RCM Challenges Past, Present and Future

number8-red-2002015 was a critical year in the revenue cycle management space, presenting challenges for many providers looking to keep their bottom line above the red. We were there to cover it all in RCM Answers first year, thanks to ZirMed’s sponsorship and support of this site. Here’s a sampling of some of the biggest issues impacting providers:

  • The October 1st transition deadline to ICD-10
  • The January 1st penalty phase for Meaningful Use, the 9-month delay of Stage 2, and escalation of audits for EHR incentive payments
  • The ongoing transition from fee-to-service to value-based care
  • Patient privacy issues related to data breaches and cybersecurity

So here are our picks for 8 articles this year dealing with RCM challenges past, present and future.

MU, PQRS and VBM Create New Payment Model MIPS
By Peggy Losey, Manager of Ambulatory Incentive Programs, ehealthcare Consulting Inc.
Twitter: @ehealthcareorg
MIPS – the emerging Medicare payment model where MU, PQRS and VBM intersect, and the construction of the payment system focusing on providing value and quality, begins. How are you doing with Meaningful Use, PQRS and VBM? Are you using your QRUR as a roadmap to help get you there? Accepting a little road trip advice now will help you prepare for a safe arrival at your destination with minimal detours. CMS recently announced that the implementation of this program has begun. Are you on the right road? Read More

Patient Payments: A Shift in Responsibility for Revenue Cycle Management
By Sarianne Gruber
Twitter: @subtleimpact
High Deductible Health Plans (HDHPs) essentially shift financial accountability to consumers. Based on recent statistics, there has been a ten-fold increase in the past 7 years of people having insurance coverage with these programs to more than 11.4 million people (as of 2011). And, according to America’s Health Insurance Plans, the growth in HDHPs is a major contributor to current expectations to grow from $250 billion in 2009 to $420 billion by 2015, a 68 percent increase in five years. Read More

CMS Begins Implementation of Key Payment Legislation
Twitter: @CMSGov
CMS has released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposal includes a number ofprovisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes. Read More

Medicare Payment Change is A-Comin’
By Matt Fisher, Esq, Mirick O’Connell
Twitter: @matt_r_fisher
The Centers for Medicare and Medicaid Services (“CMS”) made a major announcement on Monday, January 26th about payment models under Medicare. For the first time and in a very aggressive manner, CMS set a firm timeframe for implementation of alternative payment methodologies. The new timeframe furthers the goals of the Affordable Care Act in changing the manner in which healthcare is delivered and paid for in the country. As announced by CMS, it intends for 30% of all Medicare provider payments to be under an alternative payment methodology by 2016 and increasing that target to 50% by 2018. Read More

Maximizing the Value of ICD-10
By Ken Edwards, VP of Operations at ZirMed
Twitter: @zirmed
This is a moment in healthcare when we are laying the foundation for new capabilities, new precision, and new operational enhancements for healthcare organizations. If you embrace it–and if you lead your team to focus on maximizing the benefits of it–you will also be keeping your organization on the crest of the key major changes taking place in healthcare today. That is true of vendors, providers, large healthcare organizations, payers, and every one of us who can benefit from this change–every one of us who is responsible for making this transition not just seamless, but purposeful. Read More

New Wave of Meaningful Use Audits Launched by the Office of the Inspector General (OIG)
By Jim Tate, Meaningful Use Audit Expert
Twitter: @JimTate,
Most of us have gotten pretty used to the Meaningful Use (MU) audits being conducted by Figliozzi & Company. They are the folks that have been conducting the CMS EHR Incentive audits for both eligible hospitals (EH) and professionals (EP) involved in the Medicare or dually-eligible Medicare/Medicaid EHR incentive programs. You know the drill by now. MU is achieved and attested on an annual basis. A pre-payment audit could occur shortly after attestation and a post-payment audit could occur up to 6 years after an attestation. However it comes down, the audit is performed against a single attestation. Read More

Compliance and Security of PHI Build a Trustworthy Framework in Healthcare
By Lee Barrett, Executive Director for EHNAC
Twitter: @EHNAC
Some say there’s nothing like a little controversy to spark interest in your organization. Others say there’s no such thing as bad publicity. Call me old fashioned, but I contend, in healthcare, being featured on the Office for Civil Rights’ Wall of Shame or plastered on a news headline about a breach of personal health information (PHI) bad publicity, bad business and bad medicine. As health information exchanges, mobile health, patient portals, new medical devices and telehealth proliferate, the opportunity for PHI to go astray during electronic transactions is escalating exponentially. Read More

Researchers Find Transformation to Value-Based Medicine Proving Challenging for Providers
By Carol Flagg
Twitter: @CarolFlagg
Researchers Find Transformation to Value-Based Medicine Proving Challenging for ProvdersPwC’s Health Research Institute (HRI) regularly publishes research and analysis on issues and trends affecting healthcare. In its latest report, Healthcare’s Alternative Payment Landscape, HRI addresses how the industry is fairing in transforming from fee-for-service to value-based medicine. With a health system built on a fee-for-service structure that rewards quantity, the research shows providers are grappling on when and how to move to alternative payment models that rewards quality and outcomes. Read More

A variation of this article was originally posted on HITECH Answers.