Pay for Performance ? What Providers must know!

Posted by mgsionline on July 23rd, 2013

Gone are the times when Healthcare Providers got reimbursed for each and every service they rendered to their patients irrespective of the outcome. In the present era, quality is valued more than the quantity of services provided. It is better exhibited by the recently introduced Pay-for-Performance (P4P) program. Under this healthcare program, Providers get financial incentives based on the quality of services they provide to patients. To implement the best physician practice management, Healthcare Providers must learn the features of P4P. They are as follows,

Past VS Present: In the ’fee for service’ (FFS) system, Providers got paid for every patient-care service that was rendered. The best part about this system is that it yielded good incentives to Providers. But there was always the risk of fraud and the payers had to be constantly vigilant through their Fraud and Loss Prevention units. Moreover, the recent CGR rate cuts and other measures have decreased the reimbursement in the FFS system.  Under the P4P system, Providers’ billing is determined by the efficiency of the healthcare services provided. This system motivates several Providers to take part in quality improvement programs and preventive services, thereby reducing healthcare costs.

Care Coordination: Before implementing P4P system, Providers must know the objectives of care coordination. In this instance, patients with serious health disorders are considered the primary target. As they approach multiple physicians to get treated for their diseases, healthcare costs tend to rise invariably. However, the P4P system has made multiple Providers to deliver quality healthcare services to a particular patient at reduced costs. Implementing physician billing for such care coordination in-house is a challenging task as it involves high costs. Therefore, it would be a prudent choice for Providers to outsource the medical billing and collections to medical insurance billing companies.

Administrative Challenges: Implementing P4P system consumes a lot of time to carry out administrative operations including data collection and reporting, which can otherwise be devoted to patient care. It is highly essential that Providers share most of their time on patient care services. Provider billing outsourcing can be of great help in eliminating such challenges.           

About MGSI:

When it comes to outsourcing medical billing and collections, MGSI has been a pioneer in every sense. It has over 20 years of experience in offering provider billing services. Based in Florida, this medical billing company offers a helping hand to several Providers in implementing and adapting to the P4P system. For more details, log on to www.mgsionline.com