MIPS Overview & How to Avoid the 9% Payment Adjustment:

What is the Merit-based Incentive Payment System?

The Merit-based Incentive Payment System (MIPS) is one way to participate in the Quality Payment Program. Under MIPS, CMS evaluates your performance across multiple categories that lead to improved quality and value in the healthcare system.

The performance threshold for 2021 is 60 points, which means:

• A MIPS score below 60 points will result in a negative payment adjustment
• A MIPS score above 60 points will result in a positive payment adjustment

2021 Final Performance Threshold & Payment Adjustment

How is MIPS Scored?

The MIPS performance categories have different “weights,” and the scores from each of the categories are added together to give you a MIPS Final Score.

Step 1: Check Your Current Eligibility

MIPS payment adjustments are only applicable to clinicians deemed “MIPS eligible.”

The low volume threshold includes 3 aspects of covered professional services:

Step 2: Select and Perform Your Measures and Activities

Quality Category 40% of MIPS Score

Sixty (60) performance points are needed to earn full credit for the Quality category. Most clinicians must select 6 measures, including 1 outcome/high priority measure, by exploring these measures and collecting data for each measure for the 12-month performance period (January 1- December 31, 2021).

NOTE: Clinicians in SMALL practices automatically receive six points in their quality category if at least one quality measure is reported. This is called the small practice bonus.

Improvement Activity Category 15% of MIPS Score

Easiest category and points to earn! Forty (40) performance points are needed to earn full credit for the improvement activity (IA) category. Practices receive full credit for the IA category when they complete:

• 2 high-weighted activities,
• 1 high-weighted activity and 2 medium-weighted activities, or
• 4 medium-weighted activities

How Should You Submit Data? There are 3 submission types you can use for improvement activities, depending on which submitter type you are. The submission types are:

• Sign in and attest
• Sign in and upload
• Direct submission via API

Promoting Interoperability Category 25% of MIPS Score

One hundred (100) performance points are needed to earn full credit for the promoting interoperability (PI) category. All required PI measures must be reported or excluded. When a measure is excluded, the points are reallocated to a different, assigned PI measure. You must submit collected data for certain measures from each of the 4 objectives measures (unless an exclusion is claimed) for 90 continuous days (or more) during 2021. Additional requirements for this category include use of a 2015 edition certified electronic health record (EHR) and you must provide your EHR’s CMS Identification code from the Certified Health Product List and submit a “yes” to:

• The Prevention of Information Blocking Attestation,
• The ONC Direct Review Attestation, and
• The security risk analysis measure.

Additional help on this category: PI Requirements, Hardship Exceptions, How to Submit Data Links

Cost Category 20% of MIPS Score

You do not have to submit ANY data for this performance category!

For performance year 2021, CMS will use cost measures that assess: the overall cost of care provided to Medicare patients with a focus on the primary care they received, the cost of services provided to Medicare patients related to a hospital stay, and costs for items and services provided.

CMS determines measure achievement points by comparing performance on a measure to a benchmark. CMS calculates cost measure benchmarks using performance data from the performance period, rather than historical benchmarks.

Additional Help on this Category: Cost Quick Start Guide

Step 3: Understand How COVID-19 Relief Efforts Affect 2021 MIPS Payment Adjustments

The COVID-19 pandemic has impacted all clinicians across the United States and territories. However, CMS recognizes that not all practices have been impacted by COVID-19 to the same extent. For PY2021, CMS will continue to use the extreme and uncontrollable circumstances policy to allow clinicians, groups, virtual groups, and APM Entities to apply requests for reweighting of performance categories due to the current COVID-19 public health emergency.

There are two exception applications available to clinicians in PY2021:

• The Extreme and Uncontrollable Circumstances Exception application allows you to request reweighting for any or all performance categories if you encounter an extreme and uncontrollable circumstance or public health emergency, such as COVID-19, that is outside of your control.
• The MIPS Promoting Interoperability Performance Category Hardship Exception application allows you to request reweighting specifically for the Promoting Interoperability performance category if you qualify for one of the reasons identified below. This application is available for the following specified reasons:
  • You’re a small practice
  • You have decertified EHR technology
  • You have insufficient Internet connectivity
  • You face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress or vendor issues
  • You lack control over the availability of CEHRT

What Happens If Your Application is Approved?

If your application is approved, you don’t have to report for the requested MIPS performance category or categories, and those categories will be reweighted.

• Application deadlines are December 31, 2021 at 8PM ET.

