A 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:
- Denial/rejection/appeals management
- Payment posting and monitoring
- Printing, mailing, and emailing patient statements
- Unpaid balance management
- Patient and insurance payment posting
- Financial reporting
- Monthly consultations
- Support, training, and upgrades
- A billing dashboard and comprehensive reporting
- Compliance with HIPAA, OIG, and ICD-10 regulations
- Insurance payer management and fee schedule review
- A dedicated account manager leading a team of billing experts
- Use of scheduling, PM, and EHR software as part of the RCM package
- 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.