By Thomas Schildmeyer, VP RCM Strategy and Development, Modernizing Medicine
The Medicare Access and CHIP Reauthorization Act (MACRA) aims to improve physician and other clinician payments by changing the way Medicare incorporates quality measurement into payments. At its core, the Act repeals the sustainable growth rate and authorizes the U.S. Department of Human and Health Services (HHS) to implement value-based incentives. Regardless of MACRA’s original intent to improve healthcare for both patients and physicians, the new legislation can result in negative implications on practices — particularly as it relates to revenue cycle management.
The final rule for MACRA includes two pathways for provider participation: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). MIPS is designed for providers in traditional, fee-for-service Medicare. Clinicians can earn payment adjustments based on performance in three categories (Quality, Clinical Practice Improvement Activities, and Advancing Care Information) linked to quality and value. The APM is designed for providers who are participating in specific value-based care models.
For a smooth revenue cycle transition, both models rely on more accurate clinical documentation from physicians that want to be both reimbursed properly and have their risk adjustment scored correctly. It is imperative to have advanced technology that captures and reports this information in a cost effective and timely manner.
While this is critical, it is also important to keep your RCM workflow/process in mind. Following are seven tips to improve your RCM process.
Whether employing an internal billing specialist or outsourcing the function, RCM will be key to a successful value-based care transition, especially for smaller practices where a negative reimbursement could result in bankruptcy. Adopting RCM best practices will not only increase a physician’s success under MACRA, it also will lower claim denials, increase patient collections, and help physicians achieve more profitability and grow a business. By adopting RCM best practices, physicians can succeed under the value-based care transition.