Step 4: Report Categories Based on YOUR Circumstances:

The MIPS 2021 final rule is for calculating the MIPS payment adjustment for your composite score. Remember you only need 60 points to avoid the negative payment adjustment of -9% in 2023:

Scenarios to Avoid the Adjustment include:

• Scenario 1: You do not have an EHR. If you do not have a 2015 edition certified EHR, you CAN still participate in MIPS. You can report the Quality and IA categories and apply for a PI Hardship Exception, because you are a SMALL practice.
• Scenario 2: You have an EHR. If you have a 2015 edition certified EHR, you can submit data in the Quality, IA and PI categories or just the Quality and IA categories, if you submit a PI Hardship Exception application and it is approved.
• Scenario 3: The PI category is automatically reweighted. If you are a clinician type listed below, CMS automatically re-assigns the PI category points to the Quality category. As a result, you only need to report the Quality and IA categories to earn 60 points.

• Scenario 4: The PI category is reweighted due to an approved PI Hardship Exception Application. If you are a clinician or group and one of the following circumstances applies, you can submit a PI Hardship Exception application. If the application is approved, you only need to report the Quality and IA categories.

Step 5: Submit Your Data

• Submit data yourself or with the help of a third-party intermediary, such as a Qualified Registry or Qualified Clinical Data Registry (QCDR), between January 3 and March 31, 2022.
• Visit the Quality Payment Program Resource Library  to review the lists of CMS-approved Registries Qualified Registries  and QCDRs.

Step 6: Review your Feedback

Review your preliminary feedback, available once data is submitted. Review your final performance feedback and payment adjustment information in July 2022.

When you successfully submit a valid quality data code (QDC), the RA/EOB will list the RARC code N620 which means that the QDC got to our NCH database.

• If you bill with $0.00 charge on a QDC line item, you’ll get an N620 code on the EOB. N620 says: Alert: This procedure code is for quality reporting/informational purposes only.

Questions:

• Please visit the Quality Payment Program web portal – https://qpp.cms.gov/
• Contact CMS – call the Quality Payment Program Service Center at 1-866-288-8292

from
https://www.coronishealth.com/blog/mips-overview-how-to-avoid-the-9-payment-adjustment/

How Does Medical Billing and Coding Increase Cash Flow?

Accurate medical billing and coding are critical aspects of an optimized revenue cycle system. Proper billing and coding are not only necessary in terms of compliance, but are also crucial in reducing claim denials and rejections.

When you take a more proactive approach to your billing process, you not only get to prevent problems before they happen, but also maximize your cash flow. Coronis Health understands how fine-tuning your facility’s medical and coding practices can help better ensure proper reimbursements for your facility so you can continue delivering quality care to your communities. With over 100 years of combined experience in various niches, including rural hospitals, we offer customers tailored solutions and high-touch relationships you won’t find at a “Big Box” medical billing company. We recognize the tremendous need for your services and have made it our mission to assist rural facilities like yours in achieving your financial goals. Below, we share simple ways you can improve your medical billing and coding processes so that you can increase your revenue and remain financially independent.

Stop Revenue Drain by Keeping Up with Changes 

Claims that your facility does not file correctly will, of course, not be paid. It is essential to ensure all codes are accurate and that you meet all the critical requirements, including compliance with the most current healthcare laws, insurer contracts, and federal and state regulations. Failure to comply with medical billing and coding changes will only result in errors, delayed submissions, and ultimately revenue loss. Practices must responsibly delegate the job of keeping up with rules, regulations, and deadlines to ensure compliance. And by staying on top of changes in the healthcare industry, your billing process can remain accurate and efficient.

Scrub Claims to Minimize Rejections 

You must be conscientious about claim preparation. Scrub claims to ensure they’re clean, meaning the procedure, diagnosis, codes, and other data are present, complete, and accurate before submission. This minimizes rejections and reimbursement delays. A little bit of management and efficiency up front will go a long way in reducing claim denials, and fewer rejections will lead to an accelerated cash flow.

Go Online for Faster Payments

The amount of time spent making collections will impact your facility’s cash flow. Manual collections involve lots of paperwork, mail and postage, and staff overtime—all of which lower your operational profits daily. By adopting information technology such as online bill pay, you create a paperless and interconnected system that can enable better accuracy and speed. Online bill payment services allow your patients to pay their bills at home, day or night, securely and conveniently. This often leads to faster payments and quicker revenue influx while you reduce costs associated with paper statements.

