Preparing your Financial Infrastructure for a Value-Based World

By Venkat Sharma, Founder and CEO, iHealth Innovations
Twitter: @RevenueSherpa

The Boy Scouts are right.

Their motto — “Be prepared” — is equally apt in healthcare, as providers seek to be ready for whatever new practice demands lie ahead in the complex world of healthcare reimbursement under a quickly evolving value-based care model.

In my first blog of this two-part series, I discussed how essential it is to start with a probing look at the foundation of your existing billing operations. Only when the holes or cracks in that foundation can be addressed and revenue leakage stopped can providers focus on implementing new processes, tools and partners to be prepared to navigate and thrive in the future of healthcare.

As noted, you must look at everything. Examine every aspect of your current billing process — from your payer mix to what can be moved to the front office to improve patient collections in an era of high-deductible health plans and greater out-of-pocket responsibilities. Ensure you fully understand each and every payer plan and your contractual obligations, that your provider credentialing is in meticulous shape, staff is appropriately trained (and retrained…and retrained) and that you’ve evaluated and tightened the encounter (charge capture) process. That all combines for a strong foundation upon which to build.

This evaluation is time-consuming and highly complex, and is typically when you make the decision to get outside, expert help — help that can be singularly focused on this evaluation and recommendations for improvement, based on industry best practices, and assume complete or shared responsibility for your day-to-day billing operations in an outsourcing or co-sourcing arrangement. Through this partnership, providers and staff can be freed to deliver exemplary service to your patients.

The type of revenue cycle performance partner that providers need today is much more than the old “mom and pop” small billing operations. It’s not enough to simply move your standard billing function from your own back office to one down the street or across the country. You need a comprehensive partner with “skin in the game,” going at-risk with you based on agreed-upon metrics, and offering deep industry knowledge and a robust set of integrated technology, data, processes and people. These include:

  • Revenue cycle management
  • Credentialing services
  • Coding and coding audits
  • Practice management and consulting
  • Electronic health record (EHR) reporting and optimization
  • Eligibility checking and prior authorization
  • Population health analytics

Quality, Care Coordination and Population Health
This combination of revenue cycle performance solutions is essential to success in the coming months and years. It’s not “just” dealing with requirements of MACRA’s Quality Payment Program and whatever changes are made to the Affordable Care Act; providers face new responsibilities, risks and opportunities within a growing number of other care coordination and population health initiatives. These will require new alliances with other providers within emerging accountable care organizations (ACOs) and other alternative payment models (APMs) that will demand peak efficiency, accountability and data sharing on levels typically unheard of for smaller practices, clinics and even health systems.

It’s a challenging yet exciting time to be in healthcare. With the right revenue cycle performance partner, you can be freed to have healthcare be fun, personally and professionally rewarding and profitable again.

This is the second of two posts by Venkat Sharma, iHealth CEO, on how to transform your revenue cycle performance to navigate and thrive in an evolving world of value-based healthcare. 

This article was originally published on iHealth Innovations and is republished here with permission.