According to the Oct. 1, 2012 edition of Spine Review, “One of the most sweeping changes concerning the healthcare system today is accountable care organizations (ACO),” writes Laura Miller. “Hospitals, specialists, primary care physicians and insurance companies are all worried about how they will fit into this new model of care, which values quality over quantity through a pay-for-performance instead of a fee-for-service. However, some orthopedic surgeons and hospitals have decided to push forward with accountable care organizations and are finding the challenges minimal — and even seeing benefits — to participation.”
In this new ACO environment, the federal government, in tandem with commercial insurance companies, is changing the way patients pay doctors and hospitals. Reimbursement models are transitioning from volume-based to value-based focusing on quality care and efficiency. Providers will be held accountable and could lose out financially if the health of their patients doesn’t improve.
In June 2012, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most pressing practice management challenges. No. 2 was: Preparing for reimbursement models that place a greater share of financial risk on the practice.
Within the next five years, Orthopedic surgeons will be adopting this revenue reimbursement shared-risk model (vs. fee for service) with the emergence of population health management through Accountable Care Organizations (ACO) that coordinate care and meet performance standards of care for Medicare patients in order to earn incentive payments.
As a result of ACOs and its correlating population health management and shared risk models, proper Orthopedic Surgery medical coding and billing is vital – now more than ever –
to maintaining a practice’s strong skeletal structure and maximizing revenue potential. It’s an exacting science that requires in-depth, insider industry expertise of the myriad of new Orthopedic Surgery coding, billing and compliance regulations that only an independent third party Orthopedic Surgery revenue cycle management specialist with decades of expertise can provide to ensure nothing falls through the cracks and revenues are optimized.
revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in medical coding and billing that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 25 years, revMD.com partners with medical practices in Arizona and throughout the U.S. to optimize revenue for hospital based and practice based physicians.