Advanced Medical Billing Solutions

Posted by shawn on November 26th, 2020

As the new model of value based healthcare sweeps across the care-giving domain, care providers and insurers seem to be struggling to keep up. Advanced medical billing solutions have to be strategically incorporated toward population health management, patient engagement, and health care payment. With the paradigm shift from fee-for-service to the pay for performance model, adapting to the new normal requires significant adjustments. Whether it’s restructuring or a completely new design, the medical billing process needs to adapt toward value-based payment through advanced medical billing solutions. Payers and healthcare organizations need to follow medical billing solutions that are geared to comply with value based payment healthcare.

value based reimbursement payment is an approach wherein the care provider’s reimbursement is directly linked to the quality of care that is provided by the healthcare organization/ provider. It is measured through patient health outcomes, which provides benefits to healthcare providers for their quality and efficiency in the process of caregiving. It is a healthcare culture that is based on evidence-based practice. Now, you may be wondering what evidence-based practice is and how it works. Evidence-based practice is a system of value-based payment agreements, within which providers are compensated for proven health improvements, reduction of the effects and occurrences of chronic diseases, and an overall elevation of health. What evidence-based practice essentially entails is an overall responsibility of the health of the patients involved.

The present transition from the fee-for-service to pay-for-performance model carries plenty of potential for healthcare organizations, but it also comes with its set of challenges. For this transition to be smooth, there are some factors that need to be taken into consideration. The starting point for this would be to maximize your knowledge of value-based payment models and the strategic options towards advanced medical billing procedures. Value-based reimbursement in health care may seem like a simple process, but its complexity comes into play during execution. The methodology involves financial incentives that motivate caregivers to steer away from volume-based care and towards approaches that focus on increasing the quality of care and decreasing the costs involved. Within the health care reimbursement dynamic, advanced medical billing processes have to be aligned, medical billers and coders have to adapt, medical billing management adjustments have to be made, and healthcare payments have to be modified. There are multiple dimensions to value-based reimbursement in health care and providers can adopt the methods that suit their practice most closely.