Improve Collection Rates to Increase Revenue 

The collection process is time-consuming and complicated because of the number of ways that procedures can go wrong. From inaccurate patient information to coding errors and processing delays, these mistakes can lead to denials. There’s also the fact that you must deal with insurance companies to keep track of any unpaid claims.

For your facility, outsourcing won’t just free up more time for patient care. It will allow you to gain the ability to identify and implement improvements necessary for enhancing revenue capture. An experienced medical billing company can adequately manage all denials and appeals. Their knowledgeable and professional staff can develop collecting strategies designed to minimize your outstanding AR, reduce denials, optimize collection, and improve the billing process.

Outsource Your Medical Billing to Increase Your Revenue

Unless you have staff members who are experienced in billing and are trained in searching for errors and correcting them, there is a good chance you are losing revenue. At Coronis Health, not only do we take care of medical billing, but we also work toward improving every part of your revenue cycle. Our forward-thinking team of experts looks below the surface. 

We work on identifying and helping you fix the workflow issues that negatively affect your reimbursements, including the front desk, provider medical coding, practice management (PM) system optimization, account management, and extensive denials management. By going beyond the billing department, we can identify the source of cash leaks then work with your team to stop them at the source. Our goal is to remove the burden of medical billing so you can enjoy a healthy bottom line that leads to the growth and expansion of patient services. 

Connect with Coronis Health Today

We know navigating today’s healthcare environment can be daunting. With many reforms on the horizon, now is the time for your facility to optimize its revenue cycle performance. To learn more about the best practices for medical billing and coding, contact Coronis Health to request your free financial checkup.

from
https://www.coronishealth.com/blog/how-does-medical-billing-and-coding-increase-cash-flow/

5 Benefits of Revenue Cycle Management in Healthcare

The revenue cycle begins with the scheduling of an appointment and ends with the payment collected for services rendered.

It sounds simple, but there are crucial steps in between that if not performed accurately, may delay payments. And with coding errors, data duplication, or missing information, you may lose revenue that your facility depends on to stay afloat. Implementing efficient revenue cycle management is an invaluable component of your facility’s success.

Coronis Health is composed of the top medical billers in the country pooling their global resources to bring customers the best in medical billing and revenue cycle management. We understand the value of a structured revenue cycle management system, which is key to helping your facility operate more smoothly and optimize your cash flow. Below, we list 5 benefits of effective revenue cycle management in healthcare.

1. Optimize Workflow to Maximize Cash Flow

When you automate your process, you can bring efficiency to the system so payments can be made in a timely manner, while minimizing errors and denials and improving your cash flow. If you utilize an Electronic Health Record (EHR) system, for instance, you can simplify your facility’s workflow. And by improving tasks such as scheduling, coding and billing, and payment processing, you get to achieve a more effective and efficient system that saves you time for non-administrative tasks like caring for your patients, allowing you to do what you do best and meet your revenue goals.  

2. Streamline Processes to Lighten the Load

A facility that runs like a well-oiled machine will not only ensure steady collections that make your organization financially viable but also lowers the administrative burden on your staff. An electronic workflow, in particular, can help streamline all system facets, such as coordinating front and back communication, concluding a patient’s journey with timely payments, and eliminating lost paper documentation. This frees up more time for you to focus on delivering quality care.

3. Enhance Patient Experience by Improving Touchpoints 

Skilled revenue cycle management professionals and the right technology will contribute to an efficient process that minimizes standard billing and coding errors. This means simplifying the process and improving all the touchpoints involved in the patient experience. This reduces unnecessary stress to your patients, resulting in higher patient satisfaction –which you know is a factor in assessing the quality of care in hospitals. More importantly, patients benefit from improved care as your staff can devote more time to focus on them.

4. Better Claim Scrubbing for Fewer Denials

Denials are the result of payment claim errors. Optimized revenue cycle management brings accuracy to your facility’s system, leaving little room for mistakes. By getting coding right the first time, you get to reduce claim denials and receive your reimbursements faster. 

5. Faster Collections Process to Improve Revenue 

When you combine the right set of software solutions with automation tools, all the time-consuming tasks such as data collection, insurance verification, and coding will take significantly less time compared to doing them manually. By automating the cycle’s steps, from eligibility checks and payment follow-ups to data charge entry, you are able to expedite the entire process. And when you streamline tasks, you become more efficient and effective as you provide a more straightforward system to your administrative staff and fellow physicians, resulting in faster collections and improved cash flow.

