Managing Editor
@ShahidNShah
@ShahidNShah
The Challenges and Opportunities of Evolving Revenue Cycle Management Practices to Align with New Payment Models
The world of healthcare is constantly shifting and evolving in order to best serve our staff and our patients. However, in this constant shift and change, it is important that we stay vigilant to not only how this could help but also how this could hinder our efforts and our organization. One such area that is currently undergoing some evolution is Revenue Cycle Management.The transition to value-based care (VBC) requires a fundamental shift in RCM practices to align with new payment models that prioritize patient outcomes and quality over volume. Unlike traditional fee-for-service models, VBC models reward providers for the quality and efficiency of care delivered. This shift necessitates a more integrated approach to RCM, combining data from clinical, operational, and financial domains for a holistic view of performance.
Medigy Insights
Value-Based Care (VBC) is a misnomer. A VBC reimbursement model is paying for the proof of conformity to clinical guidelines using various measures. Some bonuses accumulate for improving health outcomes that are computed at an aggregate level for a specific population and not for an individual patient.Proving quality conformance via measures and documentation is complex and cumbersome, and spotting key trends while managing the claims value chain is critical to mitigating issues proactively that, if undetected or detected late, can cause significant negative financial impact. The integration of data analytics and business intelligence (BI) tools is transforming revenue cycle management (RCM) from reactive to proactive.
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