The health insurance industry is shifting dramatically in the methods they are using to determine the payment for patient services. The previous “fee-for-service(FFS)” system, which paid providers based on the quantity of specific services furnished, is rapidly transforming. Now, health plans are instituting “value based payments”; methods where the quality and outcome of services to patients are used to determine or adjust provider payments. Such models as Accountable Care Organizations, Bundled Payments, and quality based bonuses are being used today. These models place a premium on data collection and analysis, and require a different set of information be collected by providers for each of their patients. We will provide an overview of the models, and the specific data elements which need to be collected to assure providers can succeed under these new models.
Provider business models have not changed significantly over the last several years. Business practices still focus on collecting insurance information, and patient co-insurance and deductibles as the revenue stream. Under FFS, that might be all that was necessary. However, providers are facing new requirements from health plans to get paid the appropriate amount for their services. Medicare now requires quality and cost information for many of their programs to adjust payments, award bonuses, and reduce reimbursements. Providers are expected to show they are operating at a high level of quality, efficiency, and patient satisfaction. Not meeting health plan standards results in reduced payments and reduced referrals, as well as poor ratings on public websites.
It is difficult for providers to even track their progress against goals on a patient by patient basis. Providers may not even know that their patients are part of a value based program. It will be critical for providers to collect the right data to understand their patient population, health plan requirements, and progress towards goals.
We will cover areas which are necessary to revise provider systems to better understand patient characteristics and health plan requirements. These will include: What are value based models and how do they differ from FFS; what patient characteristics are necessary to understand at intake, how are diagnoses and chronic conditions important in value based care, what data needs to be tracked during and after patient care, what reporting requirements are necessary, how to track progress towards value based goals, and how to estimate payments under value based programs.
This webinar will enable you to revise your patient intake, data collection, and follow up processes to maximize your participation in the new value based payment processes.
Revenue cycle managers, financial officers, physician practice managers, administrators, revenue cycle vendors.
Years of Experience: 25+ years
Areas of Expertise: Regulatory Interpretation and Implementation, and Health IT Implementation
Stanley Nachimson is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption. The firm serves a number of clients, including, the Cooperative Exchange, EHNAC, InstaMed, and the Pew Foundation.
Stanley is focusing on assisting health care providers, vendors, and plans with regulatory interpretation and implementation, influencing HIT policy, and providing advice on HIT industry status and trends.
Stanley is the author of the authoritative paper on the cost of ICD-10 for physician practices. He served at CMS for over 30 years, with a focus on HIPAA and other HIT regulations during his last 10 years there.View all trainings by this speaker