Maximizing Revenue for Specialty Practices

June 21, 2017

As the healthcare system moves from fee-for-service (FFS) to value-based care, the next milestone comes as we approach 2018 – the first year that physicians will be required to report under one of two tracks for Medicare Part B reimbursements as part of MACRA: Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). While CMS is taking initiatives to ensure at least half of all Medicare FFS payments are processed through APMs by 2018, and HHS has set a higher goal of tying 90 percent of these payments to quality/value by 2018, a significant percentage of specialty practice revenue is still FFS. However, it is increasingly apparent that doctors will need to manage their practices differently going forward.

To address this need, we recently launched a new, turnkey revenue cycle management (RCM) service optimized for specialty practices operating under both FFS and value-based payment. Specialists tend to see a larger percentage of Medicare recipients than PCPs and as such, they are more likely to face significant financial disruption under these reimbursement models.

Our RCM service is an integrated financial, administrative and clinical offering that helps these specialty practices accurately and efficiently project revenue. It enhances practice operations while also reducing the administrative burden associated with value-based reimbursements. Perhaps most importantly, it enables providers to focus on patient care instead of utilizing resources on claim submission and related follow-up.

Our RCM service manages all of the planning, executing and collecting services to provide quality and cost-effective care. Some of the differentiating features of our service include:

  • Best-in-class payment and denial management capabilities
  • Expert teams that manage the practice FFS revenue cycle, from claim submission to collections
  • MIPS measurement, APM quality measurement, analysis, and contract oversight
  • Analytics with real-time, decision support capabilities focused on MIPS and APM performance measurement and associated alignment of RCM processes across the practice, including action plans to identify proactive clinical and/or operational intervention to improve value-based outcomes.

To learn more about our new offering, read what Healthcare IT News had to say about it here, or contact us to find out how your practice can get back to focusing on providing quality patient care while maximizing increasingly complex revenue streams.