How Coronis Can Help

Revenue cycle management is every step of the claim lifecycle, and Coronis looks at every portion of your billing process as an opportunity to increase revenue by identifying and then correcting the root cause of any problem. We understand how medical billing and collections are critical to the survival and growth of your facility, and patient collections are becoming a daunting task for your staff. We can work with you to create a process for collecting at the front and back end of the revenue cycle, and even provide staff to take care of collections. We are equipped to help you manage various revenue cycle problems, no matter what you might be facing. Our top revenue cycle management can help your facility find lost revenue, lower your time in AR, close aged payments, and handle collections efficiently. 

Coronis Health provides tailored and flexible solutions to meet the needs of your facility. With more than 100 years of combined experience in various niches including hospitals of all sizes, our experienced staff understands the importance of working down AR. As technological innovators, we utilize the latest software and employ actionable intelligence so we can assist you in getting your AR under control and most importantly, get you paid.

As a devoted healthcare revenue cycle management and medical billing company offering global capabilities and specialized solutions, we can make your workflow and processes more transparent and controllable. Our accurate coding and billing practices along with financial analysis and reporting will lead to your facility’s improved performance. We want to create endless opportunities for your facility and realize your full potential by helping you see how an efficient revenue cycle management process can benefit your facility.

Let’s Work Together To Build the Best Revenue Cycle Management System

Are you ready to increase your revenue, reduce denials, and accelerate your cash flow? Contact Coronis Health to learn more about how our data-driven solutions and consulting services can help optimize your revenue cycle. You may also request your free financial checkup today.

from
https://www.coronishealth.com/blog/5-benefits-of-revenue-cycle-management-in-healthcare/

Best Practices When Outsourcing Medical Billing

Whether a rural hospital or a surgical center, any healthcare organization’s primary focus is quality patient care, but for your facility to achieve success, you must prioritize financial health too.

A healthy revenue cycle can help your facility grow and better serve patients. Outsourcing medical billing can help you achieve the most accurate and efficient billing process possible and enhance financial performance. But if you decide to outsource, how do you choose the right company?

With 100+ years of combined experience, Coronis Health knows the complexities of the healthcare system and the equally complicated revenue cycle management process that goes with it. We are fully aware of the numerous benefits of outsourcing medical billing, and we understand how shifting your facility’s necessary process off-site can be challenging. Below, we offer valuable information about why outsourcing medical billing may be your most important financial move, as well as tips for choosing the right medical billing company.

Why Outsourcing Might Be the Right Choice for You 

Rural hospitals may be ideal candidates for medical billing outsourcing because they often struggle with organizational issues and have insufficient resources and workforce to meet those challenges. When you outsource medical billing, you can more easily prepare for the following situations.

• You are running a new or growing facility: Like other startup companies, you will need to wear many hats. This means you have to run billing processes yourself. If you have a growing organization, you need a skilled and experienced staff who can efficiently handle a growing volume of claims. Whether new or growing, your facility can benefit from a professional medical billing provider that can cost-effectively address your problems while helping you meet your financial objectives.
• You want to focus on your expertise: You studied and trained to become a healthcare provider and might not have sufficient experience on the business side. You want to spend more time focusing on your patients rather than on tedious paperwork. If you do not have the time and expertise to efficiently and accurately handle administrative tasks, it only makes sense to relieve yourself of those duties and let a professional medical biller do what they do best.
• You don’t have time to adapt to new regulations: Constant regulatory changes can put intense pressure on your facility. In effect, your medical billing process can suffer when your staff struggles to keep up with new regulations. You can avoid regulatory headaches by allowing medical billing providers to support your revenue cycle management, improving collections, and enabling you to focus on patient care.

5 Things to Look for in a Medical Billing Company 

You have to outsource wisely, of course. Who you choose as a partner will significantly impact your financial health and independence. Here are five factors to consider when selecting a medical billing provider:

1. HIPPA compliant

You have a direct responsibility to address healthcare privacy and security. By outsourcing to an experienced company with HIPAA (Health Insurance Portability and Accountability Act) compliance, you get peace of mind knowing that the company’s practices ensure the confidential handling of a patient’s health information as well as the protection of their legal rights. In addition to HIPPA, your outsourcing provider should uphold other laws, medical regulations, and guidelines. This helps you adhere to high standards of care, ethics, reduce exposure to fraud, and improve your revenue cycle overall.

