Tag Archives: fee-for-service

Roadmap to partnership: Assessing your current revenue cycle operations

Fee-for-service reimbursement is pretty cut-and-dried for revenue cycle managers. Profits revolve around billing, collecting from insurers and resolving patient claims on an individual basis. That’s not the case under fee-for-value models, where insurers capitate reimbursement for certain populations — a scenario that has revenue cycle management (RCM) leaders scrambling for ways to handle changes in […]
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Rethinking department cooperation to build IT, HIE systems

To really manage clinical and financial risks, healthcare providers may need to do more with their data. To enable that goal, they may need to rethink how tasks are divided between departments. Health Data Management reported on an issue paper from the Workgroup for Electronic Data Interchange. WEDI found a strong health IT infrastructure and […]
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Preparing your organization for value-based care

Being prepared is sound strategy in all areas of life. The Boy Scouts live by it. Homeowners in hurricane zones stay ready for the worst. And health care executives know it’s the secret to longevity in the helter-skelter world in which they operate. Preparation is even more important now that value-based reimbursement is building momentum. […]
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Timing a transition to value-based care

Once providers decide they will transition to value-based care, the next question is when should they make their move. Providers can do more than pick an arbitrary date. There are tools to help organizations make informed decisions on transition timing. Providers can conduct a financial impact assessment. Doing so allows groups to model several factors […]
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Reimbursement: The narrowest curve on the value-based journey

Health care reimbursement isn’t as easy as a provider sending an invoice and the payer cutting a check. Since DRGs were introduced by Medicare in the early 80s, getting reimbursed for services performed has become increasingly complicated. Regulatory and industry changes related to the Affordable Care Act and the ICD-10 mandate have made it even […]
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Coding and documentation are linchpins in optimizing performance

The degree to which health care organizations have access to accurate and complete data will make or break a health care organization’s ability to respond to change. In the evolving world of value-based care, this rings true in how well leaders manage coding and documentation to improve performance. Of the five steps along the “optimizing […]
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Medical necessity is a must for any value-based organization

In our previous post, we outlined how optimizing the technologies and processes behind clinical care is critical to optimizing performance in a value-based environment. The next step on the journey “Beyond the Curve of Health Care” involves medical necessity. Medical necessity can be burdensome, but its various rules must be followed to avoid significant penalties […]
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Comfortable managing chronic illness? Ready for what’s next?

When just beginning the shift to data-driven value-based care, health care providers can start by focusing on one clearly defined population. But true population health management is about successfully administering care for all patients attributed to an organization. So how do providers travel the path from novice to intermediate levels of care management? Once a […]
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Optimizing the technologies and processes behind clinical care

Our last blog discussed some of the new rules for optimizing patient access in the world of consumerism and value-based reimbursement. Today, we’ll take a look at optimizing the technologies and the processes behind clinical care. For a deeper look at ways you can optimize financial performance under value-based care, download the Optum eBook “Beyond […]
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New rules for optimizing health care financial performance

Mention “performance” in a health care context and it brings to mind different images for different people. For physicians, it may mean providing the best care possible. To a provider organization’s executive team, it may be defined by financial success due to operational excellence. Each perspective is valid. Health care organizations across the country are […]
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