Advanced Revenue Cycle Analytics: An Overview
One thing we can all agree on is that reform is on the horizon for the US healthcare. Politicians are focused on how to simultaneously bend the cost curve, improve outcomes and increase access to preventative care. Independent physicians are waiting to see how reimbursement models will change and analyzing what can be done to prepare for the anticipated shift away from fee for service to pay for performance (i.e. quality measures).
Physician Quality Reporting System
It was only a short time ago that we went from an “Initiative” to a “System” for reporting quality measures. In a program that began in 2007, we are at the end of the proverbial Carrot Stage and facing the inevitable Stick Stage. Physicians who fail to report their PQRS measures in 2013 or beyond will incur adjustments to their Medicare Fee Schedule, beginning with a decrease of 1.5% in 2015 and going up to 2.0% in subsequent years. If the average incentive at 0.5% (the rate for 2013 and 2014) results in a net gain of around $2,000 per physician, then the penalty for not reporting will be in the neighborhood of $6,000 to $8,000. That’s like working a week for Uncle Sam without getting paid.
Living in Two Worlds
It feels like we’re living in two worlds … still reporting productivity for reimbursement knowing that at some level, all that may change in the not-too-distant-future. There’s an entire industry around coding and claims that is all-consuming in the day to day operations for any healthcare provider. Who has time to add a second method of reporting for a small bump in revenue while struggling to ensure your basic claims are paid and cash flows are consistent and predictable? Maybe the incentives and penalties are not enough to justify the cost of reporting PQRS; but if this is the dress rehearsal, then shouldn’t you be rehearsing?
Ease the Pain
White Plume clients are prepared to navigate both worlds. Using AccelaSMART™ our clients can traverse the various and numbered ways that insurance payers dictate claims must be submitted while concurrently identifying eligible encounters for specific PQRS measures. With flexible workflows that support information gathering without creating lag times for filing claims and a certified Registry partner to electronically submit your Measure Groups and Individual Measures to, our clients are uniquely realizing a smoother transition into Payment Reform. AccelaPQRS™ directs our clients into easily identifying and capturing quality measures to electronically send to our certified Registry. Learn more at www.whiteplume.com.