2. Reputation

In any type of business, you only partner with people you can trust. This is why reputation means everything and a complete and comprehensive background check is necessary. The first step is narrowing the playing field to find a suitable company, then begin doing your research. Ask trusted colleagues for referrals. Ask medical professionals because you are more likely to receive reliable information from a trusted source rather than anonymous consumer reviews online.

3. Transparency

Even if you’ve already outsourced your medical billing process, you still want to know the status of your claims. It’s still your business, after all. Your billing specialist must provide you with regular and transparent reports that reflect what they’ve been handling on your behalf. This does not mean having to micromanage but instead overseeing the billing process to ensure efficiency.

4. Expertise

You want billers with expertise in your specialty to ensure correct billing. Whether you are a big city hospital, a rural hospital or a private practice specializing in pediatrics or cardiovascular health, you will have billing and coding challenges unique to your facility and specialty. This means you will need someone who knows your facility’s coding, compliance, and documentation requirements. Otherwise, you may suffer from coding inaccuracies, claim denials, and low cash flow, defeating the purpose of outsourcing in the first place.

5. Measurable Results

By outsourcing medical billing, you can achieve a more controlled approach to revenue cycle management. This proves to be more sustainable because when your medical billing process is up to date, efficient, and free of human error, you can receive payments in a shorter amount of time. If you also have transparency from your medical biller, the comprehensive performance reports will keep you informed of critical financial numbers. This also means you maintain control of your revenue cycle management without having to perform the tasks yourself.

Why Coronis is the Best Option in Medical Billing Outsourcing

Coronis Health uses industry-leading technology combined with high-touch relationship-building to allow facilities to focus on patient care, maintain financial independence, and cultivate financial success. We offer specialized financial and medical billing solutions to all types of healthcare organizations, including rural hospitals, surgical centers, FQHCs, SNFs, and LTCs.

Not only do we take care of billing, but Coronis Health also works to improve every part of your revenue cycle. Our forward-thinking team of experts looks below the surface, identifying and helping you fix the workflow issues that negatively affect your reimbursements and provide tailored solutions to get you back on track and restore your bottom line. By going beyond the billing department, we can identify the source of cash leaks and work with your team to stop them at the source. Our revenue cycle/medical billing team stays up to date on medical coding rules and guidelines, so you don’t have to. We continually monitor claims for denials and compliance issues stemming from medical coding errors. We work to remove the burden of medical billing so you can enjoy a healthy cash flow that leads to the growth and expansion of patient services.

Let Coronis Health Empower Your Facility

Outsourcing your billing and coding is one of the most significant practice management decisions your facility will ever make. Coronis Health employs top medical billers in the country, pooling their global resources to bring customers the best in medical billing and revenue cycle management. We’ll work with you to build data-driven solutions that meet your specific needs, allowing you to get back to treating patients. To learn more, contact Coronis Health to request your free financial checkup.

from
https://www.coronishealth.com/blog/best-practices-when-outsourcing-medical-billing/

How Could President Biden’s Healthcare Plan Affect Your Practice?

By implementing the American Rescue Plan, the Biden administration is delivering its promise to bring down healthcare costs.

Believing that the people deserve the peace of mind that comes from knowing they can take care of their health without going into debt is the inspiration behind the strengthening of the Affordable Care Act. The plan lowers costs for those buying plans on the exchanges. But what will these sweeping reforms to the healthcare system mean for you and your facility?

As with any changes in the healthcare system, you will need to develop strategies for successfully adapting through shifting reimbursements. This includes focusing on your medical billing process to ensure the highest possible returns on your services. With extensive experience in various niches including hospitals of all sizes, we can help you find opportunities that can allow you to achieve optimum reimbursement. We will show you how to employ the best practices to ensure you reduce debt and unpaid bills while maximizing your profits. 

Key Components of the Biden Plan

The Biden administration is aiming to patch gaps in coverage for Americans. In many ways, the Biden plan echoes the Obama administration’s more aggressive approach to healthcare. Their bold ideas for new healthcare policies will most likely have a tremendous impact on both patient and provider. 

Addition of a Public Option 

Biden’s plan proposes giving Americans a new choice for health insurance: a public insurance option similar to Medicare for customers on the individual market. This means working-age adults—not just the elderly—are allowed to buy into a public insurance plan as opposed to a private plan. Since Medicare rates are lower than private insurance, the public options would be cheaper than most insurance alternatives. While this would expand the number of covered individuals, it would also mean lower reimbursements for providers.

