It’s apparent that the traditional fee-for-service model for reimbursement cannot be sustained. New concepts have been introduced in the industry and some have “died on the vine,” others such as bundled payments are evolving, and new models have erupted, such as those outlined in the Medicare Access and Chip Reauthorization Act of 2015 (MACRA).
No matter how you frame it, reimbursement to health systems will change in the future and, paramount to that transition, will be the impact on clinicians, coders, clinical documentation improvement (CDI), case management, and finance. There is no change to the value proposition that compensation will be based on quality, outcomes, and cost. The two “hot” reimbursement models on the street (bundled payments and MACRA) have their challenges. But the foundation of both compensation methods is documentation and coding.
In a recent July survey with KPMG-AMA, 50 percent of healthcare systems had no knowledge of MACRA. That would seem to make sense since it is a new model from the Centers for Medicare & Medicaid Services. and everyone is keeping an eye on it but not prepared to react. The problem is that there are already changes in motion to the reimbursement, and most are not prepared.
Just to take a few moments to outline for you the challenges of MACRA and bundled reimbursement:
The transition to either compensation model is not easy:
In summary, healthcare is in constant change and never more so than now is the transparency between clinical, coding, operations, and finance on a track to more integration after the adoption of ICD-10.
But the real question remains: when do you pull the trigger, and is the juice worth the squeeze?
Today and in two weeks, I am going to share some tips I picked up at the ACDIS National Conference in Chicago, May 9 through11.
Denials have been on my mind for the last few weeks – specifically, how do we prevent them? According to the Public Broadcasting Service (PBS),
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Dr. Ronald Hirsch provides tried-and-true strategies and insight into outpatient in hospital bed stays including determining the applicable definition, who uses it, and when and how to bill for this circumstance, solidified with concrete case examples and expert insight.
Practical solutions for CDM departments to protect your hospital’s revenue.
This webcast teaches hospitals how to comply with CMS price transparency rules and compare their rates with peer hospitals. It covers creating a compliant machine-readable file, comparing negotiated rates, and improving pricing decisions.
The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.
This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.
Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.
Do you struggle with selecting and appending the correct modifier for your medical claims? Join our must-attend webinar, “Mastering Modifier Usage: Preventing Denials and Ensuring Compliance” to reduce claim denials and improve your reimbursement rates.
Kay Piper reviews the guidance and updates coders and CDISs on important information in the AHA’s fourth quarter 2023 ICD-10-CM/PCS Quarterly Coding Clinic in an easy to access on-demand webcast.
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