A certain point has been made clear during the recent Value-Based Care Summit in Chicago by Xtelligent Media. In enabling healthcare organizations to align their healthcare revenue cycle management with value-based reimbursements, they need to start breaking down both financial and clinical siloes that have been established using the fee-for-service payment models. Moreover, everyone in each healthcare organization must learn to work together better.
According to Carmela Roberts, JD, CEO and Administrator of Valley OB-GYN Clinic in Michigan, there is a need to promote collaboration among all hospital staff, including those serving operational, financial and clinical duties. This, according to her, would be the key to developing a value cycle instead of the traditional healthcare revenue cycle.
Balancing Quality Services and Cost Efficiency
The value cycle looks to cover all the processes that can optimize financial, operational and clinical opportunities to achieve the best possible health outcomes at the lowest possible cost. As such, it would include a number of traditional revenue cycle management components, including charge capture, claims management, compliance and pricing. In addition, there should also be data that addresses care quality, clinical outcomes, patient satisfaction, risk management and operational efficiency.
Value Cycle is Effective Due to the Superbill
The traditional healthcare revenue cycle is quite linear in its functioning. Using fee-for-service payment structures, the revenue cycle would start with patient access and go through charge capture, service and coding, eventually ending in claims denials management or claim reimbursement.
In contrast, Roberts explained that the value cycle would overlap the financial, operational and clinical functions. Moreover, its foundation is the superbill, a chargemaster data that would tie charges to the clinical outcomes, allowing payers, patients and providers to understand the value of services that were rendered.
Using the value cycle also allows for care teams to assign various responsibilities to one department. This way, there would be a defined set of responsibilities, allowing for care teams to efficiently achieve a key common goal: to deliver high quality care in the most cost-efficient manner.
Payer and Provider Goals Need Alignment
Successful contracts under the value cycle can also work to align both provider and payer goals for healthcare utilization and care quality. It should also be able to establish some provider incentives right within the healthcare organization. A recent survey conducted by Quest Diagnostics and Inovalon found that 47 percent of physicians reported an advancement in payer-provider alignment under their value-based contracts during the past year.
Consider adopting the value care model for your healthcare or medical care facility today. Should you need help, all you need to do with is consult with a company that provides enhancements to revenue cycle management to get started. This way, you can provide every patient with best quality of care possible while also making their treatment as cost efficient as can be.
Payer Collaboration Key to Value-Based Reimbursement Strategy, revcycleintelligence.com
Implementing Value-Based Healthcare Revenue Cycle Management, revcycleintelligence.com
3 Pain Points Affecting Small Practice Healthcare Revenue Cycle, revcycleintelligence.com
Pete is the Vice President of Sales & Client Services at DECO Recovery Management. He covers the Mid Atlantic region and specializes in Medicaid related topics. It is DECO’s Mission to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates to provide exemplary service.
Categories: Hospital Revenue Cycle Management