Extending Subsidies For More Americans

All healthcare organizations should be prepared for the possibility that millions of Americans will now obtain insurance. The Biden administration is pushing to increase subsidies by lowering the income share that subsidized households pay to be covered. The possible change in eligibility for the subsidies may also ensure more Americans qualify for income-based tax credits that lower premium costs.

Expansion of Medicare to Americans Age 60 and Over

Biden also wants to lower Medicare eligibility age from 65 to 60. This would greatly expand the beneficiary population, to roughly 20 million more Americans for both Medicare and Medicaid. This could result in a dramatically low reimbursement rate for facilities, as Medicare rates for admitted patients are on average half of what commercial insurance plans pay. The loss of commercial payments for adults 60-64 would eliminate an important revenue stream for providers and add new financial pressure to already struggling facilities.

Changes on the Horizon

Though the Biden administration has yet to release the many specifics of their healthcare reforms, you should prepare for significant changes. Your facility may benefit from an overall organization analysis to determine how lower reimbursements would impact your revenue stream while keeping abreast of relevant changes in the industry. Rest assured that we are monitoring the progress of the bill closely and will be able to alert you to changes as soon as they occur.

As with any changes in the healthcare system, you will need to develop strategies for successfully adapting through shifting reimbursements. This includes focusing on your medical billing process to ensure the highest possible returns on your services. With extensive experience in various niches including hospitals of all sizes, we can help you find opportunities that can allow you to achieve optimum reimbursement. We will show you how to employ the best practices to ensure you reduce debt and unpaid bills while maximizing your profits.

Lower Reimbursements Require Higher Efficiency

Coronis Health can help you stay on top of issues that matter most. While remaining constantly vigilant and compliant amid the ever-changing landscape of the healthcare industry, we can help ensure your facility remains current in medical billing and coding regulations. By bringing together the best healthcare revenue cycle management and medical billing professionals, we have the workforce and technology to provide the most current and innovative solutions to optimize the billing process, minimize errors, lower your costs, and comply with the latest regulations.

We understand that we are all at a crucial time where every penny counts. If more insured Americans means lower reimbursements, there should be no room for any errors that would further cripple your financial success. We know that your facility’s stability and growth heavily depend on an  efficient revenue cycle. Therefore, now is the time to make your billing process more efficient than ever. 

How Coronis Can Help You Increase the Efficiency of Your Billing for Higher Revenue Overall

With over 100 years of combined experience providing billing and coding services to facilities, practices, and hospitals, our team of experienced and certified billers and coders understand the importance of getting the process right. To successfully balance quality patient care with the cost of providing it, we have developed a proven, end-to-end, revenue cycle solution based on the measured value we deliver to healthcare providers. This model includes a distinctive operating partnership and an aligned financial relationship, coupled with leading-edge resource and technology positioning.

We have succeeded in working with our valuable partners to not only maintain their collections but also increase the collection amount and efficiency in which our clients receive payment. Our transparency, actionable intelligence, ability to conduct financial analysis and reporting, and wide-ranging experience in inpatient and outpatient networks, give us the ability to provide excellent medical billing services tailored to your specific needs, allowing you to maintain financial independence and focus on what you do best.

Ensure Future Success with Coronis Health

Coronis Health is ready to assist you in evaluating your facility’s processes and workflows. If you have concerns about your practice’s revenue cycle or future, contact Coronis to learn more about our consulting services or to request your free financial checkup.

from
https://www.coronishealth.com/blog/how-could-president-bidens-healthcare-plan-affect-your-practice/

What Value-Based Care Could Mean for Your Facility

A healthcare facility’s revenue is tied to its patient reimbursement model. Any shift you make in the reimbursement process can have a significant impact on your financial health.

Providers are now looking into a new healthcare reimbursement model that can streamline healthcare and cut costs called value-based care. This model is based on the quality of care rather than quantity. In other words, your facility gets rewarded for providing quality care to patients, which means better patient care while lowering costs and improving cash flow.

With over 100+ years of combined experience, Coronis Health is well versed in sliding scale and other payment models. We design our medical billing and revenue cycle services specifically for facilities to optimize their revenue cycle and increase cash flow. We identify and capture missed revenue or find new revenue streams. Our goal is to implement the appropriate systems into your workflow so you can enjoy a healthy bottom line.

Value-Based Care vs. Fee-for-Service

Under the traditional fee-for-service model, healthcare providers invoice for each service or procedure they perform. Instead of bundling, the patient pays for services separately. This system incentivizes providers to complete as many services as possible to bring in more revenue.

