Value-based reimbursement has become the standard for medical billing and coding. Years ago, when value-based reimbursement was just coming into its own, many providers doubted that it would take hold. Now, though, it has been wholeheartedly endorsed by CMS – through its Merit-Based Incentive Payment System – and many private insurers.
It is estimated that by January 1, 2019, CMS will tie 50% of all payments to quality initiatives based on value-based reimbursement. But you don’t have to wait until 2019 to see this in action; currently, virtually all (over 90%) commercial payers are incorporating fee-for-value into their payment matrix at some level.
Learning how to thrive with value-based reimbursement is critical to the health of a practice, no matter what the field.
Mastering PQRS Reporting
PQRS has become the standard for quality reporting and is CMS’s main initiative moving forward. This is important to master because half of your MIPS score for the 2017 billing year will be based on the Value-Based Payment Modifier (VBM) in PQRS.
If you are unfortunate enough to experience a negative adjustment from VBM and PQRS, you could see as much as a 6% decrease in your total reimbursements. No practice wants this, so learning how to maximize PQRS reporting and tick all the boxes is hugely important for any provider.
Incorporate EHRs into Your Practice
Electronic health records (EHRs) are crucial for fulfilling several value-based standards. Indeed, adopting EHRs can make you eligible for incentives under federal initiatives.
But more importantly, they contribute to a better environment for a practice and a better experience for the patient, which is the whole point of value-based reimbursement. Adopting EHRs can streamline your care, allow you to spend less time asking patients, labs, and pharmacies for information, reduce the cost of records management, reduce the need for transcription, and improve your margins and efficiency. You can also increase the number of visits for anything from follow-up care to preventative care.
Adopting Value as a Standard
Finally, practices should get used to the idea of value-based payment and start thinking of providing value in everything they do.
The patient experience has to come first. The more a practice focuses on a positive patient experience, the more results they’ll have, and the more the practice will flourish. Expect to see more and more payments tied to patient experiences – which means providers have to become adept at customer service.
Consult with a third-party provider who specializes in revenue cycle management to learn more about maximizing value-based reimbursement.