Reviving RCM Operations to Enable Value-Based Care Success

In the fee-for-service era, the typical revenue cycle mirrored a patient’s office visit and focused on obtaining appropriate payment for services delivered along the way. The emergence of new, value-based payment models is transforming that approach and, as one large urology group in the Carolinas discovered, the existing, fee-for-service approach to revenue cycle operational were no longer optimal. The practice reached out to Integra Connect to help them uncover and prioritize improvement opportunities within its existing revenue cycle, ultimately identifying talent management; documentation gaps; administrative workflow burden; and lack of forecasting capabilities as the top “high-impact” pain points. […]

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Aligning Clinical & Financial Performance

To comply with value-based reimbursement models like the Merit-Based Incentive Payment System (MIPS), specialty medical practices are now required to track, measure and report out on a host of quality measures – all while driving sustainable cost improvements. To optimize performance, practices will be compelled to rethink workflows around clinical and financial documentation, which must now provide a more detailed view of a patient’s treatment as well as reflect care delivered across all settings and conditions. As one large, multi-specialty practice in Southeastern Michigan uncovered, insufficient documentation and corresponding workflow challenges related to chemotherapy orders were directly impacting authorization and billing, resulting in avoidable rejections. […]

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Mitigating Operational Gaps Impacting Cash Flow

The rapid rise of fee-for-value models has produced new drivers for revenue cycle success, putting increased pressure on specialty practices to balance cost and quality outcomes across entire episodes of care, while continuing to maintain best-in-class fee-for-service revenue cycles. As the clinical and financial implications of MIPS began to emerge for one large urology practice with locations across Southeastern Michigan, they reached out to Integra Connect to first identify and then address the root causes of their slower-than-expected cash flows and unpaid claims. […]

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