reporting starting from 2013.

In this transition, a new type of information exchange system will also be required within physicians and health plans. Automating the exchange of ‘new’ information required under value-based payment models will be extremely vital for success.

Under value-based payment, physicians who fail to meet the quality requirements and lower readmissions will have to face reductions in their reimbursements. Since payers including Medicare are taking significant steps in encouraging more medical groups to focus on result rather than volume, physicians need to start gearing up. To avoid the risk for lower reimbursements, practices will have to make the necessary adjustments so that the shift from volume to value doesn’t affect revenue generation.

Are physicians prepared for the transition?

  • Practices need to evaluate the payer market and assess the billing, coding and documentation practices that come with changing payment models
  • Since the focus will be shifting from volume to value, physicians will be required to spend more time with patients which leaves them with less time to concentrate on the operational requirements of their practice
  • New payment models will result in changed revenue cycles, demanding more focus on coding and billing tasks for timely reimbursements
  • With reduction in cost of healthcare services, number of patients will increase and this will eventually increase documentation, coding and billing for the practice
  • Time and investment will be required in training the in-house staff to handle the operational side of value-based payment models

While physicians will be spending more time with patients to deliver better results, a dedicated billing partner will be required for handling revenue maximization and operational activities, including coding, billing and documentation.

Medicalbillersandcoders.com aims to help physicians in the process of coding, billing and documentation for value-based reimbursements. Our team of expert billers and coders make sure that the daunting task of migrating from fee-for-service to value-based payment model becomes easy for practices. While our team handles the operational aspect of value-based model, providers can focus on the clinical aspect, spending more time on patient care and enhancing their performance. MBC also helps providers in choosing best EHR for their practice, data analysis and revenue maximization.

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