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Insights : Article

Revenue Cycle in a Value-Based World

By   Rhonda Quast

January 06, 2017

The revenue cycle has long been recognized as the backbone of a health care organization. Patients enter to receive services through contact with patient access. Coding provides validation of the care the patients receive, and billing and reimbursement are dedicated to recouping payment for the services rendered. The dynamic health care environment is transitioning to a value-based world filled with confusing acronyms and a multitude of different payment programs. Is your revenue cycle prepared?

Engage Your Revenue Cycle Team
Health care organizations are balancing high-deductible plans and an increased demand on services while refocusing care to chronic disease management rather than acute services. Engaging your revenue cycle team allows your organization the ability to maintain focus while implementing the necessary changes to be successful in value-based reimbursement. This may include increased emphasis on timely and effective denials management, consistent communication with patients regarding financial responsibility, and utilizing your resources within patient access to engage patients in chronic disease management from the first point of contact. 

Educate to Engage
Education becomes key in engaging your revenue cycle team in the changes necessary to support your health care organization. Hierarchical Condition Category (HCC) scoring is utilized in many value-based reimbursement programs to communicate cost and effectiveness of care. Understanding the effect that concise, compliant documentation and accurate coding can have on HCC scoring allows your organization to effectively communicate cost of care to Medicare.

As your health care organization makes decisions to move from volume-based to value-based payment models such as Medicare Shared Savings Programs, CPC+, Medicare-Medicaid ACO model, and MACRA, the readiness of your revenue cycle team will be amplified. Prepare your revenue cycle team today to enable them to move to the forefront of change in supporting organization-wide initiatives.