Study confirms physicians need RCM to succeed in value-based care

Value Based CareA recent study by Quest Diagnostics shows that the road to value-based care may have potholes. The 2018 study, “Stalled progress on the path to value-based care,” is the third annual study commissioned by Quest Diagnostics to gauge perceptions of primary care physicians (PCPs) and health plan executives about the nation’s journey to value-based healthcare.

The study took a look at healthcare IT and the tools needed. When it comes to technology and the role it plays in accelerating the shift to value-based care, the study said only 42% of PCPs and health plan executives believe physicians have the tools needed to succeed in a value-based healthcare system. This is down from 46% in 2017.

There is definitely a need to invest in health information technology to succeed under value-based care models, according to 4 in 5 PCPs (80%) who participated in the study.

What are some of the tools they need? Revenue cycle management (RCM) struck a chord. RCM is a medical billing service that ranges from billing claims to denial management and all billing-related activities and support in between. Physicians can use it to:

  • Verify patient information and eligibility
  • Reach out to an insurance company about a claim
  • Collect patient payments
  • Review claims from insurance companies

These tasks are usually handled by a service for a percentage of collections or for a subscription fee. One advantage is that RCM automates numerous functions so that physicians and staff may focus on other work.

Twenty-two percent of primary care physicians (PCPs) say they need RCM to succeed in value-based care. However, the study tells us that only one-third of PCPs (34%) are using RCM to maximize reimbursement.

For those practices seeking an outside billing or RCM service, it’s important to look for one that offers these primary features:

  1. Denial/rejection/appeals management
  2. Payment posting and monitoring
  3. Printing, mailing, and emailing patient statements
  4. Unpaid balance management
  5. Patient and insurance payment posting
  6. Financial reporting
  7. Monthly consultations
  8. Support, training, and upgrades
  9. A billing dashboard and comprehensive reporting
  10. Compliance with HIPAA, OIG, and ICD-10 regulations
  11. Insurance payer management and fee schedule review
  12. A dedicated account manager leading a team of billing experts
  13. Use of scheduling, PM, and EHR software as part of the RCM package
  14. Easy payment options for patients

To learn more about how RCM can help support your practice’s journey to value-based care, call 1.888.491.7900, or read our white paper, ”How to improve practice financials: A practical guide to revenue cycle management.” More information on the 2018 value-based care survey from Quest Diagnostics can be found here.


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