Under the value-based care model, healthcare providers receive compensation based upon patient health outcomes, encouraging them to deliver quality care. In a value-based reimbursement model, effectively managing an individual’s and population’s health generates revenue. 

Many organizations have already embraced a value-based care system as one of the most efficient methods for lowering healthcare costs while increasing quality care and ultimately helping communities lead healthier lives.

Benefits of Value-Based Care

This new care delivery and payment system provides such benefits for facilities and patients alike as:

• Patients spend less money without compromising health: Since value-based care is focused on quality, patients don’t have to pay for services they don’t need. Furthermore, the model focuses on establishing solutions agreed upon between patient and provider, resulting in patients recovering from illnesses more quickly or avoiding them in the first place. This means fewer tests, procedures, and doctor’s visits, resulting in spending less money while improving health.
• Greater efficiency and patient satisfaction: To improve the quality of care, providers focus on developing medical solutions and prevention-based services and fostering better relationships with patients. All these strategic changes can contribute to increased patient satisfaction. 
• Lower costs and reduced risk: Value-based care lowers costs. Insurers have to pay less money for services that their clients use, making insurers less likely to raise deductibles and premiums. Furthermore, value-based payments encourage efficiency by allowing payers to use a bundled payment system that covers all a patient’s care.
• Prices will match value: Supply and demand determine physician services and prescription pricing. A value-care model may contribute to price changes that reflect the value that services and medications give patients. By focusing on the patient rather than the number of services provided, it becomes easier for manufacturers to align their products’ prices to the value they offer.
• Healthier society: Value-based care aims to help make your community healthier. By focusing efforts on providing efficient treatments and preventing illnesses, patients and insurers spend less money on disease management, emergencies, and hospitalizations. This means fewer chronic conditions as well. The healthier society is as a whole, the less money all parties have to spend on healthcare.

Value-Based Care Models Your Facility Can Use 

Since different payment structures enable facilities to measure value in various ways, providers may use other methods to implement them based on their or the payers’ needs. Examples of models include:

• Accountable Care Organizations (ACOs): In this care delivery model, hospitals, doctors, and other healthcare providers work together to deliver quality care to patients. This model relies on the networked team’s cooperation. When healthcare providers collaborate, stay accountable to providing high-quality care, and agree on the patients’ treatment plans, they avoid redundancy and excess services. 
• Bundled payments: Healthcare providers collectively receive payment for the costs of treating a specific condition, which may cover several procedures and physicians. But the bundled payments system is more than just grouping together a list of services. By paying for value rather than volume of care, bundled payments provide a better level of care by establishing a structure that appoints providers as clinical leaders while keeping risk manageable.
• Patient-centered medical homes: This care delivery model focuses on centralizing patient care through a primary care physician. Like ACOs, this model requires providers to work as a team to create holistic care settings conducive to catering to patient needs. Using electronic medical records (EMRs) is one great way to collaborate. EMRs provide easy access to patient information, allowing providers to retrieve procedure results quickly. By sharing information, providers get to avoid redundancy and its associated costs.

How Value-Based Care Can Create Success for Your Facility

Transitioning from volume to value takes on a more proactive and preventative approach to patient care. Employing a value-based care system will likely encourage you to build on data, technology, and collaborative efforts. In effect, you’ll develop a more integrated approach for managing people’s wellness instead of treating illness as it occurs.

The new models incentivize healthcare providers to engage patients, use data analytics, and upgrade health technologies and software, which all aid in improving the quality of care. Because when patients receive appropriate, effective, and coordinated care, they also reap the benefits. By improving your revenue cycle management strategies, you get to reduce cost-to-collect, increase cash flow, and ensure maximized collections with fewer denials.

Shift to Value-Based Care with Coronis’ Help

Value-based care is a relatively new concept for most healthcare providers. You will need to refocus your revenue cycle management system to include population health management, more efficient billing and coding techniques, and more data analytics tools. Outsourcing may be your best solution to improving your current system with value-based care in mind. To learn more, contact Coronis Health to request your free financial check-up.

from
https://www.coronishealth.com/blog/what-value-based-care-could-mean-for-your-facility/

The Top 5 Pandemic-Related Challenges Facing Primary Care Practices

Even before the pandemic, many primary care providers were struggling with unsustainable practice costs and burnout. COVID-19’s disruption of the healthcare delivery system, however, poses additional challenges to primary care.

According to a recent survey, facilities must adapt to shifting workflows, implementing new billing and coding practices, and building platforms for telehealth services—all while dealing with lower practice revenues. Coronis Health stays abreast of what is shaping health care. We understand the pandemic’s economic repercussions and are aware of the changes necessary to maintain primary care financing. We are a national healthcare revenue cycle management and medical billing company offering global capabilities and tailored solutions. 

 We know the pandemic pressures may be overwhelming. Still, we can help your facility strengthen its resilience by implementing the appropriate tools and strategies for staying afloat while you deliver the best patient care possible. By understanding the following challenges you are facing, you can equip your facility with the best practices for thriving amid the COVID-19 pandemic.

1. Medical Billing Code and Rules Changes

According to a survey conducted by the Primary Care Collaborative and the Larry A. Green Center, over half (52%) of surveyed clinicians report that their practice is often overwhelmed with constantly changing information, including medical billing codes. 

Healthcare providers should have a seamless accounting system, especially now that you face significant pressures to diagnose, treat, and provide follow-up care. Precise medical billing creates the potential for a positive cash flow, and to accomplish this you must use up-to-date medical codes and follow new regulations.

2. Patient Questions 

The spread of misinformation is a dangerous part of the pandemic. The seamless communication inherent in social media has been so efficient at spreading misinformation about COVID-19 and vaccines. 

Over 60% of surveyed clinicians report spending “a significant amount of time” correcting misinformation about the pandemic with their patients. They say there has been an alarming increase in patient distrust of public leaders (58%) and patient doubt of primary care and their practice (15%). The volume of COVID-related questions can be overwhelming. While physicians feel that the correction of misinformation is a core part of their mission, fielding questions means more effort to develop rapport with patients, which takes time away from administrative responsibilities.

3. Expanded Telehealth 

Telehealth services have become an integral part of primary care as it has grown more prevalent among patients due to its safety and convenience. While transitioning to telemedicine has effectively kept patients healthy during the pandemic, the shift has created revenue challenges for facilities trying to stay financially stable during this difficult time. In addition to lower reimbursement rates, about a quarter of clinicians who participated in the survey reports their practice’s fee-for-service volume is still more than 30% lower than pre-pandemic levels. 

4. Less Revenue 

Most primary care facilities reported dramatically reduced revenue in the early stages of the global health crisis. Generally, these facilities did not have large financial reserves to sustain them during the pandemic. Monthly expenses are also running higher than usual (e.g., higher cost of PPE). Furthermore, the financial impact caused by the decrease in in-person visits has led to some independent practices to close (2%) or merge with larger organizations (5%).

5. Loss of Staff 

The financial woes of primary care facilities have led to cutting costs, reducing their salaries, imposing staff furloughs, and implementing pay cuts. A quarter of the survey respondents (25%) have permanently lost staff, and nearly 63% reported colleagues out to COVID-19 exposure, diagnosis, or quarantine.

How Coronis Can Help

Primary care physicians are enduring daunting challenges during the pandemic, but a combination of innovative external support and business intelligence may help them to keep serving patients.

We are a global innovator in the fields of medical billing services and revenue cycle management. We’ve brought together the best of the best in medical billing. We are also invested in staying up-to-date with the latest laws and regulations, awarding you peace of mind that your facility’s medical billing practices comply with new laws, regulations, and industry standards, including codes related to COVID-19 and its vaccines. Combined with industry-leading innovations and high-touch experience, we will allow you to focus on your patients, whether by combating misinformation or delivering high-quality care—all while maintaining your independence and financial security.

We always keep a pulse on industry changes, including the expansion of telehealth services. With 100 years of combined experience, we are here to help organizations adapt to the paradigm shift in healthcare policies and new technologies. Throughout the pandemic, Coronis Health has quickly become the designated expert for COVID testing billing. We’re trusted to handle tens of thousands of claims because of our experience and innovative mindset.

Coronis is invested in your financial success. Not only do we save you money by outsourcing all billing and coding, but we help you find lost revenue, close aged payments, and lower your time in AR. Coronis Health focuses on getting you the “last dollar.” We are at the forefront of using Artificial Intelligence and the latest software to revolutionize how we collect. These innovations lead to increased and groundbreaking efficiency and savings and prevent you from compromising your staff or the quality of your patient care.

Partner with Coronis Health

It is essential to form strategies to better cope with the disruptions and financial fallout caused by the COVID-19 pandemic. Coronis Health has all the resources necessary to handle your facility’s billing obligations and financial requirements, providing you with the freedom to focus exclusively on patient care. To learn more about our tailored solutions and forward-thinking strategies or to request your free financial checkup, contact Coronis Health today.

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